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Wednesday, November 10, 2010

Letter of the day debate continues...

The game is afoot!

Since sending out my last update, I have heard back from several folks about what could have caused the muscular atrophy of our mystery patient. Some suggestions include sudden spinal injuries, early undiagnosed polio, or psychological conversion.

As many of you know, my background is in cultural studies from the Gilded Age, particularly concepts of masculinity. Initially I had also thought that our patient might be suffering from a psychological illness, especially as Dr. Leale made reference to “the insane.” Much of my own research has focused around neurasthenia, which had reached “epidemic” proportions in the US in the 1880s. It was discovered by George Beard in 1869 and was what we would consider extreme exhaustion. Men all over the United States were suffering severe, incapacitating physical and mental breakdowns (it was considered so characteristic of Americans that William James, Harvard professor and brother of Henry James, called it ‘Americanitis’). Most historians now believe that there were numerous cultural factors that led to this “epidemic”, but it would not be an exaggeration to say that most prominent Americans at the time deeply feared this mysterious mental and physical weakening of American men (this would in turn, they believed, weaken the country, making it susceptible to invasion, etc.). All this is by way of saying that though doctors did not understand the causes of mental illness at the time, they were certainly aware that it could have physical repercussions. I feel confident that the experts brought in on this particular case would have considered this possibility.

Also, while I do agree that unwanted marriage could have been a trigger for such a psychological reaction, I think in this case we do not know enough about the patient’s background to make a generalization that a marriage would have been formally or informally “arranged.”. The consultation of so many experts from this time suggests to me that 1) this was a relatively wealthy patient, and/or 2) that the patient’s condition was so unusual that it attracted medical attention. This is important because negotiations of marriage at this time depended very much on socio-economic status, class, race, and numerous other factors. Certain groups, what would have been termed “classes,” of people would certainly have been involved in more “arranged” marriages because of family reasons, religion, etc. But we just don’t know in this case.

The other possibility that occurred to me was that marriage might have been prevented because there was no possibility of consummating the marriage or having children. Depending on how the illness was presenting, doctors could have made this diagnosis. I can think of many circumstances where this would have led to the dissolution of an engagement.

Another follow-up

From Alan Hawk, Collections Manager in the Historical Division:

"The problem with your diagnosis is that spinal muscular atrophy shows up in infancy and most patients die within the first couple of years of his or her life.

A couple of possibilities.

1) This might be an early case of polio, which would account for the sudden onset and “abruptly prevented matrimony.” On the other hand it is a highly infectious disease so one would think that other doctors would have seen other examples of these symptoms.

2) This could also be a psychological conversion reaction. If the patient was severely depressed, he or she could have become paralyzed. That would account for the normal muscle tissue as there would be nothing physically wrong with the patient other than the fact that he or she convinced herself that he or she was paralyzed. The triggering event could have been either the upcoming matrimony or its ‘prevention’ as the bride and the groom frequently had little say in who they ultimately married. This would also explain why the patient was apparently the only case.

While doctors of the time would not been able to diagnose either case, Polio existed as a diagnosis since 1840, but it cause would be unknown until 1908. While depression was recognized as a disorder (melancholia) since ancient times, it wasn’t until the late twentieth century that it symptoms, causes and effects were understood. However, physicians of the time had a good grasp of anatomy and, if the muscle appeared normal, the spinal cord was the next logical place to look. It sounds like the doctors intuitively understood the problem was psychological."

A follow up: Today's letter of the day

It appears that Dr. Leale first contacted Dr. Huntington on October 17, 1883. He sent the doctor “a piece of the left gastrocnemius muscle taken from a patient having that very rare disease progressive muscular atrophy.” Leale had been the patient’s physician for six months and evidently the case had generated considerable interest in the medical community. Leale mentions consulting in excess of 11 prominent doctors who claimed they had never seen such a case. Because of the great interest in the case, Leale asked Huntington to do a microscopic examination done “to aid in the scientific investigation of one of the vexed unsolved problems on the pathology of muscular degeneration and perhaps the general paresis of the insane.”

Huntington wrote to Leale on October 20th, requesting a piece of the spinal column, to aid the investigation. On November 9, Huntington wrote to Leale with the results of the microscopic investigation. His letter:

November 9, 1883

Dear Sir:

The piece of the left gastrocnemius muscle removed from a patient suffering from progressive muscular atrophy has been examined under the microscope.

With the exception of a small inter deposit of adipose tissue and a slight increase of the cell elements of the interstitial tissue, the general appearance of the muscle was normal.

The change in the connective tissue had not yet proceeded sufficiently far to strangle the fibre, thereby producing atrophy, as the following measurements of six contiguous fibres will show:

.04, .031, .019, .031, .025, .038mm

The extreme measurements of normal fibre are stated to be .0113, .0563, mm.; therefore the measurements in the fibre before us come quite close to the mean.

It is to be regretted that a portion of the spinal cord was not preserved in which the lesion could probably have been shown more accurately.

Very respectfully,
You obed’t servt,
D.L. Huntington
Acting Surgeon General

Today’s letter of the day (November 10) is Dr. Leale’s reply. Given Dr. Huntington’s interest in the brain and spinal cord, my guess is that this patient had what we now know as spinal muscular atrophy, which I believe is genetic and was perhaps relatively new within the medical community (at least in the U.S.). Anyone out there who has any other ideas, feel free to let me know.

As for the “melancholy surroundings” and the “abruptly prevented matrimony” mentioned in Leale’s letter: Within the cultural parameters of the time, and without knowing too much about the patient, I can say generally that if this patient was female and the man she was marrying was financially secure and could afford medical care, it is possible they could have married (if her husband was willing to care for an “invalid wife”). If the patient was male it would be very unlikely, nearly unheard of, for him to marry, as he would be considered a “burden” to his wife and in death could leave her financially destitute, brokenhearted, etc. I don’t know the duration of this illness, after it first presents, but it is likely that when it did present in this case (possibly four years earlier), the parents of the patient or fiancĂ©e would have demanded an end to any engagement. I can imagine that doctor’s would not have known how long the patient would live and might have discouraged marriage for multiple reasons. When the patient lived for another four years, the parent(s) who encouraged or demanded the dissolution of the engagement might have regretted the decision.

Letter of the Day: November 10

C.A. Leale, M.D.
749 Fifth Avenue.
New York

D.L. Huntington, M.D.
A. Surgeon General, U.S.A

Dear Doctor

Please accept my sincere thanks for the microscopied examination report just received.

In this instance it was utterly impossible to secure the brain and spinal cord on account of the extremely melancholy surroundings. The death scene was very harrowing to the parent who four years ago abruptly prevented matrimony.

Very respectfully,
Your Obedt Servant

Charles A. Leale

Nov. 10, 1883

Tuesday, November 9, 2010

Letter of the Day: November 9 (2 of 2)

Curatorial Records: Numbered Correspondence 1171

 

War Department,

Surgeon General’s Office,

Washington, Nov. 9, 1895.

 

My dear Doctor:-

 

I am not aware that anything has been done with reference to the souring of hams, to which you refer. It is an interesting subject of investigation and I shall be glad to know what results you arrive at. If you could send one of the hams by express to me I would have some investigations made in the laboratory at the Army Medical Museum in this city.

 

Very truly yours,

(Signed)  Geo. M. Sternberg.

 

Dr. W.T. White,

Kansas City Medical College,

Kansas City, Missouri.

 

Letter of the Day: November 9 (1 of 2)

Fort Wadsworth D.T.
Nov. 9th, 1868

Surgeon General U.S.A.
Washington, D.C.

General:
I have since my communication of the 5th uls. explored two Tumuli and obtained a few bones, very incomplete parts of a number of skeletons seventeen tibiae, twenty one femura etc, etc, but no crania. From one I obtained about a peck of decayed wood, which had been used in interring the bones. I propose to disinter the remains of a hostile Indian (Dakota) who died of syphilis while a prisoner during the “Outbrake” [sic]. I would respectfully inquire if you desire the specimens for the museum?

I have a “Medicine Bag,” (parflesh bag) the skin of an otter, which I purpose to contribute. I have been preparing a map, or rather designating the location of the tumula on the map of the reservation, which with a description of the location, from and structure of the mounds I shall forward hereafter.

May I inquire if the implements we shipped on the 5th ult. have reached you.

Very Respectfully
Your Obed’t Servt
A. J. Comfort

Monday, November 8, 2010

Von Hagens is selling the plastinated body, and BTW animals as home decorations on his site.





I think we should get the head, its only 30k.

Happy birthday, x-rays!

Google reminds us that today is the 115th anniversary of the history of x-rays. I know there are some interesting and disturbing images on the museum's flickr pages, many more than the two linked to here.

Letter of the Day: November 8

Ira Harris General Hospital
Albany, N.Y., Nov. 8th, 1865

Sir:

I have the honor to state that I have this day forwarded to your address, for the Army Medical Museum, a box containing an album of photographs of morbid specimens + necrosed bones removed from patients treated in this hospital.

Attached to each specimen is a descriptive label upon a card.

The views in the album are taken from a collection of several hundred in my possession, being chiefly photographs of specimens in the Museum of the Albany Medical College, and in private collections.

Resp. Your Obdt. Servt.,

J.H. Armsby
Asst. Surg. U.S.V.,
in charge

[To] Brig. Gen. J.K. Barnes
Surgeon General U.S.A.
Washington, D.C.

Sunday, November 7, 2010

Letter of the Day: November 7

Ft. Concho, Texas
Nov. 7. 76.

My dear Sir-

I deferred replying to yr. last kind letter until some explorations, which I have undertaken, were concluded. I had discovered a number of ancient Indian graves 30 miles from Concho. I regret to say they proved to be too ancient. The remains having mostly crumbled away. After several days hard + dangerous work, I was only rewarded with a few fragmentary specimens which I will forward on a future occasion.

However, this is only one point. I have ascertained numerous localities, at no great distances, where I have little doubt of being more amply repaid for my exertions. It necessarily occupies time, having to leave the post for a day or two, which is not always feasible. Before Spring I trust you will concede I have done well. I know of several murderer’s and outlaws’ graves + propose sending some of their calvaria.

I wd [would] not have thus forwarded the Apache skeleton, but that it was so perfect. I dreaded an accident. Moreover any other method in Texas is slow and not remarkably safe.

More anon from,
Yrs. ever most truly,
J.H.T. King.

Surg. Geo. A. Otis. U.S.A.

Saturday, November 6, 2010

Letter of the Day: November 6

Washington, Nov. 6, 1875.

Dear Doctor

I spoke to you some time ago about making a selection of at least a single series of skulls, to represent the various tribes of aborigines of North America, for exhibition at the Centennial, either by the Army Medical Museum or by the National Museum.

I would like to hear from you to know whether you will make this display; as I consider it extremely important that the very large ethnological collection to be exhibited on that occasion, should be supplemented by the series in question.

We will gladly receive the specimens here, + be responsible for their safe return, + arrange to exhibit them under suitable circumstances, of course as the property of the Army Medical Museum.

Any other method will suit us equally well, only we hope the exhibition will be made. We are now unpacking a collection of about 300 crania from the vicinity of Santa Barbara + the adjacent islands – a most magnificent series of specimens, + we would be glad to have you come over + look at them + see whether you wish them turned over to the Army Medical Museum, + whether you have space for their accommodation. Many more are yet due.

Yours truly,
Spencer F Baird

Dr. Otis,
Army Medical Museum,
Washington, D.C.

Friday, November 5, 2010

Walter Reed medical center and Army Medical School cartoon

Reeve 43604

Army Medical School, Walter Reed Hospital, Officer of the Day. [Illustration. Cartoon.]

 

This cartoon is  almost incomprehensible to us now, so I’ll do a quick read of what I think it means. The Walter Reed medical center baby is trying to reach a toy labeled for the Army Medical School Officer of the Day – implying I think that the hospital base wanted administrative control over the medical school, which had moved onto the campus in 1907. The school eventually became the Walter Reed Army Institute of Research and will be our neighbor when we move up to Forest Glen, Md next year.

Letter of the Day: November 5

Curatorial Records: Numbered Correspondence 1171

 

Kansas City Medical College

Kansas City, MO., Nov 5” 1895

 

Dr Geo M Sternberg

Washington D.C.

 

Dear Sir:-

 

Your communication at hand I would have been willing to acted as partner in your laboratory but since thee is no opening of any kind, I can only thank you and say I am sorry.

 

I am now trying to investigate the cause of “hog hams souring” Swift + Co one of our packers looses (sic) about $8000\00 per annum and I am quite sure it is due to bacterial origin. I have worked two weeks without making much headway and have six weeks left until I make a report. If you will kindly express me any literature on the subject I will take excellent care thereof, and return at your pleasure + my expense.  Hoping you can help me I am yours very truly

 

WT White

17 + Bellview

K.C. Mo

Thursday, November 4, 2010

Post on medic's gear

http://www.washingtonpost.com/wp-srv/special/nation/a-heavy-burden-graphic/index.html?sid=ST2010110104926

Letter of the Day: November 4 [Criminal edition, part 2]

Curatorial Records: Numbered Correspondence 01779

November 4, 1896

To the
Surgeon General, U. S. Army,
Washington, D.C.

General:

The Museum has a specimen of excised testicle from a military convict, John J. Moore, who was admitted to the hospital at Alcatraz Island, California, November 25, 1892, with subacute orchitis; testicle excised December 7; Discharged from Hospital December 22, 1892.

It would be interesting in connection with the specimen to learn the history of the patient subsequent to his discharge from the Hospital on December 22, 1892, and I would therefore respectfully request that an inquiry be made at the Adjutant General’s Office for such late data as may be on record in the case of Moore.

Very respectfully,
D.L. Huntington

Deputy Surgeon General, U.S. Army
In charge of Museum and Library Division

Letter of the Day: November 4 [Criminal edition, part 1]


Headquarters, Post of Waco
Waco, Texas, November 4th 1869

My dear General:

General Reynolds and I arrived here safely last evening after a pleasant ride of two days, and today been busy in inspecting this post and enjoying the hospitalities of the citizens. We shall probably return to Austin day after tomorrow.

I write to ask you whether you would like to have me send to the Army Medical Museum, a novel specimen. It is the head of Bickerstaff, the most notorious of all Texan desperados. It is admirably preserved in alcohol, and can be sent to Washington in that state, if you desire. If you do not wish to preserve it in that state after arrival, you can have it dissected, and put the cranium in the museum as a typical representation of a Texas desperado. Bickerstaff, the head of an organized set of murders, was the terror of Northern Texas for a long time, successfully defying and eluding the civil and military authorities. His head was sent to this place for securing the reward for his capture.

Sincerely your friend,
Warren Webster
[To] Gen. C. H. Crane, &c. &c.


Wednesday, November 3, 2010

Letter of the Day: November 3

Curatorial Records: Numbered Correspondence 01782

Dr. H.L.E. Johnson
Washington, DC
Nov. 3rd, 1896

DR. Walter Reed,
Surgeon U.S. Army, Curator
Army Medical Museum

My Dear Dr. Reed:

I enclose the report which you sent me last Jany. [January] to call up the circumstances and also a similar specimen in alcohol, passed yesterday by the same patient. Would you kindly tell me the nature of this specimen. I operated upon this patient for appendicitis, evacuating a very large abscess, on the 28th. ult. I intend reading a paper on appendicitis at the Congress in Mexico, including this and other cases and if it is perfectly convenient to you and meets your approval, I wish to incorporate this last report in my paper. I expect to start for Mexico on Sunday the 8th. inst.

Thanking you for this and other favors,
I am,
Faithfully yours,

H.L.E. Johnson

(Dictated.)

Tuesday, November 2, 2010

Natural history of plague revealed

October 31, 2010

Europe's Plagues Came From China, Study Finds

By NICHOLAS WADE

http://www.nytimes.com/2010/11/01/health/01plague.html


Letter of the Day: November 2

War Department
Surgeon General's Office
Property Division
Washington, DC

November 2nd, 1885

Maj, J. S. Billings, Surgeon, U.S.A.
Curator Army Medical Museum
Washington, DC

Major:

I have to acknowledge the receipt of your letter of the 20th inst. forwarding two hundred and sixty (260) Esmarch's triangular bandages found in a storeroom at the Museum.

By order of the Surgeon General.

JH Baxter
Chief Medical Purveyor,
U.S.Army

Monday, November 1, 2010

Letter of the Day: November 1

Fort Ridgely, Minnesota,
November 1st 1862

Sir

I have the honor to acknowledge the receipt of a letter from the curator of the Army Medical Museum, under date of October 15th, 62, acknowledging the receipt of an Indian arrow head and requesting me to procure further specimens etc.

I have already collected some specimens referred to in his letter and shall continue to make further collections as opportunity shall present. Articles of Indian warfare (including both new and old shotguns), captured by our troops from the Indians, have been delivered at this Post and gone into the custody of the proper Army Officer, some of them, in my judgement, would be proper to be secured for the Army Medical Museum.

If you would obtain an order from the War-Department, directing the Commander of this post or other Officer in Charge of these "trophies," to allow me to select from them such articles as I might deem proper, for the purposes of sending them to the Army Medical Museum, I would with pleasure do so.

Very respectfully,
Your Obedient Servant,
Alfred Muller
Act. Asst. Surgeon

[To] Brig'd General Wm. A. Hammond
Surgeon General, U.S. Army
Washington, D.C.