Suction-powered Breast Pump

I had no idea that non-manual breast pumps haven’t even been around as long as computers. For as much of a frustration as my friends go through to pump their milk at work, I can’t imagine the pain and time it took to get breast milk through suction or hand-pump devices.

Druggist’s Ready Reference, issued by Morrison, Plummer & Co., importers and jobbers in drugs. 1887.

Happy New Year’s, y’all. Maybe I’ll be around more next year. Maybe not. But I’m not dead yet, and neither are you, so that’s a good thing.

No, shut up, it IS a good thing. Don’t care what you think; I know this.

Cheers. Love you all.

Two Children - One Vaccinated, one Unvaccinated

"Two children in the Municipal Hospital, one unvaccinated and the other vaccinated on the day of admission - the crust is still seen upon the leg. This child remained in the hospital with its mother (who was suffering from small - pox) for three weeks, and was discharged perfectly well. The unvaccinated child admitted with smallpox died."

Wolliez's Spirophore

As bizarre as it looks, M. Wolliez's spirophore was a forerunner of the iron lung. It was the first negative pressure ventilator that was both widely used, and easily useable over long periods of time.

The first negative pressure ventilator that has a name attached to it was described by the Scottish physician John Dalziel, in 1832. However, successful use of similar apparatuses has been recorded as far back as the turn of the 19th century.

Wolliez's model was hand-powered, but the bellows made it possible to perform resuscitation on a possible drowning victim or stillbirth for hours on end, provided your assistant had able arms. In the age of fears of premature burial, wealthy patrons with well-equipped physicians would were known to insist on their stillborn children being placed in the spirophore and ventilated for long periods, before being declared dead.

While its uses in reviving the stillborn were notable but limited, a larger version of the spirophore apparatus was also used, especially in the British Raj, where snakes with neurotoxins, and British people with poor swimming skills were frequent causes for calls to the physician. The larger spirophores (and later, automated iron lungs) were extremely useful in recovery from cobra and mamba snakebites - as most deaths were caused by paralysis of the diaphragm and suffocation, if the patient was kept alive long enough to break down the toxin, they had a decent chance of survival if they avoided subsequent infection.

Cyclopaedia of the Diseases of Children, Medical and Surgical. Edited by John M. Keating, 1890.

Bottom image via Technologies Biomedicales (original from Wolliez Patent)

Osteosarcoma of the upper jaw in 10-year-old boy

Sarcomas are relatively rare tumors in humans, formed from mesenchymal cells, rather than epithelial (surface) cells. Epithelial cell tumors are called "carcinomas". Since sarcomas are relatively uncommon, but hard tumors or cysts on the bones are not, patients are often misdiagnosed at first.

In children, osteosarcomas (sarcomas of the bone) comprise approximately 2.4% of cancer cases. Most of these tumors occur in the leg bones, but around 8% originate in the jaw. The standard treatment of osteosarcoma is resection of the affected bone - that is, removal of the tumorous section, and joining together the two sections of bone on either side of the removed area. If the tumor has spread or the bone is too overtaken by it, amputation of the limb is called for. Obviously, you can't amputate the face, but detection of facial tumors is often much less delayed than in the leg, and the removal and resection of the jaw bone is usually possible.

Five-year survival rates of pediatric osteosarcoma are still one of the lowest of all the childhood cancers, at an average of 68% across all the different manifestations. However, given that the survival rate was hovering around 5-10% at the beginning of the 20th century (and that's being generous), we've come a long way. Early detection and eliminating misdiagnoses of leg tumors is critical to survival in all age groups.

Tumors of the Jaws. Charles Locke Scudder, 1912.

Oral manifestations of childhood illnesses

1. Oral thrush - Caused by the Candida fungus overgrowing on the mucous membranes of the mouth. Also known as candidiasis when it occurs elsewhere on the body (such as vaginal candidiasis). 2. Varicella - Chicken pox. Have you ever had chicken pox in your mouth? It's awful. 3. Stomatitis herpetica or Aphthosa [Herpetic stomatitis] - Caused by the same herpes infection of the mouth that causes cold sores, but blisters and mild ulceration can occur. This condition usually occurs when the child first contracts Herpes simplex I. 4. Stomatitis ulcerosa or Scorbutus - The oral manifestation of scurvy in children. The bone weakness, dry mouth, and immune dysfunction in scurvy often causes tooth weakening, loosening, and extreme gingivitis. 5. Follicular tonsillitis - The "standard" childhood tonsillitis, with infection of the palatine tonsils. If the infection doesn't subside, removal of the tonsils is still the most common treatment. 6. Diphtheria - There are many oral manifestations of diphtheria, including "pseudo-membranes" covering the trachea, severely impairing breathing. The exotoxins exuded by Corynebacterium diphtherium can also cause thick, thrush-like patches in the pharyngotrachea.

Pediatrics: The Hygienic and and Medical Treatment of Children. Thomas Morgan Rotch, 1901.

Acute Osteomyelitis - Historically known as "Bone Fever" Osteo-: Bone -myelo-: Marrow -itis: Fever

Top: Acute supperative osteomyelitis in femur - note the purulent cavities and pus-filled medullary canal at A, B, and C. In this case, the epiphysis (E) and conjunctive cartilage (D) are uninfected. Center Left: Acute osteomyelitis of tibia, cicatrices showing common position of sinuses in bone. Center Right: Acute epiphysial separation due to osteomyelitis following typhoid fever. Bottom: Early stage of acute osteomyelitis in tibia. Note site "A" - where the infection passed from the periosteum to the interior of the bone. The articular cartilages (C) are sodden with pus from the infected joint.

Acute osteomyelitis is most commonly seen in children and those with diabetes. It is rarely "spontaneous" - the bacteria that infect the subperosteum and marrow have to be introduced into the bloodstream somehow, and there is usually a known source. Systemic infection or traumatic injury are the most common ways that bacteria (today, most commonly Staphylococcus aureus) can get to the bones. Historically, scarlet fever (caused by group A Streptococcus pyogenes) and typhoid fever (Salmonella typhi) were known to cause a large number of osteomyelitis cases in their wake.

When children develop osteomyelitis, the long bones of the body (the femur, humerus, etc.) are most often affected, whereas the spine and pelvis are most commonly affected in adults. This is because there is much greater bloodflow to the growing long bones in kids, and as such there's much more opportunity for bacteria in the blood to infect the site.

Early symptoms of what used to be called "bone fever" are fever and bone pain (as one might assume), as well as local warmth and swelling, and an overall malaise. The bone infection usually presents after a patient appears to have recovered from a disease or wound, as it takes several days to become established enough to cause symptoms. Later on, if left untreated, extreme pain and open, often purulent, wounds above the infection may occur, as the bacteria bore canals through the affected bones.

Without treatment, osteomyelitis can lead to sepsis, complete breakdown of affected bones, or gangrene. When the epiphysis is affected by the infection, growth of that bone can be significantly stunted.

Today, the condition is usually treated with long-term, high-dosage, IV antibiotic therapy. If it's not caught at the start of the infection, debridement of the bone (removing the infected tissue) may be required, and in extreme cases, bone resection (cutting out an entire chunk of infected bone) or amputation may be required. Prior to antibiotics, resection was the most common cure.

Diseases of the Bones, their pathology, diagnosis, and treatment. Thomas Jones, 1887.

Achondroplasia (left) versus normal growth in the six-year-old child

Achondroplasia can be evident at birth, but it is not always obvious to the layperson. As the child grows, however, the distinct shortness and mild hydrocephaly is clearly visible, especially when next to their full-sized peers.

The genetic anomaly that causes this disorder prevents the fibroblasts that create cartilage from forming correctly, and without the continuous growth and ossification of cartilage at the ends of the long bones, the limbs grow very little. The fact that the mutation only causes anomalous cartilage is also why the torsos of people with achondroplasia are typically normal-length - the spinal column doesn't lengthen by way of distal extension, and since other ossification factors are normal in the body, it isn't affected.

While most cases of achondroplasia are sporadic mutations (around 75%), it can also be inherited as an autosomal dominant disorder from an achondroplasic parent. With an achondroplasic parent and a parent of normal height (or who doesn't have a mutated FGFR3 gene), the chances of a child being born with the condition are 1 in 4. With two achondroplasic parents, or an achondroplasic and a hypochondroplasic parent (caused by different mutations, but on the same gene), the chances of a child being born with some form of dwarfism rises to 3 in 4 - though one of those three will inherit two copies of the disordered gene, and with no functional allele, will inevitably be stillborn or die early in life due to almost completely absent skeletal integrity.

Diseases of Children. Herman B. Sheffield, 1921.

Upper: Lateral view of the permanent teeth Lower: Lateral view of the deciduous teeth [also known as milk teeth or baby teeth]

The permanent teeth consist of 32 teeth of four different types. There are 16 teeth on each jaw, and each jaw has 4 incisors, 2 canines, 4 premolars, and 6 molars (this includes the wisdom teeth, which are shown here)

The smaller mouth of the child only accommodates 20 teeth of three different types. There are 10 teeth on each jaw, and each jaw has 4 incisors, 2 canines, and 4 primary molars. 

Atlas and Text-Book of Dentistry. Gustav Preiswerk, translated by George W. Warren, 1906

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.

Congenital nevus [strawberry hemangioma], before and after removal

If addressed before significant growth, strawberry hemangiomas are often easily removed and the skin cleared of the blemish. However, they have a tendency to be highly vascularized, and when they cover a large surface area, they can result in high levels of blood loss in surgery.

Face and Foot Deformities. Frederick Churchill, 1885.

Medieval Cures: Ensuring a healthy baby

Assuming your infant survives pregnancy and childbirth (uncommon enough as it was), you must keep the evil spirits and demons away. These demons snatch the youth from this world, and wandered the earth night and day, looking for unprotected children.

To deter the evil spirits and demonic beings: