Biomedical Ephemera, or: A Frog for Your Boils

Hoatzin chick climbing back up to its nest As a feather develops it requires a flow of blood. The shaft or calamus is a direct link to the blood supply and the feather grows out something like a flower. Once the feather is fully developed the blood source dries up and is closed. The shaft then hardens and the feather becomes functional.

The calamus is still visible in the primary feathers of this hoatzin.

Tropical Wild Life in British Guinea. William Beebe, 1917.

Top: Canker Sores (Aphthous Stomatitis)

Center: Multiple chancroid (Haemophilus ducreyi)

Bottom two: Chancre Sores (Syphilis Ulceration)

Canker, chancroid, and chancre - so similar, yet so very different!

Canker (KANE-ker) sores are recurrent aphthous ulcers - that is, small ulcerations of unknown, autoimmune, or varying origin within the mouth. They're often triggered by external stresses or immune responses to viruses, and never occur outside the oral region.

While the word "aphthae" implies these small oral ulcers, it actually is derived from the word "haptein" - "to set on fire". The pain of the canker sores is often far exceeds the size of the ulcer in the mouth. The condition of having canker sores is known as aphthous stomatitis - "swelling around the small ulcers in the mouth".

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Chancres (shankers), or "hard chancres" (when differentiating from chancroid), however, are a symptom of the primary stage of syphilis (caused by the bacteria Treponema palladum) and African sleeping sickness (caused by the protozoa Trypanosoma brucei).

While generally painless, they are unsightly, and in syphilis, generally occur between 21 days and 8 weeks after contracting the disease, during the primary phase. This is the period which is highly contagious. Secondary and tertiary phases of syphilis, while destructive to the host body, are increasingly non-contagious as time goes on. The chancre will diminish over time in both syphilis and sleeping sickness. They can form anywhere on the body, but most often form within the genital or oral region.

Syphilis chancres differ from gummas, which are formed during the tertiary phase of infection. Gummas are non-infectious tumor-like growths that have firm necrotic tissue at the center, and inflamed tissue surrounding it.

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Chancroid ("like chancres") is another sexually-transmitted infection, caused by the streptobacillus Haemophilus ducreyi. It is only transmitted sexually, and it only infects the genitals, pharynx, and lymphatic system. Because of its ability to invade the inguinal lymph nodes, it can cause buboes similar to those found in the bubonic plague.

More often, however, it is simply a painful sore (differentiating it from chancres) or group of sores, which has a "soft" edge - that is, it gradually fades back into uninfected tissue, and doesn't have a "hard" edge like chancres do. Chancroid also tend to exude pus, while chancres do not.

Both syphilis chancres and chancroid can be cured with antibiotics. Canker sores cannot be cured, but clear up on their own within several days to weeks.

White and Martin's Genito-Urinary Surgery and Venereal Diseases. Edward Martin and Benjamin Thomas, 1917.

Intracranial aspiration in cerebro-spinal meningitis of the infant

For many decades, the anterior fontanelle of the infant was used as an alternative access point for emergency care (such as emergency rehydration), when a suitable vein could not be located. It was also used as a puncture site to drain the pus from cerebrospinal meningitis.

While intraosseous (IO) injection is now the alternative access point used in most practices, relieving cranial pressure due to meningitis or encephalitis is still occasionally done through the anterior fontanelle, if it has not yet closed.

In adults and babies whose fontanelles have closed - almost all by 18 months of age - the most common way to relieve intracranial pressure is through an emergency burr hole (a hand-drilled hole surprisingly akin to trepanation) or, in cases at more equipped facilities, craniotomy (creating a temporary hole) or craniostomy (creating a permanent hole).

Diseases of Infancy and Childhood. Louis Fischer, 1917.

Giant larva of the rhinoceros beetle of British Guiana

The most common rhinoceros beetle (subfamily Dynastinae) in British Guiana (now Guyana) is the elephant beetle (Megasoma elephas). The larval stage of these beetles can last up to 3 years, where the grubs consume the organic matter of the decaying logs that they're hatched inside.

This species is one of three beetles that was used by the Pentagon to develop their so-called "bionic beetle", which has been a bizarre and interesting project. Its outcomes so far have benefited science far more than the military, because, well, it turns out that remote-control beetles are pretty easy to see. Also...they're remote-control beetles. But hey, science! We've learned a lot from them!

Tropical Wild Life in British Guiana, Vol 1. William Beebe, 1917.

Black-Necked Aracari - Pteroglossus aracari Top, Bottom - 10-day-old juvenile Center - Adult (male/female form similar)

Aracaris are toucans, in the genus Pteroglossus (along with the Saffron toucanet). Though the toucans are among the largest tropical birds, aracaris are relatively small members of their family. Aside from size, their omnivorous diet chiefly consisting of fruits, proportionally huge bill used for plundering fruits and nests of other birds, and their altricial (helpless at birth) chicks, are all characteristic of other toucans.

Top, Bottom: Tropical Wild Life in British Guyana. William Beebe, 1917. Center: Os quadros de aves tropicais do Castelo de Hoflössnitz. Albert Eckhout, ca. 1653-1659.

Gas gangrene in amputated arm of injured soldier

In WWI, most cases of gas gangrene were caused by infection with Clostridium perfringens, and Group A streptococcus. Other bacterial infections were occasionally found, as well.

The infecting bacteria could be pretty easily differentiated by the type of pus that was exuded or found when the necrotic tissue was cut into. C. perfringens produced very thin, "dishwater"-like pus, and smelled "sweetly putrid". The other bacterias produced much thicker pus, and did not smell sweet.

Not that it made any difference what bacteria was causing the gas gangrene - in the Great War, antibiotics weren't nearly effective enough to halt the progress of infection, and amputation was the default treatment modality for cases brought in from the front.

British Medicine in the War, 1914-1917. British Medical Association, 1917.

Pedicle-type tissue transplantation

Shown in use for reconstruction of nasal tissues. This technique of transplanting tissue was particularly heavily used during and after the American Civil War, both Boer Wars, as well as after the Balkans Wars, where guns that were more accurate, but not more powerful, were very commonly used by both sides.

Today, its use is mostly limited to transplantation of highly-vascular thick dermal tissue to nearby structures, such as in complete nasal structure transplant and breast reconstruction surgery.

Operative Surgery of the Nose, Throat, and Ear. Hanau W. Loeb, 1917.

Supernumerary teeth in upper palate of 15-year-old boy.

Hyperdontia of unknown etiology. These extra teeth are what is known as paramolar - "along the molar". This means that they didn't erupt behind the regular teeth, but alongside them. In this case (and a large percentage of molar hyperdontia cases), the supernumerary teeth erupted buccally to the maxillary molars - that is, they erupted on the cheek-facing side of the upper molars. These extra teeth on the outside of the maxilla forced the normal molars inwards, and those are the teeth that you see on the hard palate of this boy.

Most hyperdontia cases never even erupt, and are only visible on x-rays. In cases where the extra teeth do erupt, the most common presentation is a mesiodens - a malformed peg-like tooth between the maxillary central incisors (the upper front teeth). This boy's case was noted by the author as highly unusual not only for the number of supernumerary teeth, but for the fact that there were multiple forms of extra teeth presented. The presentation of tuberculate (barrel-shaped) and supplemental (the same shape as the teeth in the series) teeth was denoted as a very uncommon occurrence.

Surgery and Diseases of the Mouth and Jaws. Vilray Papin Blair, 1917.

Subperiosteal Hemorrhage in the Pediatric Femur

Left: "Fresh" subperiosteal hemorrhage, as seen in x-ray of 9-month old infant. Right: Result of subperiosteal hemorrhage, as seen in femur split down the anteroposterior plane. Fracture can be seen about a quarter-length down from the head, displacing the epiphysis (the rounded head of the femur that is supposed to articulate with the hip). There is a large separation of the periosteum from the upper half of the bone, with new bone formed between the shaft and periosteum, due to a pre-existing subperiosteal hemorrhage.

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In scurvy, creation of collagen and capillaries (which rely heavily on ascorbic acid, aka vitamin C) are both impaired, leading to poor wound healing, fragile capillaries and capillary beds (such as in the periosteum, which supplies nutrients to the bones), and structurally unsound bone growth. When these are combined, fractures and subperiosteal hemorrhages are inevitable, and in children, this leads to great bone deformation that affects them for the rest of their lives.

While adults may suffer many of the same symptoms of scurvy, the fact that their bones already have the support structure and are slow-growing in general, means that they're at a much lower risk for subperiosteal hemorrhage causing extraneous bone growth. Though adult bones are weakened, that generally leads to breaks straight through the shaft, rather than internal fractures.

Diseases of Infancy and Childhood. Louis Fischer, 1917.

Cerebrospinal meningitis due to influenzavirus

This 4-month-old was suspected to have developed meningitis due to the influenza “bacillus” (now known to be influenzavirus) crossing into the brain either by the frontal sinus (which is thin to begin with, but extremely delicate in young children), or through the nasopharyngeal lymph channels near the base of the brain. 

The brain was found to be partially covered in a muco-purulent exudate, with a large necrotic patch in the right frontal lobe. The infant had several seizures during the course of the illness, but it was suspected that they were febrile seizures (caused by high fever and not uncommon in babies), and unrelated to the necrosis of the frontal lobe. The bacterial infiltration of the cortex was suspected to have blocked one or more blood vessels, causing a stroke.

Influenza may not be killing off 5% of our population every year like it did in 1918 (which was after this case and, interestingly, spared the frail and killed the healthy), but it's still a fatal disease to many infants and elderly patients. And really, even the healthiest person can come down with really awful complications from the yearly flu virus. It just happens to be much more prevalent in those whose bodies are not fully capable of fighting off infection.

So if you've had the flu recently, and felt awful and unable to breathe and your body hurt like you had been sleeping on a bed of lumpy rocks, you probably can see where bad complications can come from. But if you never get the flu or haven't had it in ages, don't think it's just some little thing, or just like a bad cold or something. It's something that's actually worth going out of your way to protect yourself (and those around you) from!

Diseases of Infancy and Childhood. Louis Fischer, 1917.

Examples of Surgery on the Eye

These are just a couple examples of ocular surgery. Unlike many surgeries, it is often not beneficial for the patient to be put under general anesthesia. Historically, the topical anesthetic cocaine was used during surgery, and the patient was lightly sedated. 

Currently, topical anesthetic in nasal and ocular/lachrymal surgery is one of the only legal uses of cocaine, even though most surgeons opt for synthetic narcotic anesthetics these days. It has an extreme vasoconstrictive effect, which leads to minimal bleeding. In delicate surgery of highly vascularized areas like the nasal passages and eyeball, removing the complicating factor of loose blood at the surgical site can mean the difference between sight and blindness.

Diseases of the Eye. George E. DeSchweinitz, 1917.

Radiation burn to the hand

Note the necrotic dermatitis present in this burn. This signifies either an extremely high one-time dose, or continued exposure to a moderate dose of gamma radiation. Even with a one-time exposure to the radiation, necrosis often does not set in until 2-3 weeks after the initial burn develops. 

A Text-Book of First Aid and Emergency Treatment. A. C. Burnham, 1917.

Example Show Aquarium of Goldfish Breeder

Apparently the author of the book took this aquarium (rooted water plants and all) throughout the East coast and even won an award for them down in Tallahassee. 

I can hardly transport a tank without rooted plants halfway through a state in a decent automobile; I can't imagine transporting any aquarium, let alone one this big and fancy, with the modes of transportation back in 1917...even on a train it seems like it would be a pain.

Goldfish Varieties and Tropical Aquarium Fishes. William T. Innes, 1917.

Chinese Scaleless Telescope

Telescope eye goldfish were developed in China back in the early 18th century. They made their way to Japan, and were very popular within the gardens of the upper classes in both countries. Over in Japan, they became known as the Demekin, which is the name they're still called by today. Demekin are some of the most popular fish in Japan.

As one might expect, they don't have great eyesight. Their eyes are generally born fairly flat, with normal sight, and gradually protrude to up to 3/4 of an inch (1.9-2.0 cm) over the first six months. Telescope goldfish are pretty slow-moving and disabled, so they don't do well with fish that have normal eyesight/normal bodies. 

Goldfish Varieties and Tropical Aquarium Fishes. William T. Innes, 1917.

Fancy Goldfish Varieties

The fish without a dorsal fin looks a bit depressed. :(

Goldfish Varieties and Tropical Aquarium Fishes. William T. Innes, 1917.

Unusually Severe Desquamation

Desquamation (from the Latin desquamare - to scrape scales off a fish) is simply the peeling or shedding of the outermost layer of the skin. It happens to everyone when skin cells are replaced every 14 days or so, but the cells are generally unnoticeable, as they don't shed in large sheets. 

When skin is damaged or burned, like in a sunburn, desquamation becomes more noticeable and occurs in sheets and flakes. Some of the diseases that commonly afflicted kids, like measles and scarlet fever, caused significant damage to the epidermis, causing (sometimes very significant) desquamation after the rash dissipated. 

This child had scarlet fever with a markedly more severe rash than most, but with other symptoms within the average range. 

Diseases of Infancy and Childhood. Louis Fischer, 1917.