CPP Curiosities: Ted Williams and Cryogenics

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Greetings, medico-historico aficionados, and welcome to the latest installment of CPP Curiosities, our semi-regular foray into weird and interesting chapters in medical history. Past articles have addressed treating syphilis by infecting patients with malaria, a fake Persian mummy who may have been a real murder victim, and graverobbing on top of graverobbing.

The leaves are changing, people are gearing up for Halloween and the subsequent two-month mad dash to the holiday season (only 75 more shopping days until Christmas, everyone!). We are in the midst of an annual American tradition: Major League Baseball’s postseason. The road to the World Series is heating up, and even though our hometown Philadelphia Phillies have long since been eliminated from playoff contention (sometime around the July All-Star break if my memory serves) there are many ball fans of more successful teams who are excited. In the spirit of the postseason, I thought we’d dive into a topic that marries both baseball and weird medical history. With that in mind, read on to learn about possible life after death, the science (or lack thereof) of human preservation, and one of the greatest hitters in baseball history.

Cryonics

Some of you may have heard of cryogenics. Also known as cryonics, cryogenesis, or cryopreservation, it is the practice of having all or part of a person’s body stored at sub-zero temperatures. The ultimate goal, in theory, is they can eventually be thawed and revived. Its medical applications generally involve freezing a patient with an incurable disease or traumatic injury in the hopes that future medical/scientific advances can heal them or that technology advances enough to allow human consciousness to be transferred from the body to another vessel (i.e. preserved and stored electronically). Conceptually, the idea of placing a person in suspended animation, by freezing or otherwise, has a long history in fiction, from Shakespeare’s Romeo & Juliet to Mark Twain’s A Connecticut Yankee in King Arthur’s Court, to Philip K. Dick’s novel Ubik to Matt Groening’s Futurama. However, modern attempts to bring the concept off the page and screen date and into the real world back to the 1950s. While academic articles circulated in the 1940s and 1950s, the first work on the subject directed at a mass audience was Robert Ettinger’s 1964 book The Prospect of Immortality, a treatise on the scientific feasibility of human cryopreservation. His work led to public interest in the practice and several entrepreneurial enterprises. The first attempt to preserve a body via freezing occurred in April 1966, when Cryocare Corporation froze a recently-deceased elderly woman from California. The following year, on January 12, 1967, technicians froze deceased psychology professor James Bedford (cryonics enthusiasts celebrate January 12 as “Bedford Day”).

As described in a pro-cryonics journal, advocates for the scientific feasibility of cryonics cite four principles: (1) metabolic function is arrested in bodies preserved under sufficiently low temperatures, thus allowing them to be effectively preserved indefinitely; (2) the use of specialized chemicals can reduce or prevent the risk of damage to the body when frozen; (3) biological death, as opposed to legal death, is a process not an event; and (4) future scientific/technical methods could potentially allow cryogenically preserved people to be revived.

In the case of modern cryopreservation, after physicians establish time-of-death, representatives from a cryopreservation group or one of its subsidiaries preserve the body for transit to a cryonics facility. The body is placed in an ice water bath and attached to devices designed to maintain blood flow and respiration (to minimize deterioration) until the body reaches its destination. When it arrives, blood is replaced with a specialized solution designed to protect the body from damage while freezing. If only the patient’s head is being preserved (described in the business as neurocryopreservation or simply “neuro”), technicians remove it from the body. The body or head is then placed into a storage container called a “dewar” and frozen with liquid nitrogen, remaining in a frozen state until science catches up with science fiction (More on the procedure here).

Photo of a dewar, a cryogenic container for storing bodies under below-zero temperatures

A Dewar used in cryopreservation
Photo courtesy of Alcor Life Extension Foundation

It may not surprise you to know there are some key challenges to cryopreservation. For one thing, its efficacy is difficult to test. There’s currently no way to revive a cryopreserved patient and it’s difficult (and illegal) to subject human test subjects to a procedure that effectively has a 100% fatality rate. A patient cannot legally be preserved until after they’re dead. Alcor Life Extension Foundation, one of the more prominent cryonics services, concedes cryopreservation on a living subject is legally considered murder or suicide depending on who initiates it. This leaves cryotechnicians with the trouble of curing death in addition to whatever ailment brought about the patient’s end. As a result, cryonics leaves a lot of the work up to future scientists to help finish the job for them. Failure rates and deterioration of specimens are also issues. Modern cryonics facilities claim to make every effort to minimize the amount of deterioration due to extreme temperatures; however, there is a risk. According to a report from Alcor, with the exception of Bedford, every other cryonics patient preserved before 1974 eventually suffered some manner of failure. The general scientific consensus is, while it’s certainly possible to preserve a body under extremely low temperatures for a long period of time, the odds of revival are so low as to invalidate the endeavor. Advocates, meanwhile, retort that even an astronomically small chance of transcending death is better than no chance at all.

An image from the animated series Futurama. Shows a sign reading "Applied Cryogenics: No Power Failures Since 1997 [the seven in 1997 is taped over another number]"

Image Source: 20th Century Fox. Used under fair use.

Another challenge for cryonics enthusiasts: the process is extremely expensive. While companies like Alcor assure that much of the cost can be covered through life insurance, aspiring patients need to be prepared pay between $80,000 and $220,000 (depending on whether they opt for “neuro” or “whole body” plus additional fees) upon the event of their death. According to Alcor, the cost covers the initial procedure, general storage and maintenance as well as a trust patients can access after their reanimation. (A small price to pay for immortality?)

The Strange Case of Ted Williams

Often when one brings up the subject, as was my experience, people often mention Walt Disney. This refers to a persistent (and discredited) myth that the founder of the now-monolithic company responsible for most of our youthful amusement had himself cryogenically frozen following his death in 1966. However, perhaps the most famous person who was actually cryogenically frozen was legendary baseball player Ted Williams.

Theodore Samuel “Ted” Williams (1908-2002) was a longtime outfielder for the Boston Red Sox. During his nineteen-year career, 1939 to 1960 with a brief hiatus in the 1940s to serve in World War II, he was a two-time American League (AL) MVP (Most Valuable Player), a six-time AL batting champion (highest batting average in the league for the season), and an AL All-Star in every season he played. When he retired in 1960, he ranked in the top ten all time in career home runs, batting average, slugging percentage, and RBI (runs batted in). Williams still holds the record for the highest on-base percentage in major league history (full stats). He was a first-ballot Hall of Famer in 1966, and he ranks among one of the greatest baseball players of all time.

Photograph of Ted Williams from 1939

Ted Williams in 1939 (Source: Wikimedia Commons)

Ted Williams died of congestive heart failure on July 5, 2002. Following his death, representatives from Alcor shipped Williams’ body from Florida to their facilities in Scottsdale, AZ. There, technicians separated his head from his body, placing the head and torso in separate Dewars.

His passing and subsequent preservation triggered a bitter legal battle among Williams’ three children over the ultimate fate of his remains. His oldest daughter, Bobby-Joe Ferrell along with several other relatives and family friends, argued Ted Williams’ final wishes were to be cremated. However John Henry and Claudia Williams, his son and youngest daughter, respectively, argued Williams had had a change of heart before his death, opting instead for cryopreservation. John Henry developed an interest in cryonics in the late nineties and reached an agreement with Alcor to have his remains along with his father and sisters’ be preserved and stored at Alcor following their deaths. A legal battle ensued: John Henry asserted his power of attorney over his fathers’ affairs, while Bobby-Joe accused John Henry and Claudia of falsifying a consent form from their father. Eventually, Bobby-Joe allowed her brother and sister to keep Williams frozen on the condition that they not attempt to sell her father’s DNA (perhaps so he could be cloned and attempt to re-break his old hitting records). She also agreed to not publicly discuss Williams’ cryopreservation. In exchange, John-Henry and Claudia agreed to pay Bobby-Joe her share of her inheritance.

There was no shortage of press attention for the salacious details of Williams’ afterlife. It didn’t take long for accounts to circulate that Alcor was mishandling Williams remains. In July 2002, reports came out that his head had to be refrozen after cracks began to appear. In 2009, Larry Johnson, Alcor’s former chief operating officer, published a tell-all book about the company’s most famous tenant; among the more shocking accusations he levied against Alcor was that technicians reportedly hit Williams’s head multiple times with a wrench to jar it loose from a pedestal made out of a tuna can. (It hasn’t been the only scandal surrounding the company. In 1988 rumors circulated former Alcor executive Saul Kent poisoned his mother before cryopreserving her head). Moreover, a series of misfortunes brought his cryogenically-frozen future into jeopardy. An August 2003 article in Sports Illustrated reported John Henry still owed Alcor $110,000; according to Johnson, Alcor executives joked they would send Williams’s thawed body back to his son in a cardboard box.

It isn’t clear how matters were resolved between John Henry and Alcor; when John Henry died of leukemia in 2004, his remains were brought to Alcor for cryopreservation and his father remains there in frozen stasis to this day.

If this grisly story hasn’t satiated your need for accounts of preservation (or lack thereof) of notable figures, you can check out my previous article on the preservation of Vladimir Lenin’s body.

Until next time, catch you on the strange side!

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CPP Curiosities: Kyrie Irving’s Knee Injury

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Welcome to the third and final installment in a series of articles written by students in the Karabots Junior Fellows Program. Previous articles by our students covered nineteenth century mental health and the 1918 influenza pandemic. Today, we’re shifting away from medical history to some current affairs.

On April 8, 2018, the Boston Celtics announced star point guard Kyrie Irving would miss the remainder of the 2018 NBA season following a surgery on his surgically repaired knee. The loss of Irving, the nature of his injury, and his subsequent recovery were highly-publicized topics in the world of sports punditry, and today we’re offering our own hot take. Allow me to introduce Al Ly. Al is a student in the Karabots Program, who is combining his interest in sports medicine with his love of basketball to share his thoughts on Irving’s injury.

Al, the floor is yours!

Cleveland Cavaliers point guard Kyrie Irving goes for a layup against a defender.

Kyrie Irving in 2015 Photo Credit: Erik Drost (Flickr Commons)

During the 2015 NBA Finals, Kyrie Irving, point guard for the Cleveland Cavaliers, fractured his left knee. He underwent a surgical procedure where doctors implanted two screws to keep his kneecap in place. About 2 ½ years later, on March 24, 2018, Irving, traded to the Boston Celtics during free agency, had to undergo additional surgery. Doctors went to remove the tension wire in his left knee, but they noticed that there was an infection. The infection came from the screws he had implanted after the injury in 2015.

The knee is the largest joint in your body. It is made up of bones, cartilage, ligaments, and tendons. The three bones that form the knee joint are the femur, tibia, and patella. Tendons connect the knee bones to the leg muscles that move the knee joint. Three main ligaments provide stability to the knee. The anterior cruciate ligament (ACL) prevents the femur from sliding backwards to the tibia. The posterior cruciate ligament (PCL) prevents the femur from sliding forward to the tibia. The lateral collateral ligaments (LCL) prevents the femur from sliding side to side.

Anatomy of the knee, identifying the major parts of the knee

Anatomy of the Knee
Image Source: Bruce Blausen (Wikimedia Commons)

Your knee works like a door hinge. When you open and close a door hinge, it uses a threaded bolt secured by two nuts at the top and bottom of the hinge called acorn nuts. There is also a piece called a sleeve that protects the threaded bolt. Door plates are also part of the hinge with one connected to the door and the other to the wall. With a human knee, the threaded bolt is your knee and the sleeve is the muscle around the knee. The muscle around your knee is patella ligament and your quadriceps femoris tendon. The door plates are your bones that are around the knee, so every time you open or close a door, it’s like bending your knee. The knee is one of the easiest joints to receive an injury, especially for professional athletes who are running and jumping, and, in some sports, making full contact, on a regular basis.

When a person receives an injury like the one Irving suffered in 2015, doctors support the knee using tension wires and screws; Tension wires hold broken bones in position. When a person receives them, it can cause pain and stiffness and a sense the knee is not the same as it was before the injury. People with knee injuries go through physical therapy to regain movement and can take medication for the pain. Keeping the leg elevated will also reduce pain. In the case of Kyrie Irving, doctors discovered the wires in the Irving’s knee were causing him pain. This can happen if the wires are being knocked around, and he had been knocking them around on the court for 2 ½ years while diving for loose balls, colliding with other players, and falling to the ground.

Doctors successfully removed the two screws that had infected Irving’s knee. His season was over; however, his doctors cleared him to be healthy by training camp next season. It could have been much worse due to the infection. Osteomyelitis is an inflammation of the bone or bone marrow due to an infection caused by bacteria, mycobacteria, or fungi. It affects roughly one out of every 5,000 people. There are multiple ways to treat osteomyelitis, including antibiotics and a procedure where doctors remove unhealthy tissue. During treatment, doctors perform blood tests to monitor for signs of infection and to ensure that the treatment is effective, with follow-up visits roughly every two weeks. It usually takes 6 weeks to recover.

The areas of dead bone are hard to treat because it’s difficult for the body’s white blood cells to fight off the infection. Without adequate blood supply, some parts of the bone may die. According to Dr. Derek Ochiai, orthopedic surgeon at Nirschl Orthopedic Center in Arlington, VA, “We don’t know everything obviously, but when you have an infection with hardware, that has the potential to cede the bone. So the infection goes to the bone, which is called osteomyelitis. That can be really difficult to treat.” Left untreated, the infection could have led to swelling, fever, and life-threatening sepsis, a condition where harmful bacteria or toxins infect the bloodstream. It can also lead to fractures in the infected bone, stunted growth (in children), and gangrene. Gangrene is a condition that occurs when body tissue dies. It’s caused by loss of blood supply due to an underlying illness, injury, or infection. The most commonly affected areas are fingers, toes, and limbs. Gangrene can also occur inside your body and it damages your muscles and organs.

Depictions of gangrene's progress from an 1835 book Source: Historical Medical Library of the College of Physicians of Philadelphia

Depictions of gangrene’s progress from an 1835 book Source: Historical Medical Library of the College of Physicians of Philadelphia

Irving’s surgery attracted a lot of attention from basketball fans and the sports press. In his first public comments following the announcement of Irving’s surgery Celtics head coach Brad Stevens said of Irving, “He’s really disappointed…Obviously, after the initial surgery, the thought was he’d be back in three to six weeks. We thought it would be closer to three than six, the way he was initially progressing. Just one of those things out of his control. But he’s bummed as you can imagine.” The Celtics thought he’d would be back in about a month, but they realized he had a bone infection in his left knee so it took longer than expected. Celtics fans were devastated to hear he would miss the rest of the 2017-2018 season, although the Celtics did manage to reach the Eastern Conference Finals, where they lost to the Cleveland Cavaliers (Irving’s former team).

Thanks, Al. Great job! If you are interested in learning more about medical history from our students, check out the links at the top of the article. Click here to learn more about the different youth programs the College of Physicians of Philadelphia has to offer.

As always, catch you on the strange side!

Sources:

Maloney, Jack. “Kyrie Irving’s knee injury and second story, explained by an orthopedic surgeon.” CBS Sports (April 10, 2018).

Weiss, Jared. “Brad Stevens explains Kyrie Irving bacterial infection knee surgery.” CelticsWire (April 6, 2018).

“What is Osteomyelitis?” Summit Medical Group.  

Zillgitt, Jeff. “Celtics star Kyrie Irving will have another knee surgery and miss the rest of the season.” USA Today (April 5, 2018).

 

CPP Curiosities: Influenza Virus

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Greetings and salutations, fellow historico-medico afficionados, and welcome to another installment of CPP Curiosities, our semi-regular segment on the unusual and interesting aspects of medical history. Today’s issue is the second in a three-part series of guest articles written by students in the Karabots Junior Fellows Program. The KJF Program is a three-year after-school and summer internship for Philadelphia high school students from underserved communities who have an interest in careers in healthcare and medicine. These two wrote these articles as part of a two-week summer internship wherein they worked closely with staff in the Historical Medical Library of the College of Physicians of Philadelphia and conducted original research on a topic of their choice. This time around, Karabots Junior Fellow Cliford Louis is here to inform you about influenza.

The floor is yours, Clif!

Figure 1. “Preparing to Bury City’s Influenza Victims,” Scrapbook of newspaper clippings concerning the influenza epidemic in Philadelphia, 1918-1919.  Call no. Z10d 7.  Historical Medical Library of The College of Physicians of Philadelphia.

On March 11, 1918 at Fort Riley, Kansas,  a soldier reported a fever before breakfast and was later followed by other soldiers with the same complaints. By the end of that week, 500 soldiers were ill and being hospitalized. They were early victims of the infamous Spanish flu. An estimated  675,000 Americans died of influenza during the epidemic, more than all of the wars this century combined, and the disease killed millions worldwide during World War I. At first, scientists considered it a bacterial infection. Nowadays, scientists can confidently describe flu as a virus and explain what it does to the human body once they contain the strain of this virus. 

What is the flu …?

“The influenza virus is a member of the family [Orthomyxoviridae]” (Dehner 23), meaning that the flu is a group of RNA virus. There are three types of influenza: A, B, and C.

  • Type C is considered unimportant because it rarely causes infection.

  • Type B is mildly infectious, but it can cause epidemics.

  • Type A causes the greater threat to humanity; it attacks the respiratory system, and it is highly contagious. 

Figure 2”influenza virus,” Kathmandu Tribune, 12 October 2017. https://kathmandutribune.com/17-people-die-influenza-virus/

The influenza virus is a single stranded RNA virus and normally attacks the epithelial cell. Once the virus reaches the cell, it seizes it to develop new copies of the virus.

“Ultimately the influenza virus destroys any infected cell by destroying the outer layer. The daughter cells that infect adjoining epithelial cells quickly produce many millions of copies of the virus” (Dehner 24). 

This describes the effect of the virus inside of an infected person, and it shows why this epidemic was so deadly. Moreover, the explosive spread and large impact of the virus proves its immense dominance during the time of war. An infected person can transmit the virus to another person through the air by a cough or sneeze.

 

Figure 2 “Red Cross Ambulance Demonstration – Washington DC,” 1918 Historical Image Gallery from the Center For Disease Control And Prevention https://www.cdc.gov/flu/pandemic-resources/1918

Animals such as pigs, waterfowl, seals, horses and whales are considered sources containing the virus; they can catch and transmit the influenza virus to humans.

“Strategies of containment and eradication are impractical because the virus has unquantifiable opportunities for jumping from its natural host to other species, including humans” (Dehner 27).

“To be effective, any response to a pandemic strain must be quick enough to stay ahead of the rapidly transmissible influenza virus, consideration even more important in today’s increasingly interconnected world” (Dehner 196).

Figure 4. Image from “Is the flu shot safe during pregnancy,” The Bump. https://www.thebump.com/a/flu-shot-when-pregnanti

 

Even with current medicine and increasingly powerful technologies, the virus cannot be eliminated in the world; therefore, the CDC recommends yearly flu vaccines for everyone from six months old and older. Flu season is an important time in the world; the recommendation from doctors, nurses and other medical stuff to receive the flu shot is very vital in society. These vaccines creates antibodies, which helps to prevent viruses including the influenza. ‘Influenza pandemics are relatively rare events.’

 Previous history of influenza epidemics around the world over the past century can really help scientists finding a unique vital antidote to eradicate the flu. A lot has been learned about the influenza virus, but there is still plenty to be known and discovered to reach the stage of elimination for the virus.

Sources:

Dehner, George. Influenza A Century of Science and Public Health Response. Pittsburgh, PA: University of Pittsburgh  Press, 2012.

Thanks, Clif! Be sure to check back for our final guest article. Until next time, catch you on the strange side!

CPP Curiosities: Mental Health and “Moral Treatment”

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Greetings and salutations, fellow historico-medico afficionados, and welcome to another installment of CPP Curiosities, our semi-regular segment on the unusual and interesting aspects of medical history. Past articles have covered a variety of topics, from historic treatments for syphilis to the preservation of Lenin’s remains to the Greek and Roman god of medicine.

Today’s issue is the first in a three-part series of guest articles written by students in the Karabots Junior Fellows Program. The KJF Program is a three-year after-school and summer internship for Philadelphia high school students from underserved communities who have an interest in careers in healthcare and medicine. These two wrote these articles as part of a two-week summer internship wherein they worked closely with staff in the Historical Medical Library of the College of Physicians of Philadelphia and conducted original research on a topic of their choice. First up is Yazmeen Robinson, who chose to research “moral treatment,” a 19th century mental health practice.

Take it away, Yazmeen!  –KI

Seven female patients in the "Insane Department" at Philadelphia General Hospital sit around a small table.

“Patients in insane department,” Philadelphia General Hospital Photograph Collection, Historical Medical Library of The College of Physicians of Philadelphia, box 2, photo no. 7

Psychiatric hospitals were built for those who were suffering from mental illness and could somehow recover from it. During the nineteenth-century in the United States, there were new European ideas about the treatment of people who were mentally ill. These ideas were called “moral treatment” which promised treatment for those with mental illness in an asylum. During the 19th century, they thought that by treating the patients more like children rather than an animal, patients would have a better chance at recovering. Treating the patients as individuals and helping them to gain control of themselves was very important. Moral treatment at the asylum was connected with occupational therapy, religion, and their community. Moral treatment usually didn’t include traditional treatments like physical restraints.

The moral treatment of the insane refused to associate with the disruptive behavior of mentally ill individuals. Some people with mental illness were too violent or disruptive to stay at their homes or in their communities. Some people with mental illness received treatment at home other than a hospital.

Friends Asylum was established by Philadelphia’s Quaker community in 1814, which was the first institute designed to perform the full program of moral treatment. The Friends Asylum wasn’t run by physicians. It was run by lay staff, which made it unique. Private hospitals were more available to wealthier families to care for their mentally ill family member.

At Taunton Hospital in Massachusetts, there was a lower story that was built and designed for patients that were uncontrollable or considered “filthy.” The Taunton Lunatic Asylum Casebook (1854-1868) has 240 entries with patients’ names, mental states, family histories, and financial status. These records contained information about patients’ profession, lineage, time in America, ships sailed on, and whether their taxes had been paid.

Page from Taunton Lunatic Asylum casebook (1854 - 1868), MSS 6/011, Historical Medical Library of The College of Physicians of Philadelphia.

Page from Taunton Lunatic Asylum casebook (1854 – 1868), MSS 6/011, Historical Medical Library of The College of Physicians of Philadelphia.

Here are two patient records that I found interesting:

pg. 101:

Weigandt, Louis, 41, admitted April 3,1860, Boston
Hopeless and quiet
German in Boston, 12 years, wife lives at 70 Crystal Palace, Luicida St.
Mr. Nash reports Weigandt born in Germany, landed in New York how long ago unknown. Parents never in U.S.; Weigandt had lived mostly in Boston.
Wife Jane born in Marblehead, no doubt has a set[?] there
Is cousins with cashier of Marblehead Bank
Mr. Locke says wife [?] care of [?] Crystal Palace

pg. 96:

Copeland, John, 29, admitted Feburary 24, 1860 North Bedford
Doubtful and troublesome; now has been very [?]; fugitive slave; can go as far as health is concerned
Mr. Locke says [Copeland] born in Newburn, North Carolina
Feb 23rd 1863: He [Copeland] says does not know where he was born first found himself in Newburn. Then to Duplin County, there 4 years, came to Philadelphia in 1855 from Wilmington, thence to New York and Albany. 2 years in Albany, then to Wilton County, 9 months there, then to North Bedford, 2 months there. Send to Philadelphia.

Today there are only a few psychiatric hospitals that exist. Psychiatric care is now delivered through other services, such as crisis service. Doctors today gives patients psychiatric medications, such as, antidepressants, anti-anxiety medications, and mood-stabilizing medications, which help treat, but do not completely cure, mental illness. Depending on how severe the patient’s mental illness is, the treatment that will be given could be a mixed treatment. Today there is a treatment team that helps with a patient’s unique recovery plan, which includes educational programs, support groups, and counseling.

Thanks, Yazmeen! Be sure to check back, dear reader, for our second installment soon. Until next time. Catch you on the strange side!

CPP Curiosities: Pick Your Poison: Historic Syphilis Treatments

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Greetings, fellow historico-medico aficionados and welcome to the triumphant return of CPP Curiosities, our semi-regular segment devoted to the medically weird. Kevin here to give you another tale of mildly-interesting medical miscellany. Past installments examined such topics as the iron lung, the preserved corpse of Vladimir Lenin, and that time President Grover Cleveland had a tumor removed during a secret surgery performed on a yacht.

Today’s installment is inspired by a presentation I recently delivered to visitors to the Mütter Museum on the subject of syphilis. Visitors that day got to see books related to the disease from our Historical Medical Library, including Corky the Killer, and handle reproductions of objects in our robust collection while learning about the history of the disease.

Youth Program Coordinator Kevin Impellizeri stands behind a table of specimens and books related to syphilis for a lesson at the Mütter Museum

Syphilis has been around for a long time. Today, it is treated through antibiotics; however, before the popularization of antibiotics in the 1940s, physicians attempted a wide variety of treatments, many of which were just as bad, if not worse, than the disease itself.

Let’s start by with a brief introduction to syphilis. Syphilis aka “the French Disease” aka “the Polish Disease” aka “the German Disease” aka “the Spanish Disease” aka “the Christian Disease”  is caused by the treponema pallidum bacteria and is spread through skin-to-skin contact with syphilitic lesions, usually during sexual contact. There are a few conflicting theories of where its specific origins lie, although there appears to be some consensus that it evolved as a strain of one of several other bone/skin conditions such as yaws or pinta. The earliest outbreak that is attributed to syphilis in Europe took place in Naples in 1494/1495, and there are some who argue the first strains of the disease came to the Continent aboard Christopher Columbus’ return trip from the New World in 1493.

The disease generally follows a four-stage pattern. The first, aptly named primary syphilis, is characterized by the appearance of a large sore known as a chancre at the site of infection. Aside from being unsightly, patients with primary syphilis don’t feel any discomfort and the chancre will go away on its own after about three to six weeks. During the second stage, again aptly named secondary syphilis, the infected patient will generally have a rash or skin lesions and can also exhibit symptoms similar to the flu such as fever, sore throat, swollen lymph nodes, muscle aches, and fatigue. Secondary syphilis has also been known to cause hair loss. As with its chancrous predecessor, these symptoms will go away on their own after a few weeks after which the disease enters its latent phase (which, you guessed it, is called latent syphilis) where a patient exhibits no outward symptoms. Syphilis can lie dormant in a person’s system for up to thirty years!

When syphilis reawakens after its latent stage is when the real health problems begin. During the syphilis’ final form, known as tertiary syphilis, the disease beings to attack the body, particularly the skin and skeleton. Syphilis causes bone and skin to deteriorate, leaving disfiguring lesions on the patient’s face. Tertiary syphilis can also spread to other organ systems, such as the eyes (ocular syphilis) or brain (neurosyphilis).

Wax model of a syphilitic face

Wax model of a syphilitic face

Historic treatments were often just as bad, if not worse, for a syphilitic patient than the disease itself. Mercury was the most popular treatment for syphilis before the twentieth century; mercury treatments gave birth to a common phrase associated with the disease: “A night with Venus, a lifetime with Mercury.” According to the World Health Organization, prolonged exposure to mercury can lead to respiratory, gastrointestinal, and neurological damage. In 1909, chemist Paul Ehlich developed an alternative to mercury therapy: Compound 606 aka Salvarsan. Named because it was the 606th trial chemical, Salvarsan is generally acknowledged as the first modern chemotherapy treatment, and Elrich went on to become the co-winner of the 1908 Nobel Prize in Physiology or Medicine. While considered effective in mitigating the early symptoms of syphilis, Salvarsan introduced another potentially deadly treatment: it was chock full of arsenic. According to the WHO, short term exposure to arsenic can cause vomiting, abdominal pain, diarrhea, numbness, and (depending on the level of exposure) death. Long-term exposure has been linked to skin, lung, and bladder cancers (long-time readers will recall arsenic was a suspected killer of President Zachary Taylor, although this was later disproven following an autopsy). Elrich eventually developed a replacement for Salvarsan, the creatively-named Neosalvarsan aka Compound 914, which contained slightly less arsenic; Neosalvarsan was the predominant treatment until the 1940s.

Skull with Syphilitic Necrotic

Skull with Syphilitic Necrosis, Mütter Museum, 1161.07

During the 1920s, Austrian psychiatrist Julius Wagner-Juaregg developed a novel approach to treating syphilis: infecting people with malaria. Malariotherapy is a branch of treatments that involves battling infection by inducing a high body temperature, a treatment generally known as pyrotherapy or fever therapy. Malaria is a potentially-useful pyrotherapy tool as it causes a high fever (in addition to chills, sweating, and body aches) and is curable with quinine. Wagner-Juaregg injected late-stage syphilitic patients with malaria and observed the parasite-induced fever’s efficacy in treating neurosyphilis. For his efforts, Wagner-Juaregg earned the 1927 Nobel Prize for Physiology and Medicine. Despite sounding like something a mad scientist might suggest, malariotherapy became a fairly common treatment for syphilis well through the 1950s. However, modern scientists have been divided as to its efficacy, citing in part Wagner-Juaregg’s ethically-questionable use of institutionalized patients. Incidentally, in more recent years, malariotherapy has been proposed as a treatment for HIV (see here and here) and (in at least one ill-advised instance of self-administered malariotherapy) Lyme Disease.

Fortunately, syphilis is easily treatable today with penicillin, which, although penicillin allergies are not uncommon, does not cause the severe long-term health repercussions of its heavy-metal predecessors. Also, using protection, such as condoms, during sexual intercourse can also prevent the spread of syphilis.

 

CPP Curiosities: The Iron Lung

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Greetings, patient historico-medico aficionados. After a brief hiatus, your monthly dose of the medically weird is back again. In keeping with our transition from CEPI to the Center for Education, CEPI Curiosities is also receiving a new moniker: CPP (as in College of Physicians of Philadelphia) Curiosities. Make no mistake, however, despite the new name we are sticking to our tried-and-true formula of medical history stories to surprise you or at the very least make you look at the world of medicine just a bit differently.

This time around we are tackling the strange and fascinating history of the negative pressure ventilator, more commonly known as the “iron lung.”

Emerson Iron Lung at the Mütter Museum

Emerson Iron Lung at the Mütter Museum

“Iron Lung” is a colloquial term for a variety of artificial respiration machines that encapsulate all or part of a patient’s body. They help a person breathe through a method called negative pressure ventilation where the air pressure surrounding the patient’s body is reduced, forcing their lungs to expand and take in air; the pressure around the patient is then increased, causing them to exhale. For a time, iron lungs were a common treatment during the twentieth century for conditions where a patient could not sufficiently breathe unassisted.

However, they are most commonly associated with one particular disease: polio. Also known as infantile paralysis or poliomyelitis, polio is caused by the poliovirus, a contagious virus most commonly spread through infected feces that comes into contact with a patient’s mouth. The majority of people exposed to the poliovirus exhibit no symptoms; according to the Centers for Disease Control and Prevention, one in four people infected with the poliovirus will have relatively mild symptoms, including sore throat, nausea, fatigue, headaches, and stomach pain, and these symptoms generally go away after a few days (this is known as “abortive polio”). However, a small percentage of people exposed to the poliovirus develop temporary or permanent neurological symptoms, ranging from light sensitivity and stiffness to muscle spasms to partial or total paralysis.

Image of a patient's legs with chronic anterior poliomyelitis, Source: Historical Medical Library of the College of Physicians of Philadelphia

Image of a patient’s legs with chronic anterior poliomyelitis, Source: Historical Medical Library of the College of Physicians of Philadelphia

According to our sister page, History of Vaccines, the earliest reported polio outbreak in the United States took place in 1894. The nation’s most severe outbreak occurred in the 1930s-1950s. The development of polio vaccines and public health initiatives to inoculate the public significantly reduced the number of polio cases. Thanks to vaccines, polio has been largely eradicated in the developed world (it was eliminated in the US in 1979). However, periodic outbreaks occur in areas with limited or inadequate medical resources. Between 2013 and 2015, a polio epidemic spread through Syria and into neighboring Iraq followed by a second outbreak in Syria in June 2017 as well as another in the Congo around the same time.

Conceptually, negative pressure ventilation dates back to the late 1700s, and the earliest negative pressure devices emerged in the mid 1800s. In 1864, Alfred F. Jones of Lexington, KY, filed the first patent for a negative pressure respirator. His device, which he dubbed a “Restorator,” required the patient to sit upright in a small chamber with only their head exposed, covered in a specialized hood to maintain an air seal. Air circulated through the chamber through a hand pump. However, it’s unclear if Jones ever developed a model for mass production. In 1876, a French physician named Eugene Woillez developed what is considered the first functional negative pressure ventilator. Woillez’s “Spirophone” allowed for a patient to lie flat on their back, encasing them up to their neck in a sealed enclosure. Air was pumped into the Spirophone through the use of hand-operated bellows.

Image of Alfred Jones' "Restorator" from his patent application US Patent No: US44198

Image of Alfred Jones’ “Restorator” from his patent application US Patent No: US44198

However, the negative pressure ventilator did not receive wide usage or exposure until the early 20th century. In 1928, a pair of Harvard University professors–Drs. Philip Drinker and Louis Agassiz Shaw–developed an automated negative pressure ventilator. Similar to the Spirophone, a patient lay flat on a movable table with all but their head and neck encased within the device. The Drinker respirator generated negative pressure via a motor that pumped a bellows (this silent film demonstrates it in action). They initially tested the device by conducting preliminary experiments on a cat before moving into to human testing on an eight-year-old girl with respiratory paralysis from polio. According to Drinker’s later accounts the girl’s breathing significantly improved after being encased in the Drinker respirator for a short period of time, and their “iron lung” quickly gained wide circulation as a treatment for polio-induced respiratory failure (Louis A. Shaw, “Cutaneous Respiration of the Cat,” American Journal of Physiology. 85 (1928): 158-167; Philip Drinker and Charles F. McKhann, III. The Use of a New Apparatus for the Prolonged Administration of Artificial Respiration: I. A Fatal Case of Poliomyelitis. JAMA. 92.20 (1929): 1658-166). In 1931, a Boston machinist named John Haven Emerson devised improvements for the Drinker and Shaw design; reportedly, Emerson approached Drinker with his ideas but found a tepid response, prompting him to design and sell it on his own. The Emerson Iron Lung proved lighter, more efficient, and significantly cheaper to produce than the Drinker model and became a staple in polio treatment wards across the country (Drinker also unsuccessfully attempted to sue Emerson for patent infringement). The College of Physicians has an Emerson Iron Lung among its vast collection; however, it is not currently on display.

During the polio outbreaks of the 1930s-1950s, if paralysis impeded a person’s ability to breathe (respiratory paralysis), they would be placed into an iron lung until such time as they could breathe on their own, usually after 1-2 weeks of treatment. However, in cases of extreme paralysis, patients may periodically be encased in one over the course of months or years. For those curious about what it is like to be in an iron lung, in 2010, the Journal of the Royal Society of Medicine published an account from Marshall Barr, a patient who regularly used an iron lung for fifteen years.

Robert Hicks, Mütter Museum Director Robert Hicks in an iron lung for an episode of the YouTube series Grey Matter

Robert Hicks, Mütter Museum Director Robert Hicks in an iron lung for an episode of the YouTube series Grey Matter

With the rise in positive pressure ventilation devices (the kind used in modern ventilators), negative pressure respirators like the iron lung generally fell out of favor. However, there are reportedly a small handful of patients who still utilize an iron lung to help them breathe.

Until next time, catch you on the strange side!

CEPI Curiosities: Aesculapius/Asclepius

CEPI Curiosities: Tales from Medical History's Strange Side

Hello again, fellow historico-medico aficionados, and welcome to another installment of CEPI Curiosities, our monthly dive into the medically strange. This time around, I hand the medical history reigns to a guest speaker: Jorge Colon. Jorge is currently performing admirable work as a CEPI intern and is an alum of the Out4STEM Program. Past interns have examined such topics as Chang and Eng Bunker (the original “Siamese Twins”), Harry Eastlack and FOP (Fibrodisplasia Ossificans Progressiva), CPP Fellow Chevalier Jackson and his collection of swallowed objects, and the difference between venom and poison. Jorge’s topic today examines the history of an omnipresent figure here at the College of Physicians of Philadelphia: Aesculapius, a marble statue of whom stands at the top of the staircase in the College’s rotunda.

Marble statue of Aesculapius at the top of the main staircase at the College of Physicians of Philadelphia

 

Take it away, Jorge!

Different sources claimed Asclepius to be many things. Some claimed he was a mortal physician (such as in Homer’s Iliad) who was struck by Zeus with a lightning bolt and became god. In other accounts, Asclepius was the ancient Greek god of medicine, son of the god Apollo and Coronis. He was married to Epione, the goddess of soothing; together, they had nine children:their daughters were Panacea (goddess of medicines), Hygeia (goddess of health), Iaso (goddess of recuperation), Aceso (goddess of the healing process), Aglaea or Aegle (goddess of magnificence and splendor). They also had four sons: Machaon and Podalirius, legendary healers who fought in the Trojan War; Telesphorus, who accompanied his sister, Hygeia, and symbolised recuperation; and Aratus. In Roman mythology, he is known as Aesculapius.

Asclepius learned medicine and the healing arts from the centaur Chiron. According to legend, he once healed a snake, whom in turn taught him secret knowledge. The Greeks considered snakes divine beings that were wise and could heal mortals. This is why a single snake wrapped around a staff became the symbol of Asclepius; it later became the symbol of medicine. Asclepius became so skilled a healer he learned how to cheat death and bring people back from the underworld. As a result, Zeus killed him to maintain the balance of life and death and placed him on the night sky under the constellation of the Ophiuchus (the snake holder).

Asclepius developed a loyal following of mortals who traveled far and wide to one of many sanctuaries for healing, called Asclepions. The most famous sanctuary of Asclepius was the Epidaurus, which hosted athletic, dramatic, and even musical games in honor of Asclepius every four years. Today you may notice the staff of Asclepius adorned on things related to health and medicine, such as on medical professionals’ uniforms or on the sides of ambulances.

Logo of the American Medical Association

Logo of the American Medical Association, using the Rod of Asclepius

However, sometimes you may notice a different staff with two snakes wrapped around it and a pair of wings at the top. This symbol is the staff of Caduceus, which belongs to the Greek god Hermes. Hermes is considered the god of transitions and boundaries. He acted as herald of the gods and also escorted the souls of the dead when they transitioned from the mortal realm to the afterlife. The Caduceus was usually affiliated with public speakers and heralds. Printing companies also used the staff.

Image of the Staff of Caduceus

The Staff of Caduceus

However, because it looks similar to Asclepius’s staff, it is often misrepresented today as a symbol of medicine. This dates back to 1902 when the Medical Department of the United States Army used the staff of Caduceus. Today, professional medical organizations use the staff of Asclepius; however, many commercial medical firms make use of the Caduceus. Make sure you keep an eye out for both symbols and see if a commercial or professional group is using them.

Until next time, catch you on the strange side!