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Category Archives: Medical History

Guest Blogger: Daphne Holmes: How DNA Testing Helps Determine Paternity

DNA

 

How DNA Testing Helps Determine Paternity

The impetus for determining the paternity of a child likely dates back to the most primitive tribal cultures. Particularly in patriarchal cultures where females were regarded as the property of males, it was deemed important to ensure that a man’s “property” had not been shared, and that the virtue of the female was beyond question. As societies became more sophisticated, the need to establish paternity became as much an economic issue as a moral one. In modern cultures, paternity testing is used primarily to establish whether or not a man is responsible for providing financial support to a child, as well as determining whether the child carries any of the father’s genetic predispositions for health challenges.

Physical appearance – In more primitive cultures (some of which continue to flourish), the objectives behind determining the paternity of a child were culturally and/or emotionally based. If a child was born who lacked identifying characteristics of either parent, it was frequently assumed that the father was someone other than the woman’s mate. The repercussions to the mother were quite severe, often culminating in her death. Unfortunately – especially for the women – the comparison of obvious physical traits was highly subjective, and many women suffered dire consequences, even if their husband/mate was indeed the biological father.

Blood typing – With the early 20th century discovery that different individuals had different blood types, and the recognition in the 1920s that those blood types were genetically inherited, a more accurate means of determining paternity came into common use. It was discovered that by comparing the parents’ blood types, it was possible to determine the most likely blood type of the child. While this was admittedly a step above the “he has his father’s eyes” paternity test, it was still only about 30% accurate.

Serological testing – It was discovered in the 1930s that specific proteins not considered during blood typing could establish the presence of genetically inherited antigens that would more accurately identify the child’s biological father. Unfortunately, serological testing only improved the accuracy of paternity testing to about 40%. Hardly conclusive evidence.

Tissue typing – In the 1970s, the human leukocyte antigen (HLA) was discovered in abundance within white blood cells. When samples of this genetically inherited antigen taken from the mother and child were compared to the sample taken from the father, paternity could be established with roughly 80% accuracy. While this was a significant improvement over previous methods, the collection procedure itself was unpleasant, and the size of the sample required made it hazardous to the child, particularly if the child was less than six months old. Obviously, more work needed to be done.

DNA testing (RFLP) – In the 1980s, the technique called restriction fragment length polymorphism (RFLP) was discovered that looked at a significantly wider spectrum of variables in the blood than had been analyzed with earlier techniques. It was discovered that the offspring of two parents would have half the unique characteristics of each parent. This technique elevated the accuracy of paternity testing to the level of statistical certainty. Unfortunately, the amount of blood required for accurate sampling was, like tissue sampling, large, posing potential problems for the child. In addition, the potential for genetic mutations in the child could render a false negative, indicating that neither the woman or the man was the child’s biological parents. For these reasons, RFLP testing has been all but abandoned.

DNA Testing (PCR) – By the 1990s, the RFLP testing was replaced by the polymerase chain reaction (PCR) technique. This technique involves the computerized replication of DNA collected from even a minuscule sample that is collected anywhere on the individual’s body, then comparing the subjects’ profiles. In addition to requiring a very small sample (typically via an oral swab), the subject is not submitted to discomfort as in earlier test techniques, and the computerized analysis takes far less time, while still providing accuracy at the level of statistical certainty, 99.99%.

Author: Daphne Holmes contributed this guest post. She is a writer from www.ArrestRecords.com and you can reach her at daphneholmes9@gmail.com.

 

 

Snake Venom For Treating Seizures? On Second Thought

rattlesnake

 

In the dark ages of medicine, meaning anything before 50 to 100 years ago, those afflicted with epilepsy were treated, how shall we say, less than compassionately. They were often thought to be infected by some evil miasma, or possessed by a lurking devil or witch or warlock, or were afflicted with some contagious process. They were isolated from society, feared and shunned by all, and often subjected to horrific treatments – everything from freezing water to cutting holes in the skull to let out the evil spirits (trepanning).

 

trepan

 

This is not an uncommon reaction when people are faced with things that they don’t understand. And 100 years ago the medical profession actually understood very little.

A case in point would be Philadelphia physician Dr. Ralph Spangler who suggested that rattlesnake venom, which interestingly he had been using to treat tuberculosis (go figure), might be useful in treating epilepsy. He published an article about a Texas man who had been bitten by a rattlesnake and subsequently the epileptic seizures that had plagued him suddenly ceased. In this empirical observation of a single case he jumped to the profound conclusion that snake venom cures seizures. Thankfully cooler heads prevailed and other physicians pointed out that snake venom not only didn’t, and couldn’t, help epilepsy but rather frequently caused allergic reactions as well as hemolytic destruction of the blood. Not pretty.

The history of medicine is replete with such examples.

 

Is “Real” Artificial Blood On the Horizon?

red-blood-cells

 

Blood is indeed the river of life. It carries oxygen and nutrients to all the cells of the body and removes toxic byproducts to keep everything clean and healthy. The cardiovascular system is a closed system in that it constantly recirculates, and like submarines, leaks from the system can be disastrous, and deadly. Blood is also a living, biological material and this makes it very difficult to handle. It must be taken from a living person, treated to prevent clotting, and stored in a manner that prevents decay. The logistics of this are very difficult, particularly when blood is needed in places such as war zones, very remote areas, and even in space. If someone is severely injured and in danger of exsanguinating – – the $10 word for “bleeding to death” – – then rapidly replacing this loss blood is essential. IV fluids and plasma expanders and other assorted intravenous materials can be given to buy time, to keep the volume in the system to an adequate level, and to keep everything circulating, but these materials have a major drawback – – they don’t carry oxygen. So the only life-saving remedy is to replace the blood.

Over the years there have been many attempts to develop artificial blood, a product that would carry oxygen and be logistically more friendly. Something that did not require anticoagulation, refrigeration, and care in its transport and storage. Something that could be carried and stored like a bottle of water. Many of these endeavors have proven to be unsuccessful.

Blood substitutes have traditionally been based on hemoglobin, the oxygen-carrying molecule within the red blood cells (RBCs). Products such as HemoPure (made from bovine hemoglobin), PolyHeme (made from outdated human blood), and HemAssist (based on cross-linked hemoglobin) all seemed promising but safety issues arose with each and these have not been completely resolved.

Other forms of “artificial blood” have been based on perfluorocarbon emulsions. These too have faced many problems.

Another problem with blood therapy is keeping a steady and safe supply. There are only so many donors and the blood’s shelf-life is not all that long. If blood could be manufactured so that an adequate and steady supply could be maintained, this would be a giant step forward.

Well, now it seems that manufactured truly artificial blood might be on the horizon. A group at the University of Edinburgh is beginning clinical trials on a process for making red blood cells from stem cells. Since these would be “real” RBCs, the technique holds promise.

 
2 Comments

Posted by on April 30, 2014 in Medical History, Medical Issues

 

Guest Blogger: Eleanor Sullivan: Herbalism: Scientific or Sorcery?

Ever wonder what people used to cure old-fashioned ills? Before penicillin?

Plants, that’s what.

 

plant-images4-150x150[1]

 

Recently, I had the opportunity to meet a practicing herbalist in Minneapolis, a young woman with a quick smile and quicker wit. Lise Wolff opened my eyes to a different health care world. (For those who don’t know, I’m a nurse turned author.)

From pre-historic times to today, herbal remedies have been used to treat human ills. Often they were the only treatments available. Our existence is testament to their effectiveness. Scoffed at by medical men (yes, they were all men), herbalists and their close cousins, homeopaths, nevertheless persisted. What was known as mainstream medicine at that time, however, would be unrecognizable by today’s practitioners. Purging, puking, and bleeding as well as dosing with heavy metals, such as mercury, harmed more often than cured, their unwary patients. (See Medical Care in the 19th Century-Part One and Part Two for more on this era’s archaic practices.)

 

medicine-box[1]

 

Herbal Remedies

Herbs can be collected in the wild or cultivated in gardens. Most remedies are derived from the leaves that are harvested at the peak of their effectiveness, but sometimes the stems, roots, or early shoots prove more useful. Leaves may be dried and used in teas or combined with starch or lard for poultices. Plant parts may be soaked in water or oil, and the solutions used in tinctures, decoctions, essential oils, salves, or ointments. I watched Lise melt beeswax and combine it with St. John’s wort solution that she poured into metal cups, left to solidify and use as an ointment to treat burns, sores, and cracked lips.

In the 19th century women, often midwives, treated ill family members and neighbors with herbs, a practice passed down through generations. Realism meets fiction as Adelaide, the protagonist in my Singular Village Mystery series, works as both a midwife and herbalist in 1830s Zoar, Ohio.

Doctrine of Signatures

After famously burning classic medical texts, 16th century German physician Paracelsus declared that plants resembling human body parts could cure ails in that organ, a concept that became known as the doctrine of signatures. Thus, “like treats like.” For example, St. John’s wort doelike shape renders it perfect for treating skin wounds.

Homeopathy

Similarly, Samuel Hahneman, a 19th century German physician, agreed that like treated like but took treatments one step further, diluting substances over and over until it appeared that nothing of the original substance remained. These dilute substances, however, proved remarkably effective. The practice became known as homeopathy.

In fact, homeopathy was practiced in 19th century Zoar. Here’s a photo of a medicine box of homeopathic remedies found in Zoar’s historic artifacts.

The medical community today would argue that neither herbal remedies nor homeopathy are scientifically proven to be effective. Regardless, patients dissatisfied with mainstream medicine, often turn to alternative practitioners, such as herbalists. Medical practice is continually evolving as new remedies and treatments emerge and others decline. Might chemotherapy be deemed archaic 200 years from now?

Eleanor Sullivan: http://www.eleanorsullivan.com

Watch as Adelaide confronts problem illnesses and birthings (along with solving a murder!) in the next Singular Village Mystery: Graven Images, due September 1st!

 

Graven Images cover.indd

 

Q and A: What Potentially Fatal Disease Could My Young Female Character Suffer From in 1955?

Q: I have been browsing through FORENSICS AND FICTION but do not see the perfect solution for my story. In my WIP, set in 1955 St. Louis, a 10 year old girl has a medical problem which is difficult to diagnose. She has been living on the streets but is rescued by an older woman who takes her for medical help. Once the doctor determines the problem, he recommends treatment. Trouble is, the only place for treatment is California, so they must take a road trip. (I want it to be CA because I want them to travel on Route 66)

At first, I considered exposure to sewer gas as a good diagnosis. But once she got out of the sewers she would get well. That won’t do. I’m thinking it must be an autoimmune disease or a parasitic or unusual infectious disease. Can you think of a fatal disease in those categories which would have had cutting edge treatment being done experimentally in CA in the 50s?

Catherine Leggitt, Author, Inspirational Speaker

www.catherineleggitt.com

A: As you pointed out, sewer gas wouldn’t work since once your young lady was free of the environment its effects quickly reverse. I would suggest leukemia. In 1955, acute leukemia in a child that age was common, there was no treatment, and most sufferers died. The mortality remained around 90% for many types of leukemia until well into the 1970s. It could be months or many years between first becoming ill and dying, but death was almost inevitable in 1950s. The timeline would depend on how aggressive the particular leukemia was and how well your child handled it. But medicine could do very little.

In leukemia, white blood cells (WBCs) are overproduced by the bone marrow. These cells are abnormal in that they don’t fight diseases as do normal WBCs. This would leave the child susceptible to infections such as pneumonia, urinary tract infections, even the flu. Each bout of any of these could be weathered with antibiotics—penicillin and sulfa drugs were around in 1955—or she could die from any of these diseases.

Leukemia Cells are seen here as large and purple; the smaller pale red ones are RBCs

Leukemia Cells are seen here as large and purple; the smaller pale red ones are RBCs

As the WBCs increase in the bone marrow they literally “squeeze out” the marrow cells that make red blood cells (RBCs) and platelets. Low RBCs we call anemia and here she would be fatigued, short of breath with activity, and her physical abilities would be limited by these factors. She might appear pale and take on the look of someone who is chronically fatigued, which she would be. Platelets are involved in blood clotting so with low platelets she would bleed easily, with even the most minor trauma. She could easily have episodic nose bleeds and would bruise very easily.

Most leukemia victims suffered all three of these derangements–high but abnormal WBCs, low RBCs, and low platelets–so your girl could have any of the above symptoms, in any combination, and in any degree of severity.

Since there were no effective treatments in 1955, patients and parents sought all kinds of treatments. Herbs, electrical current, tonics of all types (most of which were alcohol based), faith healers, and almost anything you can think of. Your young girl could easily be referred to someone “out in California” by her local St. Louis doctor.

This should give you a lot to work with for your story.

Google Leukemia and you will find many sources but remember that things are much different now than in 1955. Here are a couple of links to get started:

http://serc.carleton.edu/woburn/overarching/leuk_treatment.html 

http://www.nature.com/leu/journal/v15/n4/full/2402065a.html

 
7 Comments

Posted by on February 20, 2013 in Medical History, Medical Issues

 

Quacks Are Everywhere and Have Been For a Long time

One of the things I like about reading the Journal of the American Medical Association (JAMA) is the section on articles published in the Journal 100 years ago. In November of this year an interesting article that was published on November 9, 1912 was republished. There was titled “Telepathic Diagnosis!”

It seems that Dr. J. A. Quackenbos uncovered the story of a telepathic Belgian woman who apparently had the power to diagnose diseases from afar. It seems to perform her magic she must be put into a quasi-trance by hypnosis and from there she can psychically travel to the afflicted person and look inside them and determine what their medical problem might be. Wow. Wish I could do that. It would’ve saved me countless hours of head scratching and worry over the past 40 years.

Patent Meds

Patent Medicines

At first glance you might think that Dr. Quackenbos is the origin of the term quack. But that’s not the case. It actually comes from the old Dutch word kwakzalver, which means  a person who chatters or prattles. From that the word quack, which means someone who fraudulently pretends to have medical skills that are not real, evolved. Quacks have been with us throughout history from the ancient patent medicine and snake oil salesman to the modern day manufacturers of pills and tonics and potions that are supposed to cure everything from schizophrenia to diabetes. Is all PT Barnum supposedly said, “There’s a sucker born every minute.”

 

PT Barnum and Tom Thumb

PT Barnum and Tom Thumb

 

 
5 Comments

Posted by on December 5, 2012 in Medical History, Medical Issues

 

Nightmare Sperm Donation

It seems that a Danish sperm donation facility failed to determine that one of its donors had an uncommon genetic disorder and might have passed it along to several of his “offspring.” The usual screening apparently failed to uncover the genetic markers for the disorder and as many as five children might have “inherited” the abnormal genes.

The disease in question is called Neurofibromatosis Type 1, or Von Recklinghausen’s Disease. It is characterized by multiple types of neurological tumors and cafe-au-lait spots–patches of light brown pigmentation whose color is reminiscent of coffee with milk.

 

Severe Neurofibromatosis

Severe Neurofibromatosis

 

Cafe au lait spots (black arrows) and a Neurofibroma (white arrow)

 

Though controversial, and over the years other diagnoses have been entertained, this might be the disorder that afflicted Joseph Merrick, The Elephant Man.

 

Joseph Merrick, The Elephant Man

 

A medical nightmare for these children and their families.

 

 
 

How Could My Time-traveling Physician Save the Life of My 15th Century Heroine With a Blood Transfusion?

Q: I am writing a time travel where one of the characters is a modern doctor who is sent back in time (15th century) with his family. I want to have him do something medical to save the life of the heroine (I was thinking heroine needs blood transfusion which would require a blood typing system) Any idea how it could be accomplished? I was also thinking that the heroine has rare blood type. Would that be Type B?

Doreen Jensen, Ontario, Canada

A: This is an interesting scenario in that you have someone with modern knowledge transported back to medieval times. This means he would have all the medical knowledge of transfusions––which of course did not exist then––but no scientific equipment to help. Not to mention that merely bringing it up might get him killed by the church––but that’s another issue.

The first human transfusion took place in France in 1667 when Jean-Baptiste Denis successfully transfused sheep blood into a fifteen year old boy. The first human to human transfusion was in 1818 and was performed by James Blundell on a patient suffering from postpartum bleeding. Even he had no way of matching the blood and, in fact, didn’t understand that there were blood proteins that made transfusions incompatible between many people and successful between others. It wasn’t until 1901 that Karl Landsteiner discovered the ABO blood groups and begin to understand the nature of transfusions and transfusion reactions. In 1939, the Rh factor was discovered, also by Landsteiner along with several other physicians, thus refining the process further.

So your time-traveling doctor would know all of this and would also know that transfusions are only successful if the donor and recipient match one another as far as blood type is concerned. But he would have no way of testing the donor and recipient for blood type and compatibility, which of course is essential to avoid harming or killing the recipient. But, there is a way around this. He would know that two compatible bloods could be mixed and no reaction would occur while if they were not compatible clumps would form. We call this agglutination and it is the basis of a transfusion reaction. He could simply mix the blood of the donor with that of the recipient––which is more or less the way it’s done today––and look for this reaction. The problem? This agglutination can only be seen microscopically and there were no microscopes in the 15th century.

The microscope was discovered in 1590 by two Dutch spectacle makers–Zacharias Janssen and his son Hans. They employed the glass lenses they used in their spectacle making, which had been around since the 13th century. When they placed these lenses in tubes, they discovered that they magnified any image viewed through the tube. This was the precursor of the true microscope which was developed nearly 70 years later (1660s) by Anton van Leeuwenhoek. So, your modern physician would know this and could perhaps fashion his own crude microscope from spectacle lenses. This would allow him to see any agglutination that might occur. He could then simply take the recipient’s blood and test it against several potential donors and see which one had the least reaction. This would be crude cross matching but it could work. He would then know whose blood to use in the transfusion process.

 

Q and A: Do Tight Corsets Cause Medical Problems?

Q: In my story, set in 1908 in Toronto, a 35 year-old women who has been using corsets strenuously for many years (perhaps for 20) suffers the ill effects of the tight lacing common at that time. I want the effects to be sudden and dramatic, to threaten her within an inch of her life, or kill her. However the result, she is rushed to the hospital and doctors try to save her. In the weeks leading up to the emergency event where it is discovered that the effects of the corset on her skeleton and her organs is the cause of the medical crisis, her face is showing the effects of the impending crisis. When the emergency occurs, her dress is torn off and the medical effects, or at least their exterior consequences, are revealed. One of the problems may be that she tied the corset in such a way that it flattered her figure as much as possible (the ‘wasp waist’) but that had dire bodily effects.

Whitney Smith, London, England
http://www.whitneysmith.ca

 

A: Medical problems with corsets are exceedingly rare but there are a few things that could happen. If the corset was so tight that it fractured a rib, it could puncture and collapse a lung––we call this a pneumothorax. Though this is not typically lethal, in 1908 it very easily could have been. Now we treat these with chest tubes—plastic tubes inserted through the chest wall into the space between the lung and the chest wall. The tube is attached to a suction device and left in place for a few days until the lung heals and re-inflates. These weren’t available in 1908.

Also a tight corset can restrict breathing so that the person does not take a deep breath for extended periods of time. This can lead to areas where the lung tissue collapses––we call this atelectasis. This can serve as a location for pneumonia to develop, which could be lethal, particularly in 1908 as there were no antibiotics available to treat this.

The binding effect of the corset could also cause chronic gastroesophogeal reflux, where acids are constantly pushed up into the esophagus. This happens in people who overeat and go to bed and then wake up with heartburn. With a corset this external pressure will keep pressing on the stomach and pushing the undigested food and acids up in the esophagus. This can lead to esophagitis––an inflammation of the esophagus. This in turn can lead to bleeding, which could result in death.

If the corset was extremely tight and the victim moved in certain positions, she could damage internal organs such as the spleen, liver, or bowel. The spleen, which sits in the left upper part of the abdomen, is particularly vulnerable to this type of injury. It is often injured in motorcycle and bicycle accidents and could be injured by a corset if the victim bent over suddenly. A ruptured spleen, liver, or bowel often causes severe internal bleeding that can be deadly.

Corsets can also cause a reduction in blood return to the heart through the major veins of the abdomen and lead to dizziness and fainting. Here the victim could fall down stairs or strike her head on the floor or furniture, leading to death from bleeding into and around the brain.

Your lady could also survive any of these events. If she had a collapsed lung, it could heal itself and she could do fine. If she contracted pneumonia, she could survive even without antibiotics. If she had a bleed from esophagitis, the bleed itself could stop on its own and she could do fine. If she ruptured an internal organ, surgery could be performed to repair the injured organ or, in the case of a ruptured spleen, to remove the spleen––the spleen is almost never repaired but rather is removed when damaged. We do not need it to survive and it’s very difficult to repair. If she struck her head and suffered bleeding into or around her brain, she could be unconscious for a few hours or a few days and yet survive even though there was no real medical treatment at that time for this type of injury. With a bleed around the brain–called a subdural hematoma–the one technique your 1908 doctor could employ would be the placement of what we call Burr holes (trepanning). This is simply opening a hole in the skull with a drill or similar device, which allows the doctor to remove the clot and relieve the pressure that builds in the brain with this type of injury. If a secondary infection didn’t arise your young lady could survive even this event.

This should give you several options for your story.

 
 

Black Death Bug Identified–Again

Ring around the rosies,
A pocket full of posies,
Achoo! Achoo!
We all fall down.

This innocent sounding nursery rhyme dates to the Black Death and underscores the effects and forms of this disease. Bubonic Plague caused swollen and necrotic lymph nodes, called buboes, and a circular pinkish rash (the ring of the rosies). Placing flowers  (posies) in your pocket was supposed to ward off the bad air, or evil spirits, or whatever your belief of choice for the cause of the disease. Of course, this didn’t work. When it progressed to Pneumonic Plague, where the victim coughed, sneezed, became short of breath, and coughed up blood, death followed very quickly (all fall down).


The Black Death was a human disaster of catastrophic proportions. Though estimates vary, when it struck Europe between 1348 and 1350, it killed 30-60% of the population and probably reduced the world population from approximately 450 million to 350 million. It disrupted travel and trade, set one village against another, and shook the foundations of medicine and religion. No one knew what caused it and prevention and treatment were mysteries. Nothing worked. No medicine or prayer or ceremony slowed its march or relieved those afflicted. If neither the medical practitioners nor the clergy of the day could help, then of what use were they?

All the populace could do was to burn or bury the dead, often in mass graves. Mourning, prayer, and fear then followed.

 


The cause of The Plague is the tiny bacterium we call Yersinia Pestis. That was the long held dogma anyway. More recently some have questioned this and have proposed other causes such as the Ebola virus, small pox, typhus, and several other organisms.

But recent studies seem to support dogma. Hendrik Poinar and colleagues at McMaster University in Hamilton, Ontario, recently found a very interesting way to exam the DNA from bones and teeth removed from a plague mass burial pit near London. Their “molecular probe” revealed that the causative agent was our old friend Yersinia Pestis after all.

 
 
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