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Category Archives: Medical History

The Plague—Yes That Plague—Is Alive and Well

Black Death

The Black Death. It hit Europe in the mid 1300s and killed millions—-some say 100 million or between 1/3 and 1/2 of Europe’s population. It changed history. It altered mankind’s view of religion. It disrupted travel and trade. It helped bring on the so-called Dark Ages.

The Black Death marches through Europe

The Black Death marches through Europe

In truth there were several plagues. caused by several different diseases, but the Black Death was especially destructive. Though it has been challenged by some, the Black Death was in all likelihood caused by a nasty little critter called Yersinia Pestis.

But that was centuries ago. Now we know what causes plague and we know how to treat it. It’s passed to humans by bites from infected fleas and can be eradicated with antibiotics. At least in most cases. So like small pox, isn’t it a relic of the past? Not really. The bug is out there and every now and then it raises its head as if to say—-Remember me?

Several cases have cropped in Colorado in the past couple of years, with two recent deaths: high school athlete Taylor Gaes and an as yet unnamed adult. Last year there were other cases of this infection.

And now another case has occurred in California–a child camping in Yosemite National Park.

So the plague is not just of historical significance, but rather is still with us.

I’ve blogged about this before and here are the links to those posts:

https://writersforensicsblog.wordpress.com/2012/02/08/black-death-bug-identified-again/

https://writersforensicsblog.wordpress.com/2009/09/22/the-plague-kills-researcher-maybe/

 
5 Comments

Posted by on August 7, 2015 in Medical History, Medical Issues

 

Q and A: What Happens When a Person Is Exposed to the Vacuum of Space?

Astronaut

Q: What sort of damage does the human body suffer in the vacuum of space?  How long can one survive and what will happen to the person who does survive?  My scenario involves an astronaut whose faceplate blows out, but not before he depressurizes his suit sufficiently to prevent immediate death.

A: First of all the victim would not explode as was the case in the movies such as Total Recall. But some very bad things do happen internally and they happen very quickly. Whether he depressurizes somewhat beforehand or not, his survival once he reached zero pressure (vacuum) would likely be measured in seconds.

Space decompression sickness is similar to that of a scuba diver that rises too rapidly after a prolonged exposure to the pressures of the deep. In this case the diver is going from excess pressure to normal pressure. In space the victim goes from normal pressure to zero pressure. Same thing physiologically.

In diving, the problem is that the excess pressure causes excess nitrogen (N) to dissolve in the blood. This N will come back out of the blood as the pressure is reduced. This should happen slowly to prevent decompression sickness or the bends. But, if the diver rises rapidly, the pressure drops rapidly, and the N comes out of the blood quickly, forming N bubbles in the blood stream. This is similar to popping the top on a soft drink. Here the release of the pressure allows the carbon dioxide (CO2), which was placed into the liquid under pressure, to come out of the liquid and form bubbles. We call this carbonization. A good thing for your soft drink, but not so good for your brain and heart and muscles.

In space decompression basically the same thing happens. Apparently the culprit is water and not N in this situation, however. With the sudden release of pressure, the water in the blood “boils,” becoming a gas, and bubbles form in the system. I should point out that in chemical and physical terms boiling simply means the changing of a liquid to a gas. This can be accomplished by adding heat (boiling water on a stove) or by lowering the ambient pressure (popping open a soft drink). In the case of space decompression it isn’t that the blood gets hot, but rather that the pressure that keeps the water in its liquid state is removed and the water changes to its gaseous state, or boils. Doesn’t sound very pleasant does it?

Though studies on the effects of exposure to a vacuum have been done on chimpanzees, there are no real data on what happens to humans exposed to zero pressure except for a couple of incidents where an astronaut or a pilot was accidentally exposed. Of course, rapid decompression has caused deaths in both high-altitude flights and in June, 1971 when the Russian spacecraft Soyuz 11 suddenly lost pressure, killing the 3 cosmonauts on board, but survivors are few and far between.

On August 16, 1960, parachutist Joe Kittinger ascended to an altitude of 102,800 feet (19.5 miles) in an open gondola in order to set a world record for high-altitude parachute jumping. He lost pressurization in his right glove but proceeded with his ascent and jump. He experienced pain and loss of function in his hand at high altitude but all returned to normal once he descended via chute to lower altitudes.

In 1965 at NASA’s Manned Spacecraft Center near Houston, TX, a trainee suffered a sudden leak in his spacesuit while in a vacuum chamber. He lost consciousness in 14 seconds, but revived after a few seconds as the chamber was immediately re-pressurized. He suffered no ill effects—due to his very brief exposure—but stated that he could feel water boiling on his tongue. This was actually the above mentioned boiling scenario in which water (in this case saliva) becomes a gas on exposure to zero pressure.

A case of partial, prolonged exposure occurred during an EVA (space walk) in April 1991 on the US space shuttle mission STS-37. One astronaut suffered a 1/8 inch puncture in one glove between the thumb and forefinger. He was unaware of it until later when he noticed a painful red mark on his skin in the exposed area. It appeared that the area bled some but that his blood had clotted and sealed the injury.

So, what happens to a human exposed to zero pressure? Since there is no oxygen in such an environment, loss of consciousness occurs in a matter of seconds. Also, if the victim held his breath (don’t do this during scuba diving when coming up from depths either), the air in his lungs would rapidly expand and his lungs could be damaged, bleed, or rupture. Better to open his mouth and exhale the rapidly expanding gas from his lungs.

Water in his blood stream would immediately begin to “boil,” filling the blood stream with water vapor (the gas form of water) and stopping his heart. Bubbles might appear in the blood stream and cause damage to the body’s organs, particularly the brain. As a result, the brain and nerves cease to function. As more and more gas formed within the body, the entire body would swell but it would not explode.

Exposure to heat or cold or radiation might also occur but it will do little harm since the victim would already be dead.

But what if the exposure were brief and the person rescued? Treatment would be to immediately return him to a pressurized environment and give him 100% oxygen. He may survive unharmed or may have brain and nerve damage which could be permanent.

For your scenario, whether he partially decompressed or not, he would be in trouble very quickly. When your victim’s faceplate ruptured he would hopefully begin to exhale air to prevent the expanding gases in his lungs from rupturing them. As air, and thus oxygen, flowed from his lungs and into space, the oxygen content of his blood would rapidly drop and he would lose consciousness in 10 to 20 seconds. He would then die in short order. If he were quickly rescued, he would be returned to the spacecraft, which would be pressurized, and would be given 100% oxygen via a face mask. He could survive intact or with brain damage. It’s your call. Either way works.

 

Would Lincoln Have Survived With Modern Medical Treatment?

Lincoln 1863

Lincoln’s assassination took place 150 years ago this evening. He died the next day, April 15, 1865. Since he lived overnight, could modern medicine techniques have saved him? Here is a question that appeared in my second Q&A book—FORENSICS AND FICTION

Would Abraham Lincoln Have Survived His Injuries Today?

Q: This is a pure curiosity question. Do you think that Lincoln could have been saved if they had today’s medical knowledge, techniques and equipment in 1864?

Martha Kuhn, Mt. Gilead, Ohio

A: Most likely, yes. He was shot in the back of his head, and the bullet apparently entered his brain. He lived for many hours so the shot was not immediately fatal. A surgeon probed the wound but feared removing the bullet, since it might cause bleeding. He probably should have, but we’ll never know.

Similar wounds today are treated by a trip to the OR, removal of the bullet, controlling bleeding, and preventing any subsequent infection. He would have had at least a 50 percent chance of survival. And since he survived several hours anyway his survival with modern techniques would likely have been much higher.

F&FCover400X580

 
3 Comments

Posted by on April 14, 2015 in Medical History, Medical Issues, Trauma

 

Heartbeats and Art

First a little semantics: Arrhythmia actually means “without rhythm.” So the only true arrhythmia is asystole or cardiac standstill, which means the heart has no rhythm and simply sits there quietly. Not a good thing. Not compatible with life.

The proper term is dysrhythmia, which means an “abnormal rhythm.” There are many different types of these.

Some are slow:

Sinus Brady

Others are fast:

SVT

We all have dysrhythmias but most of us are totally unaware they are happening. Other folks experience palpitations—-an awareness of a cardiac irregularity. These can sometimes be alarming and I regularly see patients in my office with this complaint.

Beethoven

But can your heart’s rhythm effect your creativity? Did a dysrhythmia contribute to Beethoven’s musical prowess? Did Shakespeare’s heart beat in iambic pentameter?

As a cardiologist, I’m not sure I buy into this but it is intriguing:

http://www.medicalnewstoday.com/articles/287809.php

 

Medicine Is Strange: Stone Man Syndrome

f1

Medicine has a lot of very strange disorders in its catalog of maladies.

Fibrodysplasia Ossificans Progressiva (FOP or Stone Man Syndrome) is one of them.

http://thechirurgeonsapprentice.com/2014/12/17/disturbing-disorders-fop-stone-man-syndrome/

 

Q and A: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

wagon_train-2

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

 

Murder By Meme: Slender Man and the Wakefield Anti-Vaccine Hoax

Slender Man

We all know that viral illnesses can kill. Ebola would be an example. So would small pox and the 1918 Flu.

But can an internet viral hoax kill? An interesting article titled “Murder By Meme: Slender Man and the Wakefield Anti-Vax Hoax” by Travis Langley, Ph.D. in Psychology Today looks at this issue.

In June, 2009, Eric Knudsen (aka Victor Surge) posted a pair of black & white photos of groups of children in which he had inserted a thin figure in a black suit into the background. This was the birth of the Slender Man hysteria. It led to the attempted murder of a 12-year-old girl by two of her classmates, also 12. Why would they stab their classmate 19 times? Apparently to serve as “proxies” for The Slender Man and to show that he really existed.

Crazy is as crazy does.

And then there’s the 14-year-old who read about Slender Man and decided she needed to burn down her home—-with her mother and brother inside. Fortunately there were no injuries but the house and family car took a hit.

But such internet hoaxes aren’t confined to the world on teen angst. It has also entered the world of legitimate medicine. And has done great harm.

MMR

Ever seen a case of Whooping Cough? Diphtheria? Probably not. I’ve never seen diphtheria and whooping cough (pertussis) only a couple of times way back during my pediatrics rotation as a junior medical student. The reason these and other childhood diseases such a rubella and mumps are now not so common is a robust and widespread immunization program that has done a stellar job in keeping these illnesses at bay.

Enter Dr. Andrew Wakefield. He apparently created an entirely fraudulent research study that suggested that the MMR (Measles, Mumps, and Rubella) vaccine caused Autism. Based on this scam, allegedly funded by an “ambulance-chasing” law firm, many well-meaning and fearful parents refused to vaccinate their children. This led to outbreaks of these uncommon diseases. Here in my own backyard, Orange County, CA, we had an outbreak of pertussis that could be traced for the most part to a single pediatrician who bought into this “bad science.”

The truth? There is not a single piece of legitimate evidence to suggest that MMR is in any way related to autism.

And Slender Man does not exist.

 
4 Comments

Posted by on October 16, 2014 in Medical History, Medical Issues

 
 
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