history of medicine

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The Gruesome Reality Of Civil War Medicine

During the Civil War, battlefield injuries often meant infection, amputation, and surgeries performed by inexperienced doctors.

At the time of the Civil War, as a result of lax laws, obtaining a medical degree was very easy; one only had to apprentice with a local physician and take a few courses at a proprietary medical college. Most physicians had little surgical experience. Many had never performed a major operation or even participated in a dissection.

Military surgeons learned to amputate and perform a wide variety of procedures as they were actively engaged in conflicts. Of the 114 surgeons in the U.S. Army in January 1861, 24 resigned to join the Confederacy and establish the Confederate Medical Service. Few were mentally or physically prepared, on either side, for what was to come. The horrendous numbers of casualties, thousands in each major encounter dictated that proper triage be established for amputation, the most commonly performed major surgical necessity. The large numbers of injured created an opportunity to hone one’s skills and become an expert.

http://www.pbs.org/mercy-street/uncover-history/behind-lens/surgery-civil-war/

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Horizontal Sections of the Adult Male
Top-to-Bottom: Mid-section of skull, section at maxilla [hard palate between sections], section below mandible

Eugène-Louis Doyen was a revolutionary (if flamboyant and controversy-loving) Parisian surgeon who lived between 1859 and 1919.

Long before the Visible Human Project created its 1,871 “slices” of Joseph Paul Jernigan at 1 mm intervals, and created over 65 gigs of anatomical data (and later created 40 gigs of data with a female cadaver), Doyen presented a new way of visualizing the cadaver: longitudinal and horizontal sections, showing exactly how the human anatomy goes together in each area, without the context of seeing the full organs or bones.

Though the full usefulness of these unorthodox sections wasn’t truly appreciated until the advent of tomography in the early 1970s, they were noted to be helpful to early radiologists, and especially to the burgeoning fields of criminal forensics and forensic archaeology.

Atlas d'anatomie topographique. Eugène-Louis Doyen. 1911.

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Inca Skull Surgeons Were “Highly Skilled,” Study Finds 
(Norris, National Geographic, May 2008)

Inca surgeons in ancient Peru commonly and successfully removed small portions of patients’ skulls to treat head injuries, according to a new study.

The surgical procedure—known as trepanation—was most often performed on adult men, likely to treat injuries suffered during combat, researchers say.

A similar procedure is performed today to relieve pressure caused by fluid buildup following severe head trauma (Decompressive craniectomy).

Around the ancient Inca capital of Cuzco (see Peru map), remains dating back to A.D. 1000 show that surgical techniques were standardized and perfected over time, according to the report.

Many of the oldest skulls showed no evidence of bone healing following the operation, suggesting that the procedure was probably fatal.

But by the 1400s, survival rates approached 90 percent, and infection levels were very low, researchers say.

The new findings show that Inca surgeons had developed a detailed knowledge of cranial anatomy, said lead author Valerie Andrushko, of Southern Connecticut State University in New Haven.

These people were skilled surgeons,” she said.

Read the entire article on NatGeo: Inca Skull Surgeons Were “Highly Skilled,” Study FindsImage Sources: 1, 2, 3, and 4

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These color lithographs illustrating amputation are from Jean Marc Bourgery’s monumental Traité complet de l'anatomie de l'homme.  This work was originally published in eight volumes over the course of twenty-three years (1831-1854); Bourgery himself died before it was completed.

The illustrations were done by Nicholas-Henri Jacob, a student of the renowned French Revolution era painter Jacques Louis David.

Skull from Ciapas, Mexico, bearing teeth adorned with gems.

Ancient peoples of southern North America went to “dentists"—among the earliest known—to beautify their chompers with notches, grooves, and semiprecious gems, according to a recent analysis of thousands of teeth examined from collections in Mexico’s National Institute of Anthropology and History.

Most of the gem-encrusted teeth were from individuals who lived before the year 1500 and who came from all walks of life–this was not a trend for the elite alone.

Source: National Geographic

bostonglobe.com
How an African slave helped Boston fight smallpox - The Boston Globe

The idea behind this radical new treatment came from Africa, specifically from a slave named Onesimus, who shared his knowledge with Cotton Mather, the town’s leading minister and his legal owner. Boston still suffered dreadfully, but thanks to Onesimus and Mather, the terror linked to smallpox began to recede after Africans rolled up their sleeves—literally—to show Boston how inoculation worked. The story of how Boston began to overcome smallpox illustrates the strife that epidemics can cause, but also the encouraging notion that humans can communicate remedies as quickly as they communicate germs—and that the solutions we most need often come from the places we least expect to find them.

Mather had come close to choosing a career in medicine, and devoured the scientific publications of the Royal Society in London. As the society began to turn its attention to inoculation practices around the world, Mather realized that he had an extraordinary expert living in his household. Onesimus was a “pretty Intelligent Fellow,” it had become clear to him. When asked if he’d ever had smallpox, Onesimus answered “Yes and No,” explaining that he had been inoculated with a small amount of smallpox, which had left him immune to the disease. Fascinated, Mather asked for details, which Onesimus provided, and showed him his scar. We can almost hear Onesimus speaking in Mather’s accounts, for Mather took the unusual step of writing out his words with the African accent included—the key phrase was, “People take Juice of Small-Pox; and Cutty-skin, and Putt in a Drop.”

Excited, he investigated among other Africans in Boston and realized that it was a widespread practice; indeed, a slave could be expected to fetch a higher price with a scar on his arm, indicating that he was immune. Mather sent the Royal Society his own reports from the wilds of America, eager to prove the relevance of Boston (and by extension, Cotton Mather) to the global crusade against infectious disease. His interviews with Onesimus were crucial. In 1716, writing to an English friend, he promised that he would be ready to promote inoculation if smallpox ever visited the city again.

American History, but something I think a lot of people would be interested to read.

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These whimsical images come from the mind of Louis Crusius, a physician and artist who was born in Wisconsin and later moved to St. Louis, Missouri.  The Antikamnia Chemical Company used Crusius’ images in a series of calendars they published from 1897-1901, which they sent to physicians who could prove their medical standing.

The company, whose name means “opposed to pain,” was known for manufacturing a patent medicine called Antikamnia tablets.  Like most patent medicines of the time, the ingredients in the tablets could have ill effects - the tablets contained acetanilide, which could cause cyanosis (a condition in which the skin becomes blue due to insufficient oxygen).

These images are strange and amusing, but are also an unfortunate product of the time period.  Both the September-October and November-December pages play on racial stereotypes, namely of Irish immigrants and African Americans.

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“Hey, has anyone seen my Snapple I left it here OH MY GOD IT’S F—ING SMALLPOX”

We found some forgotten variola (smallpox) at the FDA laboratories in Bethesda, Maryland! They were fully sealed and there’s no evidence of tampering, and are now located at the secure BSL-4 CDC laboratory in Atlanta, Georgia, where the rest of the US stockpile is located.

The last naturally-occurring Variola major case was in a Bangladeshi girl in 1975, and the last Variola minor case was in a hospital cook in Somalia, in 1977. Eradication was complete by early 1978, and was formally declared in 1980.

In late 1978, a medical photographer became infected by a smallpox sample kept at the University of Birmingham, and subsequently died from the disease. One other person also became infected, but survived. The researcher who was overseeing the photography operation was distraught and committed suicide soon after the photographer’s death. After this, the WHO strongly encouraged all countries to destroy their stockpiles of smallpox.

There was significant resistance to the recommendation and pressure by both Russia and the United States, and today there are two formally declared laboratories that have the live virus - the CDC in Atlanta, Georgia, and VECTOR in Koltsovo, Russia.

Having worked in several labs, there’s this fear of throwing things out that people might one day come back and need, or want to use again. Even samples that we can hardly identify, waaaaay back in the -80C freezers, get kept around unless we know what they are and who was using them and that they wish to destroy the sample or declare it unsuitable for future research. Stuff gets shoved to the back, and you don’t look at it for years or sometimes decades. There are some truly bizarre things to be found when cleaning old freezers…but hopefully I never come across something like this.

There are probably more smallpox samples out there, in former Soviet states, and in the US. Hopefully they’re all as well-sealed and safe as this one was.

Via The Mary Sue/@pourmecoffee

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Highlights from the Oxford Reference medicine timeline:

  1. c. 2000 BCE Medicine men in Peru practice trephination, cutting holes in the skulls of brave or foolhardy patients.
  2. c. 100 BCE The practice of acupuncture is described in Nei Qing, a Chinese medical text.
  3. c. 1489 Leonardo da Vinci begins an unprecedented series of detailed anatomical drawings, based on corpses dissected in Rome.
  4. 1545 Ambroise Paré, the greatest surgeon of his day, publishes an account of how to treat gunshot wounds.
  5. 1665 The first recorded attempt at blood transfusion, at the Royal Society in London, proves that the idea is feasible.
  6. 1796 German physician Samuel Hahnemann coins the term ‘homeopathy’ and describes this new approach to medicine.
  7. 1860 Florence Nightingale opens a training school for nurses in St Thomas’s Hospital, establishing nursing as a profession.
  8. 1978 Louise Brown, born in England, is the first test-tube baby, having been conceived by IVF (In vitro fertilization).
  9. 2000 At the turn of the century, it is calculated that 36 million people worldwide are infected with the HIV virus.

Image credits: 1) Girl skull, trepanated with a silex, 2) Hua Shou. Expression of the fourteen meridians, 3) Vitruvian Man, 4) Ambroise Paré et l'examen d'un malade by James Bertrand,  5) Sample blood bag,6)  Samuel Hahnemann, 7) Three Quarter length portrait of Florence Nightingale, 8) ICSI sperm injection into oocyte, 9) Stylized rendering of a cross-section of the Human Immunodeficiency Virus. All via Wikimedia Commons.

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These incredible foldout engravings illustrate Opera Omnia Anatomico-medico-chirurgica, a 1737 collection of works by the Dutch botanist and anatomist Frederik Ruysch.  Cornelius Huyberts’s engravings are based on real tableaux Ruysch created using fetal skeletons and other preserved body parts. Although they may seem morbid today, at the time of creation they were viewed as striking a balance between the scientific and the artistic. They served to educate people on human anatomy as well as to remind them of the fleeting nature of life. Read more about Ruysch on our blog. 

The first illustration by Camillo Golgi showing a network of neurons found in the olfactory bulb of a dog. Golgi has invented a method, now called Golgi-stain, which is used to image neurons in different tissues. Golgi-stain is based on reaction between potassium dichromate and silver nitrate, which leads to silver chromate being deposited on cell membranes and giving them dark colour. Only random and relatively few neurons are stained at a time, allowing to distinguish single cells, which are part of dense and complicated neuronal networks. Golgi has described his technique in 1873 and it provided one of the strongest evidence at that time to prove that neurons are the building blocks of the nervous system. Golgi, together with Santiago Ramón y Cajal, was awarded the Nobel Prize in 1906 in recognition of their work on the structure of the nervous system”.

Image source

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Facial clefts in the embryo and adult

Early in the development of the embryo, we’re basically just a tube, with a notochord (the precursor to our nervous system) and three layers of tissue. The branchial arches, neural crest, and somites join together as they develop to form the head and neck.

To become a creature with a face, this tube must close in a very specific way, and in mammals, the way that it comes together is very similar between the species. In fact, most mammals can end up developing very similar facial deformities.

In the human, there are 15 “clefts” (separations) that join together very early on in development. The primary regions of the face are completely brought together before the embryo is even the size of a penny (17 mm - about 2/3 of an inch). Most clefts are brought together before the fetus is 1 cm long - less than the diameter of a AAA battery.

Since most of the facial clefts are some of the earliest possible non-lethal deformities, the failure of one or more of them to fuse does not stop the development, unlike many other early congenital problems. For most serious deformities at this stage, the genes simply stop giving cogent signals to one another, and the female’s body self-aborts, as it is not evolutionarily advantageous to create a non-viable fetus.

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While all facial clefts have the potential to fail to fuse, the ones that most frequently result in viable fetuses are the clefts of the palate and the maxillary processes. These can occur bilaterally (on both sides), unilaterally (only on one side), and can involve part of the palate, only the palate, only the lip, or the complete palate and lip structure. The most common defect is an isolated unilateral cleft lip, formerly known as a “harelip” (though that term is often seen as derogatory these days).

Due to the fact that the face is the way most people identify one another, its importance in human culture can make any facial deformity a problem for the person who has it. While cleft lips have been fixed for as long as people have had stitches (at least 5000 years), fixing the bone clefts has been much more difficult and daunting. In 1827, John Peter Mettauer completed the first successful bone-flap transplant to fix a cleft palate, and reconstructive surgery has only improved since then.

While most facial cleft anomalies are now routinely fixed at a very young age in industrialized nations, there are many parts of the world where hospital access is limited, and cleft deformities are not easily repaired. The loss of nutrition that suckling difficulty in children with cleft palates have can have life-long consequences. And that’s assuming the infant survives.

Charitable organizations such as Operation Smile attempt to fill that gap - literally.

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The brain three ways.  From the top:

Thomas Willis.  The anatomy of the brain and nerves.  Birmingham, Ala. : Classics of Neurology and Neurosurgery Library, 1983; 1664.

Charles Bell.  The anatomy of the brain, explained in a series of engravings.  London: Printed by C. Whittingham, 1802.

Jean Marc Bourgery.  Atlas of human anatomy.  Los Angeles: Taschen, [2005].  Originals published between 1831-1854.