 Beethoven's Funeral On this day, March 29th in 1827, Ludwig Von Beethoven’s funeral was held. Estimates suggest between 10,000 and 30,000 people may have attending the ceremony for the famous composer. He died three days before on March 26th. Of interest to medical history is some debate over the cause of his death. What seems to be clear is that Beethoven likely died as a result of liver disease. The cause of that liver disease is the source of said debate. An autopsy performed two days after his death by Dr. Johann Wagner suggested Beethoven had liver cirrhosis, a term for scarring of the liver. The liver becomes damaged and eventually shrinks into a scarred less-functional version of itself. The scarring obstructs smooth blood flow through the liver and often results in the fluid from the blood getting extruded into the abdominal cavity, called “ascites.” Multiple procedures were done at the time prior to his death to remove the ascites fluid which can build up considerably to cause discomfort to the point where it can be difficult to breathe due to the excess of fluid. Additionally that fluid is a good broth for bacteria and can become infected which, even today in the age of antibiotics, is a serious condition. What’s not clear is what led to the cirrhosis. Some argue that alcohol and infections such as viral hepatitis may have played a role in Beethoven’s liver disease. There is also some interesting speculation that lead poisoning may have contributed. Beethoven was known to enjoy wine and so-called “lead sugar” was often used to sweeten cheaper wines of the day. It’s also suggested that damage to his hearing may have resulted from chronic lead exposure leading to nerve damage. In reality it’s probable that multiple of the above factors may have caused his liver disease, scarring and ultimately the demise of the celebrated composer. Pictured here are a normal liver, cirrhotic liver, Beethoven as well as an image of his death mask. Max[Doctor with a mustache]
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 Boston Medical Journal [March, 23 1922] Infectious disease was a difficult field before antibiotics. In this article from the BMJ, 8 years prior to the discovery of penicillin, we can see a novel approach to the treatment of bacterial pneumonia. Pneumonia refers to an infection of the lungs and at the time of this article there was not much to be done about it. The article refers to a mortality rate (how many people died) at the time of “25-30%” for “Type-1 pneumonia.” As far as what Type-1 pneumonia is, I could not find an exact definition elsewhere, but later in this journal article it seems as if the author is referring to pneumococcal pneumonia–pneumonia caused by the bacteria strep pneumoniae–as being “type-1”. This is still one of the most common bacterial causes of this disease. Certainly viruses such as influenza and COVID-19 can also cause pneumonia. In this article the physician is advocating for the use of serum which was derived from horses. Basically, horse blood was taken and separated to use the portion of it that contained antibodies. It seems as if they were able to isolate the serum that was most active against strep pneumoniae and therefore gave it to patients to help them improve. The physician author here cites his own small study that seemed to suggest the mortality rate when serum was used was as low as 10%. He was quite convinced this treatment did help and on the surface it does seem to make sense. This is a good treatment option for the time–unless you’re allergic to horse serum, which many people unknowingly may be. Check out Episode 19 “The Strangler” of our podcast for more info about the use of serum in the treatment of diphtheria, another particularly nasty bacterial illness which is now quite well prevented in most of the world with simple vaccination. [1] McGuire, L. W. (1922). Serum Treatment of Lobar Pneumonia. Boston Medical Journal, 389–390. Max[Doctor with a mustache]  Happy St. Patrick's Day! This day marks an important milestone in medical history: the first hemodialysis run. Hemodialysis, which is the process of using a machine to function as an artificial kidney, had its first successful application on March 17th, 1943. This was thanks to Dr. Willem Johan Kolff, the Dutch physician who developed the device and tested the process successfully at Kamper hospital in the Netherlands, during WWII. The first machine developed by Dr. Koff apparently featured supplies cobbled together from local industry including the use of a Model T water pump from a local Ford dealer.[1] Though there are other ways to perform dialysis other than hemodialysis, this procedure has undoubtedly saved millions of lives especially since even back in 2010, 2.5 million people worldwide relied on chronic kidney replacement therapies.[2] [1] - Willem Kolff Foundation. https://www.willemkolffstichting.nl/index.php?phm=199 [2] - Hemodialysis. https://pubmed.ncbi.nlm.nih.gov/33085443/ Max[Doctor with a mustache]  “New Books and Book Notices” Here’s a fun entry from the archives of the Brooklyn Medical Journal from March 1890. In the back pages of this journal there was a fascinating review of a then newly-released book entitled Emergency Notes: What to do in Accidents and Sudden Illness Until the Doctor Comes,” reviewed by Glentworth R. Butler, MD (it's not clear who the author of the book is). This journal snippit is a review of the aforementioned book and sadly I could not find any digital copies of that book's contents. It is worth noting something here. The author of this review says “It is rarely that we would commend a medical book for domestic use, knowing that the adage, ‘a little knowledge is a dangerous thing,’ applies especially to this class of works,” perhaps lamenting the layperson’s ability to “Google” their illness with this resource of the time. The reviewer however goes on to praise the book’s authorship and handling of several very practical emergencies such as “stopping Haemorrhage; wounds; Burns and Scalds; Frost-Bites; Treatment of Drowning and Suffocation’ Transportation of the Sick and Injured, etc.” It’s hard to argue with the practicality of the above. I for one would love to know how the various ailments above were treated in the early 1890’s. In an unrelated note, here's hoping to see "Glentworth" start climbing the charts for baby names in 2022. [1] Butler MD, G. (1890). Emergency Notes: What to do in Accidents and Sudden Illness until the Doctor Comes. Brooklyn Medical Journal, 4(3), 63. https://dspace.sunyconnect.suny.edu/bitstream/handle/1951/43006/bmj189003.pdf?sequence=12&isAllowed=y Max[Doctor with a mustache]  On March 9th, 1895, Dr. Rebecca Lee Crumpler died. She was the first African American woman to graduate with a medical degree in the U.S., doing so by completing training at the New England Female Medical College in 1860. She was able to do so in the face of discrimination on many fronts, directed against her race as well as her gender. Many medical schools at the time were not readily willing to admit women, let alone anyone of African American descent. Her medical school (NEFMC) was the first to train women M.D.s. She graduated from medical school in 1864. She helped encourage fellow African Americans to go into the medical profession through her work. She was known to treat patients in her community regardless of their ability to afford such services. Her most recognized written work was A Book of Medical Discourses, published in 1883. It featured a wide range of medical advice with a focus on treating illness in “infants and young children and women of childbearing age.” Details obtained from review of the following article: https://www.nps.gov/people/dr-rebecca-lee-crumpler.htm Digitized version of her book: https://archive.org/details/67521160R.nlm.nih.gov/page/n7/mode/2up Max[Doctor with a mustache]  In honor of #internationalwomensday and #womenshistorymonth, a giant of science...the inimitable Marie Curie, the first woman to win not one, but two Nobel Prizes for foundational work in the discovery of radiation, and the elements radium and polonium, named after her native Poland. In medical history, Marie Curie made a huge contribution to battlefield medicine in World War I, taking it upon herself to develop mobile radiology labs (second picture) to take x-rays to the front. She had to adapt x-ray technology, in addition to developing a dynamo to allow the cars to power the x-ray machines. She gathered multiple cars, outfitted them, then trained over 150 x-ray technicians to run them, and took one to the front herself. She did all of this despite the risks of x-ray exposure, a problem that she later blamed for the development of anaplastic anemia which led to her death in 1934. Photo Credits: Wikimedia, Bibliothèque nationale de France Max[Doctor with a mustache]  March is Hemophilia Awareness Month Pictured: Dr. Alfredo Pavlovsky, an Argentinian physician, discovered there were two common types of hemophilia—A and B—in 1947. Long ago, it had been noticed that certain families seemed to have issues with excessive bleeding with accounts dating back to the 2nd century AD with deaths in certain male children after circumcisions. Abu Khasim, an Arabian physician in the 10th century, noted that some families seemed to have male children that were susceptible to excessive bleeding after trauma. This proclivity for bleeding was at one time called “the royal disease” in much of the 19th and 20th centuries as it affected several royal families of England, Germany, Russia, and Spain. Leopold, the son of Queen Victoria of England died at age 30 from uncontrolled hemorrhage sustained in a fall. Hemophilia roughly translates to mean the love of blood. It is a genetic condition whereby the body does not produce certain proteins that are used to help the blood clot. People with hemophilia are unfortunately predisposed to bleed without stopping. At any given time, one’s blood is in a state of balance between forming and removing clots. If one cannot form a clot, bleeding will continue and can be life threatening even if from a small wound and a mild hit to the head could end a life. The substances in the blood that help us form and regulate blood clots are called factors. Hemophilia A is the absence of Factor VIII and hemophilia B is the absence of Factor IX. There are thirteen factors commonly considered to be part of this biochemical balance. The difference between hemophilia A and B as above was discovered by Dr. Pavlovsky. Why does this mostly affect males? The gene mutation that causes hemophilia is on the X-chromosome and is a recessive gene. Biologic males have an XY gene combination--therefore any gene on the x-chromosome is likely to be expressed. Information courtesy of hemophilia.org / picture courtesy of fundacionbyb.org Max[Doctor with a mustache] |
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