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Category Archives: Medical History

What’s the Deal with Typhus?

Ever heard of Typhus? Probably in history class, or something similar. It reared its head many times during the Middle Ages and helped take down Napolean’s Grand Army in 1812. Many believe that as much as one-third of his army succumbed to the disease. It pops up here and there from time to time. Like now. Seems LA has a Typhus problem and it’s centered around City Hall.

Typhus is what we call a Rickettsial disease since it is caused by a bacterium known as Rickettsia typhi—-at least the form that comes from fleas is. A Rickettsial disease you’ve likely heard of is Rocky Mountain Spotted Fever (RMSF). There are several types of Typhus, each caused by a different bacterium and spread by a different vector. Scrub Typhus is carried by mites, Endemic Typhus by lice, and the one that’s affecting LA is Murine Typhus, which is carried to humans by fleas from infected rats.

Flea

When an infected vector bites a human, the bacterium enters the body and spreads. A week or two later the victim will develop fever, chills, and headaches. Sometimes GI symptoms such as nausea, vomiting, and abdominal pain occur. Not unlike a bad flu. Then, a few days later, the rash appears. 

Typhus-murine

If untreated, the disease can cause severe damage to the kidneys, liver, lungs, heart, brain, and can lead to death. But once diagnosed, the treatment is rather easy. The antibiotic doxycycline, sometimes ciprofloxacin, kills the rickettsial bacterium quickly and efficiently.

Right now, LA is treating the infected and trying to figure the best way to clear the rodents and fleas from City Hall. It’ll be a big job.

Typhus Wikipedia: https://en.wikipedia.org/wiki/Typhus

Typhus in LA: http://www.newser.com/story/271086/city-hall-faces-medieval-illness.html

Napolean and Typhus: https://qcurtius.com/2017/07/16/the-victory-of-general-typhus-napoleons-catastrophic-invasion-of-russia/

Typhus WebMD: https://www.webmd.com/a-to-z-guides/what-is-typhus#1

Murine Typhus CDC: https://www.cdc.gov/typhus/murine/index.html

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Posted by on February 11, 2019 in Medical History, Medical Issues

 

Criminal Mischief: The Art and Science of Crime Fiction: Episode 11: Civil War “Limb Pit” and the History of Infectious Diseases

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Criminal Mischief: The Art and Science of Crime Fiction Podcast:https://soundcloud.com/authorsontheair/limb-pits-and-germ-theory

Past Criminal Mischief Podcasts: http://www.dplylemd.com/criminal-mischief.html

Here in the 21st century we know a great deal about infectious diseases. We can treat bacterial infections with antibiotics, immunize people against numerous diseases, understand how viruses work, and have a huge fund of knowledge about surgical sterility and disease prevention. This was not always the case. In fact, in the history of medicine, all of this is fairly new.

During the 14th century, Europeans didn’t understand infectious diseases so when the Bubonic Plague, also known as the Black Death, struck, they had no understanding of what was going on, how to prevent it, and, more importantly, how to treat it. They were at the mercy of a bacterium that currently is easily treatable. The Black Death killed between a third and a half of the population of Europe and dramatically altered the trajectory of world history.

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The transition from ignorance to enlightenment concerning infectious processes was a long process and involved some of the giants of medicine. Names like Ignaz Semmelweis, John Snow, Louis Pasteur, Joseph Lister, and Robert Koch. The observations of these famous scientists were ultimately distilled into Robert Koch’s famous Koch’s Postulates, which proved the Germ Theory of disease. These postulates served as the foundation for our understanding of infectious diseases, and still do today. Simply put they say:

koch_s postulates(1884)

!-If an organism is causing a disease, it must be present in those who suffer from the disease and not in those who are healthy.

2-The suspected organism must be isolated from the diseased individual and grown in culture.

3-The cultured organism must then be given to a healthy individual and reproduce the disease.

4-The organism must then be isolated from this newly diseased individual and identified.

Each of these steps is necessary to show that a particular organism causes a particular disease and is transmissible from one person to another. Basically, this is how infectious diseases work.

Unfortunately, Koch’s Postulates were not put forward until the 1880s, a couple of decades after the Civil War.

During the Civil War, almost any battlefield injury could lead to death, most often from a secondary wound infection. A gunshot to the leg, or arm, or really anywhere could become infected quite easily and this infection could spread through the entire body causing sepsis, which would ultimately lead to death. More soldiers died from infection than from their injuries. Surgeons at that time understood the danger of infections, even though they didn’t know what caused it, and had no clue how to prevent or treat them. This meant that serious limb injuries were treated with amputation. Get rid of the injured limb and hopefully lessen the possibility of a secondary infection. Of course, post-surgical infections were also common and also lead to death.

Not only were sterile techniques and antibiotics unavailable at that time, but also any form of anesthesia was not to be found on most battlefields. Ether was around, having been first demonstrated by William T. G. Morton in 1846, but it’s use and availability wasn’t widespread. This means that a battlefield surgeon’s best skill was speed. Sort of the surgical equivalent of “ripping off the Band-Aid.” Any surgery was agony and the quicker it was done, and the sooner it was over, the better for the victim. And the amputated limbs piled up.

It seems that Virginia’s Manassas National Battlefield Park has yielded what can only be called a “limb pit.” It is a place where surgeons deposited removed limbs. This discovery underlines the state of surgical treatment and its brutal nature during the 1860s.

http://www.newser.com/story/260874/first-civil-war-limb-pit-is-excavated.html

Germ Theory: https://en.wikipedia.org/wiki/Germ_theory_of_disease

Koch’s Postulates: https://en.wikipedia.org/wiki/Koch%27s_postulates

Joseph Lister: https://en.wikipedia.org/wiki/Joseph_Lister

Ignaz Semmelseis: https://en.wikipedia.org/wiki/Ignaz_Semmelweis

John Snow: https://en.wikipedia.org/wiki/John_Snow

Louis Pasteur: https://en.wikipedia.org/wiki/Louis_Pasteur

William T.G. Morton: https://en.wikipedia.org/wiki/William_T._G._Morton

History of General Anesthesia: https://en.wikipedia.org/wiki/History_of_general_anesthesia

 

Cancer Isn’t a Modern Disease

What is cancer? You know the term and odds are great that you know someone personally who has suffered from a member of this constellation of diseases. But what exactly is it?

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Cancer is basically a genetic disease in that something changes in the DNA inside certain cells and this, in turn, disrupts their normal functions. These changes might result in uncontrolled growth and this can cause problems simply by the tumor’s size and location. The cancerous tissues might obstruct a bowel or a bile duct, or compress brain cells and increase the pressure inside the cranium, or erode into nearby organs of blood vessels. Others changes within these cells might alter their internal workings so that they no longer function as intended or they might produce chemicals or hormones that alter the function of other cells within the body. Cancer comes in many forms.

cancer-cells-growing

What causes cancer? This has been the subject of debate, as well as a tremendous amount of research, for many many years. We have some answers, but there are even more questions. We know that things such as cigarette smoking, exposure to the sun, certain chemicals, and many other things can trigger these genetic changes within cells that can lead to cancers of various types.

Medicine has made tremendous strides in our understanding of cancer and in our methods of early detection, diagnosis, and treatment. There are programs for the early detection of breast and colon cancer and newer treatment protocols have revolutionized the approach to these malignancies. The progress in leukemia and lymphoma treatment, as compared to when I was in medical school, has been nothing short of astounding. 

We often think of cancer as a modern scourge, but cancer is not a new disease. Not by a long shot. It’s been around for many centuries. Evidence for cancers have been found in Egyptian mummies and a recent report from Live Science underscores that.

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Did “Tourista” Kill the Aztecs?

Many people who travel to other countries end up suffering from Tourista, or Traveler’s Diarrhea, a gastrointestinal upset that is manifested by diarrhea and sometimes nausea and vomiting. It’s due in many cases to E. coli, which is found everywhere. Various regions will have different strains of E. coli. Residents of the area are able to live quite compatibly with it. The problem arises when you travel to a new area and are exposed to a different strain. Until the body readjusts to this foreign strain, gastrointestinal symptoms can occur. Usually, this is mild and inconvenient and after a few days everything settles down and life goes on.

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Not so with the Aztecs. In 1545, an epidemic swept through the Aztec nation killing millions, perhaps as much as 80% of the population. Twenty years earlier an epidemic of smallpox had come through and damaged the population and 20 years later another epidemic swept through killing another huge portion of the population. There have been many infectious processes indicted for the 1545 plague, which the Aztecs called cocoliztli. Smallpox, measles, mumps, and various other infectious entities have been blamed for this. But what if it was actually a gastrointestinal bacterium that did the damage?

The symptoms the victims suffered seem to have been gastrointestinal. Apparently, there was bleeding, vomiting, diarrhea, and splotches on the skin. These symptoms and signs suggest a form of enteritis and that’s exactly what the bacterium salmonella does.

New evidence suggests that it might be a strain of salmonella that caused this problem, in particular, salmonella Paratyphi C. Genetic research using DNA obtained from the teeth of those who succumbed to the epidemic indicate that this might be the case. Where it came from is another question. Did it come with the influx of Europeans? Or perhaps extend south from northern Mexico? This is still being debated and researched but it does appear that salmonella may have been the culprit in the epidemic that destroyed the Aztec Empire.

Salmonella has been responsible for other public health crises, one of the most famous being Mary Mallon, aka  Typhoid Mary. In this situation, the type of salmonella was salmonella typhi, which causes typhoid fever.

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The Mystery of Chopin’s Heart

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Did Frederic Chopin die from Tubercular Pericarditis? And what the heck is that anyway?

Pericarditis is an inflammation has occurred of the pericardium, the sac that contains the heart. Most often it is due to a viral infection but there are many others causes. One of the worst is tuberculosis (TB).

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Tubercular Thickening of the Pericardium

 

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X-Ray Showing Thickened Pericardium
(White ring around heart shadow)

Tuberculosis has wreaked havoc in humans for centuries. It has been found in Egyptian mummies and has devastated entire populations. Treatment didn’t appear until the 20th century and in recent years new, more malignant forms have appeared. Even after several millennia, it remains a difficult medical problem.

It attacks the lungs and slowly destroys the tissues, leading to cough, fatigue, weight loss, and muscle wasting—-the reason it was called “the consumption.” It, at times, literally consumed the sufferer.

When it spreads to the heart, particularly the pericardium, it can quickly become deadly. A thick viscous fluid collects in the pericardial sac, compresses the heart, and interferes with its function as a pump. This fluid can also solidify into a leathery trap around the heart so that even survivors of the initial infection can suffer severe, long-term problems that we term constrictive pericarditis—-the encasement restricts cardiac filling and thus effects pumping.

Recent studies suggest that this is what happened to Chopin. His heart took a strange and convoluted journey. He had requested that at his death that his heart be removed and returned to his native Warsaw, Poland. When he died in Paris in 1849, his heart was indeed removed, placed in a crystal jar, and encased in a stone pillar at the Holy Cross Church in Warsaw. In a recent examination, researchers found evidence that suggested he had suffered from TB pericarditis.

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Holy Cross Church

 

Burking Still Lives After 200 Years

Asphyxia is the interruption of oxygen (O2) supply to the body, particularly the brain. Normally, air contains O2 and, when breathed in, it passes into the blood, using hemoglobin as a transport molecule, where it is distributed to the tissues. Any interruption of this delivery chain can lead to death from asphyxia.

The air might be deficient in oxygen such as at high altitude or when another gas such as carbon dioxide (CO2) accumulates, depressing the O2 content to dangerous levels. Or flow into the mouth and nose could be restricted by smothering, choking, or strangulation, or by anything that restricts the expansion of the chest. Or the inhaled air could contain a toxin such as carbon monoxide (CO) or cyanide (CN), and these, in turn, interfere with O2 delivery to the tissues.

Burking is the term applied to asphyxial deaths that result from someone sitting on another in a fashion that restricts breathing. The victim dies from asphyxia. This is a form of Mechanical Asphyxia, where the movement of the chest wall is restricted to the point that breathing isn’t possible. Burking refers to the famous case of Burke and Hare.

 

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From FORENSICS FOR DUMMIES:

Applying Pressure: Mechanical Asphyxia

Mechanical asphyxia results when some external force applied to the body prevents the expansion of the chest and leaves the victim unable to breathe. A person trapped beneath a heavy object, such as a car or a collapsed wall or ceiling, can die because the force of the external pressure prevents the victim from taking in a breath.

A boa constrictor kills in exactly this way. This muscular species of snake wraps itself around its prey. Each time the prey exhales, the snake coils a little tighter. So, each successive breath becomes increasingly shallower until the prey can’t take another breath. Death follows quickly.

 

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Suffocation by “Burking” 

Experts have come to know a particular form of mechanical suffocation as Burking. William Burke was a merchant of sorts around Edinburgh, Scotland, in the early 1800s. In 1827, he hooked up with William Hare, who ran a beggars hotel in the village of Tanners Close. In December of that year, a resident of the hotel died, and Burke arranged to sell the body to a Dr. Knox, who needed corpses for his dissection demonstrations. Burke and Hare loaded a coffin with bark and buried it in front of many witnesses. They then delivered the body to Dr. Knox and received seven pounds and ten shillings. The men struck an arrangement whereby Burke and Hare would deliver the doctor more bodies for eight pounds in summer and ten in winter. (Apparently grave robbing was more difficult when the ground was cold.)

Burke and Hare began digging up fresh corpses for their new enterprise, but the local populace refused to die fast enough for the greedy men. They began kidnapping and killing people who were not likely to be missed. Burke sat on his victims, holding their mouths and noses closed until they suffocated, after which Burke and Hare delivered the corpse and collected their fee.

A lodger at the hotel notified authorities when she discovered the sixteenth and last victim beneath a bed. Police arrested the two men. Hare then cut a deal and testified against Burke. Burke was convicted and experienced asphyxia for himself when he was hanged on January 28, 1829, an event attended by as many as 40,000 people.

 

Burking is alive nearly 200 years later. It seems that 325-pound woman sat on her 9-year-old cousin to punish her for some indiscretion. Unfortunately, the child died from mechanical asphyxia—-“Burking.”

 

What Killed the Aztecs? Lessons From Typhoid Mary.

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History tells us that in 1519 Hernando Cortes reached the shores of Mexico where he encountered the Aztecs. It has been estimated that around 25 million Aztecs existed at that time. But the arrival of the conquistadors changed everything. History also indicates that two epidemics, one in the 1540s and the other in the 1570s, crippled, essentially destroyed, the Aztec Empire. It is estimated that 10 to 20,000,000 Aztecs succumbed to some form of infectious process.

The Aztecs called these epidemics cocoliztli, their word for pestilence. Historians have long argued about what caused this horrific outbreak. At various times, researchers have suggested that the culprit was measles, mumps, smallpox, and several other disorders.

It’s important to note that epidemics of this size occur when an organism is introduced into a population that has no immunity to it. The Aztecs had never confronted such infectious agents and therefore had no individual or community resistance. The same thing happened in Europe when the Plague made its appearance. The most famous of these epidemics we call The Black Death. It killed millions and changed history. Same was true for the Aztecs.

But what exactly happened?

A new study suggests that the pathogen responsible just might be Salmonella, specifically S. Paratyphi C. DNA analysis indicates that this organism can be traced back to Europe and might indeed have traveled in the bodies of the conquistadors and infected the unprotected Aztec population. More research is needed but this is an intriguing development.

You’ve heard of salmonella I’m sure. It’s occasionally picked up in contaminated food and water by travelers to foreign countries and on some occasions. it can become a devastating illness and can even be deadly. A famous US epidemic occurred in the early 1900s when Mary Mallon, a healthy carrier of the organism and a cook, spread typhoid to numerous people. She became known as Typhoid Mary and her story is very interesting. Typhoid is caused by the organism Salmonella typhi, which places it in the same family as the organism that might have taken down the Aztec Empire.

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TYPHOID MARY

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6 Comments

Posted by on September 28, 2017 in Cause & Manner of Death, Medical History

 
 
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