Highcock, A .J., K. Rourke, and D. Brown (2008). ‘The University Rollerdisco: An Unusual Cause of a Major Incident.’ Injury Extra 39 (12): 386–88.
In Brief
‘Punk Rocker’s Lung: Pulmonary Fibrosis in a Drug Snorting Fire-Eater’
by D. R. Buchanan, D. Lamb, and A. Seaton (published in the British Medical Journal, 1981)
The Toothless Rule of Louis XIV
French teeth are something of a specialty for the president of Great Britain’s Royal Historical Society. Colin Jones, who is also a history professor at Queen Mary, University of London, has written two memorable monographs on the subject.
Evidence of a huge Parisian tooth-yanker. ‘A French Dentist Shewing a Specimen of His Artificial Teeth and False Palates’ by Thomas Rowlandson (1811). Wellcome Library, London
Jones’s study, called ‘Pulling Teeth in Eighteenth-Century Paris’, centres on a literally huge Parisian tooth-yanker called Le Grand Thomas. Jones explains: ‘For nearly half a century, from the 1710s to the 1750s, Thomas was a standard fixture, a living legend, plying his dental wares on the Pont-Neuf in Paris ... If the tooth he was attacking repulsed his assaults he would, it was said, make the individual kneel down, then, with the strength of a bull, lift him three times in the air with his hand clenched on the recalcitrant tooth.’ Jones suggests that a well-informed toothache sufferer, surveying the major healthcare options, might reasonably opt for Le Grand Thomas or one of his many self-taught peers.
Surgeons, the people most likely to do a good job, were enjoying a rise in prestige and fees. They would commonly decline the pedestrian, relatively low-paying task of tooth-pulling. Doctors and apothecaries ‘were both still primarily hands-off practitioners’ whose services might be expensive and whose array of remedies still included things like ‘the ingestion of flayed, crushed and cooked mouse’.
Given these alternatives, Jones writes, ‘it is not difficult to imagine that the limited dental skills of the smithy or the therapeutic value of casseroled mouse must have opened up a niche for a more helpful and more imaginative approach. This niche appears to have been filled by men of the stripe of Le Grand Thomas’.
Jones also wrote a study called ‘The King’s Two Teeth’. The title refers to the two choppers present at birth, in 1638, in the mouth of Louis XIV, the man who would later be called Louis the Great and Louis the Sun King. ‘To contemporaries’, writes Jones, ‘this prodigious, gluttonous, voracious pair of teeth seemed to presage the wonders which the hungrily devouring prince would in the fullness of time effect on the map of Europe.’
Jones mentions a tradition of French royal portrait painting: kingly teeth, even when existing and beautiful, were always hidden behind closed lips.
But traditions would change.
A much-celebrated portrait done in 1701, of a sixty-three-year-old Louis ‘at the height of his powers’ shows the king with impressively youthful legs and posture. Even with this blatant inaccuracy, Jones says, ‘one feature stands out – and shocks – for its stark naturalism: hollow cheeks and wrinkled mouth reveal a ruler with not a tooth in his head’.
Together with the development of better dental medicine, he concludes, ‘the replacement of the tooth puller by the dentist and the emergence on the marketplace of a powerful demand for a different kind of mouth all in their different ways highlighted a silent revolution of the teeth and the smile which bade to put paid to the Old Régime of Teeth’.
Jones, Colin (2000). ‘Pulling Teeth in Eighteenth-Century Paris.’ Past and Present 166 (1): 100–45.
–– (2008). ‘The King’s Two Teeth.’ History Workshop Journal 65: 79–95.
Mummies’ Recipe for Good Health
Nowadays, powdered mummy may not be everyone’s cup of tea, but for many years it was just what the doctor ordered. That’s one of the takeaway messages of Richard Sugg’s study ‘“Good Physic but Bad Food”: Early Modern Attitudes to Medicinal Cannibalism and its Suppliers’. Sugg, a research fellow in literature and medicine at Durham University, in the UK, begins with an observation: ‘The subject of medicinal cannibalism in mainstream western medicine has received surprisingly little historical attention.’
Sugg tells us that mummy, generally in powdered form, ‘having originally been a natural mixture of pitch and asphalt, came in the twelfth century to be associated with preserved Egyptian corpses’. It then ‘emerged as a mainstream western medicine’ and remained a standard-issue drug until ‘opinion began to turn against it in the eighteenth century’.
Physicians prescribed powdered mummy for diverse ailments. An English pharmacopeia published in 1721 specifies two ounces of mummy as the proper amount to make a ‘plaster against ruptures’. Ambroise Paré, royal surgeon to sixteenth-century French kings, proclaimed mummy to be ‘the very first and last medicine of almost all our practitioners’ against bruising.
Dr Paré harboured doubts about the drug’s efficacy, lamenting that ‘wee are ... compelled both foolishly and cruelly to devoure the mangled and putride particles of the carcasses of the basest people of Egypt, or such as are hanged’. But Paré was an unusually driven doubting Thomas – he lamented having ‘tried mummy “an hundred times” without success’.
Sugg’s study explains that ‘mummy was an important commodity. It is often seen in long lists of merchants’ wares and prices.’ The marketplace attracted counterfeiters. Sugg supplies an anecdote: ‘Tellingly, when Samuel Pepys saw a mummy it was in a merchant’s warehouse; while “the abuses of mummy dealers in selling inferior wares” were especially widespread and notorious by the end of the seventeenth century.’
The best suppliers maintained high standards. The presumably admirable recipe used by seventeenth-century German pharmacologist Johann Schroeder included ‘the cadaver of a reddish man (because in such a man the blood is believed lighter and so the flesh is better), whole, fresh without blemish, of around twenty-four years of age, dead of a violent death (not of illness), exposed to the moon’s rays for one day and night, but with a clear sky. Cut the muscular flesh of this man and sprinkle it with powder of myrrh and at least a little bit of aloe, then soak it.’
Sugg, Richard (2006). ‘“Good Physic but Bad Food”: Early Modern Attitudes to Medicinal Cannibalism and its Suppliers.’ Social History of Medicine 19 (2): 225–40.
To Be Michael Jackson, After a Refashioning
In 1997, a twenty-four-year-old Belgian man requested that his head be reconstructed to make him resemble the singer Michael Jackson. Three plastic surgeons granted his wish. Their report about it, published in the journal Annales de Chirurgie Plastique et Esthetique, is a lovely sight to behold. The loveliness is partly in the detailed technical description, monochromatically in the set of before-and-after X-rays of the facial bones, and memorably in the medically stylish photographs that show the young man before and after his course of treatment.
The doctors, Maurice Mommaerts and Johan Abeloos, of the Hôpital Général Saint-Jean in Bruges, Belgium, and H. Gropp, of the Diakoniehospital in Bremen, Germany, described the patient’s challenge to them: ‘His quest was to obtain the facial features of Michael Jackson, his idol that he imitated professionally.’ This was an unusual demand. The doctors explain that ‘normally, patients strive for an ideal, beautiful, normal contour [of the facial bones]. We were confronted with a patient who requested a three-dimensional overcorrection.’
Their patient was no ordinary young man. He impressed the doctors with the firmness of his desire, but also with his detailed knowledge of his own craniofacial anatomy (especially his gonial angles and malar prominence).
This task, the doctors decided, after only minimal hesitation, was something they could do. ‘After thorough discussion and psychiatric analysis, we agreed to morph him in a way that all changes could be undone and that the tissues were not at risk for considerable permanent damage.’
The case was both easy and hard. The surgeons immediately saw simple ways to rearrange the young man’s chin and also
his cheekbone arches. But how to achieve the desired posterior-mandibular augmentation? That was the puzzler; solving it would be a medical first.
The doctors rose to the posterior-mandibular augmentation challenge. They conquered it and, in so doing, made history. Two rounds of surgery did the trick. Full details are in their report. For non-specialists, the important feature may be the simple and comforting piece of knowledge: Yes, we now know, it is possible to surgically morph a long-jawed Belgian white youth so that he looks just like Michael Jackson.
Yet, a prominent institution that houses that particular type of individual suddenly has, at least potentially, a big problem. Hordes of people want to see him, touch him, admire him, maybe even serve legal papers on him. I found no reports of that happening with this Belgian doppelganger. I suspect that is because the surgeons kept up with the medical literature, and had learned from a 1996 report in the journal Hospital Security and Safety Management. That instructional article, written in the wake of Mr Jackson’s unfortunate and dramatic collapse on stage in New York City, is called: ‘Michael Jackson at Beth Israel: Handling Press, Fans, Gawking Employees’.
Mommaerts, M. Y., J. S. Abeloos, and H. Gropp (2001). ‘Mandibular Angle Augmentation with the Use of Distraction and Homologous Lyophilized Cartilage in a Case of Morphing to Michael Jackson Surgery.’ Annales de Chirurgie Plastique et Esthetique 46 (4): 336–40.
N. A. (1996). ‘Michael Jackson at Beth Israel: Handling Press, Fans, Gawking Employees.’ Hospital Security and Safety Management 16 (12): 10–11.
Pursuing a Wretched Itch
Can capsaicin – the chemical that causes most of the burning sensation when you chomp on a chilli pepper – relieve itching at the nether end of the digestive tract? A team of Israeli scientists tried to find out.
They tackled a maddening medical condition called ‘idiopathic intractable pruritus ani’. Most people, including most doctors when they are talking informally to each other, use the less-formal name: ‘persistent butt itch’. It is one of a wide class of medical conditions that sound humorous until you experience them yourself. And then they still sound funny, which perhaps adds to the discomfort.
Dr Eran Goldin and a large team of colleagues at Hadassah University Hospital, in Jerusalem, collected forty-four patients who suffered from chronic butt itch. Each had endured at least three months of suffering. None had responded to the traditional treatments – gentle washing and drying of the affected area, and avoidance of certain foods that are famous for causing chronic butt itch.
Coffee, tea, cola, beer, chocolate, and tomatoes are thought to be the six biggest causes of the problem, identified as such in a 1997 report by William G. Friend of the University of Washington. Friend believed that coffee is the main culprit, responsible for about eighty percent of all cases of intractable butt itch. Drink less coffee and you’ll be able to sit still, if you are one of the luckier butt itch sufferers. The forty-four Israeli itch victims, though, did not have that sort of luck. Theirs was an itch of unknown origin, a head-scratching puzzle for any doctor who tried to treat them.
Goldin and his team solved this puzzle for thirty-one of their forty-four patients by applying the capsaicin topically. Four patients did feel what Goldin called ‘a very mild perianal burning lasting 10–15 minutes’ after the treatment, but apparently this was for them a small price to pay.
Some months later, the doctors checked up on eighteen of the patients. All said they were still feeling pretty good, so long as they gave themselves an anal dose of capsaicin every day or two. The Goldin report concluded that ‘capsaicin is a new, safe, and highly effective treatment for severe intractable idiopathic pruritus ani’.
While new for treating this very specific ailment, capsaicin was already, as the doctors themselves point out, generally ‘known to be effective and safe in the treatment of pain and itching’. Capsaicin was also, of course, known to have rather ferocious effects when placed into the front end of a person’s digestive system.
A 2002 experiment by doctors at L. Nair Hospital in Mumbai, India, explored both sides of the action. The research team fed ten grams of red chilli powder (in other words, a heaping dose of capsaicin) to twenty-one men who have well-tempered bowels. The doctors report that this ‘increases the rectal threshold for pain’. You will forgive me, I hope, for not describing how they performed that measurement.
Lysy, J., M. Sistiery-Ittah, Y. Israelit, A. Shmueli, N. Strauss-Liviatan, V. Mindrul, D. Keret, and E. Goldin (2003). ‘Topical Capsaicin – A Novel and Effective Treatment for Idiopathic Intractable Pruritus Ani: A Randomised, Placebo Controlled, Crossover Study.’ Gut 52: 1323–26.
Friend, William G. (1977). ‘The Cause and Treatment of Idiopathic Pruritus Ani.’ Diseases of the Colon and Rectum 20 (1): 40–42.
Agarwal, M. K., S. J. Bhatia, S. A. Desai, U. Bhure, and S. Melgiri (2002). ‘Effect of Red Chillies on Small Bowel and Colonic Transit and Rectal Sensitivity in Men with Irritable Bowel Syndrome.’ Indian Journal of Gastroenterology 21 (5): 179–82.
The Fingernails of Dr Bean
Many people, especially academics and taxi drivers, take pride in having arcane knowledge at their fingertips. Dr William B. Bean bested them all. Bean’s arcane knowledge was not only at his fingertips; it was about them. Bean spent much of his adult life monitoring the growth of his fingernails. He trimmed his nails neither to be fashionable nor to add to his press clippings. He did it for science.
William B. Bean (born 1909, died 1989) conducted what is known as a longitudinal self-study of fingernail growth. It is one of the few such studies known, and perhaps the lengthiest. Bean taught for many years at the University of Iowa College of Medicine and later at the University of Texas medical branch at Galveston, Texas. The cuticle research was published, in pieces and at intervals, in the Archives of Internal Medicine, of which Bean happened to be editor.
In 1968, the first of the Bean nail papers arrived in print. Called ‘Nail Growth: Twenty-Five Years’ Observation’, its timing was unfortunate for Bean, in that the world was distracted by riots, assassinations, the Vietnam war, and the nail-biting American presidential election in which Richard Nixon rose to power. The year 1974 saw the publication of Bean’s extended observations. His paper ‘Nail Growth: 30 Years of Observation’ was published just a few weeks after President Nixon’s attention-grabbing resignation from the American presidency. Again, Bean received scant acclaim.
Dr Bean’s twenty-year nail chart from ‘Nail Growth and Unusual Fingernails’
Two years later, perhaps growing a little impatient, Bean drummed his metaphorical fingertips on a different tabletop, publishing a cuticle-centric essay not in his own journal, but in the International Journal of Dermatology. Under the headline ‘Some Notes of an Aging Nail Watcher’, he explained: ‘Growth of deciduous tissues gives us a natural kymograph to record secular trends and in some instances makes the mark on the moving record. For the observant clinician, knowledge of the rate of nail growth may permit an occasional spectacular diagnosis, although much more often it merely adds a small bit to our understanding of simple but basic biological principles in health and disease.’ This seems to have produced a gratifying response.
Thereafter, Bean returned to his original, deliberate publication schedule. In 1980 he produced ‘Nail Growth: Thirty-Five Years of Observation’. It is as complete a story as the world has ever seen about the growth of one physician’s fingernails. Here is his summary: ‘A 35-year observation of the growth of my nails indicates the slowing of growth with increasing age. The average daily growth of the left thumbnail, for instance, has varied from 0.123 millimeters a day during the first part of the study when I was 32 years of age to 0.095 millimeters a day at the age of 67.’
Bean, William B. (1962). ‘A Discourse on Nail Growth and Unusual Fingernails.’ Transactions of the American Clinical and Climatological Association 74: 152–67.
–– (1968). ‘Nail Growth: Twenty-Five Years’ Observation.’ Archives o
f Internal Medicine 122 (4): 359–61.
–– (1974). ‘Nail Growth: 30 Years of Observation.’ Archives of Internal Medicine 134 (3): 497–502.
–– (1976). ‘Some Notes of an Aging Nail Watcher.’ International Journal of Dermatology 15 (3): 225–30.
–– (1980). ‘Nail Growth. Thirty-Five Years of Observation.’ Archives of Internal Medicine 140 (1): 73–76.
New Pet Theory
Some Australian researchers have put forward a new pet theory about older people and their beloved pets, which many have claimed, including the Medical Journal of Australia, are ‘good for health’ – the health of humans. This new theory is blunt in overturning this assumption.
Susan Kurrle and Robert Day, of the Hornsby Ku-ring-gai Health Service in Sydney, Australia, and Ian Cameron, of the University of Sydney, looked at cases of pet-related falls that brought patients seventy-five years and older to one particular hospital during a six-month period. They defined pets as ‘an animal which is kept as a companion and is treated with affection’. This included animals such as goats and donkeys, as well as dogs, cats, and birds. They narrowed their definition of the injured to fall victims who sustained a traumatic bone fracture. Their analysis excluded injuries that ‘occurred as a result of older people being startled by mice, cockroaches or spiders, as these animals were not considered pets for the purpose of this study.’
The circumstances of each case, as presented in the report, are plaintively stark. Here are a few, each quite typical:
Taking Jack Russell terrier for walk using retractable leash. Dog ran round and round patient’s legs and pulled him over.
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