Archive for the ‘medicine’ Category

Does Hillary Clinton have Parkinson’s Disease?

Sunday, September 18th, 2016

The Hillary collpase last Sunday has prompted a lot of speculation on her condition. Early on I was inclined to blame her neurological condition on her history of concussion and cerebral vein thrombosis.

That seemed logical, given her history. However, it does not explain her quick recovery. It also has nothing to do with pneumonia.

This video has now convinced me that she has Parkinson’s Disease, and it is fairly advanced. In the video, the physician mentions Apomorphine, which is not morphine but an alpha adrenergic drug used in Parkinson’s Disease.

Currently, apomorphine is used in the treatment of Parkinson’s disease.

What use does it have in Parkinson’s? It is used for “Non-motor symptoms.”

What does that mean ? Parkinson’s Disease is characterized by a serious of motor disabilities.

The cardinal symptoms of Parkinson’s disease are resting tremor, slowness of movement (bradykinesia) and rigidity. Many people also experience balance problems (postural instability). These symptoms, which often appear gradually and with increasing severity over time, are usually what first bring patients to a neurologist for help. Typically, symptoms begin on one side of the body and migrate over time to the other side.

These symptoms are typically controlled with Dopamine like drugs, such as L-Dopa. There are other symptoms less easily controlled.

For example, in advanced cases, difficulty swallowing can cause Parkinson’s patients to aspirate food into the lungs, leading to pneumonia or other pulmonary conditions. Loss of balance can cause falls that result in serious injuries or death. The seriousness of these incidents depends greatly on the patient’s age, overall health and disease stage.


There are also side effects of L Dopa.

L-DOPA therapy is further complicated by the development of movement disorders called dyskinesias after 5 – 10 years of use in most cases.

Dyskinesias are movement disorders in which neurological discoordination results in uncontrollable, involuntary movements. This discoordination can also affect the autonomic nervous system, resulting in, for example, respiratory irregularities (Rice 2002). Dyskinesia is the result of L-DOPA-induced synaptic dysfunction and inappropriate signaling between areas of the brain that normally coordinate movement, namely the motor cortex and the striatum (Jenner 2008).


Hillary Clinton and cavernous sinus thrombosis.

Tuesday, September 13th, 2016

The episode of Hillary Clinton’s collapse at the 9/11 Memorial Sunday has raised some interesting questions. Several years ago, she had a series of neurological events.

Getting a true picture of the events requires that we go to British newspaper sites, as the US media has shielded her for ten years.

1998 Blood Clot
Clinton’s first known blood clot occurred in 1998, while she was still first lady.
Clinton experienced symptoms while attending a fundraiser for Sen. Charles Schumer of New York, who would soon become her Senate home-state colleague. Her right foot swelled up to the point where she couldn’t put on her shoe.
Clinton got quietly taken to the National Naval Medical Center in Bethesda for treatment at the time. She was found to have ‘a big clot’ blood clot behind her knee, Clinton wrote in her memoir, ‘Living History.’
She called it ‘the most significant health scare I’ve ever had,’ the Washington Post noted.
According to her physician, Mt. Kisco physician, Lisa Bardack, Clinton was advised at the time to take Lovenox, described as a short-acting blood thinner, when she took flights. The meds were discontinued when she went on Coumadin.

That history has not been discussed, to my knowledge in light of her recent problems.

2009 Blood Clot
Clinton had a second blood clot incident in 2009. The episode was described by her doctor in a 2015 letter.
The doctor didn’t provide a detailed description of the event. Rather, she wrote that Clinton’s ‘past medical history is notable for a deep vein thrombosis in 1998, 2009 and a concussion in 2012.

Her extensive air travel might be a factor in the DVT episodes. This has been referred to as Economy Class Syndrome, and was first described by physicians at London’s Heathrow Airport. There are other factors involved.

In recent years, the association between air travel and the incidence of deep-vein thrombosis or pulmonary embolism has become clearer. Epidemiologic studies reveal an increased relative risk of thromboembolism after flights of more than 8 hours and especially in subjects at higher risk for this disease, due, for example, to congenital thrombophilia or the use of oral contraceptives. However, the absolute risk of deep-vein thrombosis or pulmonary embolism after prolonged air travel is very small. Studies have shown that a combination of factors present during prolonged air travel may account for increased activation of coagulation. There is no definitive proof that elastic stockings are effective in reducing the incidence of clinically relevant thromboembolism during air travel. Acetylsalicylic acid is not effective in the prevention of thrombosis during air travel and may be dangerous.

Hillary Clinton certainly does not travel “coach class.” What about the concussion?

2012 Blood Clot and Concussion
Clinton got a bad stomach bug and fainted at her home in Washington in 2012, an event that led her to get a concussion. Information about what exactly had happened emerged only slowly over time.
As her doctor put it, ‘In December 2012, Mrs. Clinton suffered a stomach virus after traveling, became dehydrated, fainted and sustained a concussion.’
The then-secretary of state wasn’t seen in public between Dec. 7th and when she left the hospital in New York January 2, 2013.
Clinton experienced ‘double vision for a period of time and benefited from wearing glasses with a Fresnel Prism,’ a special corrective lens, her doctor wrote in a letter voluntarily released to the media in 2015 as part of Clinton’s presidential campaign. Her concussion ‘resolved within two months,’ Bardack wrote.

That is a very severe concussion and would disqualify anyone with that history from the US military. The whole story is suspicious.

Clinton was diagnosed with a blood clot in the brain, transverse sinus venous thrombosis, and began anticoagulation therapy, her doctor wrote.
Clinton had to work from home and postpone planned testimony before a House Benghazi committee.

That is NOT part of a concussion and suggests a much more severe condition.

Cerebral venous and sinus thrombosis (CVST) can present with a variety of clinical symptoms ranging from isolated headache to deep coma. Prognosis is better than previously thought and prospective studies have reported an independent survival of more than 80% of patients. Although it may be difficult to predict recovery in an individual patient, clinical presentation on hospital admission and the results of neuroimaging investigations are–apart from the underlying condition–the most important prognostic factors. Comatose patients with intracranial haemorrhage (ICH) on admission brain scan carry the highest risk of a fatal outcome. Available treatment data from controlled trials favour the use of anticoagulation (AC) as the first-line therapy of CVST because it may reduce the risk of a fatal outcome and severe disability and does not promote ICH. A few patients deteriorate despise adequate AC which may warrant the use of more aggressive treatment modalities such as local thrombolysis. The risk of recurrence is low (< 10%) and most relapses occur within the first 12 months. Analogous to patients with extracerebral venous thrombosis, oral AC is usually continued for 3 months after idiopathic CVST and for 6-12 months in patients with inherited or acquired thrombophilia but controlled data proving the benefit of long-term AC in patients with CVST are not available.

What are the possible consequences of CVST ? A comment in the Wall Street Journal today suggests one.

“The clot does not dissolve or disappear as Clinton camp has inferred. About 1/2 of patients will continue to have a blocked vein, & half will have partial reopening of the vein, but either way, there will always be some insufficiency in drainage…. It is not a question of whether the intracranial pressure increases. It is a question of how severe and how bad are the symptoms that follow…I have treated numerous patients for this very issue—the consequences can lead to significant disability. It deeply concerns me that one of the 2 leading presidential candidates may have such serious health issues…Hillary [must release] her full & unaltered medical records.”

I have seen epidural and subdural hematomas from trauma, sometimes rather trivial trauma, but I have no experience with cavernous sinus thrombosis from trauma. That is usually a consequence of local infection, such as sinus or ear infection.

The next subject is her blue sunglasses, which are often prescribed for seizures. They can be used to treat Photosensitive Epilepsy.

Hmmm… Could those blue sunglasses be cross polarized lenses ?

One of our patients had clinical seizures that were inadequately suppressed with moderate doses of valproate (VPA) but completely suppressed with blue cross-polarized lenses. The second patient’s photoparoxysmal response was suppressed by both parallel-polarized and blue cross-polarized glasses, whereas the third patient’s photoparoxysmal response was not suppressed by either.
These preliminary data suggest that blue cross-polarized lenses may be useful in the treatment of photosensitive epilepsies and that their efficacy can be predicted in the EEG laboratory.

Maybe Hillary needs to release her EEG results.

My brief review of the medical literature shows that cerebral venous thrombosis is rare and I can find no reports of association with trauma or concussion. Something else is going on.

Why Importing Foreign Doctors may not fix the shortage.

Sunday, April 17th, 2016

MoS2 Template Master

The coming doctor shortage that I have previously written about might be dealt with as Canada did with theirs some years ago, by importing foreign medical graduates. Britain has adopted a similar plan as thousands of younger doctors plan to leave Britain.

How is the plan to import foreign doctors working out ?

Not very well.

Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.

First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.

This was the case with Mexican medical schools, like that in Guadalajara where many American students attended. A program was devised to provide them with a year of clinical training before they could be licensed.

The revelations come just a week after it emerged health bosses want to lure 400 trainee GPs here from India, to help ease short-staffing in the NHS.
Last night Julie Manning, chief executive of think-tank 2020 Health, said: ‘The NHS has thrived on many international doctors coming to work in the UK – but the public needs reassuring they are all truly fit to practise in the first place.’

Of course, the foreign doctors have their defenders.

Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin, admitted ‘there is a problem’ with the high strike-off rate among foreign doctors. But he claimed racism played a part.

We have a similar problem with affirmative action medical graduates but the figures are not available about their rates of license revocation. For example, the The Alan Bakke case went to the US Supreme Court, which eventually ruled in his favor. By the time the court ruled, years had gone by and Bakke eventually did gradate from medical school and has practiced quietly ever since.

However, a black student admitted by the program that denied Bakke a place was subsequently prosecuted for gross negligence and his license removed. Affirmative Action has been vigorously defended.

An admissions process that allows for ethnicity and other special characteristics to be used heavily in admission decisions yields powerful effects on the diversity of the student population and shows no evidence of diluting the quality of the graduates.

However, the conclusion does not match the findings in the study.

Regular admission students had higher scores on Parts I and II of the National Board of Medical Examiners examination, and special consideration students were more likely to repeat the examination to receive a passing grade.

The article goes on to explain that There was no difference in completion of residency training or evaluation of performance by residency directors.

A friend of mine was the Chairman of the Department of Surgery at a UC medical school who decided to fire a black female resident for incompetence. He was advised by the UC system and the other department heads that he would lose a lawsuit if she filed one. She did, in fact, file such a lawsuit alleging racial prejudice (of course). The department chair was able to successfully defend his decision but the fact that no one else was willing to try explains the finding that There was no difference in completion of residency training or evaluation of performance by residency directors.

I have had the experience of being a Surgery Department Chair in a community hospital confronted with the application of a known incompetent surgeon. The same factors apply to those known to be dishonest. A request for a letter of reference from the department in which the applicant trained usually results in a response that states, “The applicant completed the residency from X date to Y date.” No other information is provided and a further request is usually answered by “The matter is in litigation,” or words to that effect. This applies to all such applicants but affirmative action individuals are almost impossible to find negative information on even if the “grapevine” has provided warnings.

The general concern can be found, but details are thin on the ground.

A quick scan of the documents reveals that white students applying to medical school with a GPA in the 3.40-3.59 range and with an MCAT score in the 21-23 range (a below-average score on a test with a maximal score of 45) had an 11.5% acceptance rate (total of 1,500 applicants meeting these criteria). Meanwhile, a review of minority students (black, Latino, and Native American) with the same GPA and MCAT range had a 42.6% acceptance rate (total of 745 applicants meeting these criteria). Thus, as a minority student with a GPA and MCAT in the aforementioned ranges, you are more than 30% more likely to gain acceptance to a medical school.

There are other sources of the facts, but they don’t appear in mainstream publications. Social Justice keeps most of these concerns underground.

A friend of mine, who is Cuban born and an immigrant as a child, applied to UC, San Francisco medical school. This was in the 1970s. Affirmative Action was well underway. He waited several weeks, then months, to hear if he had been accepted. Finally, he drove to San Francisco and asked someone in the Admissions Office what had happened to his application. He was told that it was in the “Hispanic Applicant Committee.” Having no idea what criteria such a committee might be using to determine who should be admitted, he asked if his application could just be considered as a “white” applicant. This was done and he received a letter approving his admission a few days later.

The pressure is now on medical education to provide the hundreds of thousands of new doctors this society believes it needs. Productivity of the present graduates is well below that of my generation. Some of that is the disappearance of fee-for-service practice which motivates work ethic. Some of it is a result of the 60% female medical school classes.

The female doctor population is acknowledged to work less.

Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This was the reason why medical school admissions committees “discriminated” against female applicants in the 1960s when I was a medical student. They were concerned, even then, about a doctor shortage and assumed women would stop working to have children or practice part-time.

They were absolutely correct.

Canada is finding some productivity issues and even some explanation.

a fee for service model, and its inherent encouragement of increased productivity through increased volume of patients, a significant shift away from this single model is taking hold.

This, of course, will not deter the Social Justice types as more doctors with less productivity is somehow more efficient than paying doctors more to encourage higher work loads. Socialism is the aim, productivity will have to take care of itself.

In the meantime, PHYSICIANS WHO DID not attend medical schools in the United States or Canada, referred to as “international medical graduates (IMGs)”, play an integral role in the U.S. health care system. Such physicians now represent approximately 25 percent of practicing doctors nationwide.

It’s going to increase.

The Doctor Shortage, discovered once more.

Friday, April 1st, 2016

33 - Lister

I have previously written posts about a coming doctor shortage.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?

The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.


Another update on the NHS, Bernie’s favorite health plan.

Friday, February 12th, 2016


I have mentioned problems with the NHS here before.

That was about emergency care.

Last fall there was a concern about junior doctors emigrating to other countries.

Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

Two-thirds of practices are now finding it ‘difficult’ or ‘very difficult’ to find locums — freelance medics — to cover the shortfall.
As our population gets steadily older, and sicker, frontline surgeries are becoming increasingly swamped.
‘We are in dire straits if we do not act to address the GP recruitment crisis immediately,’ the Royal College of GPs warned last week.

In standard government medicine fashion, the British Health Minister imposed a new employment contract that ignored doctors complaints.

The result ?

Junior doctors are threatening a mass exodus to Australia after Jeremy Hunt forced through his controversial new contract yesterday.
There has been a huge surge in the numbers seeking certificates to practise abroad and some have already lined up jobs.
Almost 760 doctors were issued with documents by the General Medical Council in the first four weeks of this year – nearly 200 a week and almost double the usual number. Although they include some older GPs and consultants, the vast majority were disillusioned younger doctors.

Becoming a doctor is a classic middle class occupational choice. Few doctors become rich and almost none do so from actual practice. There was a phase in the 1960s when doctors suddenly became much more prosperous as Medicare was introduced, providing payment for care that had been done for no charge mostly. With time, the US government has reduced compensation and imposed rules designed to reduce costs. With the imposition of Obamacare, many older doctors who do not have heavy student loan balances and whose own children are educated, are choosing to drop all insurance, including Medicare, and practice for cash.

Obamacare has resulted in many hospitals consolidating and buying up medical practices to develop a vertically integrated system of health care delivery that resembles old industrial models. The result for physicians is a trend to salary jobs and dissatisfaction with their careers.

I met a woman geriatrician, the only fellowship trained geriatric specialist in central Iowa. She had quit Medicare. That sounds a bit suicidal if all your patients are Medicare age. What had happened was she was being harassed by Medicare because she was seeing patients too often. Many of them were frail elderly living at home. She dropped out and began charging her patients cash for services. She was making a decent living after a year and was happy with her decision. I don’t know how many realize that geriatrics, as a specialty, is a university subsidized field. There is no private geriatric practice because the doctor can’t survive on what Medicare pays. She tried and had to quit. She is doing it on her own now.

That was about Medicare. The same is happening with Obamacare and the medical conglomerates that have been assembled in anticipation of the “Industrial Model” of medical care. How is that working out in Britain ?


2015 is gone, thank God.

Friday, January 1st, 2016


I am content to see the year 2015 gone. I can remember as a college student thinking that 1960 would never come. That was a good year. I didn’t graduate from USC as planned but I did get married and I did get accepted to medical school.

Some of the story is here in my short biography. More of it is here in my “stream of consciousness.” The next installment is here as I describe Basic Training.

When I got back from Basic Training in December 1959, I had my first date with Irene Lynch. A year later to the day, we were married and a week later, I got a letter from SC Medical School telling I had been accepted to the class beginning in September 1961. So, 1960 was a pretty good year.

In 2015 I spent what I think will be my last year teaching medical students at what is now named “Keck School of Medicine of USC” and is where I attended from 1962 to 1966. I went back to teaching there in 1998 in a program called Introduction to Clinical Medicine, which seems to be disappearing into the “Family Medicine” Department which is a shame.

I now have a book of memoirs called “War Stories: 50 years in Medicine” and which is a Kindle book only so far. Much of my medical school experience is included along with stories from my years as a surgeon. It started to be “40 years a surgeon” but I decided to include the rest and changed to 50. In June 2016, it will 50 years since I graduated from Medical School and that seemed a appropriate.

I enjoyed my time with students and I am quitting only because of frustrations with the Electronic Medical Record, about which I used to be enthusiastic, and with changes in the County Hospital which used to be a wonderful teaching institution. The Electronic Medical Record, now more often called The Electronic Health Record, probably because much of it is not about medicine, is a big problem.

The EHR, as it is called, has acquired a bad reputation.


What the black college students are rioting about.

Monday, November 16th, 2015


Power line has a post today that seems to me to be right on the topic of what these students want, which is freedom from accountability. They are afraid they are overmatched against white colleagues. They can’t hack it and want a pass. It is called “Mismatch.”

The biggest change since Grutter, though, has nothing to do with Court membership. It is the mounting empirical evidence that race preferences are doing more harm than good?—even for their supposed beneficiaries. If this evidence is correct, we now have fewer African-American physicians, scientists, and engineers than we would have had using race-neutral admissions policies. We have fewer college professors and lawyers, too. Put more bluntly, affirmative action has backfired.

Why is this ? We know that the normal distribution of IQ is a standard deviation lower for blacks than whites.


This is the over all curve with the distribution around an average of 100, by definition.


The curve for blacks has a peak at IQ about 80. White peak at 100 to 104. Asians peak at around 106. What this means is that the average IQ is lower for blacks but this does not mean that all blacks are less intelligent than whites. At an IQ of 110 there is a large difference but the number of blacks who will do well in certain academic fields like Medicine is still significant. It would seem important to identify those blacks who will do well in fields requiring higher than average intelligence but the present system of affirmative action ignores this truth.


The Medical History of the American Civil War. VI

Friday, September 4th, 2015

This will be the final installment of the history. It is in parts because WordPress starts to drop text if the pst gets too long.


Amputations were the most common procedures for war wounds. Below knee amputations had about a 33% mortality. Most deaths were from infection and wound shock, which was a mystery until World War I.


Abdominal wounds were mostly fatal although there were survivors. One of the survivors was Joshua Chamberlain, who was awarded the Medal of Honor for conspicuous bravery at the Battle of Gettysburg.


Chamberlain was a survivor of an abdominal wound and, like many, was left with life-long disability. He had a bladder fistula that continuously drained urine the rest of his life.

Chamberlain offered his services to the governor of Maine who appointed him Lieutenant Colonel of the newly raised 20th Maine regiment. The scholar-turned-soldier would take advantage of his position as second-in-command and studied “every military work I can find” under the close tutelage of his commander, West Point graduate Col. Adelbert Ames.

Though present at Antietam, Chamberlain and his regiment saw their first trial by fire in one of the doomed assaults on Marye’s Heights at Fredericksburg but missed a chance to be involved at the Battle of Chancellorsville due to an outbreak of smallpox. Losses at Chancellorsville elevated Col. Ames to brigade command, leaving Chamberlain to command the regiment in the next major engagement of the war, the Battle of Gettysburg.

On July 2, 1863, Chamberlain was posted on the extreme left of the Federal line at Little Round Top—just in time to face Confederate General John B. Hood’s attack on the Union flank. Exhausted after repulsing repeated assaults, the 20th Maine, out of ammunition, executed a bayonet charge, dislodging their attackers and securing General Meade’s embattled left. Though the exact origin of the charge is still the subject of debate, Congress awarded Chamberlain the Medal of Honor for “conspicuous gallantry.”

He received a bullet wound in the battle of Petersberg that left him with a permanent disability. Even so, he had a successful career. He was wounded six times in all.

After the war, Chamberlain returned to Maine, where he served four terms as the state’s Governor. He later served as president of Bowdoin College alongside former general and Bowdoin alum, Oliver Otis Howard. Prolific and prosaic throughout his life, Chamberlain spent his twilight years writing and speaking about the war. His memoir of the Appomattox Campaign, The Passing of the Armies was published after his death in 1914.

His wound was ultimately fatal.

His old wound became infected in 1914, and on Feb. 24, at age 85, Joshua Chamberlain, the very model of a citizen soldier, died. He was the last Civil War veteran to die of wounds sustained in battle.

He wrote that Army Manual of Leadership, FM -6-22 which is still in use.


Another example of a survivor is Major Henry A. Barnum, a Major of Volunteers who ended the war as a Major General.


The Western Campaign brought forth General William T Sherman, who is in my opinion the greatest American general since Washington, who was really more of a political leader.


Sherman led his army across Georgia after the successful siege of Atlanta which assured Lincoln’s re-election in 1864.


The Siege of Atlanta, which was followed by the burning as depicted in “Gone With The Wind.”


During the siege, instances of Scurvy rose among Sherman’s soldiers and in the residents under siege, Once the siege ended and trains resumed bringing fresh fruit and vegetables, the scurvy declined.


Women played various roles in the war. One captured Confederate officer, while in a prisoner of war camp in Ohio, delivered a child in spite of the fact that she had campaigned and been captured as a male officer. Her husband was also a Confederate officer.


Elizabeth Blackwell was the first American female medical school graduate. She was instrumental in the founding of the US Sanitary Commission, which was modeled on a similar British Commission during the Crimean War. Her organization was called, “the Women’s Central Relief Association of New York,” and had Dorothea Dix as its head.


Dix was a well known health reformer who had previously worked on the treatment of mental illness. She began to recruit female nurses although most nurses during the war were male.


Clara Barton was working in DC when she saw wounded men making their own way into the city after the battle of Bull Run. She organized relief supplies. The Surgeon General, William Hammond, placed her in charge of distributing donated goods to the wounded in 1862.

In 1881, she organized the American Red Cross.


Mother Bickerdyke is a little known but hugely important member of Sherman’s army. She began as a volunteer in Illinois, joined his army and marched all the way to Savannah with the army. They insisted she accompany them in the Grand March in Washington City after the war. She organized field kitchens and bakeries to feed the troops. She organized freed slaves to build her kitchens and field hospitals. It was she who discovered that black berries, growing wild in the South, would prevent scurvy.

After the war ended, Bickerdyke was employed in several domains. She worked at the Home for the Friendless in Chicago, Illinois in 1866. With the aid of Colonel Charles Hammond who was president of the Chicago, Burlington, and Quincy Railroad, she helped fifty veterans’ families move to Salina, Kansas as homesteaders. She ran a hotel there with the aid of General Sherman. Originally known as the Salina Dining Hall, it came to be called the Bickerdyke House. Later, she became an attorney, helping Union veterans with legal issues including obtaining pensions.

Congress had made no provision for pensions or the care of wounded veterans. Mary Ann Bickerdyke worked with Sherman to employ veterans on the railroad that was crossing the plains and to provide care of those wounded and the families of the dead. She and Sherman establish what would eventually became the Veterans Administration. Sherman’s friend and associate General Grenville Dodge was the Chief Engineer for the Union Pacific Railroad.


In May 1866, he resigned from the military and, with the endorsement of Generals Grant and Sherman, became the Union Pacific’s chief engineer and thus a leading figure in the construction of the Transcontinental Railroad.[3]

Dodge’s job was to plan the route and devise solutions to any obstacles encountered. Dodge had been hired by Herbert M. “Hub” Hoxie, a former Lincoln appointee and winner of the contract to build the first 250 miles of the Union Pacific Railroad. Hoxie assigned the contract to investor Thomas C. Durant who was later prosecuted for attempts to manipulate the route to suit his land-holdings.[3] This brought him into vicious conflict with Dodge and Hoxie. Eventually Durant imposed a consulting engineer named Silas Seymour to spy and interfere with Dodge’s decisions.

Seeing that Durant was making a fortune, Dodge bought shares in Durant’s company, Crédit Mobilier, which was the main contractor on the project. He made a substantial profit, but when the scandal of Durant’s dealings emerged, Dodge removed himself to Texas to avoid testifying in the inquiry.

The Medical History of the American Civil War V

Friday, September 4th, 2015

This series is a slightly annotated version of a lecture I have given in several places. One of them was at the Royal Army Medical Corps Museum in the Salisbury Plain.


Two major diseases at the time of the war were Smallpox and Malaria. Both affected large bodies of men in close quarters. Both were infectious but not water borne. Vaccination had been discovered by Edward Jenner in 1796.

In the years following 1770, at least five investigators in England and Germany (Sevel, Jensen, Jesty 1774, Rendell, Plett 1791) successfully tested a cowpox vaccine in humans against smallpox.[20] For example, Dorset farmer Benjamin Jesty[21] successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Jenner’s work some 20 years later that the procedure became widely understood. Indeed, Jenner may have been aware of Jesty’s procedures and success.

By the early years of the Napoleonic Wars, Larrey had vaccinated the French Grand Army. By 1870, the French army had forgotten Larry’s work and they were decimated by smallpox while the Prussian army had been vaccinated by Billroth.

Malaria could be treated with Quinine, an extract of Cinchona bark.

Quinine occurs naturally in the bark of the cinchona tree, though it has also been synthesized in the laboratory. The medicinal properties of the cinchona tree were originally discovered by the Quechua, who are indigenous to Peru and Bolivia; later, the Jesuits were the first to bring cinchona to Europe.

The Union Army used 19 tons of cinchona bark to treat malaria in the troops. The Confederates were blockaded and had little to use. The Germans were blockaded in World War I and used their new organic chemistry industry to find alternatives, chiefly from organic dyes, like Methylene Blue.


There obviously was some understanding of the role of mosquitoes in transmission of malaria as we see with the use of mosquito nets in hospitals.


Other infectious disease were scourges although nothing was known about the cause. Tonsillitis was seasonal and diphtheria was treated with tracheostomy although I don’t know how many were done. The story of diphtheria is the story of the great triumph of bacteriology in the late 19th century. In the Civil War the only treatment was tracheostomy.

Wounds were always assumed to be infected and treated accordingly.


The treatment of extremity wounds was almost always amputation as there was no understanding of infection.

Here is an amputation tent with a pile of amputated limbs nearby. Baron Larrey, Napoleon;s surgeon personally amputated 200 limbs in 24 hours at the battle of Borodino. That was one amputation every seven minutes and was prior to the discovery of anesthesia.

There was little treatment available for wounds of the head or the body.


The wounds from a small battle are listed in The History. Head wounds were mostly fatal although a few survived.


Early wound care was mostly in the open as the dressing stations were overwhelmed easily.


Saber wounds, inflicted by mounted cavalry were survivable if the skull was not penetrated and they did not become infected.


The Battle of Chancellorsville was a success for Lee but a great loss resulted as Jackson was lost.


Many believe that all chance of success in the war died with Jackson.


Jackson was shot by his own men as he reconnoitered the battlefield. His left arm was amputated but he did not survive. His wife was with him when he died.


Gunshot wounds of the extremities were most of the survivors. The mortality rate of amputation was 27%. In the Franco-Prussion War, the incompetent French military surgeons had a 50% mortality rate even though antisepsis had been described three years before by Joseph Lister. Lister was treating tuberculosis of the joints, which was a common condition at the time. He found that infection was prevented by carbolic acid.

In August 1865, Lister applied a piece of lint dipped in carbolic acid solution onto the wound of a seven-year-old boy at Glasgow Infirmary, who had sustained a compound fracture after a cart wheel had passed over his leg. After four days, he renewed the pad and discovered that no infection had developed, and after a total of six weeks he was amazed to discover that the boy’s bones had fused back together, without the danger of suppuration. He subsequently published his results in The Lancet[8][9] in a series of 6 articles, running from March through July 1867.

He instructed surgeons under his responsibility to wear clean gloves and wash their hands before and after operations with 5% carbolic acid solutions. Instruments were also washed in the same solution and assistants sprayed the solution in the operating theatre. One of his additional suggestions was to stop using porous natural materials in manufacturing the handles of medical instruments.

The Germans adopted “Listerism” and the French did not. His reports were after the American Civil War although Semmelweis had tried to introduce hand washing in 1846.


Vascular injuries were untreatable and would remain so until Vietnam, when new techniques resulted in salvage of most arterial injuries.

To be continued.

The Medical History of the American Civil War IV

Friday, September 4th, 2015

More of the series on my lecture on the Civil War.


The Ambulance Corps were organized and the photo shows one group during the war.


The next Army Surgeon General was Letterman who changed Tripler’s organization and built larger hospitals and worked on sanitation projects that had been ignored by the early medical services. Disease was a greater risk to soldiers than wounds and had been since Classical Greece. When large numbers often were accumulated without proper sanitation, disease was rampant. Florence Nightingale was one of the first to realize the importance of cleanliness.


One of the greatest medical pioneers of the Civil War was John Shaw Billings who designed hospitals, including The Johns Hopkins Medical Center. He was never Surgeon General but he did organize what became the Public Health Service.


One of Letterman’s new hospitals was this one which was constructed in time for the battle of Gettysburg.


One of the brilliant surgeons who joined up and contributed was this man, John H. Brinton. Typically, he was dismissed by the politicians around Lincoln because McClellan had appointed him.


The most common medical problem was chronic diarrhea.

27,558 Union soldiers died of chronic diarrhea. Without bacteriology, still unknown in 1865, it is impossible to trace the causes.

Typhoid fever killed another 27,056 soldiers.

In the Boer War, in 1899 to 1902, typhoid fever killed thousands of British troops.

of the British Force of 556 653 men who served in the Anglo-Boer War, 57 684 contracted typhoid, 8 225 of whom died, while 7 582 were killed in action.(11) As had been the experience in America, the disease was found to be one which occurred in static camps.

This occurred years after infectious diseases had been identified and the cause of illnesses had been described.

The First Word War was the first war in which more men died of wounds than of disease.


This slide, from the “Medical and Surgical History of the War of the Rebellion, shows the seasonal nature of the disease. The nutritional aspects are seen in the incidence during the siege of Atlanta.


One example of another page of the History. There were over a million cases of acute diarrhea during the war. “Colored Troops” only appeared after 1863.


Diseases were classified according to the medical knowledge of the time. “Miasma” were those which we now know to be infectious. Malaria, for example, mean “Bad Air” in Latin.


Tuberculosis was a severe chronic disease which would not be curable until Streptomycin came along in 1946. There were two forms, “consumption” which was the pulmonary form, was not known to be contagious. “Scrofula” is the cervical lymph node form and is associated with milk from infected cows. This was the form studied by Louis Pasteur who recognized that it was transmissible and that heating milk prevented it.


Treatment of disease was as primitive as one might expect although quinine was known and used by the Union Army. The blockade of the South prevented its use there. Vaccination was widely practiced and opium was used for pain. There was anesthesia since 1846 and chloroform was more common than ether.


Malaria was widespread in the US at the time. Mosquitoes were vaguely known to be associated. Mosquito nets were used although the mechanism was not well understood.