Archive for the ‘medical history’ Category

Medicine and Obama’s Third Term.

Friday, June 4th, 2021

Obamacare changed American Medicine forever. I am becoming convinced that was a major purpose. Since 1978, Medicine and doctors have become the most regulated sector of the American economy.

Five years ago, I predicted one consequence. A doctor shortage. Why ?

A few years ago, it was reported that 10,000 doctors were leaving UK every year. How has the NHS dealt with this shortage?

By importing third world doctors.

The UK’s National Health Service (NHS) will soon begin a major campaign to recruit health workers from other countries to meet growing staff shortages.

Reports suggest a strategy has been drawn up to target a number of countries around the world, including poorer nations outside Europe.

One estimate in March this year said the NHS will need 5,000 extra nurses every year – three times the figure it currently recruits annually.

But what about the countries that it will recruit from – what impact will it have on them?

Where do non-UK staff come from?
The NHS already recruits globally to meet its staffing needs.

More than 12% of the workforce reported their nationality as not British, according to a report published last year.

How are we dealing with our doctor shortage ? By adding “Practitioners” instead of doctors.

How did this begin? In 1978, a new federal program was created called “Professional Standards Review Organizations.”

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More Biology

Friday, November 30th, 2018

I have posted a few times on Biology and should really do more. Here is one.

In a previous post, I stated that mitochondria are not present in sperm.

The “African Eve” theory is derived from the fact that all mitochondria are inherited from the mother. There are no mitochondria in the sperm.

That was a mistake as, someone pointed out, sperm have motile flagellae and that requires Mitochondria. However, my second comment was also, perhaps, incorrect.

An astute reader pointed out that my statement above is incorrect. Actually, it is a sign of how old I am as this was the previous understanding. However, sperm do have mitochondria but they are tagged for destruction and do not survive in the egg. Why this is, is not explained although the paternal mitochondria may be harmful in some fashion.

Now, I might still have been wrong.

But new research suggests that in some cases, mitochondrial DNA can be inherited from fathers, too. A group of researchers found three unrelated families where individuals had mitochondrial DNA from both parents. A total of 17 people across these three families were affected, suggesting that mitochondria aren’t as exclusively maternal as scientists believed.

In nearly all mammals, this mitochondrial genome is inherited exclusively from the mother, and transmission of paternal mitochondria or mitochondrial DNA (mtDNA) has not been convincingly demonstrated in humans. In this paper, we have uncovered multiple instances of biparental inheritance of mtDNA spanning three unrelated multiple generation families, a result confirmed by independent sequencing across multiple unrelated laboratories with different methodologies. Surprisingly, this pattern of inheritance appears to be determined in an autosomal dominantlike manner. This paper profoundly alters a widespread belief about mitochondrial inheritance and potentially opens a novel field in mitochondrial medicine.

There are lots of new developments in biology, such as studies of dental specimens in archeology.

An example is the use of plants in the diet of Neanderthals.

The most popular idea is that the disappearance of the Neanderthals was caused by the greater competition of the ancestors of modern humans, Homo Sapiens, who appeared more or less at the same time as the Neanderthals disappeared from Europe, and one of the explanations as to how that happened could be their diet. The Neanderthals are thought to have had more limited diets, while our ancestors had more flexible, adaptive diets that included seafood and a variety of plants.

Yet even though archaeological science has advanced considerably over the last few decades and has come up with new theories about the diets of the Neanderthals, today we still only have a patchy image of their dietary ecology given that we lack full, environmentally representative information about how they used plants and other foods.

This new piece of research into the fragments of dental calculus or tartar shows that the use of plants was a widespread, deeply-rooted subsistence strategy of the Neanderthals.

More detail is coming as dental tartar is beginning to be analyzed.

Archaeological tooth tartar has previously been shown to preserve milk proteins, but the international study, led by researchers at the University of York and the Max Planck Institute for the Science of Human History, has proved for the first time that it can also reveal more precise information about a wider range of food proteins, including those from plants.

And

Analysing 100 archaeological samples from across Britain, as well as 14 samples from living dental patients and recently deceased individuals, the research team found that potential dietary proteins could be found in about one third of the analysed samples.

Dr Speller added: “In the teeth we look at from individuals who lived around the Victorian era we identified proteins related to plant foods, including oats, peas and vegetables in the cabbage family. Occasionally, we find evidence of milk and oats in the same mouth — I like to think it’s from eating porridge!”

We know quite a bit about the diet of “Otzi,” the Iceman found in the glacier in 1991. His remains are a unique treasure for anthropology.

More recent analysis of Ötzi’s stomach and intestines has resolved this contradiction: the contents of his intestines have revealed fragments of bones from an ibex, alongside various remains of plant origin. A detailed genetic analysis of his intestinal contents also showed that he had consumed venison. The latest study conducted on his stomach contents revealed that his last meal consisted largely of ibex and venison with a high percentage of fat. Studies have also shown that the Iceman – and, indeed, the entire population of present-day South Tyrol – had a very balanced diet. Early types of grain – such as einkorn and emmer – were probably consumed in the form of porridge or bread. The diet also included a large number of other plant products, including various vegetables, fruits and wild berries, as well as dried wild fruits.

We knew this by 1998 when I wrote my medical history book. Here is a 1998 article on his diet, which was known at the time./


But at the top of the colon, Zur Nedden made out a slight bulge, which the radiologist suspected was a clump of half-processed food. The progress of the food indicated that the Iceman had last eaten about eight hours before he died, possibly of hypothermia, on the Hauslabjoch pass, which cuts over the main Alpine ridge dividing Austria from Italy at 10,500 feet above sea level.

Not until several years after the discovery did the Innsbruck scientists finally cut a hole into the mummy, insert an endoscope, and snip out about .004 ounces from the colon. Dr. Werner Platzer, the University of Innsbruck anatomist then in charge of research on the corpse, gave .0016 ounces milligrams of the material to Oeggl, who had already been studying the rich botanical finds from the site.

Pollen provided a snapshot of the environment the Iceman was exposed to in the hours before his death
Oeggl’s sample was barely the size of his little fingernail. Under the microscope, he quickly identified the flake-like, semi-digested material that made up the bulk of the sample as einkorn, the most important wheat of the Neolithic, the period of prehistory in which people lived in semi-permanent settlements and survived by agriculture and keeping animals. The discovery of einkorn, which does not occur naturally in Europe, in the Iceman’s intestinal tract suggested that he had contact with an agricultural community. The dominance of bran in the sample led Oeggl to believe that the wheat had been finely ground into meal and made into bread, rather than eaten as a porridge, where the grains would have been eaten whole and found in larger pieces in the colon. But the bread would have been little like modern breads. In order to get bread to rise when yeast is added, the wheat grains must contain a high level of gluten, which lends the dough a durable elasticity and therefore holds the pockets of air. Einkorn has low levels of gluten, so the bread made with it was probably hard, somewhat like a cracker, and rather tough on the teeth.

That is interesting.

There are even suggestions of medical therapy in dental calculus from Neanderthals.

The international team analysed and compared dental plaque samples from four Neandertals found at the cave sites of Spy in Belgium and El Sidrón in Spain. These four samples range from 42,000 to around 50,000 years old and are the oldest dental plaque ever to be genetically analysed.

“We found that the Neandertals from Spy Cave consumed woolly rhinoceros and European wild sheep, supplemented with wild mushrooms,” says Professor Alan Cooper, Director of ACAD. “Those from El Sidrón Cave on the other hand showed no evidence for meat consumption, but appeared instead to have a largely vegetarian diet, comprising pine nuts, moss, mushrooms and tree bark — showing quite different lifestyles between the two groups.”

“One of the most surprising finds, however, was in a Neandertal from El Sidrón, who suffered from a dental abscess visible on the jawbone. The plaque showed that he also had an intestinal parasite that causes acute diarrhoea, so clearly he was quite sick. He was eating poplar, which contains the pain killer salicylic acid (the active ingredient of aspirin), and we could also detect a natural antibiotic mould (Penicillium) not seen in the other specimens.”

“Apparently, Neandertals possessed a good knowledge of medicinal plants and their various anti-inflammatory and pain-relieving properties, and seem to be self-medicating. The use of antibiotics would be very surprising, as this is more than 40,000 years before we developed penicillin. Certainly our findings contrast markedly with the rather simplistic view of our ancient relatives in popular imagination.”

The “Iceman” also had some evidence of medical treatment, although probably ineffective.

Who we are and how we got here.

Thursday, April 5th, 2018

I’m reading the new book, “Who we are and how we got here.”

It is about ancient DNA which is now being identified and studied. I have been interested in this topic since reading “The 10,000 year explosion,
which is about evolution and DNA but it is ten years old. One of the authors, Greg Cochran, has a blog, and has been reading and commenting on the Reich book.

The Denisovans were closer to the Neanderthals than they were to AMH, but not by much. Apparently modern humans split with the common ancestors of Denisovans and Neanderthals about 700,000 years ago, while Neanderthals and Denisovans separated not much later. Almost a trichotomy. Something similar happened when AMH spread into Eurasia: quite early, maybe 50,000 years ago, we split into eastern and western branches. Probably it’s all geography.

AMH is Anatomically Modern Humans.

Another interesting sidelight to this story of how ancient populations moved and replaced forbearers, is the role of Yersinia pestis, the plague organism.

Three pandemics have been attributed to plague in the last 1,500 years. Yersinia pestis caused the third, and its DNA was found in human remains from the second. The Antiqua biovar of Y. pestis may have caused the first pandemic; the other two biovars, Medievalis and Orientalis, may have caused the second and third pandemics, respectively. To test this hypothesis, we designed an original genotyping system based on intergenic spacer sequencing called multiple spacer typing (MST). We found that MST differentiated every biovar in a collection of 36 Y. pestis isolates representative of the three biovars. When MST was applied to dental pulp collected from remains of eight persons who likely died in the first and second pandemics, this system identified original sequences that matched those of Y. pestis Orientalis. These data indicate that Y. pestis caused cases of Justinian plague. The two historical plague pandemics were likely caused by Orientalis-like strains.

Now, the DNA of Y pestis has been found in remains of ancient skeletons, that suggests it might have been responsible for the replacement of ancient farmer by the nomadic Yamnaya people.

Late last fall, I reported that scientists had discovered a European ghost population. This group of people then referred to as the ANE, Ancient Northern Europeans, was a previously unknown population from the north that had mixed into the known European populations, the Hunter-Gatherers and the farmers from the Middle East, the Neolithic.

That discovery came as a result of the full genome sequencing of a few ancient specimens, including one from the Altai.

Recently, several papers have been published as a result of ongoing sequencing efforts of another 200 or so ancient specimens. As a result, scientists now believe that this ghost population has been identified as the Yamnaya and that they began a mass migration in different directions, including Europe, about 5,000 years ago. Along with their light skin and brown eyes, they brought along with them their gene(s) for lactose tolerance. So, if you have European heritage and are lactose tolerant, then maybe you can thank your Yamnaya ancestors.

They also had domesticated the horse and used wheeled carts, both huge innovations.

yamnaya

They may have been the ancient Scythians referred to by the Greeks. The preceding population of Europe may have been more easily replaced because they had been victims of Y pestis plague, making an even more ancient example of the power of this organism to change history.

Deep prehistory was always complicated: we just didn’t know much about it before. Ancient DNA analysis is the path forward.

I will add more as I finish the book.

Genetics and Archeology

Monday, May 9th, 2016

Neanderthal

I recently read a book titled, The 10,000 Year Explosion.

Its premise is that evolution did not stop or “pause” with the development of modern man 40,000 years ago.

A few basic facts about genetics. Genes are sets of nucleotides that encode proteins by encoding RNA. This is all in my book, A Brief History of Disease, Science and Medicine. One key fact is that:

Genes can acquire mutations in their sequence, leading to different variants, known as alleles, in the population. These alleles encode slightly different versions of a protein, which cause different phenotype traits.

I discussed this at some length two years ago and then, because it stirred a hornets nest at Ricochet, I posted some of the nasty replies here.

Mutations occur at random or under the influence of outside influence like UV radiation. Some are harmful, like cancer, and are not continued in the “gene pool.” Some are beneficial and may persist as they provide an advantage to the individual who may live longer, have more children and have more of the children survive to reproduce.

Humans evolved in Africa and spread outside of Africa before 50,000 years ago. There have been successive waves of modern humans that were better adapted to life, especially in areas that were new and often inhospitable like Ice Age Europe. One such group was called the “Neanderthal, as they were found in the Valley of the Neander River in Germany.

Neanderthals came to Europe some 300,000 years ago. They hunted big game with stone tools. Their territory spanned Europe and Asia. They left distinctive “Mousterian” artefacts.

There were other groups and we are starting to find out who and what they were from their DNA.

We know that modern humans first arrived in Europe about 45,000 years ago when the continent was still a Neanderthal stronghold. Over the next 30,000 years – archaeological work has revealed – a procession of different cultures, each associated with different artefacts and lifestyles, rose in Europe.

Archaeologists tend to think these sort of cultural shifts reflect the spread of new ideas through an unchanging population. But a new analysis of nuclear DNA taken from 51 ancient Eurasians tells a different story. They actually reflected the spread of different peoples.

The Neanderthals were gone earlier than recently believed.

“Until recently, I and many with me had thought that Neanderthals survived until 30,000 years ago, or perhaps even slightly later,” says Svante Pääbo of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany. “The new dates make it clear that they disappeared 10,000 years earlier.”

What happened ?

For Pat Shipman of Penn State University, this supports her theory that modern humans acted like an invasive species in Europe, beating the Neanderthals in a competition for resources. That’s a “distinct possibility”, Higham says.

But that does not mean we murdered our cousins. There is no evidence humans ever killed Neanderthals, and they probably didn’t meet often, says Higham.

So what role did we play? Many now suspect we were the last straw for an already fragile species. Genetics suggests Neanderthal numbers dropped sharply around 50,000 years ago. This coincides with a sudden cold snap, hinting climate struck the first blow.

The Ice Ages were a huge stress.

Over the next 30,000 years – archaeological work has revealed – a procession of different cultures, each associated with different artefacts and lifestyles, rose in Europe.

Archaeologists tend to think these sort of cultural shifts reflect the spread of new ideas through an unchanging population. But a new analysis of nuclear DNA taken from 51 ancient Eurasians tells a different story. They actually reflected the spread of different peoples.

Some of this change involved breeding with Neanderthals, and many of us (including me) have some Neanderthal DNA. Why ? The Neanderthals might have been better adapted to Ice Ages which waxed and waned.

During this period, there were several changes between glacier advance and retreat. The Last Glacial Maximum, the maximum extent of glaciation within the last glacial period, was approximately 22,000 years ago. While the general pattern of global cooling and glacier advance was similar, local differences in the development of glacier advance and retreat make it difficult to compare the details from continent to continent (see picture of ice core data below for differences).

From the point of view of human archaeology, it falls in the Paleolithic and Mesolithic periods. When the glaciation event started, Homo sapiens were confined to Africa and used tools comparable to those used by Neanderthals in Europe and the Levant and by Homo erectus in Asia. Near the end of the event, Homo sapiens spread into Europe, Asia, and Australia.

Maybe Neanderthals were better adapted to glacial epochs.

The Aurignacian culture was dominant between about 45,000 and 35,000 years ago. This culture produced fine bone and stone tools, and some of Europe’s oldest and most beautiful art – for instance at Chauvet cave in southern France.

By about 33,000 years ago a new culture that began in south-east Europe was beginning to spread across the continent: the Gravettian. This is famous for big-game hunting of mammoths and bison.

And later, at the height of the Ice Age about 19,000 years ago, yet another culture swept across west and central Europe. This Magdalenian culture is famous for its reindeer hunts and for its artwork, carved into bones and antlers.

One of the oldest individuals examined by David Reich at Harvard Medical School in Boston and his colleagues is represented by a thigh bone found at a site called Goyet cave in Belgium. Radiocarbon dating shows it is 35,000 years old, meaning the Goyet individual is associated with the Aurignacian industry.

Now, it appears that these people were quite different genetically.

the Aurignacians were pushed aside by an expanding wave of Gravettians.

“It is exciting and striking how a relatively homogeneous population sweeps across large parts of Europe between 33,000 and 26,000 years ago, displacing the populations that were there before,” says Reich.

But that’s not the full story. The genetic analysis also looked at six Magdalenians: they are descendants of the displaced Aurignacians.

This is a real surprise, says team member Cosimo Posth at the Max Planck Institute for the Science of Human History in Jena, Germany. It shows that the Aurignacian lineage didn’t disappear when the Gravettians swept across Europe.

“In fact from the end of the Last Glacial Maximum some 19,000 years ago, its genetic component reappeared in Spain. From then to around 14,000 years ago this nuclear signal spread in Europe again,” he says.

They may have been pushed into a cul de sac in Spain but returned as the glaciers retreated. Why ?

We know a few things, such as why white skin evolved. As humans moved from Africa to Europe and faced cold climates, they needed Vitamin D which is synthesized in the skin.

Dark skin is useful and provides and evolutionary advantage in tropical settings. It also has some protective effect on sun burning and skin cancer. One negative consequence of inadequate Vitamin D is Ricketts, a disease of bones.

Rickets is defective mineralization or calcification of bones before epiphyseal closure in immature mammals due to deficiency or impaired metabolism of vitamin D,[1] phosphorus or calcium,[2] potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries.

This provides a strong feedback for selecting beneficial mutations.

Some of this will lead to modern therapy and that is why I wrote that I would not recommend a student for medical school who did not believe in evolution. Here is some of the negative response I got. I quit Ricochet when my subscription expired.

The Muslim war on immunization.

Saturday, January 16th, 2016

If anyone wonders about the level of civilization in Muslim countries and especially those in “radical” or “takfiri” subsets, the war on polio immunization should be a clue.

Recently, a suicide bomber attacked a polio immunization center in Pakistan.

The World Health Organization’s anti-polio vaccination program inside Pakistan has been a prime target of the Taliban. Mullah Fazlullah, the emir of the Movement of the Taliban in Pakistan, was one of the first leaders to have opposed polio vaccinations. On his radio program, Falzullah, who is also known as Mullah Radio, denounced polio vaccinations as Western attempts to sterilize Muslim boys.

Other Taliban commanders, including Mullah Bahadar and Mullah Nazir, who was killed in a US drone strike, as well as Pakistani clerics and leaders in the tribal areas, suspended polio vaccinations in areas under their control until the US ceased drone strikes against Taliban, al Qaeda, and other jihadist commanders.

Taliban commanders have also accused vaccination programs as serving as cover for CIA and western operations to target jihadist leaders inside Pakistan.

The largely Muslim state of Uttar Pradesh in India has been the last outpost of remaining polio cases in the world.

India was declared free of the wild polio virus in January 2011 however cases of flaccid paralysis continue to be reported in thousands from across the country. “In spite of the WHO declaring India polio-free, there has been an increase in the cases of non-polio paralysis. It is a huge cause of concern,” said Dr SD Gupta, president, IIHMR University.
In 2004, 12,000 cases of non-polio paralysis were reported which increased to 53,563 cases by 2012. According to the data published by the union health ministry in July, 2015, the total number of non-polio acute flaccid paralysis (NPAFP) cases across the country were 18,141, of which 5918 were reported from UP, 668 from Rajasthan, 102 from Telangana, 385 from Karnataka and 865 from Maharashtra, among others.

What is going on ? It seems that new enteroviruses may be involved. India has been largely successful in eliminating wild Polio virus.

India’s success in eliminating wild polioviruses (WPVs) has been acclaimed globally. Since the last case on January 13, 2011 success has been sustained for two years. By early 2014 India could be certified free of WPV transmission, if no indigenous transmission occurs, the chances of which is considered zero.

Great efforts were made.

The VE against types 1 and 3 was the lowest in Uttar Pradesh and Bihar, where the force of transmission of WPVs was maximum on account of the highest infant-population density. Transmission was finally interrupted with sustained and extraordinary efforts. During the years since 2004 annual pulse polio vaccination campaigns were conducted 10 times each year,

Muslims are determined to stop this effort. More evidence that they are not ready for civilization.

2015 is gone, thank God.

Friday, January 1st, 2016

2015-a-maes-Marty_thumb

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.

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The Medical History of the American Civil War III

Friday, September 4th, 2015

This continues the series from a lecture I have given a few times.

Slide23

William W Keen was a student when he first served as an Army surgeon at Bull Run. That experience changed the Army medical services and gave a great deal of power to the volunteer organizations.

Slide24

William Hammond quickly replaced the incompetent surgeons who had been in place when the war began. He was competent but argumentative and clashed with Stanton who became Secretary of War.

Hammond met Jonathan Letterman. Hammond worked with Letterman and Rosecrans on the design of a new ambulance wagon.

The atmosphere in the upper levels of medical services was then one of internal strife and personal conflicts. Hammond—a tall and imposing young man[12]—was no man of intrigue, nor even, according to all accounts, a very flexible person. However, the situation offered him the possibility for advancement. When Finley, the 10th Surgeon General, was fired after an argument with Secretary of War Edwin M. Stanton, Abraham Lincoln, against Stanton’s advice and the normal rules of promotion, named the 34-year-old Hammond to succeed him with the rank of brigadier general. Hammond became Surgeon General of the Army on 25 April 1862, less than a year after rejoining the army.

Lincoln liked “Men who fight” and defended his choices but Hammond was just too hard headed.

On his initiative, Letterman’s ambulance system was thoroughly tested before being extended to the whole Union. Mortality decreased significantly. Efficiency increased, as Hammond promoted people on the basis of competence, not rank or connections, and his initiatives were positive and timely.

On 4 May 1863 Hammond banned the mercury compound calomel from army supplies, as he believed it to be neither safe nor effective (he was later proved correct). He thought it dangerous to make an already debilitated patient vomit. A “Calomel Rebellion” ensued, as many of his colleagues had no alternative treatments and resented the move as an infringement on their liberty of practice. Hammond’s arrogant nature did not help him solve the problem, and his relations with Secretary of War Stanton became strained. On 3 September 1863 he was sent on a protracted “inspection tour” to the South, which effectively removed him from office. Joseph Barnes, a friend of Stanton’s and his personal physician, became acting Surgeon General

Stanton later died of an asthma attack so his “personal physician” was important to him. Calomel was “The Blue Pill” that had been advocated by Benjamin Rush. It was an ancient remedy based on the success of mercury in the treatment of syphilis dating back to Paracelsus in the 14th century. Medicine until the 20th century was quite primitive and many remedies were tried for wildly inappropriate indications.

van gogh

For example, a Van Gogh painting of his doctor shows evidence of digitalis intoxication which might have caused his death. Yellow vision is one indication of overdose of digitalis (sudden death is another) and a Van Gogh painting, Portrait of Dr. Gachet shows the characteristic yellow tint plus an example of the plant held by the doctor.

Anyway, Hammond was replaced after some of his innovations including evacuating the wounded from the Peninsula Campaign of McClellan. They were taken by ship back to large hospitals near DC.

Slide25

Slide26

Treatment of the wounded early in the war was primitive and would soon improve under Hammond’s reforms.

Slide27

The volunteer organizations began to make their influence felt and the Army was unable to resist the reforms.

Slide28

Tripler, for whom the great Army hospital in Hawaii is named, was chosen by McClellan to be the chief surgeon for the Army of the Potomac. His great innovation was the “Ambulance Corps.”

Slide29

The “Ambulance Corps” restored the invention of Baron Larrey and began the reforms of the Union

To be continued

The Medical History of the American Civil War II

Friday, September 4th, 2015

This continues the story of medicine in the Civil War. Samuel Gross, a Professor of Surgery at Pennsylvania Hospital in 1860, realized that no textbook of military medicine and surgery existed so he wrote his own in 60 days. It is shown in this exhibit at the Warren Collection at Harvard’s medical library.

manaual of mil surg

The Confederate Army also had no manual so the Gross manual was used by both sides in the war. It was quickly copied for Confederate Military surgeons. A copy of the manual, which was identical to the Union Army manual is preserved at Jefferson Medical College in digital form.

Slide16

The first battle, famously, was at Fort Sumpter where the commanding office during the battle was actually the medical officer, Samuel Crawford.

Slide17

The woeful state of the army medical department was recognized immediately and a volunteer organization quickly organized. The first was the US Sanitary Commission. It was rebuffed by the Army but quickly became very powerful. This was a people’s war and the Army was incompetent, as everyone knew.

Slide18

Here is the cover of Gross’s book. It was used throughout the war, which had enormous influence on American and world Medicine. The book from which this lecture is taken was used by Theodore von Billroth to design the Prussian Army medical corps for the Franco-Prussian War in 1870. The French had forgotten Baron Larrey’s lessons and suffered terribly.

Slide19

The cover of the Confederate version of Gross’s textbook.

Slide20

Joseph Woodward was an academic surgeon, such as it was known at the time.

“Woodward was the first scientist to establish photomicrography as a tool for both scientific and medical investigations.” According to an article in the Archives of Pathology and Laboratory Medicine:[2] “In addition to collecting specimens for the museum’s archive, he co-authored the definitive medical history of the Civil War in the 6-volume 1870 publication of the MSHWR.4 Woodward’s technique using aniline dyes for staining thin sections of tissue, along with his pioneering work in photomicroscopy, helped prepare the groundwork for modern surgical pathology.”

The “History” is “The Medical and Surgery History of the War of the Rebellion” of which there are six existing full copies. I found one copy in the USC Medical Library and asked the library staff, who had no idea of its value, to place it in a locked collection room. It would be like finding a copy of “De Revolutionibus” on the shelves of an open university library.

Slide21

The design of Union Army Hospitals was entrusted to Frederick Olmsted, who had designed New York City’s Central Park. He was, after the war, very involved in establishing The National Park Service.

Slide22

The first battle of the war illustrated the appalling condition of the medical services of both sides. There were no ambulances and the wounded and to walk back to Washington City, as DC was known then.

A famous American surgeon, who would write one of the world’s great medical textbooks, William W Keen acted as a young army surgeon at the battle.

He studied at Brown University, where he graduated in 1859. He graduated in medicine from Jefferson Medical College in 1862. During the American Civil War, he worked for the U.S. Army as a surgeon. After the war, he spent two years studying in Paris and Berlin.

His “An American Textbook of Surgery” was a hugely influential text and the 1905 edition had a chapter on brain surgery by Harvey Cushing and a chapter on “Appendicitis,” the first use of the term in medical literature, written by John B Murphy, who was the first advocate of early appendectomy for appendicitis.

To be continued.

The Medical History of the American Civil War.

Wednesday, September 2nd, 2015

Slide01

This is a lecture I have given a few times and am converting to a long blog post. The American Civil War was the first major war since a number of major advances of medicine had occurred. Sanitation had been studied by John Snow and Florence Nightingale. Anesthesia had been discovered by two Americans, Morton and

Unfortunately, antisepsis would not be described until, 1867, after the war. Infection than was the great scourge of the wounded.

Slide02

The state of medical art before the war was limited.

Slide03

Baron Larrey was the greatest army surgeon of the Napoleonic Wars. He invented the ambulance and pioneered some sanitary advances but the cause of infection was still obscure.

Slide04

Benjamin Rush was a famous American physician but little of what he knew or advocated was of use.

Slide05

The discovery of Ether anesthesia was momentous but it did add the factor that more operations would be attempted before infection was understood.

Slide06

Semmelweiss was tragic figure who realized that infection was transmissible from physicians’ hands to patients but he was unable to convince his colleagues. His discovery of the uses of hand washing were ignored.

Slide07

Florence Nightingale discovered the use of hand washing in caring for the wounded but she did not know why it worked. She is a great hero of the British Army and her apartment in Scutari Barracks in Istanbul is preserved in a shrine.

Slide08

The Scutari Barracks from across the Bosphorus.

Slide09

I visited the museum about ten years ago and visited her quarters which the Turkish Army preserves.

Slide13

The history of Military Medicine really begins with Ambrose Pare’ who served several French Kings and who invented the hemostat.

200px-Ambroise_Paré

His methods were a huge improvement on the Greeks but not much else can be said for their efficacy.

Slide14

The American Army in 1860 was tiny and the medical establishment was a joke.

Slide15

The war resulted in many of the army surgeons resigning to join the Confederacy. The lack of military medical texts resulted in Samuel D Gross, professor of surgery at Jefferson Medical College, writing his own textbook.

To be continued.

The fate of babies in medieval Italy.

Saturday, July 4th, 2015

Sienna babies ladder

This painting is on the wall of a medieval hospital in Sienna, Italy which depicts babies climbing a ladder to heaven. This probably represents the fate of many babies in those times. A figure, probably the Blessed Virgin, is seen helping them once they reach to top.

This photo was taken on a trip to Italy with a medical history group in 2003.