Posts tagged 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.

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.

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.

biomedicalephemera: Diphtheria is known for creating a slimy/sticky/smelly exudate in the throat and mouth, but there are quite a few variations on its etiology and presentation. A. Common type of diphtheria. Child three years old, seen on fourth day of illness. Exudate covering pharynx, tonsils, and uvula. Received 16,000 units of antitoxin. Throat clear on sixth day. Discharged cured. B. Follicular type of diphtheria. Child seven years old, seen on second day of illness. The membrane involved the lacunae of the tonsils. Resembles follicular tonsillitis. Received 6,000 units of antitoxin total. C. Hemorrhagic type of diphtheria. Child seven-and-a-half years old, seen on sixth day of illness. Tonsillar and post-pharyngeal exudate. Severe nasal and post-pharyngeal hemorrhages during exfoliation of membrane. Received in all 15,000 units of antitoxin. Throat clear on ninth day of illness. Myocarditis developed. Case discharged cured four weeks after admission.  D. Septic type of diphtheria. Child eight years old, seen on fifth day of illness. The pseudo-membrane in this case covered the hard palate and extended in one large mass down the pharynx, completely hiding the tonsils. Diseases of Infancy and Childhood. Louis Fischer, M.D., 1917.

biomedicalephemera:

Diphtheria is known for creating a slimy/sticky/smelly exudate in the throat and mouth, but there are quite a few variations on its etiology and presentation.

A. Common type of diphtheria. Child three years old, seen on fourth day of illness. Exudate covering pharynx, tonsils, and uvula. Received 16,000 units of antitoxin. Throat clear on sixth day. Discharged cured.

B. Follicular type of diphtheria. Child seven years old, seen on second day of illness. The membrane involved the lacunae of the tonsils. Resembles follicular tonsillitis. Received 6,000 units of antitoxin total.

C. Hemorrhagic type of diphtheria. Child seven-and-a-half years old, seen on sixth day of illness. Tonsillar and post-pharyngeal exudate. Severe nasal and post-pharyngeal hemorrhages during exfoliation of membrane. Received in all 15,000 units of antitoxin. Throat clear on ninth day of illness. Myocarditis developed. Case discharged cured four weeks after admission. 

D. Septic type of diphtheria. Child eight years old, seen on fifth day of illness. The pseudo-membrane in this case covered the hard palate and extended in one large mass down the pharynx, completely hiding the tonsils.

Diseases of Infancy and Childhood. Louis Fischer, M.D., 1917.

Cerebrospinal meningitis due to influenza bacillus This 4-month-old was suspected to have developed meningitis due to the influenza bacillus 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.

Cerebrospinal meningitis due to influenza bacillus

This 4-month-old was suspected to have developed meningitis due to the influenza bacillus 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.

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.

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.

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.

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.

The Mastoid Process and Infections - Before Antibiotics

From Medscape:

The mastoid develops from a narrow outpouching of the posterior epitympanum named the aditus ad antrum. Pneumatization takes place shortly after birth, after the middle ear becomes aerated. This process is complete by the time an individual is aged 10 years. Mastoid air cells are created by the invasion of epithelial lined sacs between spicules of new bone and by the degeneration and redifferentiation of existing bone marrow spaces. Other areas of the temporal bone, including the petrous apex and zygomatic root, pneumatize similarly. The antrum, similar to the mastoid air cells, is lined with respiratory epithelium that swells in the presence of infection.

Blockage of the antrum by inflamed mucosa entraps infection in the air cells by inhibiting drainage and by precluding re-aeration from the middle-ear side. The mastoid is surrounded by the posterior cranial fossa, the middle cranial fossa, the canal of the facial nerve, the sigmoid and lateral sinuses, and the petrous tip of the temporal bone. Mastoiditis can erode through the antrum and extend to any of the above contiguous sites, causing clinically significant morbidity and life-threatening disease.

Ok, I know that’s a bunch of crazy doctor-speak if you haven’t specifically studied the ins and outs of the anatomy of the skull, but the development of the ear takes a long time. The mastoid isn’t fully formed at birth, far from it.

Acute mastoiditis can easily take hold during untreated middle ear infections, when the mastoid is being formed and the immune system isn’t yet up-to-speed (almost always before 2 years of age). Chronic mastoiditis is more complicated, but is still generally influenced by the fact that the mastoid is still forming.

Though antibiotics can almost always clear up ear infections before mastoiditis sets in these days, before their advent, mastoiditis was actually a very significant cause of childhood mortality. Since the mastoid process is so close to other critical parts of the skull (namely just a thin bone away from the brain, and right next to cranial nerve VII), complications were not uncommon, and were not easy to survive.

This x-ray shows one of the more common complications that killed children.

From Monographic Medicine: The clinical diagnosis of internal diseases. L.F. Barker, 1917.