Wednesday, November 10, 2010

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 fiancée 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.

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