A Glimpse into the Disease and Trauma of Andy Warhol’s Life

Andy Warhol (1928-1987) in 1975. Source: Mondadori Publishers, gettyimages.co.uk, Public Domain, Wikimedia Commons

 

Retired Seattle surgeon and medical historian, John A. Ryan Jr. with his wife, Jody

Source: http://www.virginiamasonfoundation.org/john-ryan

 

Though Andy Warhol’s death has been associated with routine gallbladder surgery over the past three decades, one medical expert is saying that the legendary pop artist’s death shouldn’t be considered such a shock. “This was major, major surgery – not routine – in a very sick person,“ medical historian and retired surgeon Dr. John Ryan told The New York Times in a recent phone interview. Ryan, is the meritus chief of surgery at Virginia Mason Hospital in Seattle, Washington, and has been spending the past four years since his retirement studying Warhol’s medical history. Warhol’s family had a history of gallbladder issues, and Warhol himself had been very ill for at least a month before his death. However, his fear of hospitals combined with his hefty workload made him put his health on the back-burner.

 

In terms of Warhol’s early health: in third grade, he had Sydenham’s chorea (also known as St. Vitus’ Dance), the nervous system disease that causes involuntary movements of the extremities, which is believed to be a complication of scarlet fever which causes skin pigmentation blotchiness. Often bedridden as a child, he became an outcast at school and bonded with his mother. At times when he was confined to bed, he drew, listened to the radio and collected pictures of movie stars around his bed. Warhol later described this period as very important in the development of his personality, skill-set and preferences. After graduating from high school, his intentions were to study art education at the University of Pittsburgh in the hope of becoming an art teacher, but his plans changed and he enrolled in the Carnegie Institute of Technology in Pittsburgh, where he studied commercial art.

 

Warhol went in for a seemingly simple gallbladder operation in 1987 but ended up dying just 12 hours later – shocking the nation. But now, Dr. Ryan says we should have seen the icon’s death coming. According to Dr. Ryan, who presented his findings, last week at the annual meeting of the Pacific Coast Surgical Association, Warhol’s death should not have come as such a surprise. Looking at the pop artist’s medical history, Dr Ryan discovered that Warhol had almost 15 years of gallbladder trouble and a family history of it as well. Warhol’s father had his gallbladder removed in 1928, the same year his son was born. Warhol had been sick for at least a month before his death, although he had attempted to hide it. His fear of hospitals was another factor in his lack of receiving any serious treatment. The revered artist had a fear of hospitals which had delayed his ability to receive serious treatment. Further medical records research showed Dr Ryan that Warhol was dehydrated and gaunt from having barely eaten in the previous month. Additionally, Warhol had been taking speed daily for years. And he was still feeling the effects of a brush with death in 1968 after he was shot by Valerie Solanas, a radical feminist writer. At that time, he had been declared dead in the emergency room and had nine damaged organs – Warhol’s surgeon gave even odds on the artist lasting the night. His recovery left him with a lifetime of trouble with eating and swallowing, as well as a split in his abdominal muscles that gave him a large hernia. After he survived the gunshot wounds, for the rest of his life, Warhol had to wear a special truss or corset to hold his innards together.

 

So in 1987, on top of the gallbladder removal, and repair to his stomach wall, according to reports, the operation seemed to go well, and Warhol was in his room making calls that evening. A private nurse who went to check on him at 4am said he still seemed fine. But about two hours later, Warhol was found blue and unresponsive, and resuscitation efforts failed. An autopsy concluded that �ventricular fibrillation’ was the cause of death, meaning that Warhol’s heart had quivered and stopped. Stewart Redmond Walsh, a professor of vascular surgery at the National University of Ireland, Galway, has researched sudden death after surgery, and says it’s more common than we think. He explained that when a sick body goes through the trauma of a major surgery, the entire body feels the stress, not just the organ being operated on, which can be fatal. When Dr Ryan entered the data from Warhol’s case into the new Surgical Risk Calculator of the American College of Surgeons, it put such a patient’s chance of dying at 4.2 percent.

 

Andy Warhol suffered from many health problems throughout his life

 

Gallbladder

Andy Warhol’s family suffered from a history of gallbladder illness. In 1928, his father Orenja, had his gallbladder removed. And less than 12 hours after a routine gallbladder removal, Warhol passed away from complications.

 

Chorea 

At the age of eight, Warhol came down with a rare disease known as chorea, or St. Vitus’ dance, characterized by involuntary movement, disturbed gait, grimacing, and hypotonia, or abnormally low muscle tone. Originally, Warhol was diagnosed with rheumatic fever. At the time, before antibiotics, approximately 10 percent of cases of rheumatic fever worsened and became chorea. Warhol stayed in bed for about ten weeks. When he finally returned to school, he had a relapse of the illness on the first day and returned to bed.

 

Skin

Blotchy skin is a common symptom of chorea. By the time Warhol became famous, in the early 1960s, the blotches had gone away, but they marked his face in adolescence and early adulthood, and he had bad skin his entire life. He wrote: �I had another skin problem, too – I lost all my pigment when I was eight years old. Another name people used to call me was “Spot“.

 

Drug Use

Warhol also had a huge drug problem. His New York City studio, the Factory was the hip hangout for amphetamine (speed) users. In particular, Warhol was addicted to Obetrol, marketed today as Adderall, a fairly common drug used to treat ADHD. He took a daily dose throughout his life.

 

Shooting

In June 1968, he was shot at close range by Valerie Solanas, a radical feminist writer. For the rest of his life he wore a corset that held his bowels together where his ruined abdominal muscles could no longer.

 

Hypochondria 

He also worried about �catching’ cancer, his fluctuating weight, colds that he was convinced presaged pneumonia, about brain tumors and strokes, blood pressure and blackouts. In the last years of his life, Warhol worried most about AIDS, and carefully avoided those (even close friends or ex-lovers) whom he knew to be suffering from the �magic disease’.

Sources: NY Times, Wikipedia, DailyMail.uk.com;

 

A Short History of MRIs

MRI Scanner Mark One. The first MRI scanner to be built and used, in Aberdeen Royal Infirmary in Scotland. Source: Andy Gaskell – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=54271471

 

U.S. President George W. Bush with the six 2003 American Nobel laureates in the Oval Office. From left to right, Dr. Roderick MacKinnon, New York City (chemistry); Dr. Anthony Leggett, Urbana, Illinois (physics); Dr. Robert Engle, New York City (economics); Dr. Alexei Abrikosov, Argonne, Illinois (physics); Dr. Peter Agre, Baltimore, Maryland (chemistry); and Dr. Paul Lauterbur, Urbana, Illinois (physiology/medicine). Source: This work is in the public domain in the United States because it is a work prepared by an officer or employee of the United States Government as part of that person’s official duties under the terms of Title 17, Chapter 1, Section 105 of the US Code; Wikipedia Commons

 

Magnetic resonance imaging was invented by Paul C. Lauterbur in September 1971; he published the theory behind it in March 1973. The factors leading to image contrast (differences in tissue relaxation time values) had been described nearly 20 years earlier by Erik Odeblad (physician and scientist) and Gunnar Lindstrom. In 1950, spin echoes were first detected by American, Erwin Hahn and in 1952, Herman Carr produced a one-dimensional NMR spectrum as reported in his Harvard PhD thesis. In the Soviet Union, Vladislav Ivanov filed (in 1960) a document with the USSR State Committee for Inventions and Discovery at Leningrad for a Magnetic Resonance Imaging device, although this was not approved until the 1970s. By 1959, Jay Singer had studied blood flow by NMR relaxation time measurements of blood in living humans. Such measurements were not introduced into common medical practice until the mid-1980s, although a patent for a whole-body NMR machine to measure blood flow in the human body was already filed by Alexander Ganssen in early 1967. In the 1960s and 1970s the results of a very large amount of work on relaxation, diffusion, and chemical exchange of water in cells and tissues of all sorts appeared in the scientific literature. In 1967, Ligon reported the measurement of NMR relaxation of water in the arms of living human subjects. In 1968, Jackson and Langham published the first NMR signals from a living animal.

 

Raymond Damadian’s “Apparatus and method for detecting cancer in tissue“ Source: This patent drawing by Raymond Damadian, belongs to a US govt Patent number 3789832 filed 17 March 1972, issued Feb 5, 1974. Image is from the US Patent and Trademark Office.

 

 

In a March 1971 paper in the journal Science, Raymond Damadian, an Armenian-American physician and professor at the Downstate Medical Center State University of New York (SUNY), reported that tumors and normal tissue can be distinguished in vivo by nuclear magnetic resonance (“NMR“). He suggested that these differences could be used to diagnose cancer, though later research would find that these differences, while real, are too variable for diagnostic purposes. Damadian’s initial methods were flawed for practical use, relying on a point-by-point scan of the entire body and using relaxation rates, which turned out not to be an effective indicator of cancerous tissue. While researching the analytical properties of magnetic resonance, Damadian created a hypothetical magnetic resonance cancer-detecting machine in 1972. He filed the first patent for such a machine, U.S. Patent 3,789,832 on March 17, 1972, which was later issued to him on February 5, 1974. Zenuemon Abe and his colleagues applied the patent for targeted NMR scanner, U.S. Patent 3,932,805 on 1973. They published this technique in 1974. Damadian claims to have invented the MRI. The US National Science Foundation notes “The patent included the idea of using NMR to ‘scan’ the human body to locate cancerous tissue.“ However, it did not describe a method for generating pictures from such a scan or precisely how such a scan might be done.

 

Meanwhile, Paul Lauterbur at Stony Brook University expanded on Carr’s technique and developed a way to generate the first MRI images, in 2D and 3D, using gradients. In 1973, Lauterbur published the first nuclear magnetic resonance image and the first cross-sectional image of a living mouse in January 1974. In the late 1970s, Peter Mansfield, a physicist and professor at the University of Nottingham, England, developed the echo-planar imaging (EPI) technique that would lead to scans taking seconds rather than hours and produce clearer images than Lauterbur had. Damadian, along with Larry Minkoff and Michael Goldsmith, obtained an image of a tumor in the thorax of a mouse in 1976. They also performed the first MRI body scan of a human being on July 3, 1977, studies they published in 1977. In 1979, Richard S. Likes filed a patent on k-space U.S. Patent 4,307,343. During the 1970s a team led by John Mallard built the first full-body MRI scanner at the University of Aberdeen. On August 28,1980 they used this machine to obtain the first clinically useful image of a patient’s internal tissues using MRI, which identified a primary tumor in the patient’s chest, an abnormal liver, and secondary cancer in his bones. This machine was later used at St Bartholomew’s Hospital, in London, from 1983 to 1993. Mallard and his team are credited for technological advances that led to the widespread introduction of MRI.

 

In 1975, the University of California, San Francisco Radiology Department founded the Radiologic Imaging Laboratory (RIL). With the support of Pfizer, Diasonics, and later Toshiba America MRI, the lab developed new imaging technology and installed systems in the US and worldwide. In 1981 RIL researchers, including Leon Kaufman and Lawrence Crooks, published Nuclear Magnetic Resonance Imaging in Medicine. In the 1980s the book was considered the definitive introductory textbook to the subject. In 1980 Paul Bottomley joined the GE Research Center in Schenectady, NY. His team ordered the highest field-strength magnet then available – a 1.5 T system – and built the first high-field device, overcoming problems of coil design, RF penetration and signal-to-noise ratio to build the first whole-body MRI/MRS scanner. The results translated into the highly successful 1.5 T MRI product-line, with over 20,000 systems in use today. In 1982, Bottomley performed the first localized MRS in the human heart and brain. After starting a collaboration on heart applications with Robert Weiss at Johns Hopkins, Bottomley returned to the university in 1994 as Russell Morgan Professor and director of the MR Research Division. Although MRI is most commonly performed at 1.5 T, higher fields such as 3 T are gaining more popularity because of their increased sensitivity and resolution. In research laboratories, human studies have been performed at up to 9.4 T and animal studies have been performed at up to 21.1 T.

 

Reflecting the fundamental importance and applicability of MRI in medicine, Paul Lauterbur of the University of Illinois at Urbana-Champaign and Sir Peter Mansfield of the University of Nottingham were awarded the 2003 Nobel Prize in Physiology or Medicine for their “discoveries concerning magnetic resonance imaging“. The Nobel citation acknowledged Lauterbur’s insight of using magnetic field gradients to determine spatial localization, a discovery that allowed rapid acquisition of 2D images. Mansfield was credited with introducing the mathematical formalism and developing techniques for efficient gradient utilization and fast imaging. The actual research that won the prize was done almost 30 years before while Paul Lauterbur was a professor in the Department of Chemistry at Stony Brook University in New York.

Rebecca Davis Lee Crumpler MD, First African American Female Physician

Rebecca Crumpler plaque. Source: Kate Kelly, americacomesalive.com

 

Cover of A Book of Medical Discourses by Rebecca Lee Crumpler

Source: nih.gov; Wikipedia; The National Library of Medicine believes this item to be in the public domain 

 

Rebecca Davis Lee Crumpler, nee Davis, (February 8, 1831 – March 9, 1895) was the first African-American woman to become a physician in the United States. She married Arthur Crumpler who had served with the Union Army during the American Civil War. Her publication of A Book of Medical Discourses in 1883 was one of the first written by an African American about medicine. Rebecca Davis was born in 1831 in Christiana, Delaware to Matilda Webber and Absolum Davis. She was raised in Pennsylvania by an aunt who cared for infirm neighbors. Crumpler later attended the elite West Newton English and Classical School in Massachusetts where she was a special student in mathematics. Crumpler moved to Charlestown, Massachusetts where she married Wyatt Lee, a Virginia native on April 19, 1852. During the next eight years, she was employed as a nurse until she was accepted into the New England Female Medical College in 1860. It was rare for women or black men to be admitted to medical schools during this time, and during the antebellum years, medical care for poor blacks was almost non-existent.

 

When the Civil War began, Crumpler was forced to quit her school. She went back to college in 1863, but her financial aid was no longer available. To complete her schooling, she won a tuition award from the Wade Scholarship Fund, which was established by the Ohio abolitionist, Benjamin Wade. When she graduated in 1864, Rebecca Lee was the first African-American woman in the United States to earn a Doctor of Medicine degree, and the only African-American woman to graduate from New England Female Medical College. The school closed in 1873, without graduating another black woman, when it merged with Boston University. Crumpler describes the progression of experiences that led her to study and practice medicine in her A Book of Medical Discourses (1883):

 

“It may be well to state here that, having been reared by a kind aunt in Pennsylvania, whose usefulness with the sick was continually sought, I early conceived a liking for, and sought every opportunity to relieve the sufferings of others. Later in life I devoted my time, when best I could, to nursing as a business, serving under different doctors for a period of eight years (from 1852 to 1860); most of the time at my adopted home in Charlestown, Middlesex County, Massachusetts. From these doctors I received letters commending me to the faculty of the New England Female Medical College, whence, four years afterward, I received the degree of Doctress of Medicine.“

 

Crumpler first practiced medicine in Boston, primarily for poor women and children. During this time she “sought training in the ‘British Dominion.’ In St. John, New Brunswick, on May 24, 1865, Rebecca married Arthur Crumpler, a former fugitive slave from Virginia who had served with the Union Army at Fort Monroe, Virginia. After the American Civil War ended in 1865, she moved to Richmond, Virginia, believing it to be

 

“a proper field for real missionary work, and one that would present ample opportunities to become acquainted with the diseases of women and children. During my stay there nearly every hour was improved in that sphere of labor. The last quarter of the year 1866, I was enabled to have access each day to a very large number of the indigent, and others of different classes, in a population of over 30,000 colored.“

 

Crumpler worked for the Freedmen’s Bureau to provide medical care to freed slaves; She was subject to “intense racism“: “men doctors snubbed her, druggist balked at filling her prescriptions, and some people wisecracked that the M.D. behind her name stood for nothing more than ‘Mule Driver.“  By the time she moved back to Boston her neighborhood in Joy Street, Beacon Hill was a predominantly African-American community. She

 

“entered into the work with renewed vigor, practicing outside, and receiving children in the house for treatment; regardless, in a measure, of remuneration.“

 

Rebecca and Arthur were active members of the Twelfth Baptist Church where Arthur was a trustee, and in mid-December, 1870, their daughter, Lizzie Sinclair Crumpler, was born at their 20 Garden Street home. When Massachusetts Senator Charles Sumner died in 1874, Rebecca was in Delaware. At a service in his honor,

 

“Rebecca Crumpler, MD read a beautiful original poem on the death of Sumner wherein she touchingly alluded to his love for the gifted Emerson.“

 

By 1880 Rebecca and Arthur had moved to Hyde Park, Boston. There was no great demand for her service in the community. She was no longer practicing medicine by 1883, when she published A Book of Medical Discourses from the notes she kept over the course of her medical career. It was dedicated to nurses and mothers, and focused on the medical care of women and children. Although “no photos or other images“ of Rebecca Crumpler survive a Boston Globe article described her this way.

 

“She is a very pleasant and intellectual woman and an indefatigable church worker. Dr. Crumpler is 59 or 60 years of age, tall and straight, with light brown skin and gray hair.“

 

A drawing of Arthur Crumpler, however, has survived. It appears in the feature article about him previously cited. Rebecca Crumpler died on March 9, 1895 and is buried at the Fairview Cemetery near her residence in Hyde Park. She was survived by her husband, Arthur, who died in Boston in 1910. The Rebecca Lee Society, one of the first medical societies for African-American women, was named in her honor. Her home on Joy Street is a stop on the Boston Women’s Heritage Trail.

 

Arthur Crumpler, Husband of Dr. Rebecca Lee Crumpler

 

Sketch of Arthur Crumpler, Boston Daily Globe from 1898

Source: Kate Kelly, americacomesalive.com
Arthur Crumpler escaped slavery and overcame the fact that slaves were prevented from learning to read or write; he attended night school when he was in his sixties. The article in The Boston Daily Globe in 1898 about him as a good student was a well-deserved bonus but he had already lived a full and productive life. Crumpler was born a slave in Southampton County, Virginia. He belonged to Robert Adams who owned the estate where his mother worked. Arthur’s father, Samuel, a slave on a neighboring plantation, was owned by a white man named Benjamin Crumpler. While Arthur belonged to his mother’s master, he took his name from the surname his father must have used.  When Arthur was nine, his master died unexpectedly. Because Robert Adams had several sons, his estate (including the slaves) needed to be sold to apportion the wealth among his children. Arthur had liked living on the Adams estate, so he came up with an idea that he thought might get the attention of Robert Adams’s oldest son, John. Arthur approached John and said, “John, I can wrestle you down!“ as he told a Boston reporter many years later. John didn’t believe that a nine-year-old slave boy could take him down, but Arthur was strong and tough. Before long the young white master had had enough. Arthur’s gamble paid off as he had hoped – he earned John’s admiration. All of the other slaves were sold, but John kept Arthur for himself. John Adams took Arthur with him to Smithfield, Virginia, for a year. Then Adams decided it would be more profitable to lease Arthur to other men. He made a deal with a slave trader to take Arthur for four years. It is not clear what work this entailed, but at the end of the four years, Arthur was returned to John Adams. By this time, John had married, and his in-laws needed help. John gave them Arthur. While working for John Adams’s in-laws, Arthur worked at harvesting and processing apples. Arthur described to a reporter from The Boston Daily Globe an improvement he made to an apple-paring machine used on the plantation. John Adams stopped by to check on things one day. He observed what Crumpler could do with the mechanism he had fashioned. He removed Arthur from the in-laws’s apple farm and told Arthur he would give him his pick of a new trade. Arthur could choose carpentry, shoemaking, blacksmithing, or brick-laying. While no one quite knows what transpired here, Adams may have realized how capable Arthur was and wanted to put him in a job where Adams could make money from his work. But there is also the possibility that John Adams saw a way to profit from Arthur’s improvements on the device. By rewarding him with other options, it might keep him from telling others about his invention. There is no patent for an apple-parer that would match Arthur’s or John Adams’s dates or location, but it is still possible that Adams found a way to sell or benefit from Arthur’s accomplishment. Blacksmithing was Arthur’s choice of the new trade he wanted to learn so Adams arranged for him to apprentice to the local blacksmith. Arthur earned $250 per year plus clothing (it would have been usual for the master to take the money). Arthur learned blacksmithing, but soon seemed restless. Adams set him up in his own shop to try to keep him from running away as other slaves were doing.

 

When the Civil War began with the attack at Fort Sumter in 1861, the slaves in the Smithfield area saw their opportunity to escape. Crumpler and many others ran from their masters. They made their way to the Norfolk Navy Yard where they took refuge on the The U.S.S. Cumberland. The gunboat soon went on to Fort Monroe where many of the former slaves disembarked. Crumpler got a job at Fort Monroe to shoe horses, and he proved to be of great value to the Union in that capacity. Later he worked for Union General McClellan on the Virginia peninsula. By July 1862, Crumpler was ready to leave Fort Monroe and go to Boston where he knew other slaves had settled. He was supposed to collect $160 from the Union Army for his services. The quartermaster had to inform him that they couldn’t begin to pay him that much. Why didn’t he settle for $40? Crumpler was eager to move on, so he agreed. The Army wanted him to sign an agreement to accept $40 as compensation. “They took hold of my hand and held it while I made an �X’ to something.“ t was then that Arthur made a promise to himself:

 

“I made up my mind I would never make an X again beside my name written by someone else, and I have kept my word. I have learned to write.“

 

When Arthur Crumpler arrived in Boston, he was taken in by Nathaniel Topliff Allen who ran a school in Cambridge. Crumpler slept in the barn, and did chores to earn his keep. It is around this time that he must have met his future wife, Rebecca Davis Lee Crumpler. (Rebecca had been previously married to a fellow named Wyatt Lee. Lee passed away in 1863.) Rebecca had been a student at Allen’s School, and Nathaniel Allen may have introduced the two. At any rate, Rebecca and Arthur were married in St. John, New Brunswick, on May 24, 1865. In 1870, Rebecca gave birth to their only child, Lizzie Sinclair Crumpler. Rebecca set up a medical practice in Boston (she was the first African American female doctor), and Arthur may have switched from being a blacksmith to being a porter at this time. His work involved taking care of stores in Boston – an occupation that he pursued for many years. Both Arthur and Rebecca were devout and involved church members. Rebecca recognized Arthur’s interest in learning, and she encouraged him to sign up for night classes early in their marriage. But he became frustrated. To ease his discomfort, Rebecca offered to read and write for him – and she did so until her death in 1894. From an article in The Boston Daily Globe on April 3, 1898, we learn how Arthur Crumpler learned to manage on his own. “When she [Rebecca] passed away, I found that I should have to depend upon myself if I wanted to learn anything. I could not read the newspapers during the last war, but if we have a war now, I shall be able to read all about it myself. I can do my own signing, and I am not making any more crosses.“ The reporter writes that Arthur had spent the previous three years attending Franklin Evening School, a school that attracted a diverse immigrant student body as most people worked during the day and then took classes at night. “I find considerable pleasure in reading my Bible and papers and books. I sit down and practice my writing lessons, and write my own letters, and then I sit down and add up, subtract, multiply, and divide my figures all by myself. There is nothing to excuse any colored man or woman in the city of Boston from learning how to do these things,“ said Arthur to the reporter. The headline for the article was “Boston’s Oldest Pupil.“ (The article states that he was age 74 but in working through his personal details, it is more likely that he was 64 as he was probably born in 1834 or 1835.) The headline also could have been “Boston’s Happiest Pupil.“

 

Only once did Crumpler return to Virginia. He attended a reunion of the Grand Army of the Republic in Washington. He returned to Virginia afterward, looking for a sister. On the last day he had before returning to Boston, he heard news of her: she married and moved to Tarboro, North Carolina, and had several children. Before 1898 (when the article was published), Arthur re-connected with one family member. One of his sister’s children came north and located Arthur. In 1898, Crumpler was living in a one-room apartment on Piedmont Street. The apartment was filled with books and one well-displayed Bible. These must have given Arthur enormous pleasure. When Arhur Crumpler died in 1910, he left all his possessions to his niece Maggie King of 50 Hickory St. Orange, New Jersey. (Perhaps this was the child of his sister whom he met later in life.) As his executor, Arthur Crumpler named the reverend of the church he attended, the Calvary Baptist Church in Boston.

William Bradley Coley MD – Pioneer of Immunotherapy

William Bradley Coley (center)

 

William Bradley Coley (1862 – 1936) was an American bone surgeon and cancer researcher and the pioneer of cancer immunotherapy. He developed a treatment based on provoking an immune response to bacteria. In 1968 a protein related to his work was identified and called tumor necrosis factor-alpha.

 

William Coley was born to a very old Connecticut family, on January 12, 1862 in Westfield, to Horace Bradley Coley and Clarina B. Wakeman. He went to college at Yale and graduated from Harvard Medical School in 1888. He then joined the staff of the New York Hospital as an intern on the surgical service, following which he began his career as a bone surgeon at New York Cancer Hospital (which later became part of the Memorial Sloan-Kettering Cancer Center). Coley became more interested in cancer treatment when one of his early patients, Elizabeth Dashiell, died from bone cancer. While going through hospital records, Coley found a sarcoma case study of one patient named Fred Stein, whose tumor disappeared following a high fever from erysipelas infection, now known as Streptococcus pyogenes. This sparked Coley’s interest and drove him to find what few examples of similar cancer treatment had been previously recorded. He discovered that other medical pioneers including Robert Koch, Louis Pasteur, and Emil von Behring, had recorded observations of erysipelas infection coinciding with cancer regression.

 

From 1925 to 1933, Coley served as Surgeon-in-Chief of the Hospital for Special Surgery in New York City, where he developed the theory that post-surgical infections had helped patients to recover better from their cancer by provoking an immune response. In 1891 he began to experiment by deliberately causing this phenomenon, injecting streptococcus bacteria directly into people being treated; later because this had the adverse effect of causing infection, he switched to using dead bacteria. Coley published the results of his work as a case series, making it difficult to interpret them with confidence. According to the American Cancer Society, “More research would be needed to determine what benefit, if any, this therapy might have for people with cancer“. Cancer Research UK say that “available scientific evidence does not currently support claims that Coley’s toxins can treat or prevent cancer“. People with cancer who take Coley’s toxins alongside conventional cancer treatments, or who use it as a substitute for those treatments, risk seriously harming their health. By 1901, the development of x-rays as a cancer treatment showed great promise. In particular, the therapy resulted in immediate tumor destruction and pain relief. Although Coley claimed successful treatment of hundreds of patients, the absence of proven benefit or reproducibility led to broader emphasis on surgery and on the newly developing field of radiation therapy. This decision was borne out by the eventual successful treatment of millions of people worldwide with radiation therapy. Coley arranged for a wealthy friend to provide funds to purchase two x-ray machines for his use. However, after several years of experience, Coley came to the conclusion that the effect of that primitive x-ray therapy in the untrained hands of experimenters was localized, temporary and not curative. The scientific majority disagreed, most notably his contemporary James Ewing. His contemporary critics cited the dangerous and unpredictable effects, predominantly the fever caused by the bacteria, that the vaccine had upon individuals weakened by cancer. Furthermore, the vaccine had to be made to a patient’s exact needs, making it more labor-intensive, time-consuming and expensive.

 

In 2009, Coley’s theory that immune systems in humans functioned in a cycle was demonstrated by a research team led by Associate Professor Brendon Coventry, which could have significant ramifications for cancer treatment. In 2005, drug makers including Pfizer and Sanofi-Aventis had a renewed interest in modern versions of Coley’s Toxins. Pfizer has acquired the Coley Pharmaceutical Group, set up in 1997. The historical results of Coley vaccine therapy are difficult to compare with modern results. Coley’s studies were not well controlled and factors such as length of treatment and fever level were not adequately documented. Many of his patients had also received radiation and sometimes surgery. According to the analyses of Coley Nauts and Starnes, treatment success correlated with length of therapy and the fevers induced by the toxins. Coley’s daughter, Helen Coley Nauts, established the nonprofit Cancer Research Institute in 1953 to study her father’s work. The organization has since become a leader in funding research in immunology and tumor immunology at universities and hospitals worldwide.

 

Today immunotherapy (plus personalized medicine) is cutting-edge cancer treatment. But more than 100 years ago, it was extremely difficult to get other physicians to agree with William Coley MD. Here is a more detailed account of the cases contributing to Dr. Coley’s ideas:

 

In the late summer of 1890 young Coley was getting ready to examine a new patient at his practice in New York City. What he didn’t know was that the young woman waiting to see him would change his life and the future of cancer research. Her name was Elizabeth Dashiell, also known as Bessie. Bessie was 17 and showed up complaining of a problem with her hand. It seemed like a minor injury, just a small bump where she’d hurt it, but it wasn’t getting better, and she was in a lot of pain. She’d seen other doctors but nobody could diagnose the problem. At first Coley thought Bessie must have an infection. But when he took a biopsy, it turned out to be a malignant, very advanced cancer called a sarcoma. In those days there wasn’t very much anyone could do for Bessie. This was before radiation and chemotherapy, so Coley did the only thing he could – he amputated Bessie’s right arm just below the elbow in an attempt to stop the disease from spreading. Sadly, it didn’t work, and within a month, according to David Levine, the cancer had spread “to her lungs, to her liver and all over her body.“ Bessie’s final days were wrenching and painful. Coley was with her when she died on Jan. 23, 1891. Bessie’s death made a huge impression on the young surgeon. “It really shocked him,“ says Stephen Hall, who wrote about Coley in his book A Commotion in the Blood: Life, Death and the Immune System. Bessie’s death also spurred Coley into action. There wasn’t a lot known about cancer at the time, so Coley started digging through dozens upon dozens of old records at New York Hospital. He was looking for something that would help him understand this cruel and aggressive disease. As a student, Coley had read Charles Darwin, and one of the lessons he took away from Darwin, Hall says, was to always pay attention when there’s a biological exception to the rule. “To ask yourself: Why this has happened?“ Coley discovered one of these biological exceptions. It was the case of a German immigrant named Fred Stein. Stein had been a patient in New York Hospital eight years earlier. He had a tumor on his neck that doctors tried to remove several times. Unfortunately for Stein, the tumor kept coming back and doctors expected him to die from the disease. Then Stein contracted a serious infection of the skin caused by the strep bacteria. “It looked like Stein’s days were numbered,“ Levine says. But Stein didn’t die. In fact, his tumor disappeared, and he was discharged. Coley wondered if all these years later, Stein could still be alive. So in the winter of 1891, William Coley the surgeon became William Coley the detective. He headed for the tenements of the Lower East Side of Manhattan where the German immigrant community lived. He knocked on door after door asking for a man named Fred Stein who had a distinctive scar across his neck. After several weeks of searching, Coley found him alive and cancer-free. So why did Stein’s cancer go away and stay away after he got a bacterial infection? Coley speculated that the strep infection had reversed the cancer. and wondered what would happen if he tried to reproduce the effect by deliberately injecting cancer patients with bacteria. He decided to test his idea on people who were the most seriously ill. His first subject was an Italian immigrant named Zola who, just like Bessie Dashiell, was suffering from sarcoma. Zola had tumors riddling his throat. He was so sick he could barely eat or speak or even breathe. For months Coley would try to make Zola sick from infection by creating little cuts and rubbing the strep bacteria into them, Hall says. There would be “a slight response but not too much.“ Then Coley got his hands on a much stronger strain of the bacteria. This time, Zola became violently ill with an infection that could easily have killed him. But within 24 hours, Zola’s orange-sized tumor began to liquefy and disintegrate. “This was a phenomenon that occurred rarely, but when you saw it you were utterly astonished,“ Hall says. Zola completely recovered. Coley knew he was on to something. He kept experimenting and refining his use of bacteria. Eventually, he named the treatment Coley’s toxins.

 

It was an exciting time. Coley was having tremendous success and his efforts were celebrated in America and abroad. But Bradley Coley Jr., William Coley’s grandson, says the American medical establishment at the time was skeptical. Nobody knew how Coley’s toxins worked, or why they worked sometimes and not others. Not even Coley could explain it. That’s largely because the immune system was still a mystery and would remain so for decades to come. When radiation therapy came along in the early 1900s, interest in Coley’s toxins was completely overshadowed by this new therapy. When his grandfather died, Bradley Coley says, “All interest in [Coley’s toxins] stopped.“ And quite possibly, that’s where Coley’s legacy would have ended except for this: After Coley’s death in 1936, his daughter, Helen Coley Nauts, started looking through her father’s papers while doing research for his biography. She found about 1,000 files of patients her father had treated with Coley’s toxins. She spent years carefully analyzing these cases and could see that he had extraordinary rates of success in regressing some cancerous tumors. She couldn’t get anyone interested in studying her father’s work, so she decided to do it herself. With a small grant, in 1953 Helen Coley Nauts started the Cancer Research Institute, dedicated to understanding the immune system and its relationship to cancer. In the more than 60 years since, researchers have expanded their understanding of the immune system dramatically and today, that understanding is paying off. Treatments that harness the power of the immune system are now available for a range of cancers such as stomach, lung, leukemia, melanoma and kidney. Jedd Wolchok, chief of the melanoma and immunotherapeutics service at Memorial Sloan Kettering Cancer Center, says any treatment currently in use that exploits the power of the immune system to fight cancer has to “tip its hat“ to the work William Coley began more than 100 years ago. William Coley’s intuitions were correct: Stimulating the immune system may be effective in treating cancer. He was a model of the clinician-scientist, treating patients and using his practice to initiate research and build theories. But he was a man before his time, and he met with severe criticism. Despite this criticism, however, Coley stuck with his ideas, and today we are recognizing their potential value.

Sources: NIH.gov; The University of Iowa; npr.org; Wikipedia

Thrilling Rescue Revealed, of U.S. Medics & Nurses, During WW 2 in Albania

U.S. Medics at work during WW2;  Source: Public Domain, Wikipedia Commons

 

Harold Hayes was a member of a band of airborne American medics and nurses who crash-landed in Nazi-occupied Albania in 1943 and trekked 600 miles to their rescue. All of these brave heroes were military trained army lieutenants. Harold Hayes, was the last surviving member of a band of airborne American medics and nurses who crashed-landed in Nazi-occupied Albania in 1943 and survived German attacks, blizzards and horrific privations on a 600-mile trek to their rescue on the Adriatic coast. He died last Sunday in Medford, Ore. He was 94. His death, at a hospital, followed an operation to remove a blood clot from his leg, his daughter Margaret Bleakley said.

 

The survival of the 30 noncombatants was a long-held secret of World War II: the story of 13 female nurses, 13 male medics and the four-man crew of a medical evacuation plane who were stranded behind enemy lines for nine weeks, hiding in villages and caves in wintry mountains, afflicted with lice and dysentery, often near starvation and hunted by German patrols. Their odyssey was classified during the war and for years afterward to protect partisan fighters, Allied agents and villagers who gave them food, shelter and guidance. Some were shot by the Germans for their acts of kindness, and after the war, as rumors became death sentences, those even suspected of helping the Americans were executed by Albania’s Communist dictator, Enver Hoxha, whose rule ended with his death in 1985.

 

“For many years, I didn’t say anything about what happened in Albania,“ Mr. Hayes said in a 2015 telephone interview with The New York Times from his assisted-living home in Medford. “After the war was over, Hoxha was ruthless. If he discovered the names of anyone who had helped us, he had them and their families executed.“ Mr. Hayes had no special role in the group’s survival, but by outliving all his wartime comrades, he became a last conduit for their story, which was related in a 1999 memoir by one of the nurses, and more recently in several books, notably “The Secret Rescue“ (2013), by Cate Lineberry, whose account relied heavily on Mr. Hayes’s recollections.

 

Harold Hayes and the other medics and nurses were part of a Medical Air Evacuation Transport Squadron. The United States medical air evacuation program was an innovative new medical military program within the Army Air Forces that transported wounded and sick from hospitals near the frontlines to better-equipped facilities for additional care. It was started in 1942, and during the war transported more than one million troops, with only forty-six dying in flight. In 1945, General of the Army Dwight Eisenhower deemed air evacuation as important as other WWII medical innovations, including penicillin and sulfa drugs. At the time the air evacuation program was developed in 1942, most Americans had never been on an airplane before. In fact, on January 14, 1943, FDR became the first U.S. president to fly on official business while on his way to the Casablanca Conference. The perilous adventure began two months after Italy surrendered and Allied forces invaded Italy to begin pushing the Germans back across Europe. On Nov. 8, 1943, the nurses, medics and fliers of the Army Air Force’s 807th Medical Air Evacuation Transport Squadron took off from Catania, Sicily, bound for Bari, on Italy’s east coast, where hundreds of wounded troops awaited air evacuation. Their twin-engine cargo plane carried no weapons, but the pilot, First Lt. Charles Thrasher, 22, anticipated no fighting. With him were a co-pilot, radio operator and crew chief. The nurses, all second lieutenants, were 22 to 32 years old. The medics, including Mr. Hayes, 21, from Indianola, Iowa, were all equivalent to staff sergeants and ranged in age from 21 to 36.

 

There wasn’t a cloud in the sky when we left the airfield, but the closer we got to Bari, the more clouds appeared. We were soon caught in a violent storm and lost all communication with the station at Bari. The plane’s compass and communications failed. In addition, the plane was low on gas. The pilots ascended above the clouds, but when the plane got up to about 8,000 feet, the wings started icing up, so we had to dive down through the clouds. Blown 100 miles off course, our plane crossed over into Albania. We could see a coastline; the pilots thought we might have flown across Italy and were near Italy’s western coast. They didn’t realize we’d crossed the Adriatic. The pilots tried to land on what looked like an abandoned airfield, and that’s when someone started shooting at us. The pilots immediately headed for the clouds. That was probably the scariest part?flying through a valley where the tops of the mountains were higher than the clouds. When we emerged from the clouds, our plane was very close to a German fighter plane and then to another, which attacked with antiaircraft guns. The pilots continued trying to dodge the enemy planes and eventually found a place near a lake where we crash-landed, 25 miles inland. When they started landing, medic, Harold Hayes thought the pilots wouldn’t be able to stop in time and that they would end up in the water. The pilots braked hard, and the landing gear sank in the mud. Just before the plane would have hit the water, it came to a violent stop. The force embedded the plane’s nose in the marshy ground, and the fuselage hovered upright for a few seconds before falling to the ground in a belly flop. The crew chief in the back of the plane was the only one not strapped in, and he went flying forward. Willis Shumway, 23, the crew chief, was the only casualty, with a knee injury that left him unable to walk. The disoriented Americans had no idea where they were. Fearing a fuel explosion, they scrambled out of the plane and encountered their first bit of luck. Striding out of a woods was a band of rugged-looking men with rifles and daggers. One spoke a little English. He was Hasan Gina, an anti-German partisan leader. He told the Americans they were in Albania. Two resistance groups were essentially fighting to see who would control Albania after the war ended. The partisans who met the Americans were one group, and the Balli Kombetar, or BK, was the second group. The BK was a right-wing nationalist group, opposed to the communist-led National Liberation Movement. The two groups had formed when the Italians occupied Albania. Italy had surrendered to the Allies in September 1943, two months before the Germans took control of the country. When the partisans led the Americans through the countryside they had to avoid not only the Germans but also the BK. Later, they would learn that they were 150 miles east of Bari, on the wrong side of the Adriatic, surrounded by German forces that had occupied Albania for months, and were caught in a civil war between rival partisan groups. With only a general plan to reach the west coast and somehow cross the Adriatic to Italy, the group began walking in the wrong direction.

 

After five days, they rested at a partisan-controlled town called Berat, but their respite was brief. German forces entered the town and three nurses were separated. They hid in Berat for four months while the group continued.

Over the ensuing weeks, they trekked through mountains and valleys, battling starvation, parasites and diarrhea. Sometimes they had to cut back or travel in circles to avoid German patrols. Lt. Gavan Duffy, a British secret agent, found the group in eastern Albania and began leading them westward, intending to reach the coast. At Gjirokaster, German troops blocked the way, and the Americans were too sick and exhausted to go on. He radioed for an American air rescue. Two C-47 cargo planes flew in with fighter escorts. But the Germans disrupted the landing. On Jan. 9, after a 63-day ordeal, they finally boarded a British launch and crossed to Italy.

 

The Americans knew almost nothing of Albania, a small, mostly Muslim country that had changed little in centuries. The mountainous terrain was dotted with impoverished villages. There were no railroads and few roads. Mules and horses were the main transportation. There was little running water or electricity. Winters were brutal, food was scarce, and blood feuds were common among the ferociously proud peoples. With only a general plan to reach the west coast and somehow cross the Adriatic to Italy, the Americans began walking in the wrong direction. Over the ensuing weeks, guided by the partisans, they trekked through mountains and valleys, sometimes cutting back or traveling in circles to avoid German patrols, living in the open or sheltering in villages and sharing cornbread with peasants. The Americans were soon listed as missing in action, and War Department telegrams, beginning “regret to inform you,“ were sent to their families back home.

 

The survivors, meantime, carried Sergeant Shumway on a stretcher made of seats from the plane; they later found pack animals for him. After five days, they rested at a partisan-controlled town called Berat, where they were cheered, mistaken for the vanguard of an Allied invasion to liberate Albania. They also met other partisan leaders, and learned of a British agent who had recently parachuted into the country. Their respite lasted only a few days. Then, they awoke to gunfire and the explosion of artillery shells as German forces entered the town. In the ensuing confusion, German planes strafed a truck carrying some of the escaping Americans. Three nurses were separated from the main group and left behind in Berat; they took refuge in a farmhouse, and remained in hiding in the area for four months. The main group of Americans climbed on foot to a mountain village and were caught in a crossfire between partisan groups. “It was the first time the Americans had heard of the rival group, and they were beginning to realize they were in as much danger from the country’s internal battle as they were from the Germans,“ Ms. Lineberry wrote in “The Secret Rescue.“ They encountered other perils. “Some of the blankets offered to them to ward off the cold night air were infested with fleas and lice,“ the author wrote. “Since they’d crashed, most of them had been unable to bathe, aside from splashing some water on their faces and arms from mountain streams or an occasional basin, and they were all filthy and now battling fleas, lice and the GIs,“ Army slang for diarrhea. The Americans were often unable to find food. Facing starvation, they made tea by boiling straw and ate berries that worsened their diarrhea. Sharing with peasants was sometimes a culture shock. Mr. Hayes and another medic saw a sheep’s head roasted over coals, then split in half with an ax. “The Americans watched wide-eyed as two women each took one-half of the head and ate everything, including the eyeballs,“ Ms. Lineberry wrote. “Nothing was wasted.“

 

As autumn waned, blizzards enveloped the Americans. Their clothing was too thin. Their shoes were worn out. “Though all their feet soon felt like blocks of ice and their bodies shivered, they knew they had to keep going,“ Ms. Lineberry wrote. “The snow was coming down so fast they could barely see the person in front of them, but they had to stay together to avoid losing one another in the blinding white storm.“ On Nov. 27, British intelligence in Albania learned from partisans that the American plane had crashed and that the nurses, medics and crew were alive, trying to reach the coast. Gen. Dwight D. Eisenhower, the Allied commander in Europe, and President Franklin D. Roosevelt and the families of the missing were told. In December, an American rescue plan was developed, led by an Army captain, Lloyd G. Smith, 24, who was assigned to the Office of Strategic Services, precursor of the Central Intelligence Agency. Under cover of darkness, he slipped onto the heavily guarded Albanian coast by boat and set up a base camp in a cave in the cliffs overlooking the Adriatic. Others joined him, and they moved inland to find the Americans. The British, meantime, organized a second rescue effort under Lt. Gavan Duffy, a secret agent who with a small team had reached Albania months earlier by parachute and on foot. Through partisan contacts, he found the Americans in eastern Albania and began leading them westward, intending to reach the coast. But halfway there, at Gjirokaster, German troops blocked the way, and the Americans were too sick and exhausted to go on. He radioed for an American air rescue. Two C-47 cargo planes flew in with fighter escorts. But the Germans disrupted the landing, and Lieutenant Duffy called it off. The Americans, after the euphoria of nearly being rescued, were crushed. But they resumed their journey, and with American and British help reached the coast. On Jan. 9, after a 63-day ordeal, 27 Americans – 10 nurses and 17 medics and fliers – boarded a British launch and crossed to Italy.  Three nurses remained behind in German-occupied Berat. Captain Lloyd Smith brought them to safety in March 1944. They rode pack mules most of the way to the coast and were met by a torpedo boat, which took them across the Adriatic.

 

Kostaq Stefa was the main Albanian partisan leader, who led the Americans for several weeks. Sadly, when Kostaq returned from helping the Americans, he was tortured for several days by the BK. After the war, communist dictator Enver Hoxha had Stefa executed in 1948. He left behind a widow and five children.

 

After the war, Mr. Hayes returned to civilian life, attended Iowa State College and became an aeronautical engineer for North American Aviation, designing military planes and conducting studies for the Air Force and the National Aeronautics and Space Administration until he retired in 1984. He married the former Betty Allen in 1944. She and their daughter survive him, as does another daughter, Victoria Sprott; two brothers, Karl and James; a sister, Virginia McCall; two grandsons; and a great-granddaughter. Harold Lyle Hayes was born in Pekin, Iowa, on April 11, 1922, to Ralph and Jenella Van Gorp Hayes. He graduated from high school in Indianola in 1940. After Japan attacked Pearl Harbor on Dec. 7, 1941, he was drafted, volunteered as a medic and by 1943 was in Sicily, flying evacuation missions. “When he first returned to Allied lines, he had nightmares of being chased,“ Ms. Lineberry wrote of Mr. Hayes. “Those faded with time, but as was true of many in the group, he rarely talked about his ordeal over the years.“ Source: The New York Times, by Robert D. McFadden

 

Ancient Methods of Birth Control

Ancient silver coin from Cyrene depicting a stalk of silphium

Sources: Wikipedia Commons

 

The Egyptian Ebers Papyrus from 1550 BCE and the Kahun Papyrus from 1850 BCE have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm. It is believed that in Ancient Greece silphium was used as birth control which, due to its effectiveness and thus desirability, was harvested into extinction. In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church, although it is believed that women of the time still used a number of birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina. Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. The oldest condoms discovered to date were recovered in the ruins of Dudley Castle in England, and are dated back to 1640. They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted diseases during the English Civil War. Casanova, living in 18th century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century.

 

A CycleBeads, used for estimating fertility based on days since last menstruation. Credit: By Dellex – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=5608730

 

 

Birth Control Movement

 

And the villain still pursues her“, a satirical Victorian era postcard. Source: Wikipedia Commons

 

 

The birth control movement developed during the 19th and early 20th centuries. The Malthusian League, based on the ideas of Thomas Malthus, was established in 1877 in the United Kingdom to educate the public about the importance of family planning and to advocate for getting rid of penalties for promoting birth control. It was founded during the “Knowlton trial“ of Annie Besant and Charles Bradlaugh, who were prosecuted for publishing on various methods of birth control. In the United States, Margaret Sanger and Otto Bobsein popularized the phrase “birth control“ in 1914. Sanger was mainly active in the United States but had gained an international reputation by the 1930s. At the time, under the Comstock Law, distribution of birth control information was illegal. She jumped bail in 1914 after her arrest for distributing birth control information and left the United States for the United Kingdom to return in 1915. Sanger established a short-lived birth-control clinic based in the Brownville section of Brooklyn, New York in 1916, which was shut down after eleven days and resulted in her arrest. The publicity surrounding the arrest, trial, and appeal sparked birth control activism across the United States.

 

The first permanent birth-control clinic was established in Britain in 1921 by Marie Stopes working with the Malthusian League. The clinic, run by midwives and supported by visiting doctors, offered women’s birth-control advice and taught them the use of a cervical cap. Her clinic made contraception acceptable during the 1920s by presenting it in scientific terms. In 1921, Sanger founded the American Birth Control League, which later became the Planned Parenthood Federation of America. In 1924 the Society for the Provision of Birth Control Clinics was founded to campaign for municipal clinics; this led to the opening of a second clinic in Greengate, Salford in 1926. Throughout the 1920s, Stopes and other feminist pioneers, including Dora Russell and Stella Browne, played a major role in breaking down taboos. In April 1930 the Birth Control Conference assembled 700 delegates and was successful in bringing birth control and abortion into the political sphere. Three months later, the Ministry of Health, in the United Kingdom, allowed local authorities to give birth-control advice in welfare centers. In 1936 the U.S. court ruled in U.S. v. One Package that medically prescribing contraception to save a person’s life or well-being was not illegal under the Comstock Law. Following this decision, the American Medical Association Committee on Contraception revoked its 1936 statement condemning birth control. A national survey in 1937 showed 71% of the adult population supported the use of contraception. By 1938 347 birth control clinics were running in the United States despite their advertisement still being illegal. First Lady Eleanor Roosevelt publicly supported birth control and family planning. In 1966, President Lyndon B. Johnson started endorsing public funding for family planning services, and the Federal Government began subsidizing birth control services for low-income families. The Affordable Care Act, passed into law on March 23, 2010 under President Barack Obama, requires all plans in the Health Insurance Marketplace to cover contraceptive methods. These include barrier methods, hormonal methods, implanted devices, emergency contraceptives, and sterilization procedures.

 

In 1909, Richard Richter developed the first intrauterine device made from silkworm gut, which was further developed and marketed in Germany by Ernst Grafenberg in the late 1920s. In 1951, a chemist, named Carl Djerassi from Mexico City made the hormones in progesterone pill using Mexican yams. Djerassi had chemically created the pill but was not equipped to distribute them to patients. Meanwhile, Gregory Pincus and John Rock, with help from the Planned Parenthood Federation of America, developed the first birth control pills in the 1950s, such as mestranol/noretynodrel, which became publicly available in the 1960s in the US under the name Enovid. Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogs in the 1970s and mifepristone in the 1980s.

 

2017 marks the 57th anniversary of the birth control pill, which many considered to have empowered women and sparked the sexual revolution. However, for centuries, women have had some control over reproduction, although perhaps, not as effective as what’s available today.

 

Records exist of women in ancient Rome and Greece relying on dances and amulets to prevent pregnancy, and we can assume that those practices probably didn’t work.

 

Citric Acid

 

Credit: Wikipedia

 

 

Citric acid is said to have spermicidal properties, and women used to soak sponges in lemon juice before inserting them vaginally. Mentioned in the Talmud, this was a preferred method of birth control in ancient Jewish communities. The sponge itself would act as a pessary, a physical barrier between the sperm and the cervix. The great womanizer Casanova was said to have inserted the rind of half a lemon into his lovers as a primitive cervical cap or diaphragm, the residual lemon juice serving to annihilate the sperm. Lemon- and lime-juice douches following coitus were also recommended as a form of birth control, but this method was likely less effective, since sperm can enter the cervix – and hence out of reach of any douching – within minutes of ejaculation. Incidentally, some alternative medicine practitioners today suggest that megadoses of vitamin C (6 to 10 g a day) could induce an abortion in women under 4 weeks of pregnancy, but there’s no evidence that citrus fruits were used in this way in ancient times.

 

Queen Anne’s Lace

 

Queen Anne’s Lace (most beautiful wild flower). Credit: Wikipedia

 

 

Queen Anne’s Lace is also known as wild carrot, and its seeds have long been used as a contraceptive. Hippocrates described this use over two millennia ago. The seeds block progesterone synthesis, disrupting implantation and are most effective as emergency contraception within eight hours of exposure to sperm, a sort of “morning after“ form of birth control. Taking Queen Anne’s Lace led to no or mild side effects (like a bit of constipation), and women who stopped taking it could conceive and rear a healthy child. The only danger, it seemed, was confusing the plant with similar-looking but potentially deadly poison hemlock and water hemlock.

 

Pennyroyal

 

Pennyroyal Credit: Wikipedia Commons

 

Pennyroyal is a plant in the mint genus and has a fragrance similar to that of spearmint. The ancient Greeks and Romans used it as a cooking herb and a flavoring ingredient in wine. They also drank pennyroyal tea to induce menstruation and abortion. 1st-century physician Dioscorides records this use of pennyroyal in his massive five-volume encyclopedia on herbal medicine. Too much of the tea could be highly toxic, however, leading to multiple organ failure.

 

Blue Cohosh

 

Blue cohosh found on the grounds of the University of Michigan.

Credit: Wikipedia Commons

 

Blue cohosh, traditionally used for birth control by Native Americans. It contains at least two abortifacient substances: one mimics oxytocin, a hormone produced during childbirth that stimulates the uterus to contract, and a substance unique to blue cohosh, caulosaponin, also results in uterine contractions. Midwives today may use blue cohosh in the last month of pregnancy to tone the uterus in preparation for labor. The completely unrelated but similarly named black cohosh also has estrogenic and abortifacient properties and was often combined with blue cohosh to terminate a pregnancy.

 

Dong Quai or Chinese Angelica

 

Dong quai, also known as Chinese angelica, has long been known for its powerful effects on a woman’s cycle. Women drank a tonic brewed with dong quai roots to help regulate irregular menstruation, alleviate menstrual cramps and help the body regenerate after menstruation. Taken during early pregnancy, however, dong quai had the effect of causing uterine contractions and inducing abortion. European and American species of angelica have similar properties but were not as widely used.

 

Common Rue

 

The Tacuinum Sanitatis, a medieval handbook on wellness, lists the following 5 properties of rue:

  • Nature: Warm and dry in the third degree.
  • Optimum: That which is grown near a fig tree.
  • Usefulness: It sharpens the eyesight and dissipates flatulence.
  • Dangers: It augments the sperm and dampens the desire for coitus.
  • Neutralization of the Dangers: With foods that multiply the sperm.

 

The refined oil of rue is an emmenagogue and was cited by the Roman historian Pliny the Elder and the gynecologist Soranus as a potent abortifacient (inducing abortion). Rue, a blue-green herb with feathery leaves, is also grown as an ornamental plant and is favored by gardeners for its hardiness. It is rather bitter but can be used in small amounts as a flavoring ingredient in cooking. Soranus, a gynecologist from 2nd-century Greece, described its use as a potent abortifacient, and women in Latin America have traditionally eaten rue in salads as a contraceptive and drunk rue tea as emergency contraception or to induce abortion. Ingested regularly, rue decreases blood flow to the endometrium, essentially making the lining of the uterus non-nutritive to a fertilized egg.

 

Cotton

 

Cotton Shrub; Credit: Wikipedia Commons

 

The earliest evidence of cotton use has been found at sites where cotton threads were preserved in copper beads; these finds have been dated to Neolithic (between 6000 and 5000 BCE). Cotton cultivation in the region is dated to the Indus Valley Civilization.In the ancient medical manuscript the Ebers Papyrus (1550 BCE), women were advised to grind dates, acacia tree bark, and honey together into a paste, apply this mixture to seed wool, and insert the seed wool vaginally for use as a pessary. Granted, it was what was in the cotton rather than the cotton itself that promoted its effectiveness as birth control – acacia ferments into lactic acid, a well-known spermicide – but the seed wool did serve as a physical barrier between ejaculate and cervix. Interestingly, though, women during the times of American slavery would chew on the bark of cotton root to prevent pregnancy. Cotton root bark contains substances that interfere with the corpus luteum, which is the hole left in the ovary when ovulation occurs. The corpus luteum secretes progesterone to prepare the uterus for implantation of a fertilized egg. By impeding the corpus luteum’s actions, cotton root bark halts progesterone production, without which a pregnancy can’t continue.

 

 

Papaya

 

Papaya tree and fruit, from Koehler’s Medicinal-Plants (1887). Source: Wikipedia Commons

 

 

In South Asia and Southeast Asia, unripe papaya was used to prevent or terminate pregnancy. Once papaya is ripe, though, it loses the phytochemicals that interfere with progesterone and thus its contraceptive and abortifacient properties. The seeds of the papaya could actually serve as an effective male contraceptive. Papaya seeds, taken daily, could cut a man’s sperm count to zero and was safe for long-term use. Best of all, the sterility was reversible: if the man stopped taking the seeds, his sperm count would return to normal.

 

Silphium

 

Silphium on ancient Banner. Source: Italian Wikipedia, Wikipedia Commons

 

 

Silphium was a member of the fennel family that grew on the shores of Cyrenaica (in present-day Libya). It was so important to the Cyrenean economy that it graced that ancient city’s coins. Silphium had a host of uses in cooking and in medicine, and Pliny the Elder recorded the herb’s use as a contraceptive. It was reportedly effective for contraception when taken once a month as a tincture. It could also be used as emergency birth control, either orally or vaginally, as an abortifacient. By the second century CE, the plant had gone extinct, likely because of over harvesting.

 

Mercury

 

Credit: Wikipedia Commons

 

Civilizations the world over, from the ancient Assyrians and Egyptians to the Greeks, were fascinated by mercury and were convinced that it had medicinal value and special curative properties, using it to treat everything from skin rashes to syphilis. In ancient China, women were advised to drink hot mercury to prevent pregnancy. It was effective at convincing a woman’s body that she wasn’t fit to carry a child, leading to miscarriage, so, it did work as a contraceptive. However, mercury is enormously toxic, causing kidney and lung failure, as well as brain damage and death. Sources: Iva Cheung; Wikipedia

 

100 Years Later, Death Theories of Healer, Grigori Rasputin Remain a Mystery

Grigori Rasputin 1869-1916: Photo source: Public Domain, Wikipedia Commons

 

 

Grigori Yefimovich Rasputin was a Russian peasant, an experienced traveler, a mystical faith healer, and trusted friend of the family of Nicholas II, the last Tsar of the Russian Empire. He became an influential figure in Saint Petersburg, especially after August 1915 when Nicholas took command of the army fighting in World War I. Advising his wife, Alexandra Feodorovna, in countless spiritual and political issues, Rasputin became an easy scapegoat for Russian nationalists, liberals and aristocrats. There is uncertainty over much of Rasputin’s life and the degree of influence that he exerted over the extremely shy Tsar and the strong-willed Tsarina. Accounts are often based on dubious memoirs, hearsay, and legend. While his influence and position may have been exaggerated by society gossip and his own drunken boasting his presence played a significant role in the increasing unpopularity of the Imperial couple. It is believed that Rasputin was murdered by monarchists who hoped to save Tsarism by ending his sway over the royal family. The end of December 2016, marked the 100th anniversary of the death of Rasputin, the “mad monk of Russia“, or “lover of the Russian queen.“

 

Grigori Yefimovich Rasputin, a mystic and spiritual healer born in Pokrovskoe in Siberia, wielded huge influence over the Russian royal family, particularly Alexandra, the Tsarina, who looked to the spiritual healer to cure her hemophiliac son, heir, Tsesarevich Alexei.

 

On 13 October 1906, Rasputin paid a visit to the Imperial family and presented an icon. On request of the Tsar, he then visited the next prime minister, Pyotr Stolypin. A few weeks before, 29 people had been killed on Aptekarsky Island in a bomb attack by the Maximalists and two of Stolypin’s children were wounded. Rasputin was invited to pray. On 6 April 1907, Rasputin was invited to Alexander Palace in Tsarskoe Selo, this time to see Tsesarevich Alexei, the heir. The boy had suffered an injury which caused him painful bleeding. By then, it was not known that Alexei had a rare form of hemophilia. The doctors could not supply a cure, and the desperate Tsarina invited Rasputin. He was able to calm the parents and their son, standing at the foot of the bed and praying. From that moment, Alexandra believed Rasputin was Alexei’s savior. Pierre Gilliard, the French historian Helene Carrere d’Encausse, and journalist Diarmuid Jeffreys speculated that Rasputin’s healing practice included halting the administration of aspirin, a pain-relieving analgesic available since 1899. Aspirin is an anticoagulant and has blood-thinning properties; the mechanism of action of aspirin is that it prevents clotting and promotes bleeding, which could have caused the hemarthrosis at the root of Alexei’s joints swelling and pain. On September 1912, the Romanovs were visiting their hunting retreat in the Bialowieza Forest; on 5 September, the careless Tsesarevich jumped into a rowboat and hit one of the oarlocks. A large bruise appeared within minutes. Within a week the hematoma reduced in size. In mid-September, the family moved to Spala (then in Russian Poland). On 2 October, after a drive in the woods, the “juddering of the carriage had caused still healing hematoma in his upper thigh to rupture and start bleeding again.“ Alexei had to be carried out in an almost unconscious state. His temperature rose and his heartbeat dropped, caused by a swelling in the left groin; Alexandra barely left his bedside. A constant record was kept of the boy’s temperature. On 10 October, a medical bulletin appeared in the newspapers, and Alexei received the last sacrament. His condition then improved at once, according to the Tsar. The positive trend continued throughout the next day. According to Nelipa, Robert K. Massie was correct to recommend that psychological factors do play a part.

 

It is not exactly clear on which day, either 9, 10, or 11 October, the Tsarina turned to her lady-in-waiting and best friend, Anna Vyrubova, to secure the help of the peasant healer, who at that time was out of favor. According to his daughter, Rasputin received the telegram on 12 October. If Maria Rasputin was right about the day, the telegram was sent “the longstanding claim that Rasputin had somehow alleviated Alexei’s condition is simply fictitious“, according to Nelipa. The next day he seems to have responded, with a short telegram, including the prophecy: “The little one will not die. Do not allow the doctors [c.q. Eugene Botkin and Vladimir Derevenko] to bother him too much.“ On 19 October, Alexei’s condition was considerably better and the hematoma disappeared, but he had to undergo orthopedic therapy to straighten his left leg. The court physician, Botkin, believed that Rasputin was a charlatan and his apparent healing powers arose from his use of hypnosis, but Rasputin was not interested in this practice before 1913 and his teacher Gerasim Papnadato was expelled from St. Petersburg in 1914. Felix Yusupov, one of Rasputin’s enemies, suggested that he secretly drugged Alexei with Tibetan herbs which he had obtained from a “quack doctor“. For Fuhrmann, these ideas on hypnosis and drugs flourished because the imperial family lived such isolated lives. For Moynahan, “There is no evidence that Rasputin ever summoned up spirits, or felt the need to; he won his admirers through force of personality, not by tricks.“ For Maria Rasputin and Vladimir Sukhomlinov, it was magnetism. For Shelley, the secret of his power lay in the sense of calm, gentle strength, and shining warmth of conviction.

 

What is known about the death of Rasputin, December, 1916, one hundred years ago, is that one evening Rasputin went to the Yusupov Palace in St Petersburg at the invitation of Prince Felix Yusupov. Rasputin’s dead body was recovered from the frozen Neva River days later. No one is completely sure what happened in between these two events. The most well-known account of the events comes from Prince Yusupov himself in his memoirs Lost Splendour. This autobiography reads more like a boy’s own adventure story than a reliable historical document and many doubt the authenticity of what he wrote. According to Yusupov, when Rasputin arrived at the palace he was taken down to the cellar where he was given cake and madeira wine. Upstairs, a gramophone played Yankee Doodle Dandy to fool the monk in to believing there was a party in full swing. Yusupov and his accomplices had planned things carefully. The cakes offered to Rasputin had been laced with enough potassium cyanide to slay a monastery full of monks. But Rasputin just kept eating them. Incredulous at the monk’s survival, Prince Yusupov poured madeira into a cyanide-laced wine glass and handed it to Rasputin. Instead of collapsing into unconsciousness within seconds, as would be expected from a massive dose of cyanide, Rasputin continued to sip the wine like a connoisseur. A second lethal glass disappeared into the monk’s mouth with little apparent effect other than some difficulty swallowing. Asked if he was feeling unwell he replied “Yes, my head is heavy and I’ve a burning sensation in my stomach.“ A third glass of tainted wine only seemed to revive him. Having ingested their whole stock of cyanide, the group of assassins were somewhat at a loss as to what to do next. So they shot him. The bullet appeared to have entered the body near the heart – certain death, or so they thought. But, soon after, Rasputin’s eyes opened and, clearly upset at the turn of events, he attacked Yusupov. There was a ferocious struggle before the prince could free himself and run away up the stairs. Rasputin followed. The group finally emerged into a courtyard, where four more shots were fired into Rasputin’s body before he slumped to the ground. To make sure they wouldn’t be troubled again, the assassins wrapped and tied the body with a piece of heavy linen, bundled it into a car and drove to Petrovski Island, where it was dropped from a bridge into the frozen river below.

 

The whole account sounds fanciful from start to finish, but remarkable things do happen. Human beings have achieved incredible physical feats in spite of horrible injuries. Maybe Rasputin really was still alive after the first shot and capable of a fight. But what about the poison? Surely no one could eat so much cyanide with so little effect? The theories as to why the cyanide didn’t kill Rasputin are almost as numerous as the theories of how he really died. What is surprising is that the theories are scientifically credible. The first theory is that the poisoners were not the supposed strength. Either they didn’t use enough, or the cyanide they had was old stock that had decayed into something far less toxic. Though plausible, a century after the events it is impossible to tell if this is true. The second theory is that Rasputin, aware that someone might be trying to kill him (he had survived at least one assassination attempt already), had decided to protect himself against poison. Perhaps he was inspired by Mithridates, king of Pontus in the first century BCE, who, fearful of poisoners, concocted an antidote or preventative. By ingesting sub-lethal amounts of every known poison he developed an immunity. When Mithridates was under threat from the local populace he tried to kill himself with poison, but the attempt failed and he had to request that a guard kill him with a sword. It is true that the body can develop a natural immunity or tolerance to some very toxic substances by administering very small doses over a period of time. Some of these toxic compounds include snake venom, ricin and opiates, to name but a few. Unfortunately, cyanide isn’t one of those substances. You simply cannot build up a natural tolerance to cyanide by using this method. The third theory is that Rasputin had alcoholic gastritis, which can lead to having less stomach acid. Without acid in the stomach, the potassium cyanide can’t be converted into hydrogen cyanide, and is therefore considerably less toxic. It’s another plausible explanation, but no one really knows if Rasputin suffered from this complaint or not. The fourth theory is that his poisoners unintentionally gave him the antidote along with the poison. Studies have shown that rats fed sugar with cyanide fare a lot better than those fed cyanide without it. The theory, though not proven, is that the sugar binds to the cyanide in a way that allows its excretion before it can be fully absorbed into the body. The assassins therefore may have chosen poorly when they elected to deliver the cyanide in sugary cakes and wine. The final theory is that Yusupov made the whole thing up, and Rasputin was simply shot shortly after he arrived at the palace by a person or persons unknown. This is probably much nearer the truth – but it isn’t nearly as interesting as stories of an “unkillable“ monk.

 

Rasputin was an extraordinary but minor figure. He contributed little to the tragedy that engulfed Russia in the first two decades of the 20th century. Far more important were a grossly incompetent monarch in the shape of Nicholas II, a ruthless revolutionary in the form of Lenin, and a world war that the Russian government was no more able to avert than any other. All combined to bring down a nation that, if left to itself, might perhaps have become what so many Russians have hoped for, a “normal“ and prosperous country. Sources: The Guardian (Kathryn Harkup); Wikipedia

 

Homosexuality

Burning of two homosexuals at the stake outside Z?rich, 1482 (Spiezer Schilling).

Source: Public Domain, Wikipedia Commons

 

 

Classical period: Europe

 

The earliest Western documents (in the form of literary works, art objects, and mythographic materials) concerning same-gender relationships are derived from ancient Greece. With regard to male homosexuality such documents depict a world in which relationships with women and relationships with youths were the essential foundation of a normal man’s love life. Same-gender relationships were a social institution variously constructed over time and from one city to another. The formal practice, an erotic yet often restrained relationship between a free adult male and a free adolescent, was valued for its pedagogic benefits and as a means of population control, though occasionally blamed for causing disorder. Plato praised its benefits in his early writings but in his late works proposed its prohibition. Aristotle, in the Politics, dismissed Plato’s ideas about abolishing homosexuality; he explains that barbarians like the Celts accorded it a special honor, while the Cretans used it to regulate the population.

 

Little is known of female homosexuality in antiquity. Sappho, born on the island of Lesbos, was included by later Greeks in the canonical list of nine lyric poets. The adjectives deriving from her name and place of birth (Sapphic and Lesbian) came to be applied to female homosexuality beginning in the 19th century. Sappho’s poetry centers on passion and love for various personages and both genders. The narrators of many of her poems speak of infatuations and love (sometimes requited, sometimes not) for various females, but descriptions of physical acts between women are few and subject to debate.

 

Sappho reading to her companions on an Attic vase of c. 435 BCE.

Source: Public Domain, Wikipedia Commons

 

 

In Ancient Rome the young male body remained a focus, but relationships were between older free men and slaves or freed youths who took the receptive role. The Hellenophile emperor Hadrian is renowned for his relationship with Antinous, but the Christian emperor Theodosius I decreed a law on 6 August 390, condemning passive males to be burned at the stake. Justinian, towards the end of his reign, expanded the proscription to the active partner as well (in 558), warning that such conduct can lead to the destruction of cities through the “wrath of God“. Notwithstanding these regulations, taxes on brothels of boys available for homosexual relationships continued to be collected until the end of the reign of Anastasius I in 518.

 

Renaissance

 

During the Renaissance, wealthy cities in northern Italy – Florence and Venice in particular – were renowned for their widespread practice of same-gender love, engaged in by a considerable part of the male population and constructed along the classical pattern of Greece and Rome. But even as many of the male population were engaging in same-gender relationships, the authorities, under the aegis of the Officers of the Night court, were prosecuting, fining, and imprisoning a good portion of that population. From the second half of the 13th century, death was the punishment for male homosexuality in most of Europe. The relationships of socially prominent figures, such as King James I and the Duke of Buckingham, served to highlight the issue, including in anonymously authored street pamphlets: “The world is chang’d I know not how, For men Kiss Men, not Women now;.Of J. the First and Buckingham: He, true it is, his Wives Embraces fled, To slabber his lov’d Ganimede“ (Mundus Foppensis, or The Fop Display’d, 1691).

 

18th and 19th Centuries

 

Love Letters Between a Certain Late Nobleman and the Famous Mr. Wilson was published in 1723 in England and was presumed by some modern scholars to be a novel. The 1749 edition of John Cleland’s popular novel Fanny Hill includes a homosexual scene, but this was removed in its 1750 edition. Also in 1749, the earliest extended and serious defense of homosexuality in English, Ancient and Modern Pederasty Investigated and Exemplified, written by Thomas Cannon, was published, but was suppressed almost immediately. It includes the passage, “Unnatural Desire is a Contradiction in Terms; downright Nonsense. Desire is an amatory Impulse of the inmost human Parts.“ Around 1785 Jeremy Bentham wrote another defense, but this was not published until 1978. Executions for certain activities continued in the Netherlands until 1803, and in England until 1835. Between 1864 and 1880 Karl Heinrich Ulrichs published a series of twelve tracts, which he collectively titled Research on the Riddle of Man-Manly Love. In 1867, he became the first self-proclaimed gay person to speak out publicly in defense of gayness when he pleaded at the Congress of German Jurists in Munich for a resolution urging the repeal of discriminatory laws. A book by Havelock Ellis, published in 1896, challenged theories that homosexuality was abnormal, as well as stereotypes, and insisted on the ubiquity of homosexuality and its association with intellectual and artistic achievement. Although medical texts like these (written partly in Latin to obscure the graphic details) were not widely read by the general public, they did lead to the rise of Magnus Hirschfeld’s Scientific-Humanitarian Committee, which campaigned from 1897 to 1933 against discriminatory laws in Germany, as well as a much more informal, unpublicized movement among British intellectuals and writers, led by such figures as Edward Carpenter and John Addington Symonds. Beginning in 1894 with Homogenic Love, Socialist activist and poet Edward Carpenter wrote a string of pro-gay articles and pamphlets, and “came out“ in 1916 in his book My Days and Dreams. In 1900, Elisar von Kupffer published an anthology of homosexual literature from antiquity to his own time, Lieblingminne und Freundesliebe in der Weltliteratur.

 

Dementia

Credit: Garrondo, National Institute on Aging; Public Domain, Wikipedia Commons

 

Credit: National Institutes of Health nlm.nih.gov/medline; Public Domain, Wikipedia Commons

 

 

The history of dementia is probably as old as mankind itself. In recent years, considerable advances have been made in our understanding of the epidemiology, the pathogenesis and the diagnosis of Alzheimer’s disease (AD) and related disorders, and the nosology of these disorders is under scrutiny. Furthermore, we are witnessing the emergence of therapeutic agents specifically designed to enhance memory and cognition in AD patients. Despite the limited efficacy of the agents currently available, their introduction has shed an entirely new light on the field. We therefore feel that this is a good time to look at the past to understand the present and perhaps gain insight into the future. Until the end of the 19th century, dementia was a much broader clinical concept. It included mental illness and any type of psychosocial incapacity, including conditions that could be reversed. Dementia at this time simply referred to anyone who had lost the ability to reason, and was applied equally to psychosis of mental illness, “organic“ diseases like syphilis that destroy the brain, and to the dementia associated with old age, which was attributed to “hardening of the arteries.“

 

Dementia has been referred to in medical texts since antiquity. One of the earliest known accounts was written by the 7th century BCE Greek physician and mathematician Pythagoras, who divided the human lifespan into six distinct phases, which were 0-6 (infancy), 7-21 (adolescence), 22-49 (young adulthood), 50-62 (middle age), 63-79 (old age), and 80- (advanced age). The last two he described as the “senium“, a period of mental and physical decay, and of the final phase being where “the scene of mortal existence closes after a great length of time that very fortunately, few of the human species arrive at, where the mind is reduced to the imbecility of the first epoch of infancy“. In 550 BCE, the Greek Athenian statesman and poet Solon argued that the terms of a man’s will might be invalidated if he exhibited loss of judgement due to advanced age. Chinese medical texts made allusions to the condition as well, and the characters for “dementia“ translate literally to “foolish old person“.

 

Aristotle and Plato from Ancient Greece spoke of the mental decay of advanced age, but apparently simply viewed it as an inevitable process that affected all old men, and which nothing could prevent. The latter stated that the elderly were unsuited for any position of responsibility because, “There is not much acumen of the mind that once carried them in their youth, those characteristics one would call judgement, imagination, power of reasoning, and memory. They see them gradually blunted by deterioration and can hardly fulfill their function.“ For comparison, the Roman statesman Cicero held a view much more in line with modern-day medical wisdom that loss of mental function was not inevitable in the elderly and “affected only those old men who were weak-willed.“ He spoke of how those who remained mentally active and eager to learn new things could stave off dementia. However, Cicero’s views on aging, although progressive, were largely ignored in a world that would be dominated by Aristotle’s medical writings for centuries. Subsequent physicians during the time of Roman Empire such as Galen and Celsus simply repeated the beliefs of Aristotle while adding few new contributions to medical knowledge.

 

Byzantine physicians sometimes wrote of dementia, and it is recorded that at least seven emperors whose lifespans exceeded the age of 70 displayed signs of cognitive decline. In Constantinople, there existed special hospitals to house those diagnosed with dementia or insanity, but these naturally did not apply to the emperors who were above the law and whose health conditions could not be publicly acknowledged. Otherwise, little is recorded about senile dementia in Western medical texts for nearly 1700 years. One of the few references to it was the 13th-century friar Roger Bacon, who viewed old age as divine punishment for original sin. Although he repeated existing Aristotelian beliefs that dementia was inevitable after a long enough lifespan, he did make the extremely progressive assertion that the brain was the center of memory and thought rather than the heart. Poets, playwrights, and other writers however made frequent allusions to the loss of mental function in old age. Shakespeare notably mentions it in some of his plays including Hamlet and King Lear.

 

Dementia in the elderly was called senile dementia or senility, and viewed as a normal and somewhat inevitable aspect of growing old, rather than as being caused by any specific diseases. At the same time, in 1907, a specific organic dementing process of early onset, called Alzheimer’s disease, had been described. This was associated with particular microscopic changes in the brain, but was seen as a rare disease of middle age because the first patient diagnosed with it was a 50-year-old woman. During the 19th century, doctors generally came to believe that dementia in the elderly was the result of cerebral atherosclerosis, although opinions fluctuated between the idea that it was due to blockage of the major arteries supplying the brain or small strokes within the vessels of the cerebral cortex. This viewpoint remained conventional medical wisdom through the first half of the 20th century, but by the 1960s was increasingly challenged as the link between neurodegenerative diseases and age-related cognitive decline was established. By the 1970s, the medical community maintained that vascular dementia was rarer than previously thought and Alzheimer’s disease caused the vast majority of mental impairments in old age. More recently however, it is believed that dementia is often a mixture of both conditions.

 

Much like other diseases associated with aging, dementia was comparatively rare before the 20th century, due to the fact that it is most common in people over 80, and such lifespans were uncommon in preindustrial times. Conversely, syphilitic dementia was widespread in the developed world until largely being eradicated by the use of penicillin after WWII. With significant increases in life expectancy following WWII, the number of people in developed countries over 65 started rapidly climbing. While elderly persons constituted an average of 3-5% of the population prior to 1945, by 2010 it was common in many countries to have 10-14% of people over 65 and in Germany and Japan, this figure exceeded 20%. Public awareness of Alzheimer’s Disease was greatly increased in 1994 when former US president Ronald Reagan announced that he had been diagnoses with the condition. By the period of 1913-20, schizophrenia had been well-defined in a way similar to today, and also the term dementia praecox had been used to suggest the development of senile-type dementia at a younger age. Eventually the two terms fused, so that until 1952 physicians used the terms dementia praecox (precocious dementia) and schizophrenia interchangeably. The term precocious dementia for a mental illness suggested that a type of mental illness like schizophrenia (including paranoia and decreased cognitive capacity) could be expected to arrive normally in all persons with greater age (see paraphrenia). After about 1920, the beginning use of dementia for what we now understand as schizophrenia and senile dementia helped limit the word’s meaning to “permanent, irreversible mental deterioration“. This began the change to the more recognizable use of the term today.

 

In 1976, neurologist Robert Katzmann suggested a link between senile dementia and Alzheimer’s disease. Katzmann suggested that much of the senile dementia occurring (by definition) after the age of 65, was pathologically identical with Alzheimer’s disease occurring before age 65 and therefore should not be treated differently. He noted that the fact that “senile dementia“ was not considered a disease, but rather part of aging, was keeping millions of aged patients experiencing what otherwise was identical with Alzheimer’s disease from being diagnosed as having a disease process, rather than simply considered as aging normally. Katzmann thus suggested that Alzheimer’s disease, if taken to occur over age 65, is actually common, not rare, and was the 4th or 5th leading cause of death, even though rarely reported on death certificates in 1976. This suggestion opened the view that dementia is never normal, and must always be the result of a particular disease process, and is not part of the normal healthy aging process, per se. The ensuing debate led for a time to the proposed disease diagnosis of “senile dementia of the Alzheimer’s type“ (SDAT) in persons over the age of 65, with “Alzheimer’s disease“ diagnosed in persons younger than 65 who had the same pathology. Eventually, however, it was agreed that the age limit was artificial, and that Alzheimer’s disease was the appropriate term for persons with the particular brain pathology seen in this disorder, regardless of the age of the person with the diagnosis. A helpful finding was that although the incidence of Alzheimer’s disease increased with age (from 5-10% of 75-year-olds to as many as 40-50% of 90-year-olds), there was no age at which all persons developed it, so it was not an inevitable consequence of aging, no matter how great an age a person attained. Evidence of this is shown by numerous documented supercentenarians (people living to 110+) that experienced no serious cognitive impairment. There is some evidence that dementia is most likely to develop between the ages of 80-84 and individuals who pass that point without being affected have a lower chance of developing it. Women account for a larger percentage of dementia cases than men, although this can be attributed to their longer overall lifespan and greater odds of attaining an age where the condition is likely to occur. Also, after 1952, mental illnesses like schizophrenia were removed from the category of organic brain syndromes, and thus (by definition) removed from possible causes of “dementing illnesses“ (dementias). At the same, however, the traditional cause of senile dementia – “hardening of the arteries“ – now returned as a set of dementias of vascular cause (small strokes). These were now termed multi-infarct dementias or vascular dementias.

 

In the 21st century, a number of other types of dementia have been differentiated from Alzheimer’s disease and vascular dementias (these two being the most common types). This differentiation is on the basis of pathological examination of brain tissues, symptomatology, and by different patterns of brain metabolic activity in nuclear medical imaging tests such as SPECT and PETscans of the brain. The various forms of dementia have differing prognoses (expected outcome of illness), and also differing sets of epidemologic risk factors. The causal etiology of many of them, including Alzheimer’s disease, remains unclear, although many theories exist such as accumulation of protein plaques as part of normal aging, inflammation (either from bacterial pathogens or exposure to toxic chemicals), inadequate blood sugar, and traumatic brain injury. Sources: nih.gov; Wikipedia

 

Carl Tanzler (1877-1952): Who Knew Bacteriologists Were So Interesting!

Tanzler in 1940

 

 

Carl Tanzler, or sometimes called, Count Carl von Cosel (February 8, 1877 July 3, 1952), was a German-born bacteriologist at the United States Marine Hospital in Key West, Florida. He developed an obsession for a young Cuban-American tuberculosis patient, Elena “Helen“ Milagro de Hoyos (July 31, 1909 – October 25, 1931), that carried on well after the disease had caused her death. In 1933, almost two years after her death, Tanzler removed Hoyos’s body from its tomb, and lived with the corpse at his home for seven years until its discovery by Hoyos’s relatives and authorities in 1940.

 

Tanzler went by many names; he was listed as Georg Karl Tanzler on his German marriage certificate. He was listed as Carl Tanzler von Cosel on his United States citizenship papers, and he was listed as Carl Tanzler on his Florida death certificate. Some of his hospital records were signed Count Carl Tanzler von Cosel. He was born as Karl Tanzler or Georg Karl Tanzler on February 8, 1877 in Dresden, Germany. Around 1920 he married Doris Anna Shafer (1889-1977) and he was listed as “Georg Karl T?nzler“ on the marriage certificate. Together they had two children: Ayesha Tanzler (1922-1998), and Crystal Tanzler (1924-1934), who died of diphtheria. Tanzler grew up in Germany. The following “Editorial Note“ accompanying the autobiographical account “The Trial Bay Organ: A Product of Wit and Ingenuity“ by “Carl von Cosel“ in the Rosicrucian Digest of March and April 1939, gives details about his stay in Australia before and during World War I and his return to Germany after the war:

 

Many years ago, Carl von Cosel travelled from India to Australia with the intention of proceeding to the South Seas Islands. He paused in Australia to collect equipment and suitable boats, and to become acquainted with prevailing weather and sea conditions. However, he became interested in engineering and electrical work there, bought property, boats, an organ, an island in the Pacific?so that he was still in Australia at the end of ten years. He had just begun to build a trans-ocean flyer when the war broke out and the British military authorities placed him in a concentration camp for ‘safe-keeping’ along with many officers India and China who were prisoners of war. Later he was removed to Trial Bay to a castle-like prison on the cliffs, and there the work in this narrative was accomplished. At the end of the war no prisoner was permitted to return to his former residence, but all were shipped to the prisoner’s exchange in Holland. When Carl von Cosel was released he set out to find his mother from whom he had not heard since the beginning of the war. Finding her safe, he remained with her for three years, witnessing the chaos that followed in the wake of the war. Finally, she suggested that her son return to his sister in the United States.

 

Tanzler’s account of Trial Bay Gaol, his secret building of a sailing boat, etc., is confirmed by Nyanatiloka Thera, who mentions that he planned to escape from the Gaol with “Count Carl von Cosel“ in a sailing boat, and provides other information about the interment of Germans in Australia during WWI. Tanzler emigrated to the United States in 1926, sailing from Rotterdam on February 6, 1926 to Havana, Cuba. From Cuba he settled in Zephyrhills, Florida, to where his sister had already emigrated, and was later joined by his wife and two daughters. Leaving his family behind in Zephyrhills in 1927, he took a job as a radiologic technologist at the U.S. Marine Hospital in Key West, Florida under the name Carl von Cosel.

 

During his childhood in Germany, and later while traveling briefly in Genoa, Italy, Tanzler claimed to have been visited by visions of a dead ancestor, Countess Anna Constantia von Cosel, who revealed the face of his true love, an exotic dark-haired woman, to him.

 

On April 22, 1930, while working at the Marine Hospital in Key West, Tanzler met Maria Elena “Helen“ Milagro de Hoyos (1909-1931), a local Cuban-American woman who had been brought to the hospital by her mother for an examination. Tanzler immediately recognized her as the beautiful dark-haired woman that had been revealed to him in his earlier “visions.“ By all accounts, Hoyos was viewed as a local beauty in Key West. Elena was the daughter of local cigar maker Francisco “Pancho“ Hoyos (1883-1934) and Aurora Milagro (1881-1940). She had two sisters, Florinda “Nana“ Milagro Hoyos (1906-1944), who married Mario Medina (c.1905-1944) and also succumbed to tuberculosis; and Celia Milagro Hoyos (1913-?). Medina, Nana’s husband, was electrocuted trying to rescue a coworker who hit a powerline with his crane at a construction site. On February 18, 1926, Hoyos married Luis Mesa (1908-?), the son of Caridad and Isaac Mesa. Luis left Hoyos shortly after Hoyos miscarried the couple’s child, and moved to Miami. Hoyos was legally married to Mesa at the time of her death. Hoyos was eventually diagnosed with tuberculosis, a typically fatal disease at the time, that eventually claimed the lives of almost all of her entire immediate family. Tanzler, with his self-professed medical knowledge, attempted to treat and cure Hoyos with a variety of medicines, as well as x-ray and electrical equipment, that were brought to the Hoyoses’ home. Tanzler showered Hoyos with gifts of jewelry and clothing, and allegedly professed his love to her, but no evidence has surfaced to show that any of his affection was reciprocated by Hoyos.

 

The corpse of Maria Elena Milagro de Hoyos (1910-1931) encased in wax and plaster circa 1940. Source: Wikipedia Commons

 

 

Despite Tanzler’s best efforts, Hoyos died of terminal tuberculosis at her parents’ home in Key West on October 25, 1931.Tanzler paid for her funeral, and with the permission of her family he then commissioned the construction of an above ground mausoleum in the Key West Cemetery, which he visited almost every night. One evening in April, 1933, Tanzler crept through the cemetery where Hoyos was buried and removed her body from the mausoleum, carting it through the cemetery after dark on a toy wagon, and transporting it to his home. He reportedly said that Elena’s spirit would come to him when he would sit by her grave and serenade her corpse with a favorite Spanish song. He also said that she would often tell him to take her from the grave. Tanzler attached the corpse’s bones together with wire and coat hangers, and fitted the face with glass eyes. As the skin of the corpse decomposed, Tanzler replaced it with silk cloth soaked in wax and plaster of Paris. As the hair fell out of the decomposing scalp, Tanzler fashioned a wig from Hoyos’s hair that had been collected by her mother and given to Tanzler not long after her burial in 1931. Tanzler filled the corpse’s abdominal and chest cavity with rags to keep the original form, dressed Hoyos’s remains in stockings, jewelry, and gloves, and kept the body in his bed. Tanzler also used copious amounts of perfume, disinfectants, and preserving agents, to mask the odor and forestall the effects of the corpse’s decomposition.

 

In October, 1940, Elena’s sister Florinda heard rumors of Tanzler sleeping with the disinterred body of her sister, and confronted Tanzler at his home, where Hoyos’s body was eventually discovered. Florinda notified the authorities, and Tanzler was arrested and detained. Tanzler was psychiatrically examined, and found mentally competent to stand trial on the charge of “wantonly and maliciously destroying a grave and removing a body without authorization.“ After a preliminary hearing on October 9, 1940 at the Monroe County Courthouse in Key West, Tanzler was held to answer on the charge, but the case was eventually dropped and he was released, as the statute of limitations for the crime had expired. Shortly after the corpse’s discovery by authorities, Hoyos’s body was examined by physicians and pathologists, and put on public display at the Dean-Lopez Funeral Home, where it was viewed by as many as 6,800 people. Hoyos’s body was eventually returned to the Key West Cemetery where the remains were buried in an unmarked grave, in a secret location, to prevent further tampering. The facts underlying the case and the preliminary hearing drew much interest from the media at the time (most notably, from the Key West Citizen and Miami Herald), and created a sensation among the public, both regionally and nationwide. The public mood was generally sympathetic to Tanzler, whom many viewed as an eccentric “romantic“.

 

Though not reported contemporaneously, research (most notably by authors Harrison and Swicegood) has revealed evidence of Tanzler’s necrophilia with Hoyos’s corpse. Two physicians (Dr. DePoo and Dr. Foraker) who attended the 1940 autopsy of Hoyos’s remains recalled in 1972 that a paper tube had been inserted in the vaginal area of the corpse that allowed for intercourse. Others contend that since no evidence of necrophilia was presented at the 1940 preliminary hearing, and because the physicians’ “proof“ surfaced in 1972, over 30 years after the case had been dismissed, the necrophilia allegation is questionable. While no existing contemporary photographs of the autopsy or photographs taken at the public display show a tube, the necrophilia claim was repeated by the HBO Autopsy program in 2005.

 

In 1944, Tanzler moved to Pasco County, Florida close to Zephyrhills, Florida, where he wrote an autobiography that appeared in the Pulp publication, Fantastic Adventures, in 1947. His home was near his wife Doris, who apparently helped to support Tanzler in his later years. Tanzler received United States citizenship in 1950 in Tampa. Separated from his obsession, Tanzler used a death mask to create a life-sized effigy of Hoyos, and lived with it until his death on July 3, 1952. His body was discovered on the floor of his home three weeks after his death. He died under the name “Carl Tanzler“. It has been recounted that Tanzler was found in the arms of the Hoyos effigy upon discovery of his corpse, but his obituary reported that he died on the floor behind one of his organs. The obituary recounted: “a metal cylinder on a shelf above a table, in it wrapped in silken cloth and a robe was a waxen image“. It has been written (most notably by Swicegood) that Tanzler had the bodies switched (or that Hoyos’s remains were secretly returned to him), and that he died with the real body of Elena.

 

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