tioedong's Xanga

Cutting for the stone

Fri, 14 Jun 2013 10:25:20 GMT

Tycho Brahe had a brass nose, not a silver nose.

(he lost it in a dual)

and he died of a ruptured bladder from a kidney stone, not mercury poisoning.

more at Neatorama...

read the whole thing, especially the part about his drunken pet moose...

and a PDF about the history of Bladder stones and treatment can be found here.

Pepys had his removed surgically...

and the surgical treatment is ancient: Which is why it is mentioned in the Hippocratic oath.

The ancient Greek Hippocratic Oath
includes the phrase: "I will not cut for stone, even for the patients
in whom the disease is manifest; I will leave this operation to be
performed by practitioners," a clear warning for physicians against the
"cutting" of persons "laboring under the stone"; an act that was better
left to surgeons (who were distinct from physicians at that time in history). Operations to remove bladder stones via the perineum, like other surgery before the invention of anesthesia, were intensely painful for the patient.^[1]

more here.

and wikipedia has some very nice descriptions of how they used to smash or chisel the stone to get it small enough to take out.

from nlm.nih

the reason for the perineal approach is that if it got infected, the pus could drain out. If you went in above the pubic bone, there is a chance you would clip the peritoneum and end up with a patient who dies from peritonitis .

And yes, this position today is still called the "lithotomy" position, although we use that position for Pap smears and some childbirth.

Small factoid about the lithotomy position: When I was in Africa, I always had problems trying to instruct the women to get into this position for examination...until one day I was helped by one of our senior nurses, a married lady, instead of one of the nursing students. When the poor patient was trying to figure out how to sit, the wiser nurse quietly said something, at which point the woman laughed and quickly went into the correct position.

Later I asked her what she said: She said she told her to "make like a woman"...

another factoid: Dogs can get them too...one of our small dogs died from a stone; he was in severe pain and couldn't pass the stone,

...because of the delay in diagnosis, his kidneys shut down even though the vet removed the stone.

Leprosy

Fri, 14 Jun 2013 00:08:59 GMT

From New Scientist...

Leprosy is still around ( I only saw a few cases in Africa, but it is still a problem).

Yet leprosy was common in the late Medieval period, and pretty well disappeared after the black death plague hit.link

So a lot of folks wondered if this "leprosy" is the same as what we see now (or another germ that gave people chronic sores/wounds and tissue destruction).

So the scientist dug up some bones from a medieval cemetary:

The researchers pulled the ancient bacterial DNA out of the bones by using an array of short sequences from modern M. leprae, which bound to matching ancient DNA. They were then able to reconstruct the ancient bacterium's entire genome and compare it with sequences of 11 modern M. leprae strains from different regions of the world. The resulting evolutionary tree suggested that the strains began to diverge several thousand years ago.

That divergence probably began shortly after M. leprae entered humans from another species, probably an African primate, says Anne Stone at Arizona State University in Tempe, who was not involved in the research. She recently sequenced an M. leprae genome from a captive West African mangabey monkey and found it was very similar to human strains.

So a fairly "new" disease by human standards...

The BBC says that the DNA suggests it was related to the strain found in the Middle East (which suggests it was indeed brought back by Crusaders).BBC LINK

and although it is not known where the disease evolved into infecting humans, the earliest skeleton with signs of Leprosy was found in India, dating back to 2000 BC.

OH yes: It is easy to treat once diagnosed, but in countries were lepers by custom are isolated from society, often early cases are hidden by the patient until the disease is obvious.

the next "disease" they want to analyze is Tuberculosis, which is related to lerprosy. But TB doesn't usually affect the bones (or rather, most bone TB is from infected milk: i.e. animal Tuberculosis. This is why they pasteurize milk). article about Tuberculosis

BonesDontLieBlog has a nice article about tuberculosis of the bone, which has been found as early as Neolithic times.

M. tuberculosis, and is primarily transmitted by droplet infection between humans. First the pathogen infects the lung tissue and then the lymph system, followed by spreading to the other organs. The second most common to humans is M. bovis. The pathogen spreads through the consumption of infected milk, dairy products, and meat. TB only affects the bones in 2-5% of cases where virulence is highest. Changes in the joints can be indicators of TB, although these also mimic other diseases. TB can also be diagnosed in ancient populations through the use of DNA when analysis of bone is not conclusive enough.

Ricketts and that beautiful white complexion

Wed, 12 Jun 2013 11:21:28 GMT

from TeaAtTrianon Blog, link,who links to n article in the UK Mail on ricketts in the Medici...LINK

she comments:

We often forget that in former times the children of the wealthy often suffered from diseases caused by vitamin deficiencies, such as rickets. Peasants, due to being outdoors and eating raw foods and coarse grains, were generally healthier.

and this from the Mail article:

‘For example, according to historical sources, Filippo was a weak and unhealthy child, suffering from recurrent illness episodes and likely to have been frequently kept indoors.

‘Furthermore, in the Renaissance period, non-ambulant children were swaddled, leaving very little skin exposed.’

Newborn babies should have enough vitamin D from their mothers at birth but, researchers suspect, the mothers may also have suffered from vitamin D deficiency, perhaps as a result of being kept indoors or their practice of wearing thick make-up to prevent them getting a tan.

And the article adds that frequent child bearing also might cause low Calcium and vitamin D in the mothers.

What does this have to do with the modern world? Well, there are a lot of studies that show low vitamin D levels are found in those with cancer or other diseases. One problem: we don't know if this is coincidence, or a cause of the disease, or maybe if the disease itself causes low vitamin D levels.

but with all the sunscreen being used, it suggests sun protection, although protective of cancer, can also be a problem if overdone.

Bad and sad and heroic

Thu, 16 May 2013 03:03:00 GMT

First the bad news: WHO reports that they have had a case of the new SARS like virus (from the middle East) being spread from a patient to a nurse.LINK

-------------------------------------------

The sad: A New Mexican Hispanic activist slowly deteriorates mentally and dies alone, after refusing to keep in touch with distant relatives. LINK

I wish such things never happened, and it's easy to say that obviously she was mentally ill and needed treatment, but even if the family had recognized her "hoarding" and failure to keep clean was a symptom of mental illness, there is the possibility that they would never have been able to get her treated against her will

Sigh

------------------------------------

the heroic? Angela Jolie for getting publicity for women with genetically linked forms of breast cancer.

When the late Alice Roosevelt Longworth (the "bad girl" daughter of Teddy) had a double mastectomy for breast disease, she called herself the topless wonder.

In 1956, Alice discovered she
had breast cancer. She underwent a mastectomy and it was success. In
1970, the cancer returned to the remaining breast and she had a second
mastectomy. Taking it in her usual Alice stride, she said she was the
only "topless octogenarian" in Washington.

and now, the headlines say that Angelina Jolie has had a double mastectomy because she carries a gene that gives her a very high risk for breast cancer.

Good for her. Too often these ladies instead get yearly MRI's and repeated biopsies and we still miss cases.

And another alternative, a drug that is touted to decrease their risk, does lower their risk but puts some women into a depression and results in a loss of libido.

I had one woman who was so bad her marriage was at risk: I told her to ask her husband if he would prefer a sexless marriage or a wife without boobs...

NYTimes article here.

it should be noted that the risk of breast cancer is 10 percent, and getting higher, probably because early pregnancy, many pregnancies and breast feeding protect you from breast cancer (and now, having ten kids is rare).

Having a close relative (mother, sister) with cancer increases your risk, but there is also a familial risk, where nearly every woman has had breast cancer in a family. This is the type that Ms Jolie apparantly has, and actually I think her choice was wise, and that she is brave for chosing to make her choice public.

Ancient military medicine

Mon, 13 May 2013 09:10:16 GMT

StrategyPage has a book review about ancient military medicine. (They are a site that summarizes the backstory of the military and wars around the world)

Well, I doubt I'm going to be able to get the book at the used book kiosk at the local mall in our rural area, and I don't have the money to buy it via Amazon, but luckily I found some stuff on line.

Richard Gabriel's The Ancient world has a few remarks about war medicine link

and an article (PDF) on Imenhotep and the Egyptian military is here.

Imenhotep was probably the origin of the Greek god Ascalapius.

I mainly posted this for my later reading, since I am busy and the weather is stormy, meaning the internet will go on and off

Granddad has secrets

Sun, 12 May 2013 19:12:05 GMT

I was watching a youtube video where people's ancestors were investigated, and while discussing a person's great grandparents, it was noted that the great grandmother had three children die at an early age, and then went on to have five healthy children. Yet the cause of death wasn't diarrhea or pneumonia but the Victorian equivalent of "failure to thrive".

When asked what could cause that, the "medical expert" said congenital syphillis: because after being infected, the woman would miscarry then would have stillborn, but later would have children who died as infants of unknown causes, but later, as the disease went into the latent phase, they would have normal children.

and they said ten percent of people had syphillis so this was a major cause of childhood mortality.

This brought a "headsup" to me.

When we were in medical school, we still saw tertiary syphillis from cases not treated in the 1940's. And we were told that syphillis was "the great pretender": It often appeared like many other diseases.

Yet, outside of the gay community, we rarely saw any cases, since aggressive penicillin treatment wiped the disease out.

Back then, every person who entered a hospital got a test for syphillis, and once in awhile we picked up a case. Yet thanks to penicillin, even then (this is the 1960's before the pill and the sexual revolution) most of the cases we picked upwere "false postives". Disease like mononucleosis and lupus would give a positive test so we had to do a more expensive test to check the first test...and if it came back postive, it meant we had to treat, and often it meant we had to do a spinal tap to check for neuosyphillis. This last procedure was painful so there was a lot of debates about it...

Unless one worked in public clinics that treated gays or sex workers, you probably didn't see many early cases, But we did see a lot of syphillis in Africa. The men traditionally worked in mines or factories, but lived in barracks...no place for the wife, and even those who could afford separate housing often didn't bring her, since the land was owned by the tribe, not the family, and if you didn't keep your wife home farming your fields, the tribe chiefs would assign those fields to others. In other words, if you wanted to retire, there was no pension but you and your family would have their fields to keep them fed, as long as you left her behind in the rural areas.

Well, anyway, one problem with infectious disease is that few nowadays sees such disease that hasn't been treated, so modern "experts" too often seem clueless about it.

Back to syphillis: If you thought that the sexual revolution started in 1968, well, read this book : the third great plague

based on large experience, of such men as Lenoir and Fournier, that 13 to 15 per cent of all adult males in Paris have syphilis. Erb estimated 12 per cent for Berlin, and other estimates give 12 per cent for London. Collie's survey of British working men gives 9.2 per cent in those who, in spite of having passed a general health examination, showed the disease by a blood test. A large body of figures, covering thirty years, and dating back beyond the time when the most sensitive tests of the disease came into use, gives about 8 per cent of more than a million patients in the United States Public Health and Marine Hospital Service[Pg 25] as having syphilis. It should be recalled that this includes essentially active rather than quiescent cases, and is therefore probably too low.

This article also assumes a ten percent incidence of syphillis in Victorian cities

So lots of stuff went on back then.

as for neonatal deaths, skimming down to page 101 gives a story of the sickly child. Sigh

Even in this book written for lay people, there are a lot of details about the disease that I had forgotten...and yes it can be spread via mucus membranes in the very infectious state.

yet syphillis was not the only cause of high childhood mortality in Victorian cities.

This article discusses how pollution, keeping children indoors, and early weaning caused ricketts.

. Britain’s skies became overcast from smoke, both from the great new industries, and from the millions of domestic coal fires kept burning for heating and cooking purposes. Coal consumption soared. The country’s coal output rose from 17.4 million tonnes in 1811–1815, to 287.4 in 1913. Consumption doubled between 1830 and 1850, and again to 1875.6 Little sunlight penetrated the urban smoke canopy, and it also encouraged women and children to spend their time indoors, out of the constant fall of oily, smoky smuts. For many babies and small children, the physical consequences of sunlight deprivation were compounded by poor diets and misguided childcare practices. The diets of working class women and children too often consisted largely of bread and tea, with sugar and the occasional smear of jam or margarine. Babies of all social classes were generally weaned on ‘pap’—bread and water or bread and milk, depending on local custom; and they were often also kept indoors throughout the winter months. The impact of urban life on the incidence and distribution of rickets was very plain.

So pollution is not a "modern" problem, and is probably better thanks to clean air laws and a decrease in coal burning furnaces. However, the problem persists in China, and even here in Manila, where we aren't cold enough for anyone to have furnaces, I often have to use an inhaler thanks to car exhaust...and yes, they are now starting to inspect cars for emissions in the last few years, and they limit traffic by only allowing cars with certain tags to be used on different days. This discourages using cars for local travel to work or school, but for us, it means we have to do deliveries on certain days when it is legal to drive.

Back to STD's

Nowadays, the problem is not syphillis, but HIV. In the past, they tested everyone for syphillis: when you got pregnant, when you entered a hospital, when ou got married, but stopped whcen the disease became rare. Now the public health folks are saying everyone needs a test for HIV.

again, a lot of controversy by folks who see this as accusing them of playing around when they aren't.

So is it worth it? Well, the dirty little secret of HIV is that the promiscuity of the "MSM" community is at high risk. But another dirty little secret is that some of them who played around now settle down and get married (because they are bisexual). And estimates of who is doing what is hard to estimate: both overestimated and underestimated. youth risk survey by the cdc gives some hard statistics...And don't forget date rape (8 percent) and child abuse (ten percent), and IV drug use (1 to ten percent) which are also causes of HIV spread.

Blame the Fleas

Fri, 10 May 2013 21:59:01 GMT

Scientists have confirmed that the Plague of Justinian was caused by Y. Pestis, aka the Black death.

The bacterium Yersinia pestis, which caused the disease known as
the Black Death in the fourteenth century, has been identified in DNA
samples taken from 19 skeletons of people who died in sixth-century
southern Germany. It is thought that these people were felled by the Justinianic Plague,
which killed more than 100 million people between the sixth and eighth
centuries. Named for the Byzantine emperor Justinian I, the plague is
thought to have contributed to the decline of the Roman Empire.

this was after the "fall of the Roman empire" aka the fall of the western Roman empire, with the sacking of the city of Rome a few centuries earlier.

However, it was not the only plague that weakened Rome.

The introduction of Malaria into the swamps near Rome probably led to a lot of babies dying (not to mention adults feeling weak and lazy).

And of course, the Antoinine plague had already weakened Rome. that's named after the Emperor in the film Gladiator, who died of it (not from his wicked son, which is implied in the film).

The disease killed as much as one-third of the population in some areas and decimated the Roman army.^[5]

Ancient sources agree that the epidemic appeared first during the Roman siege of Seleucia in the winter of 165–66.^[6] Ammianus Marcellinus reports that the plague spread to Gaul and the legions along the Rhine. Eutropius asserts that a large population died throughout the Empire.^[7]

that was probably an epidemic of smallpox, as was the Plague of Cyprian.

In the past, measles was blamed (and if you never saw a person die of severe measles, you can be excused for wondering how the two could be mistaken for each other.).

But now it is believed Measles evolved from Rinderpest in the Middle Ages. (11th -12th century) from that cattle disease.

Another factoid: Rinderpest killed so many wild animals in South Africa that the limit of the tsetse fly went north. When I lived in zimbabwe, they still had a fence to prevent the fly and their wild animals from going south into the European farming areas, and Europeans killed most of the wild game that they saw, partly to keep down the population of wild game (that supported the fly).

Get rid of the Tsetse fly, and you could make Eastern Africa into the new grainbelt of the world...but with it, it means you have to migrate with your cattle (as the Masai do) to keep them (and you) from dying.

But of course, having those nice films about wildlife in east Africa is more important to the western elites than having more black people becoming rich farmers...which is why the "development" types discouraged the green revolution in Africa...

The good news is that China is buying up and planting crops and tends to ignore the political correctness of the green revolution...

The bad news is that pollution in China is rampant, and that they keep getting new diseases from their animals, yet I suspect this is not from modern farming techniques, since it is not new, but partly due to the old fashioned customs of keeping pigs and free range chickens in the same habitat as humans (think Irish Pigs in the parlor)...

So right now, the world faces a new influenza virus from China LINK : and a new "SARS" type virus LINK from the middle east.

both could result in plague redux, or at least a repeat of the deaths from Spanish flu of 1918/1919...

Yet maybe not: One reason for those deaths was the young men in army barracks etc. where it could spread easily, and it also killed many more than normal because much of the non eliter population in much of Europe had been weakened by famine (something that few US history books know about, but Professor Anderson's course on German history notes that a million Germans civilians died from the Britich blockade of Germany during WWI, and one of Tolkien's letters to his son mentioned his wife carried her first pregnancy during the famine year of 1917)...nor did famine end with the end of the war: in eastern Europe, the demise of the Hapsburg empire of Austria Hungry meant a disruption of normal trade between these new countries, not to mention the massive casualties of young men needed to grow crops. My aunt said they ate tree bark during that time, and since she was only 4foot 10 inches, I can believe she was malnourished during her growing years).

So the Spanish flu might not kill that many today.

As for the "SARS" virus in the Middle East: even without the US army being there, the real danger is people spreading it after the Haj, and of course, the millions of foreign workers there could easily spread it when coming home to visit family. Indeed, we now read that there are cases in France....

Monday, May 06, 2013

Mon, 06 May 2013 19:32:41 GMT

from Dr. Topol, the new editor of a medical website Medscape:

This is the most exciting, momentous time in the history of medicine. For the first time, we can rapidly and affordably sequence a human genome. We have sensors that can remotely track virtually any physiologic metric, from vital signs to glucose to intraocular pressure. We can add a lab-on-a-chip to a smartphone to assay almost any routine chemistry and digitize pills to ensure adherence. Or use a smartphone to conduct all the components of the physical examination. This is superimposed and convergent with a remarkable digital infrastructure that includes ever-increasing bandwidth, pervasive connectivity, cloud- and supercomputing, enormous social networks, and those little mobile devices that we cannot put down.

What's wrong with this picture? it makes the human beings we treat into machines to be analyzed and tweaked, and sees Medicine not as a caring profession but as a "science" that sees the lab values and technological measurements as more important than listening to a person.

My relatives told me about going to their doctors and having the doctor type in the conversations to the computer, as if that, not listening person to person, was the most important part of the visit. And you know what? To the technocrats of modern medicine IT IS

Again from the letter:

Medicine is thus poised for its biggest shakeup ever as it transforms to a more precise, individualized, and democratized model.

No, a more dehumanized model.

Unrelated or maybe related item: An article on the saintly doctor Martin De Porres, one of the first American "saints" who treated the poor in Lima back in their colonial times. at Touchstone archives

essentially it says he was an individual, not a 'humanitarian" who supplied systemic changes to alleviate poverty.

Ironically Christopher Hitchens said the same thing about Mother Teresa, and one of his complaints was that she pushed natural family planning. Yet now I am reading a book on gender imbalance that points out how the rich American foundations literally poured millions into India at that time to lower population growth. link

So why was the usually honest Hitchens repeating the party line? One small woman versus the millions of dollars behind the push to limit India's population by Ford Foundation and the US government? pdf link

CFam document pdf here

1988 article in the NYTimes here

that article mentions the small cut back of US funding, mainly after a graduate student publicized coerced late term abortions in China that was partly paid for by US money to international planned parenthood type organizations.

So what's wrong with this picture?

well, when I worked in Africa, our villages didn't have clean water supplies and children died of malnutrtion and diarrhea, but hey, every village had a pill lady.

And here in the Philippines,the US State Department and the population money pressured the gov't to pass a bill to "give" free contraception to women going to government clinics, never mind that one third of women deliver their babies without a trained birth attendent, and even where the trained midwives are available and supposed to be "free", they often require large "gifts" to give you free medical care. Sigh.

Yesterday, an article in a Japanese paper mentioned that the Catholic church was losing influence here (and written as if that was a good thing). Oh well...must obey our American masters, or they won't help us keep China from stealing our fishing grounds and off shore resources.

Happy drinking water week

Sun, 05 May 2013 21:13:46 GMT

CDC link

If you are living longer, blame the public health folks: improvements public health in last century

In the early 1900s in the United States, many major health threats were infectious diseases associated with poor hygiene and poor sanitation (e.g., typhoid), diseases associated with poor nutrition (e.g., pellagra and goiter), poor maternal and infant health, and diseases or injuries associated with unsafe workplaces or hazardous occupations (4,5,7,8). The success of the early public health system to incorporate biomedical advances (e.g., vaccinations and antibiotics) and to develop interventions such as health education programs resulted in decreases in the impact in these diseases.

check PDF article here.

Suicide

Sun, 05 May 2013 20:48:47 GMT

I saw a lot of suicides when I worked in the Indian Health Service in the USA...

The despair was a real problem, and many of the car wrecks/substance abuse and family breakdown was cultural, and the suicides were often due to these problems.

Yet one worrisome problem in the middle class whites of the US is a strange trend to kill themselves, made worse by the lowgrade propaganda that "rational" suicide should be a choice (the propaganda is not really about rationality of course: depite the propaganda, if you check the small print or the articles on the bioethics literature journals, most have an agenda of eugenic removal of untermensch in their fine print, or are "bioethicists" who see euthanasia as a way to keep down the health care bills...).

I will link to two articles on the problem, mainly for my later perusal.

The Christian Science Monitor article notes:

Another theory notes that white baby boomers have always had higher rates of depression and suicide, and that has held true as they've hit middle age. During the 11-year period studied, suicide went from the eighth leading cause of death among middle-aged Americans to the fourth, behind cancer, heart disease and accidents.

"Some of us think we're facing an upsurge as this generation moves into later life," said Eric Caine, a suicide researcher at the University of Rochester.

One more possible contributor is the growing sale and abuse of prescription painkillers over the past decade. Some people commit suicide by overdose. In other cases, abuse of the drugs helps put people in a frame of mind to attempt suicide by other means, said Thomas Simon, one of the authors of the CDC report, which was based on death certificates.

People ages 35 to 64 account for about 57 percent of suicides in the US.

The report contained surprising information about how middle-aged people kill themselves: During the period studied, hangings overtook drug overdoses in that age group, becoming the No. 2 manner of suicide. But guns remained far in the lead and were the instrument of death in nearly half of all suicides among the middle-aged in 2010.

The CSM tends to be a sympathetic mildly progressive site, who underplay shock stories.

In contrast, Freakonomics tends to be counterintuitive and sarcastic.

Here is their podcast on the problem from last year.

WRAY: The American suicide belt is comprised of about ten western states, this sort of wide longitudinal swath running from Idaho and Montana down to Arizona and New Mexico. … So, yes the inner mountain west is a place that is disproportionately populated by middle-aged and aging white men, single, unattached, often unemployed with access to guns. This may turn out to be a very powerful explanation and explain a lot of the variance that we observe. It’s backed up by the fact that the one state that has rates that is on par with what we see in the suicide belt is Alaska. If Alaska were contiguous with the U.S. it would really have to be considered part of this western suicide belt.

And Veralyn Williams reports on places where there’s a paucity of suicides: African-American communities. As it happens, blacks are only about half as likely to kill themselves as whites. (When it comes to murder, meanwhile, blacks are nearly six times more likely than whites to die.) There are just three places in the U.S. where the overall homicide rate is higher than the suicide rate: Louisiana, Maryland and the District of Columbia. It’s not a coincidence that these are also places with large African-American populations. Donna Barnes, who founded the National Organization for People of Color Against Suicide, tries to explain why there’s such a huge black-white suicide gap:

Missing, of course, is the underlying question of God: In most religions, God has a path for you to follow and it might include suffering. So suicide is a rejection of God.

As for the "Samurai" and "stoic" arguments in Freakonomics, well, remember both there groups were small elite groups. The poverty stricken Japanese peasant and the Roman slaves were the majority in both cultures, so it's not as if these ideas were widespread among the non elites.

One thing I have noted: I saw three "rational suicide" attempts when I worked in an Emergency room...all of whom suffered from hyponatremia, an easily corrected eletrolyte imbalance that can be brought on by medicines or stress.

The Mayo Clinic has an article about that problem...and here is a link to the problem of inappropriate Anti Diuretic hormone secretion, which is behind many of the cases that I saw:link.