Category Archives: non-psychiatric treatment modalities

The City of Lights and Medicine

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Denizens of the 21st century complain of how super-specialized the practice of medicine has become. Few modern medical students aim to be generalists – even the discipline now known as Family Practice is a specialty – as most aim for many additional years of training to become expert in scientific minutiae.

It would appear, however, that our world has nothing on 19th century Paris.

The City of Lights in the epoch between Napoleon and the Franco-Prussian War was an epicenter of medical study, one reason being that French citizens were entitled to free medical care by royal decree. Students and young doctors flocked there from all over the continent, and from across the Atlantic, because of the amazing proliferation of facilities dedicated to very specific conditions and illnesses. No where else could doctors-in-training see so much pathology at the sides of renowned clinicians all in the same place.

Obstetrical complications? That would be Hôpital de la Maternité, with no fewer than a dozen births per day. Gravely sick children? The largest such hospice in the country was Hôpital des Enfants-Malades, sadly filled to capacity. Venereal diseases? There were two: for the women, Hôpital Lourcine, and for the men, Hôpital du Midi – the former being a house of tertiary-staged horrors, and the latter, while equally ghastly, mandating in the earliest years the additional ‘treatment’ of public whippings to teach patients to stay away from strumpets and keep their trousers on.

Lunatic women of childbearing years, idiots and imbeciles and morons of both genders, the terminally ill, the deaf, the blind, the dumb… all had their own specific destinations in the capital. There was a hospital for elderly married couples who wanted to die together in the same room (they could bring their own furniture and effects, the price of admission in part being bequeathment to the facility on joint passing of all personal property).

Lepers, however, were not welcomed, and instead were shipped out of the city limits should any show up at the front doors.

There was even Hôpital des Enfants-Trouvés for homeless children (distinct from an orphanage, as Enfants-Trouvés had physicians on staff to tend to the lesser ailments of the abandoned whose sicknesses didn’t quite require admission to Enfants-Malades). Some of the arrivals were orphaned when their mothers died at la Maternité (1:50), while others were voluntarily surrendered by caretakers unable to provide for their special needs. When these youngsters were deemed medically stable, they were offered for public adoption, though without surprise, many stayed at Enfants-Trouvés until they reached majority and were turned back to the streets by the hundreds.

Enfants-Trouvés had an anonymous drop-zone called le tour d’abandon (‘the desertion tower’) where sliding doors and a small bell would herald to the nurses within the arrival of a new human deposit. The citizens of Paris were encouraged to mark their children so they could potentially be reclaimed, though very few were ever later sought.

The American doctors in town, however, were most astonished by École Pratique d’Anatomie. While not a hospital per se – it was more of a pathology foundation – it allowed any physician, for the equivalent of $6, to access his own personal cadaver for dissection (no doubt many of whom were unfortunate former patients of Paris’ other healing institutions). In the early 19th century, human dissection remained illegal in the U.S., and many practitioners there had to resort to grave robbing to obtain specimens. In Paris, for a modest fee, cadavers were plentiful for the taking.

There was one small catch. The stuffy and warm dissection room often contained two dozen physicians whittling away on unpreserved corpses. The smell was said to be overpowering, and at the end of the day, leftover chunks of the deceased were tossed to packs of snarling street dogs who waited out back.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

The Wonder Drug

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A (foreign-born) relative of mine – one with extensive medical training – has chronic difficulty sleeping. X has attempted all of the usual sleep-hygiene techniques. X has also tried the rather traditional drug/ health food store aids (e.g., Tylenol PM, Benadryl, Melatonin, l-Tryptophan) and much of the prescription stuff (e.g., Seroquel, Remeron, Ambien). X often sleeps in fits and spurts regardless, and has become frustrated, tired of going to the family doctor for help that doesn’t actually help.

One day recently, X and I were going through the belongings of another relative who had visited the U.S. and then departed, inadvertently forgetting some personal items and then asking for smalls to be mailed to her. In reviewing what to send and what to keep for the next visit, X came across a small bottle of liquid. X sat down, looking at the label, and smiling.

Corvalol

Corvalol

“What did you find?”

“Ah, this is what we used in [the Old Country]. It’s great stuff.”

“For what?”

“It’s a nerve medication. And a heart medication, for high blood pressure, angina, and tachycardia. It calms you down. It even works for gastrointestinal cramping. But most people also use it for sleep. Old people love it. You mix it with water and maybe some sugar. I used it years ago. It’s great.”

Intrigued by this rather vague and all-inclusive description from a fellow medical professional, I asked for translation, as the label was written in a tongue I do not speak.

C-O-R-V-A-L-O-L

Before I go further, let me remind readers that much-vaunted Western Medicine (and culture) has a long history of employing stuff back in the day that we wouldn’t be caught dead using now. Freud was a vocal proponent of cocaine, a sanguine view shared by the original recipe for Coca Cola. 7-Up at one time contained lithium. The Victorians freely employed alcohol for colicky children. Before it was outlawed in the 1960s, many residency programs employed LSD as a means of teaching budding psychiatrists about psychosis. Benzodiazepines (e.g., Valium and its brethren) were handed out like candy by some practitioners when first on the market, as a “safe” alternative to other sedative-hypnotics. You get the picture.

So, a MedPub search of Corvalol turns up some very interesting information.

It is OTC in many central and eastern European nations and in former Soviet states, and there is a booming market for it in immigrant communities. Usually brought into this country in small amounts as personal Rx (and with labels that can’t be read by customs anyway), it is available as scored tablets, though it is more often found as a (liquid) tincture to be mixed with a beverage of choice before consumption.

It is neither approved nor legal in the U.S. in its traditional formulation. It can be obtained online, but is then missing some of its key ingredients when shipped via approved channels, rendering it, in the words of one disgusted user, “piss water.”

Okay, so what comprises this wonder drug? As brewed by its two manufacturers – Farmak Pharmaceutical Manufactory of Kiev, Ukraine, and Krewel Meuselbach GmbH of Frankfurt, Germany – it contains myriad inactive ingredients (i.e., lactose monohydrate, magnesium stearate, β-cyclodextrin, potassium acesulfam, peppermint oil), and then

• Alcohol (the tincture 96% by volume) which needs no introduction;
• Ethyl ether of α-bromizovalerianate, a combination of bromide and herbal valerian root extract;
• Phenobarbital.

Bromides have been employed as flame retardants, gasoline additives, and pesticides – appetizing, yes? – though in humans, they have a long and storied history as anxiolytics and anticonvulsants starting in the 19th century.

[sidebar: for those readers from Baltimore who are familiar with the city’s landmark Bromo-Seltzer tower, that widely-known medicinal agent lost its namesake ingredient in 1975 by U.S. Food and Drug Administration fiat]

Valerian started as perfume in the 16th century Mediterranean basin. It has been historically used for insomnia and conditions associated with anxiety. It has also been applied in folk medicine for infantile convulsions, epilepsy, attention deficit, chronic fatigue, joint pain, asthma, migraines, menstrual cramps, and symptoms associated with menopause. Despite minimal scientific data that valerian can reduce coronary vessel spasm in certain cases, the remainder of these therapeutic claims are unsupported by any research at present.

As for Phenobarbital, it is an anticonvulsant barbiturate and DEA schedule IV controlled substance. There are no clinical trials supporting its use in cardiovascular or bronchospastic states. It can also alter the metabolism of other Rx when taken in combination – thus, gerontologists oppose its use in the elderly due to the high rate of physical dependence and risk of toxicity even at low doses.

And yet, the lack of controlled studies notwithstanding, in a number of countries, Corvalol is widely available – sometimes even mandated – in first aid kits (e.g., those accessible on public transportation), alongside aspirin, nitroglycerin, and activated charcoal, and freely dispensed as needed.

Sleep tight!

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Pharma Sleight of Hand

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Viagra By Mail!
Enhance Your Performance!
Only 99 Cents Per Tablet!

This is what most of us find in our spam baskets, usually written in pidgin English and from strange overseas ISPs. Viagra, as you probably know, is one of Pfizer’s all-time blockbusters, and remains under (very expensive) patent protection in the United States until 2019. Although its sales peaked in 2008, four years later it still earned the mother ship over $2B in global sales. Depending on the insurance/ copays/ deductibles my male readers might possess, a tablet of 50mg can cost upwards of $32 each.

[sidebar, overheard at one pharmacy window: “$32?!? No thanks. The missus sent me. Not worth it”]

So the above e-solicitation is obviously bogus, right?

Not exactly.

confiscated counterfeit blue gold

confiscated counterfeit blue gold

Viagra, patented first in the U.K. in 1996, came on the U.S. market two years later. Its active ingredient, sildenafil citrate, was originally investigated as an anti-hypertensive and treatment for angina pectoris. It acts by inhibiting cGMP-specific phosphodiesterase type 5, an enzyme that promotes degradation of cGMP… pretty boring stuff, unless you’re a biochemist. But it was only during clinical trials that its other, far more lucrative and now famous, physiologic effect was discovered. Now ubiquitous in late night comedians’ monologue punchlines, aging men (think Hugh Hefner, Bob Dole, Pelé) sing its praises, and a robust grey market has developed. Not a few marriages have been saved, and probably more destroyed, by its easy (albeit expensive) availability. It is said to be the most counterfeited drug anywhere. In short, Viagra’s pop culture notoriety has done for American – nay, world – sexuality in the 21st century what The Pill did for the Sexual Revolution back in the 1960s.

But it’s so damned pricey!

[sidebar: now working with the Veterans’ Administration, I’ve noticed that a majority of my male patients are prescribed Viagra by their primary care docs. However, the VA puts a strict limit on how many Vitamin Vs a patient can receive, likely because of cost. In case you’re wondering, Washington allows twelve tablets per 90 days. I’ve had more than one vet come to my office fuming, saying something to the effect of, “I served honorably for [x] years in [insert Third World hellhole]. And now Uncle Sam tells me that I can only get lucky* once a week?!?”]

[*“get lucky” is not the actual phrase used]

I have written before about off-label prescribing, the (perfectly legal and widely practiced) mechanism by which drugs approved for one indication can be used for whatever the prescriber wants, once the Rx is on the market. In a related vein, many medications were first envisioned for one role but quickly segued to other uses as clinical findings and needs dictated.

Thorazine was at first a veterinary anesthetic before it was an antipsychotic tranquilizer

Monoamine Oxidase Inhibitors were being applied to treat TB before their antidepressant effects were realized.

Minoxidil was used for hypertension and then was found to grow hair on bald scalps.

The moiety Bupropion has been marketed as both Wellbutrin (for depression) and Zyban (smoking cessation).

Fluoxetine is best known when prescribed as Prozac, another antidepressant, although it also is the active ingredient in Sarafem, for monthly pre-menstrual symptoms.

[sidebar: I remember a time when Wellbutrin and Prozac were on formulary, while Zyban and Sarafem were not. Easy to get around that, however… just prescribe the formulary agent for the non-formulary indication and everyone is happy except the accountants]

In short, if it’s FDA approved, on the market, and you have a medical license and can prescribe, go for it!

Why this is germane: Viagra for male erectile dysfunction loses its U.S. patent protection in 2019. But sildenafil, its active ingredient, has already been available to internists and pulmonologists as a generic for the treatment of pulmonary arterial hypertension since 2012. And as a generic, sildenafil’s cost has plummeted, now running about $1 per 20mg tablet (or $3 for three of them, roughly approximating the dose of sildenafil in a costly 50mg Viagra)

To make matters even more interesting, local pharmacies can usually order generic sildenafil with little effort, and will often mail these meds to one’s home if the doctor calls in a prescription and you provide a credit card number. These are not fly-by-night foreign mail order pharmacies. These are (licensed) pharmacies here in the US of A providing an accepted pharmaceutical for a recognized medical use – the treatment of pulmonary arterial hypertension.

Although seen in other illnesses as a related finding (e.g., pulmonary embolus, scleroderma, lupus), at a frequency of only 3 per million, idiopathic pulmonary arterial hypertension is a far less common condition than, say, middle aged erectile dysfunction.

So, with a wink from your doctor and pharmacist, what one does with the cheap sildenafil when it arrives with your electric bill and copy of TIME magazine is entirely up to you.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Self Preservation

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The following is a true story. Some may find it distasteful, unprofessional, unethical, and all of those other ‘non-PC’ adjectives. I offer it without commentary, merely to illustrate the lengths to which overworked, exhausted, and stressed people will go in their attempts at self-preservation.

While a senior medical student at UVa, I did a six week stint as an acting intern at the Medical Center of Louisiana at New Orleans – you know it as Charity Hospital.

Charity Hospital

Charity Hospital

Even in those pre-Katrina days, Charity was at baseline a chaotic zoo. The currently extant but abandoned Art Deco building, constructed in 1939, was at its opening the second largest hospital in the U.S., with over 2600 beds. It was so large that it hosted students and residents from not one, but two, medical schools (LSU and Tulane). I was with the former, on the pulmonary service.

In 1988, we used to say that Charity offered “state of the art medical care… from 1940.” That wasn’t entirely inaccurate. While the trauma unit was well known and highly regarded because of the constant stream of knifings and gunshot wounds that showed up on the doorstep, other aspects of the physical plant left much to be desired. For example, on the pulmonary service where I worked, those with TB were put in ‘isolation,’ which in Charity parlance meant pulling a floor-to-ceiling curtain all the way around their bed. No joke. We’d be rounding past patients coughing and hacking with nothing but a gossamer-thin curtain between us. Today, such patients are put in sealed rooms with negative pressure airflow, but back in the 1980s, the curtains were the best that Charity could offer. It’s a miracle that I never seroconverted.

[gross humor sidebar: the house staff referred to the 24-hr cafeteria in the basement of Charity as “the fistula” because “it’s always open.” If you don’t get the medical double-entendre there, look up the definition of ‘fistula’]

Anyway, there was a senior resident at Charity whom I knew – let’s call her Dr X – who found herself one night in a particularly difficult bind. She hadn’t slept in ages (these were the days before there were rules about how many hours a resident could work without a break). She hadn’t eaten either, and she had ten admissions waiting to be seen. It was after midnight, and the pager kept urgently demanding attention for all of the new problems on the inpatient wards.

And then Mrs Y died. Dr X went to see her and she had expired. She was elderly, very ill, and death was not unexpected, as she was DNR (no-code). Still, this came at the worst possible time for Dr X. Stopping to do the death certificate and all of the related paperwork would have set her even further behind answering pages and seeing new admissions (forget about eating and sleeping).

In Charity Hospital in those days, there were few orderlies available, so most times the residents themselves hauled patients onto gurneys and transported them wherever they needed to go within the complex. It was hard physical labor, but often a better choice than calling and waiting for an orderly who might never actually arrive.

Then, with apologies to Dr Seuss and the Grinch, “[S]he got an idea. An awful idea. [Dr X] got a wonderful awful idea.”

Mrs Y had not been dead for long. She was a small woman. Dr X moved her onto a gurney with a pillow, covered her with a blanket, and wheeled her along the darkened labyrinthine halls and onto an elevator. It was in the wee hours of the morning and there were few people around. She took the elevator down to radiology and pushed the gurney to xray. She quickly completed a request form for a chest film, tucked it under the pillow, and left Mrs Y on the gurney outside the radiology suite along with several other patients who were lined up for studies. All was quiet. Dr X returned to the ward to answer pages and see new admissions.

Within the hour – now pushing 3:00 a.m. – Dr X rec’d a page from radiology. The technician’s voice on the other end of the line said, “Dr X? I’ve got some bad news. You ordered a chest xray on Mrs Y a while ago, but she has died. I’m really sorry to report this.” A brief moment of silence was then followed by, “Dr Z [the radiologist] will take care of the paperwork down here.”

Which was exactly the plan all along. Mrs Y went to her reward, and Dr X lived to fight another day.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Blowing Smoke

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[Today’s post is sponsored by Sergei Chernikov, PhD, of Apex, NC. As a fellow employee of state government, I know that the (not so subtle) similitude of our shared bureaucratic experiences will not escape him]

Native Americans were known by early explorers to use tobacco in a variety of ways, including to treat medical ailments. European doctors quickly picked up on this – recall that tobacco was an exotic product at the time – and began to prescribe the noxious weed to treat everything from headaches to cancer, hernias to emphysema, and abdominal cramps to typhoid and cholera (all without much or any supporting empirical evidence).

For reasons lost to history, and though it was likely in practice earlier, a Dr Richard Mead in London first suggested in writing in 1745 that administering tobacco per anum was an effective way to resuscitate near-drowning victims.

Yes, you read correctly. Tobacco. Per Anum. Drowning.

This is how it worked in theory: upon pulling an unconscious victim from the water, a rubber tube was to be inserted in the rectum. The tube was to be connected to a fumigator/ bellows which compressed air and forced smoke into the colon. Sometimes a more direct route to the lungs could be substituted by forcing smoke into the nose and mouth, but most physicians of the period felt that the rectal approach was more effective. The nicotine in the tobacco was thought to stimulate the heart to beat stronger and faster, thus encouraging respiration. The smoke was also thought to warm the victim and dry out the person’s insides, removing excessive moisture from those waterlogged and near death.

from a medical textbook of 1776

from a medical textbook of 1776

[sidebar: this method was not recommended for the geriatric population, as it was believed that tobacco per anum dessicated the humours, made the brain sooty, and only exacerbated dryness in old people who were dried up anyway – I’m not making this up]

One of the earliest documented references to employing this treatment for resuscitation comes to us from the year following Dr Mead’s publication. In 1746, a man in Amsterdam pulled his unconscious wife from a canal. The absence of bellows notwithstanding, a passing sailor suggested that emergency tobacco administration might revive her, at which point the husband took his pipe filled with burning tobacco, shoved the stem into his wife, and blew hard. As one can imagine, hot embers of tobacco being blown up her rectum had the intended effect and she was, indeed, revived.

In the later 18th century, it was not uncommon to see bellows hung alongside major waterways, such as the Thames – much as we have defibrillators in public venues today – in case someone was found in the water and could be ‘saved’ by a timely tobacco intervention.

don't attempt this at home

don’t attempt this at home

In 1811, an English medical writer noted that “[t]he powers of the tobacco enema are so remarkable, that they have [captured] the attention of practitioners in a remarkable manner; of the effects and the method of [administering] the smoke of tobacco per anum, much has been written”; he then provided a long list of (peer reviewed?) European publications on the subject.

Eventually, artificial respiration was recommended by some practitioners for near-drowning victims… but only if the tobacco method didn’t work first.

By the second quarter of the 19th century, though, as medical science progressed, the practice of blowing smoke up someone’s rear finally became a thing of the past.

Figuratively, however, the practice remains alive and well.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

An Observation On Socialized Medicine

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Prior to leaving for our family visit in Lithuania earlier this month, we learned that my 92 year old grandmother-in-law, Antanina, had been hospitalized in Kaunas. She’s a hardy individual – a 1950s Soviet gulag survivor who still lives independently and has all of her mental faculties about her – but any hospitalization at that age is of concern. At first we were told it was simple dehydration, but then we learned that some pneumonia was involved as well. Thus, as soon as we landed in Vilnius, we made arrangements to drive the 1.3 hours to the hospital to visit and find out more for ourselves.

There are several campuses of the medical center in Kaunas, and Antanina was at one of the older ones. The visit to this Soviet-era hospital is a story in itself: no central climate control (or even electric fans that I could see), no private rooms, no electronic medical records, and only one tiny elevator – meaning that most staff and visitors used the un-air-conditioned staircases. Did I mention that the geriatric unit of this particular building is on the 5th floor?

Kaunas Hospital, early 1950s

Kaunas Hospital, early 1950s

Anyway, we reached Antanina’s room, and the first thing that surprised me was that she didn’t have an IV running or evidence of one having been d/c’d recently. She looked good and sat up in bed talking and later walking down the hall under her own steam. But she wasn’t able to give us much medical information, so we hunted down the ward’s doctor to learn more.

This doctor – from Ukraine – was very interested in learning the ‘American perspective’ on the current civil war in her home country (we had to tread lightly on this topic, since it wasn’t immediately apparent on which side of the divide she fell). Once we had (successfully) navigated and dispensed with the politics, we inquired of Antanina’s condition. The doctor said that she had been receiving IV fluids and antibiotics last week, but was now doing “very well” and not needing IVs any longer. There were, however, some abnormalities in her blood.

“What abnormalities,” we asked?

It seems that Antanina was mildly anemic and also had a modest dip in her serum calcium level (not unexpected in a woman in her 90s). In the U.S., neither of these findings on their own would necessitate hospitalization. An elderly person in this condition could be easily be given oral Rx and followed on an outpatient basis with an office or home health visit scheduled.

The doctor added that Antanina might need to stay in the hospital for as much as another week before discharge.

Another week?! In the U.S., 3d party payors often kick you out of your hospital room when the bandages are still bloody.

Rumor has it that medical house staff can be, er, persuaded to keep patients in the hospital a bit longer than might otherwise occur; whether the Ukrainian doctor had been thusly encouraged by others in our family before our arrival I do not know.

My GMIL seemed happy enough with her surroundings and the attention she was getting, so we visited a bit longer and then bid her farewell. I am thankful to the staff of the hospital for taking good care of her and keeping her stable and safe. But as we drove back to Vilnius, I couldn’t help but wonder if there might exist – somewhere – a happy medium of resource allocation between full-blown capitalism and the accountants who rush you out the door, and socialized medicine and what seems like overly protracted inpatient stays that aren’t entirely indicated?

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Hygiene is Overrated II

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In follow-up to my earlier post on bathing from last month:

http://alienistscompendium.com/?p=1283

it is interesting that, despite personal misgivings held by many in times past regarding the need for regular hygiene, the medical community was not entirely opposed to bathing for certain therapeutic indications. In the 16th and 17th centuries, for example, much was written about the benefits of taking to the waters for those women who were unsuccessful at conceiving and carrying a child to term.

The mechanism by which the waters supposedly exerted this effect was not clearly outlined, merely the wondrous (if not miraculous) outcomes to be had by engaging in therapeutic baths at just the right time.

A barren woman helped thusly, according to a 17th century English treatise on the benefits of bathing while procreating, was the wife of one Thomas Horton, esq., who “after seven years’ interval from having a child [concluded that as she was 42 years old,] she had done breeding.” However, she then fell from a horse and injured her leg, deciding afterward to visit the town of Bath for recuperation. No sooner did she take to the curative waters than she “went home and quickly conceiv’d … and had a son, who lived to be a proper [and] hopeful young gentleman.”

The same text went on to claim that Lady Killmurry, Countess of Huntington, at middle age had miscarried at least three times, but having taken therapeutic baths but one season, and that for only five weeks, “conceiv’d quickly with child, went out her full time, and became a mother of a living and lively son.”

No word on whether Mrs Horton or Lady Killmurry were happy to have had fertility restored at their respective ages or not.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

Hygiene is Overrated I

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[Today’s post is sponsored by my stepdaughter Anna Maria… and she knows why]

Perhaps you recently read about one Amou Haji, an 80 year old fellow in the tiny village of Dejgah in southern Iran who claims not to have bathed in over six decades, in part because he fears that cleanliness will make him ill.

Go ahead. Google him.

His beliefs aren’t as rare as you might think, at least by historical standards.

In early Christian centuries, authorities allowed the public to use bathhouses just as had been the case in Roman times. However, as it became apparent that the baths were being used for hedonism as much as, or for more than, hygiene, church fathers began to crack down on such licentiousness. Starting in the early 5th century CE, first women were banned from the baths, and then nudity in general was prohibited. Finally, the whole concept of public baths was largely proscribed.

Bathing, it was proclaimed, lead to immorality, promiscuous sex, and the spread of diseases.

Sin aside, by the 400s, it had become widely accepted that water could carry diseases from the air directly into the body via the skin’s pores, so the church’s ban on bathing as a (primitive poorly understood) public health measure had traction, and held sway in Western medical circles for more than a millennium.

This meant that – not having to be told more than once – most of the lower classes began foregoing baths altogether, opting instead to wash their hands, parts of their faces, and mouths (by rinsing) only.

[sidebar: washing the entire face was believed to risk developing catarrh and weakening the eyesight]

The upper classes restricted their bathing to a few times a year, trying to balance the desire to avoid diseases against overpowering body odor.

Case in point: one Russian ambassador to France in the early 18th century noted that Louis XIV “stunk like a wild animal,” as court physicians regularly advised His Gallic Majesty to bathe as infrequently as possible to maintain good health. Louis was apparently a good patient, bathing only twice in his lifetime it is said – at his birth and at his wedding.

[sidebar: the Eastern Orthodox churches didn’t get as agitated about bathing as did the Western church, and therefore Russians of this era tended to bathe more frequently than those of the Pope’s domains – perhaps as frequently as once per month; Russians were therefore held by many in the West to be sexual perverts]

To get past eye-watering stench, many aristocrats in the Middle Ages rubbed their bodies with scented rags, and used perfumes liberally. Both men and women wore small bags containing herbs between the layers of their clothing, especially in their undergarments.

Amazingly, this complete lack of personal hygiene in parts of western Europe lingered in some circles into the early 19th century.

Rock on, Amou!

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

A Futile Search For Virility

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It seems that the promise of restoring youth to aging men appealed as strongly in days past as it does in the present.

In the 1920s, testicular tissue transplantation was the ‘little blue pill’ of the era, purported in many medical circles to reestablish lost-function in the old and infirm [it was also used to address skin problems, neurasthenia, epilepsy, dementia praecox, senility, alcoholism, prostatic hypertrophy, cancer, rheumatism, gingivitis, paralysis, arteriosclerosis, and the “moral perversions of old age,” whatever that is]. In some quarters, testicular tissue transplantation was attempted as a treatment for male homosexuality, albeit without any measurable success.

One proponent of testicular tissue transplantation was Leo Stanley, the chief surgeon of San Quentin prison in California and a devotee of the theories of the late-Serge Voronoff.

Monkey Bread (aka Monkey Balls)

Monkey Bread (aka Monkey Balls)

Dr. Voronoff, you see, had started his research and resulting scrotal activities using parts from (willing?) monkeys at the turn of the 20th century, opining that “the monkey is superior to man by the sturdiness of its body, the quality of its organs, and the absence of those defects, hereditary and acquired, with which the main part of mankind is afflicted.” Though he had plenty of detractors, Voronoff’s theories were accepted by a large minority of (male) physicians up until WWII, and there was never a shortage of middle aged volunteers desiring to freshen up their manhood.

Given the placebo effect and wishful thinking, it was only a hop-skip-jump from (unsuccessful) monkey-donor tissue transplants to (unsuccessful) human-donor tissue transplants.

[sidebar: Voronoff’s monkey-grafts have been postulated as one possible way in which HIV made the jump from simians to homo sapiens, though nothing has been proven]

Anyway, our Dr Stanley was responsible for autopsies once the condemned at San Quentin were launched into eternity. In May 1928, one Clarence Kelley – having been convicted of multiple counts of murder during an armed robbery spree in San Francisco – swung by the hempen necktie, after which his body was released to the family for burial. Only then was it noticed by then next-of-kin that the corpse was missing that part of the anatomy which renders the bearer male. Upon investigation, it was learned that Stanley had helped himself to the junk of the decedent – he wouldn’t be needing it, right? – and had accordingly transplanted some bits into a patient in a nearby hospital.

Further inquiry revealed that Stanley had been cutting off the balls of hanged inmates and putting them into other men’s coin purses since at least 1918. Being a doctor on one of the nation’s busiest death rows gave him a steady supply of human tissue – that is, when he wasn’t doing futile experiments with the testicles of goats, boars, rams, and stags. And astoundingly, despite threats of lawsuits and the absence of any semblance of informed consent, Stanley kept his job at San Quentin until 1951. He spoke freely of his testicular activities and the >10,000 transplants in which he was involved over his career, basking all the while in the laudatory op-ed pieces of many papers of the day.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]

[from the medical records dept] Sorcery, Body Parts, and Pharmaceuticals

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[some of the following was originally posted by the Alienist last summer, but you really can’t get enough of this stuff]

In keeping with April’s mummy theme – soap cadavers, artists’ corpses – I now complete the trifecta with observations on the use of dead people as medicinals and ingestibles.

Cannibalism has existed for as long as there have been humans, and probably longer. It’s the societal revulsion at such behavior, and not the actual metabolic issues of the consumption, that renders the subject anathema. But the proscribed always fosters lurid fascination, and makes for good press.

Take, for example, the British Gazetteer on 3 May 1718, wherein was reported:

“We have intelligence from Lincoln [of] a man being hanged there … [who] within three days after his execution, [had] … apothecaries contract[] with a butcher for a sum of money, to take the body out of the grave, and cut off all the flesh, fit for them to make a skeleton of; which flesh he sold for venison to an inn-keeper; who making it into a pasty, invited many of his neighbors to the eating of it; but sometime after the villainy being detected, the butcher and the two apothecaries were committed to [the] Lincoln [jail].”

Accurate? I’m not certain. And with apologies to honest druggists everywhere, and even the Demon Barber of Fleet Street, this is not really the flavor – pun intended – of today’s post. Instead, I wish to talk about the odd and surprisingly common archaic belief that noshing on the dead was somehow therapeutic, not just delicious. And we start with blood.

In order to restore vigor and youth, some medical practitioners of the late Middle Ages recommended drinking the blood of those not so aged. The physician Marsilio Ficino, in the 15th century, wrote, “why shouldn’t our old people, namely those who have no [other] recourse… suck the blood of a youth? A youth who is willing, healthy, happy and temperate, [and] whose blood is of the best but perhaps too abundant. They will suck, therefore, like leeches, an ounce or two from a scarcely- opened vein of the left arm; they will immediately take an equal amount of sugar and wine; they will do this when hungry and thirsty and when the moon is waxing. If they have difficulty digesting raw blood, let it first be cooked together with sugar; or let it be mixed with sugar and moderately distilled over hot water and then drunk.”

Blood therapy was not a rare recommendation it appears.

Edward Taylor (c.1658–1702), a Puritan minister and lay physician in New England, wrote that “human blood, drunk warm and new is held good in the falling sickness [epilepsy].” In Denmark, the use of blood as a cure for epilepsy was widespread; it is documented that the sick and infirmed would gather under a scaffold hoping to catch the spilt blood of a freshly executed criminal for this very purpose. Many English physicians, too, believed in the curative potency of blood, and recommended it to patients as late as 1747.

Regarding other parts of the human corpus, physician [Nicholas] Lemery recommended mother’s milk for inflamed eyes, feces to heal sores, and skull, brain, fat, nails and “all the parts of man” to cure a variety of conditions in 16th century France.

axungia hominis (human fat)

axungia hominis (human fat)

In The Marrow of Physick (1669), Scotsman Thomas Brugis wrote, “a man’s skull that hath been dead but one yeare, bury it in the ashes behinde the fire, and let it burne untill it be very white, and easie to be broken with your finger; then take off all the uppermost part of the head to the top of the crowne, and beat it as small as is possible; then grate a nutmeg, and put to it, and the blood of a dog dryed, and powdered; mingle them all together, and give the sick to drinke, first and last, both when he is sick, and also when he is well, the quantity of halfe a dram at a time in white wine.”

Though a few formulas called for fresh, when fresh wasn’t available, dessicated would do; one of the most commonly advertised apothecary substances at that time was ground mummy, a preparation of the ancient remains of an embalmed or dried body from the distant sands of Araby. One 16th century surgeon, Ambrose Paré, noted that mummy was “the very first and last medicine of almost all our practitioners.”

Mummy heads were used to create plasters to assist with wound healing as late as 1750. Many practitioners were also prescribing “three drams of [crushed] human skull” for epilepsy, or “two ounces of mummy in a plaster against ruptures.” These forms of therapy, though, were beginning to fall from favor by the early 18th century as public opinion – not necessarily ‘science’ – turned against the practices.

That said, the best is never cheap, and mummy in 1678 was selling in London for 5s 4d for a pound! Thus, many apothecaries substituted, for a genuine Bedouin, cheap imitations that typically came from the corpses of east-side beggars, lepers, and plague victims.

Assuming one could afford it, perhaps the palate craved mummy with sweetener? Then mellified man, or human mummy confection, was for you. This was a legendary substance created by steeping a human cadaver in honey. Interestingly, it is only mentioned in a single Chinese source from the 16th century by one Li Shizhen, a pharmacologist relying on second hand hearsay (sound reliable?) Li wrote in his reference work, Bencao Gangmu, in the chapter entitled ‘Man as Medicine,’ that in the deserts far to the west, there were elderly men who would volunteer to undergo mummification in honey to create a medicinal suspension that would help their descendants. What separated this mellification process from simple body donation was that it had to commence ante-mortem. It was reported that the donor would stop eating all food other than honey. The donor would even bathe daily in honey. Soon, his feces became mellified, and even his sweat was said to be sweet and thick. When the diet or other illness finally proved fatal, the donor’s corpse would be placed in a stone coffin filled with honey… for about a century. By then, the contents would have turned into a thick rich yellowish goo that was said to be capable of healing broken bones and curing other ailments. Li claimed that this was available in Middle Eastern bazaars at a very hefty price.

Maybe one desired mummy, with sweetener or without, but just couldn’t afford it? Fear not, for you too could still partake of the goodness of the body tissues of others. In one 17th century French kabbalist’s magic book (the genre often doubling as a medical text), there is listed what we would call today a sedative, tranquilizer, or anxiolytic, one guaranteed to defuse those with short tempers and violent tendencies.

It involved scraping and collecting the white skin from the tongue of a newborn on a clean piece of linen, and then secretly placing it under the infant’s bonnet during baptism. The tongue, with its ability to curse or bless, was considered a potent anatomical part. Thus activated, the tissue was said to calm the angry, though whether it had to be ingested or just placed in close proximity to a potential outburst remains vague.

At first glance, quack practices such as these seem far removed from our own advanced healthcare. However, the utilization of body parts in therapy still persists. Though blood transfusions and organ transplantations are dramatically different than drinking blood or eating flesh, such interventions do share a core belief in the human body as an instrument of healing.

[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]

[Copyright 2013 @ The Alienist’s Compendium]