Letter of the Day: May 22

Curatorial Records: Numbered Correspondence 06713

Surgeon General's Office,
U.S. Army Medical Museum and Library
Corner of 7th and B Streets S.W.

Washington, May 22, 1903.

Major W.C. Borden
Surgeon U.S. Army
Washington Barracks, D.C.

Sir:

I have the honor to submit the following report of the results of an examination of a portion of a tumor of the rectum handed me several days ago by 1st Lieut. J.C. Gregory, Asst. Surgeon, U.S. Army.

The essential lesion is a cancer with extensive infiltration of the muscularis and indaration [sic]. There is also a well marked purulent infiltration of the tissue with localized areas of necrosis. Some of these areas present the appearance of tubercular caseation but the structure of a tubercle is nowhere apparent. Sections are being stained for tubercle bacilli and if they are found the fact will be reported. The primary lesion is carcinoma.

Very respectfully,
James Carroll
1st Lieut. Asst. Surgeon, U.S.A.
Asst. Curator.

Letter of the Day: May 19

Curatorial Records: Numbered Correspondence 03890

Dr. F. T. Meriwether,
U.S. Army Retired.
No. 14 Grove Street.

Asheville, N. C. May 19th, 1899

Maj. Walter Reed, U.S.A.
Washington, D.C.

Sir,

I send today in your care specimens of a probable Sarcoma of the Jaw, and what is of more interest a piece of a cancer of the lung. The history in brief of the latter is as follows. Male, age 35. Both father and mother died of Carcinoma of some form. Three months ago he was tapped Aspirated while in Baltimore for supposed Pleutritic effusion. Only a pint obtained. History up that time was an almost perfect one so far as health concerned. Cough developed shortly and he was sent to Asheville for supposed Tuberculosis. The chest when I saw him in consultation was enlarged upon the side affected, the left one; respiration was disturbed, had Hemoptysis and twice coughed up large masses of what seemed to be lung tissue. Temp and pulse record about that of Tuberculosis. The diagnosis was never made with certainty , though I rather incline towards malignancy. Aspiration secured some broken down cheesy looking masses which did not contain T.B. Patient suffered much at the last from Dyspnoea, and died five weeks after arriving here, the total duration being Three months. "Post" showed a lung very much broken down in spots, and the remainder of the tissue I send you. A small spot in the centre of the right lung seemed to be of the same tissue. Knowing the infrequency of Cancer of the lung I take the liberty of sending you this specimen, and request that when an accurate diagnosis is made you let me know the results. The largest piece is that of the lung and the smaller that from the jaw. The case will probably be reported at the meeting of the State Society to be held here shortly and I will see that you get a more complete history if you would like one. Let me also know the form of Sarcoma the smaller specimen.

I trust I am not imposing on your kindness too much and that I will be able to return the favor.

Very respectfully,
F[illegible] Meriwether

Letter of the Day: May 4

Curatorial Records: Numbered Correspondence 02230

May 4, 1897

Dr. W.C Gorgas, Asst. Surg., U.S. Army,
Fort Barrancas,
Florida.

Dear Doctor:

Referring to your letter of May 1st, '97, I have to report that the specimen of sputum therein referred to has been examined with the following result: No tubercle bacilli present, but many diplococci are seen which have the shape and staining re-action of the diplococcus lanceolatus, the organism for croupous pneumonia. I do not mean to say that your patient has pneumonia, because this organism is so often met with in the normal saliva of human beings.

Sincerely yours,
Walter Reed
Surgeon, U.S. Army,
Curator.

Letter of the Day: April 28

Curatorial Records: Numbered Correspondence 01441

April 28, 1896

Lieut. R. S. Woodson
Assistant Surgeon U.S. Army,
Fort McIntosh, Texas.

Dear Doctor:

It required the mounting of several slides of the sample of sputum referred to in your letter of April 22, 1896, before we found any tubercle bacilli. On the third slide we were fortunate enough to bring two of them into the field. These appear so characteristic in shape and staining that I am willing to say that there a few tubercle bacilli in the officer's sputum. On account of their very great scarcity, and of the fact that you would not probably again stumble on these two bacilli, I have refrained from sending you the slide.

Upon receipt of this letter I would be obliged to you if you will obtain another sample of the early morning sputum, and let us confirm, if possible, our diagnosis.

I will see what i can do towards preparing for you some bacteriological mounts. If you have not already studied the pathological changes found in tissues under the microscope, I feel like saying that you would not be able to obtain much information from pathological slides. One has to be trained in this particular work. I trust that you appreciate my meaning. I shall be glad at any time to do what I can to promote your microscopical studies.

Very truly yours,
Walter Reed
Surgeon, U.S. Army,
Curator

Letter of the Day: March 29

Curatorial Records: Numbered Correspondence 01383

Fort McIntosh, Texas

March 29, 1896

Maj. Walter Reed U.S.A.
Washington, D.C.

Dear Doctor:

I have this day forwarded to your address some sputa collected with aseptic care from a tuberculous patient, whom I have treated for six weeks with Paguin's serum.

An examination made at the beginning of treatment revealed a great number of bacilli. For the last few days I have endeavored to demonstrate their prisence [sic] but without success, whether this is due to my own imperfect technique, or to the fact the serum has been this effective I am unable to say, at any rate I am unwilling to rely upon the results of my own investigation. As the question is one of great importance to the patient, upon which depends the continence of the treatment, I beg that you will kindly give me the results of your examination thereof-the patient is a member of an officer's family.

x x x x x x

Please pardon the inquiry, but when may I expect the histological mounts that you are preparing? I understand that in the midst of your official duties you have little time for outside work; but I am extremely anxious for them and am prompted to ask the question at the expense of propriety.

Very respectfully
R.S. Woodson

Letter of the Day: March 6

Curatorial Records: Numbered Correspondence 07375

Post Hospital Fort Keogh Montana
March 6, 1904

To the
Curator of the Army Medical Museum
Washington, D.C.

Sir:-

I am sending today by mail, under separate cover, five flamed cover glass smears of sputum which I would request to have examined for the presence or not of tubercle bacilli.

Frequent examinations here have not revealed any, and as the patient presents symptoms, suspicious of tuberculosis, a confirmation or not of the findings here is desired.

The gross appearance of the sputum is mucoid with presence here and there of muco-purulent streaks. The patient claims to have had two attacks of memoptysis, not verified however by myself.

In the event of a positive finding it is requested that the stained specimen be returned to me, for future reference and comparison.

Very respectfully,

Edward F. Geddings
1st. Lieut. Asst. Surgeon, U.S.A.
Surgeon.

Letter of the Day: October 6

Curatorial Records: Numbered Correspondence 1736

 

Fort Crook Neb.

Oct 6^th 1896

 

Major Walter Reed U.S.A.

Washington D.C.

 

Dear Doctor,

 

As I am anxious to get the laboratory in the new hospital here in shape for a course in bacteriology this winter, I wish to ask if it would inconvenience you too much to send me cultures of the following bacilli, viz; B. Diphtheria, Typhoid Fever, Coli communis, Tuberculosis, Cholera, Anthrax, Prodigiosus, Glanders, and Finkler-Prior Vibrio.

 

All of my cultures became extinct in the move from Fort Omaha to this post as no one looked after them when I left to organize this hospital.

 

Very Sincerely

WB Banister

Capt. + Asst. Surgeon U.S.A.

The Surgeon

Letter of the Day: August 13

Fort Riley, Kansas.

August 13^th 1874

 

Ass’t Surg. Geo. A. Otis U.S.A.

 

Dear Sir,

 

On the 27^th day of June last, Major Compton 6^th U.S. Cavalry engaged in a fight with a band of the Kiowa Indians about forty miles south from Fort Dodge. Several Indians were killed in the engagement. I succeeded in procuring the skulls and a greater portion of the skeletons of two noted warriors slain. One, in particular, known in the tribe as “Cunning Jim”, a most notorious horse thief and desperado generally.

 

Do you receive such specimens into the museum? And if so, shall I ship by express? I made a special trip, sometime ago, to what was once called “Sheridan” then the terminus of the K.P.R.R. and not far from Ft. Wallace to obtain the remaining cervical vertebrae of the body from which I obtained the double Axis I forwarded you over a year ago but was unable to find the grave by reason of the head boards having been burned and carried away by hunters for fuel.

 

Do you also receive into the Museum such specimens as I enclose samples of  - I mean fossil remains of any or all kinds of animals?  No. 688 Sec. VI

 

Doctor I have another matter to broach which, perhaps, might better be done in another communication but I trust you will pardon me if it is too unofficious or asking too much trouble at your hands.

 

The Hospital Steward on duty at the Post, John McKenzie, is anxious to return East on duty, on account of his wife’s rapidly failing health since their arrival at this Post. Mrs. McKenzie is certainly and surely declining – the cause is obscure. I cannot think that it is a disease of nostalgia – although she is constantly entreating to return to their eastern home. From a robust woman, the patient has become so emaciated as to excite the comments of all. I suspicion incipient phthisis [ie tuberculosis] as there is a slight “hacking” cough, a result, however, I imagine, of some other more serious difficulty. The Steward has been in the service over thirteen years, and as the request is made at my hands, solely on account of his family, I have determined to present the case to you – feeling that your influence might procure him the consideration asked for. He is, moreover, an invaluable man in the Corps, and unless the change can be made for him he will be forced – although loathe to do so – to resign his position. If you will lend your influence towards consummating the change of station requested, I will consider it most decidedly, a personal favor as I esteem the Steward highly.

 

With Respect,

Yours Sincerely,

M.M. Shearer

A.A. Surg. U.S.A.

The NY Times as a history of medicine primer

A front page article on the current state of military medical evacuation -

As Afghan Fighting Expands, U.S. Medics Plunge In
By C. J. CHIVERS
Published: June 12, 2010
Nearly nine years into the Afghan war, the pace for air crews that retrieve the wounded has become pitched.

an obituary dealing with 20th century neurology -

Fred Plum, Neurologist Who Helped Coin ‘Persistent Vegetative State,’ Dies at 86
By LAWRENCE K. ALTMAN
Published: June 11, 2010
Dr. Plum’s influential research improved the diagnosis and treatment of patients who lose consciousness from head injuries, strokes, metabolic disorders and drug overdoses.

The country's last tuberculosis sanitarium -

In Florida, a Lifeline to Patients With TB
By DAMIEN CAVE
Published: June 12, 2010
Sixty years after it opened for tuberculosis patients, A.G. Holley State Hospital in Florida is both a paragon of globalized public health and a health care anachronism.

And the difficulties of genomic medicine ten years later -

A Decade Later, Genetic Map Yields Few New Cures
By NICHOLAS WADE
Published: June 12, 2010
The primary goal of the $3 billion Human Genome Project — to ferret out the genetic roots of common diseases and generate treatments — remains largely elusive.

Letter of the Day: May 20 (2 of 2)

 

Curatorial Records: Numbered Correspondence 8352

 

War Department,

Office of the Surgeon General,

Army Medical Museum and Library,

Washington,

May 20, 1905

 

To the Surgeon General,

U.S. Army.

(Through the Officer in charge of Museum & Library Division).

 

Sir:

 

I have the honor to ask the Commanding Officer of the U.S. General Hospital at Fort Bayard, N.M. to be requested to have prepared and forwarded to the Army Medical Museum, from time to time, as they can obtained, a series of specimens preserved by the Kaiserling method for the purposes of showing, in their natural appearance, the various lesions of tuberculosis and any other interesting pathological condition that may be encountered at post mortem examination. Such a collection would be of great interest and value, and the number of specimens should be large, in order to show the variations occurring in lesions essentially the same. It is desired to illustrate tuberculosis of all the tissues and organs, including the brain, meninges, bones, serous membranes, testicles, etc.

 

Kaiserling’s method is published in the work on Pathological Technique, by Mallory and Wright, and it requires only care and a little practice to insure success. Sections through organs should usually not be more than an inch in thickness, and for the purpose of identification a small parchment tag, bearing a number in India ink, should be stitched to each specimen. A number of specimens could be shipped in the same container and they should be accompanied by a brief note of the findings at autopsy, stating also whether from the clinical point of view the case was acute, subacute or chronic.

 

Very respectfully,

James Carroll

First Lieut, Asst. Surgeon, U.S.A.

Curator, Army Medical Museum

 

1^st Indorsement

Surgeon General’s office,

Museum & Library Division,

May 20, 1905

Respectfully forwarded recommended.

 

C.L. Heinzmann

Col. Asst. Surg. Genl. U.S.A.

In charge of M&L Division

 

Public medical appeals through the Post Office

The Museum has a stamp (or philately) collection, although not much has been done with it in recent years. Here’s two new additions to it – cancellations attempting to raise funds for medical charities

 

The 1952 appeal for the American Cancer Society seems early, inasmuch as a ‘war on cancer’ hadn’t been declared yet. The American Lung Association is known for putting out its Christmas Seals and we have a fairly good collection through the middle of the last century.

Letter of the Day: April 25 - tuberculosis

Here’s a sad case of a soldier from the 37th US Colored troops who had a horrible case of tuberculosis that was everywhere but in his lungs.

SS 8259

Post Hospital, Fort McHenry
Baltimore, Md. April 25, 1866

Bvt Major & Asst Surgeon
DeWitt C. Peters, U.S.A., Post Surgeon
Fort McHenry, Md.

Sir,

I have the honor to transmit herewith the Ante & Post Mortem History of Private James Turpins Co. F, 37 U.S. C Troops, Age 23 Years, who died in this hospital April 109, 1866, of tubercular caries of spine, the pathological specimens of which was forwarded to the Army Medical Museum, Washington, D.C., April 20, 1866.

This patient was admitted into this hospital Feby 20, 1866 from the Hicks U.S.A. General Hospital suffering at that time with a severe pain, much increased upon pressure over the region of the Lumbar Vertebrae, attended with loss of motive power in lower extremities, with which was associated great constitutional debility and scrofulous cachexia. He stated that he had first contracted his sickness while in Hospital at Fortress Monroe, Va. With Frostbitten feet; that it had commenced with pain in the back which increased from day to day until he was unable to use his lower extremities, an abscess had formed and had been opened by the attending Surgeon shortly after his admittance into this Hospital. This opening continued to discharge profusely a quantity of very fetid and cloudy pus; at times he was considerably troubled by incontinence of urine. About three weeks before his death another larger Abscess formed lower down over the Junction of last lumbar vertebra with sacrum which being laid open discharged about a pint and a half of fetid cloudy pus followed by a quantity of yellow inspirated matter in which little specks of necrosed bone could be seen, carious bone could be felt through both of these openings. He continued to grow weaker from day to day, and was found dead in his bed by the night nurse early in the morning of April 10, 1866 after having eaten his supper as usual the night before and without having any convulsions or other symptoms of nervous irritation except the paraplegia.

The treatment consisted essentially in the administration of alturatives and tonics calculated to support the vital energies together with a good nourishing diet.

On Post Mortem examination the body was found much emaciated; rigor mortis not well marked.

Brain.
The dura-mater normal; pacchionian bodies much larger than normal. About three ounces of purulent fluid escaped from subarachnoid space upon opening the dura mater. Vessels of the piamater somewhat congested, the surfaces of the arachnoid and piamater in surarachnoid space were covered with a thick layer of yellowish pus, which was especially marked in the situations of the so-called anterior and posterior subarachnoid spaces and between certain convolution on the uppers surface of the hemispheres in these last situations little leaks had formed in some cases in the sulci which were filled with a thick cloudy pus. This matter on microscopical examination was found to contain a large quantity of half disintegrated tubercular matter. The anterior horn of the left [illegible] ventricle contained about two drachmas of pus of the same character as that found in other parts of the brain. The third ventricle also contained a small quantity of purulent matter. The fourth ventricle was found full of pus which seemed to have effected an entrance by breaking down the membranes forming the inferior boundary of the ventricle. The fifth ventricle was unusually large. The choroid plexuses of all the ventricles was much engorged with blood. No tubercular masses could be discovered in the brain substance or in any of its membranes. The substance of the brain was of normal consistence; the entire surface of the spinal covered was covered with pus. Brain weighs 39 ounces.

Lungs.
The pleural surfaces were absent upon the left side of their upper part; both lungs were every where crepitant [ie made a crackling sound] except a portion of about 2 inches in width along the anterior edge of the upper and middle lobes of right lung. This portion was of a leaden color, tough, fibrous, non-crepitant and of a greater specific gravity than water. No tubercules could be found in either lung but the surface of these organs was every where speckled over with melanotic matter. The bronchial glands were of normal size but infiltrated with pigmentary matter. Right lung weighed 11 ½ ounces. Left lung weighted 9 ½ ounces.

Heart.
This organ was somewhat enlarged, its muscular substance being hypertrophied; valves normal, cavities filled with whitish fibrous clots, the upper surface of that occupying the right auricle was distinctly grooved by the passage over it of the blood from the venae cavae. Heart weighed with clots 17 ounces.

Liver.
Had a yellowish brown color. Under the microscope numerous fat granules were found in the cells of this organ; weighed four pounds and one ounce.

Gall Bladder. Filled with bile of a greenish yellow color.
Spleen was of normal appearance, weighed 5 ½ ounces.
Kidneys, somewhat congested, right weighed 6 ounces, left 4 ½ ounces.
Suprarenal capsules normal, weighed each 2 drams.
Pancreas. Natural. Weighed 3 ½ ounces.

Intestines and Stomach.
The mucus membrane slightly infected in some portions, mesenteric glands were enlarged and contained in some cases deposits of tubercular matter. About 8 ounces of yellowish serum was found in the peritoneal cavity.

The lower dorsal, lumbar, sacral, coccyxal vertebrae were all diseased and in some places extensively destroyed by caries; in the lumbar region the ulceration of the vertebrae had proceeded to such an extent as to have eaten its way into the spinal canal and through the theca and forcing its way up the canal, as the man lay on his face, accounted for the presence of pus in such large quantities over the whole surface of the spinal cord and brain and throughout the ventricles of the latter organ and also offered an explanation of the patients sudden death. The lymphatic glands in the inguinal and pelvic regions were infiltrated with cloudy pus.

Pus was also found beneath the sheaths of both psoas major muscles having destroyed the greater portion of their muscular substance. Carious abscesses were found of the fifth rib on the right sight and of the second and forth of the left side at the point of junction with their respective cartilages. The end of the sternum was also carious as far up its junction with the cartilage of the fifth rib. The pelvic bones were studded with spots of caries.

I am, Major, Very Respectfully,
Your Obedient Servant,
Henry McElderry
A.A. Surg. U.S. Army

Letter of the Day: February 16 1 of 2

Note the continuing confusion of types of fevers. Dale Smith's written an excellent paper on this. Carroll had made his reputation working with Walter Reed on yellow fever a few years earlier. The cause of the anemia he refers to would eventually be defined by US Army doctor Bailey Ashford.

War Department,
Office of the Surgeon General,
Army Medical Museum and Library,
Washington

February 16, 1904

Private Julian W. Moody,
Hospital Corps, U.S.A.
(Through the Surgeon, Fort Monroe, Va.).

Sir

I have to acknowledge the receipt of a bottle of sputum containing tubercle bacilli, and thank you for sending it. This is material we can usually obtain in abundance. If you could send me, however, at any time specimens of blood showing quartan or aestivo-autumnal malarial parasites, pernicious or secondary anemia, eosinophilia or any marked pathological condition of the blood, I shall be very glad to have them.

Respectfully,

James Carroll

1st Lieut. Asst. Surgeon, U.S.A.
Curator, Army Medical Museum

TB Sanatorium records donated today

Charlotte Perry donated George Ellis Mills' records to the archives today. Mills, Charlotte's grandfather, was Director of the Boehne Tuberculosis Sanatorium in Evansville, Indiana, in the 1920s, until his untimely death in 1929. We received annual reports (no, no, not the boring, all-number kind; these have a lot of interesting narrative about the hospital with some great photos as illustrations), typewritten manuscripts about the rules and regulations there, more transcripts about tuberculosis, and 5 panoramic photos of staff and patients. I'll be making a finding aid next week, which will give me more time to read everything and scan some of the photos from the annual reports.

Telemedicine, literally

Wired.com reports on a new strategy to get TB patients to take their medicine: free cell phone minutes.

While human interaction is still necessary because self-reporting isn't always reliable, allowing patients to text-message results from their urine tests - and get free minutes as a reward - apparently gets better participation during the six-month regimen.