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Archive for the 'disease' Category

I have had for the first time the courage to say, “Monsieur, I am growing deaf” – Marie Bashkirtseff, Artist

By H Dominic W Stiles, on 16 November 2018

Maria Konstantinovna Bashkirtseva or Marie Bashkirtseff (1858-1884), was a Ukrainian Russian born artist and diarist.  She lead a fascinating if brief life, and kept a regular diary from the age of twelve, where she put everything of herself, her hopes, fears, sorrows and joys.  Gladstone famously called it “a book without a parallell.”

The diaries were originally published by her family in an expurgated version in 1888, which was translated into English by the German born English poet, Mathilde Blind.  Marie describes her life, struggles to be accepted in art, and her illness, of which her hearing loss and deafness was a side effect.  More details of her life are to be found on the web (see links below) and her portrait paintings are very fine, well worth seeking out.  She attended the same Art School in Paris as the British Deaf art student George Annand Mackenzie did some years later, the Académie Julian.

Her experience of losing her hearing will, I believe, be recognized by many in a similar situation.  The follow entries date from 1880.  At first there is the mishearing –

Saturday, May 8th. — When people talk in a low voice I do not near. This morning when Tony asked me whether I had seen any of Pemgino’s work, I said “No,” without understanding.

And when I was told of it afterwards, I got out of it, but very badly, by saying that indeed I had not seen any of it, and that, on the whole, it was better to admit one’s ignorance. (p.406)

Then she has tinnitus, and has to endure the ignorant behaviour of others –

Thursday, May 13th. — I have such a singing in my ears that I am obliged to make great efforts in order that it may not be noticed.

Oh ! it is horrible. With S___ it is not so bad because I am sitting near him ; and besides, whenever I like, I can tell him that he bores me.  The G___s talk loud. At the studio they laugh and tell me that I have become deaf; I look pensive, and I laugh at myself: but it’s horrible. (p.407)

There are times when it improves –

Wednesday, July 21st. — I have commenced my treatment. You are fetched in a closed Sedan chair. A costume of white flannel — drawers and stockings in one — and a hood and cloak ! Then follow a bath, a douche, drinking the waters, and inhaling in succession. I accept everything. This is the last time that I mean to take care of myself, and I shouldn’t do it now but for the fear of becoming deaf. My deafness is much better — nearly gone. (p.416)

Then she is told how serious her condition is –

Friday, September 10th. — … Doctor Fauvel, who sounded me a week ago and found nothing the matter, has sounded me to-day and found that my bronchial tubes are attacked ; his look became . . .  grave, affected, and a little confused at not having foreseen the seriousness of the evil ; then followed some of the prescriptions for consumptive persons, cod-liver oil, painting with iodine, hot milk, flannel, &c. &c, and at last he advises going to see Dr. Sée or Dr. Potain, or else to bring them to his house for a consultation. You may imagine what my aunt’s face was like ! I am simply amused ! I have suspected something for a long time ; I have been coughing all the winter, and I cough and choke still.

Besides, the wonder would be if I had nothing the matter ; I should be satisfied to have something serious and be done with it

My aunt is dismayed, and I am triumphant Death does not frighten me; I should not dare to kill myself but I should like to be done with it . . . If you only knew ! . . . . I will not wear flannel nor stain myself with iodine; I am not anxious to get better. I shall have, without that, quite enough health and life for all I shall be able to do in it.

Friday, September 17th. — Yesterday I went again to the doctor to whom I went about my ears, and he admitted that he did not expect to see matters so serious, and that I should never hear so well as formerly. I felt as if struck dead. It is horrible! I am not deaf certainly, but I hear as one sees through a thin veil. For instance, I cannot hear the tick of my alarm-clock, and I may perhaps never hear it again without going close up to it. It is indeed a misfortune. Sometimes in conversation many things escape my hearing. . . . Well, let us thank heaven for not being blind or dumb as yet. (p.422-3)

This was two years before Robert Koch, the founder of modern microbiology, identified the causative agent of ‘consumption’ – Tuberculosis, as Mycobacterium tuberculosis.  It seems likely that the this was the cause of her deafness, but we cannot be sure.  In that year, 1882, she was confronted by the news that her hearing was gone and would not return –

Thursday, November 16th. — I have been to a great doctor — a hospital surgeon — incognito and quietly dressed, so that he might not deceive me.

Oh! he is not an amiable man. He has told me very simply I shall never be cured. But my condition may improve in a satisfactory manner, so that it will be a bearable deafness ; it is so already ; it will be more so according to all appearances. But if I do not rigorously follow the treatment he prescribes it will increase. He also directs me to a little doctor who will watch over me for two months, for he has not the time himself to see me twice a week as is necessary.

I have had for the first time the courage to say, “Monsieur, I am growing deaf.” Hitherto I have made use of, ” I do not hear well, my ears are stopped, &c.” This time I dared to say that dreadful thing, and the doctor answered me with the brutality of a surgeon.

I hope that the misfortunes announced by my dreams may be that But let us not busy ourselves in advance with the troubles which God holds in reserve for his humble servant. Just at present I am only half deaf.

However, he says that it will certainly get better. As long as I have my family to watch round me and to come to my assistance with the readiness of affection all goes well, yet …. but alone, in the midst of strangers !

And supposing I have a wicked or indelicate husband ! … If again it had been compensated by some great happiness with which I should have been crowned without deserving it ! But . . . why, then, is it said that God is good, that God is just ?

Why does God cause suffering? If it is He who has created the world, why has He created evil, suffering, and wickedness ?

So then I shall never be cured. It will be bearable ; but there will be a veil betwixt me and the rest of the world. The wind in the branches, the murmur of the water, the rain which falls on the windows . . . words uttered in a low tone … I shall hear nothing of all that ! With the K____ s I did not find myself at fault once ; nor at dinner either ; directly the conversation is just a little animated I have no reason to complain. But at the theatre I do not hear the actors completely ; and with models, in the deep silence, one does not speak loud . . . However . . . without doubt, it had been to a certain decree foreseen. I ought to have become accustomed to it during the last year … I am accustomed to it, but it is terrible all the same.

I am struck in what was the most necessary to me and the most precious. (p.565-6)

She died on October the 31st, 1884, and was buried in the Cimetiere de Passy in Paris, a few weeks before her twenty-sixth birthday.

It is certainly wrong to portray her by her illness alone.  She was a dynamic and interesting person, and the tragedy is she did not have the opportunity to show what she might have achieved.  I hope some of you will be interested to read her diaries and see her paintings.

Marie_Bashkirtseff1878Journal of Marie Bashkirtseff, Translated by Mathilde Blind, London 1890

https://www.britannica.com/biography/Marie-Bashkirtseff

http://www.gutenberg.org/files/13916/13916-h/13916-h.htm

Marie Bashkirtseff. Part 2 her later life and diaries

http://en.wikipedia.org/wiki/Marie_Bashkirtseff

Marie Bashkirtseff. Part 1 The portraitist and feminist

Gladstone, W. E. (1889). JOURNAL DE MARIE BASHKIRTSEFF. The Nineteenth Century: A Monthly Review, Mar.1877-Dec.1900, 26(152), 602-607. Retrieved from https://search.proquest.com/docview/2630378?accountid=14511

Her paintings:

https://www.wikiart.org/en/marie-bashkirtseff/all-works#!#filterName:all-paintings-chronologically,resultType:masonry

https://www.ecosia.org/images?q=marie+bashkirtseff

The following looks interesting but I have not seen the article:

VALLERY-RADOT P 1955 Nov 26;63(79):1659-60. Une curieuse malade (1860-1884); Marie Bashkirtseff peinte par elle-même d’après son journal. [A strange patient (1860-1884); Marie Bashkirtseff who, according to her diary, she portrayed herself]. [Article in French]

 

Guichard Duvernay, pioneer of Otology (1648-1730)

By H Dominic W Stiles, on 14 September 2018

Guichard Joseph Du Verney (5 August 1648 – 10 September 1730) was a pioneer of otology.  He was born in Feurs, in the south of France, and studied at Avignon as a doctor befoire moving to Paris.  He became Court Anatomist – a post created for him (Hawkins, p.9).  As Hawkins says, “Duverney’s treatise is remarkable not only for its anatomical presentations, but also for its author’s thoughts on the physiology and pathology of the ear” (ibid).  Neil Weir and Albert Mudry say that it was also significant that it was published in French rather than Latin.  He was also, they continue, the first to show that the boney external meatus developed from the tympanic ring; that the Eusachian tube was a channel wherby the air in the tympanum was renewed; he explained bone conduction; he was the first to use the term boney labyrinth for the whole inner ear.  He produced his brilliant drawings without the aid of a microscope (Weir & Mudry, 2013 p.38-9).

That his book was translated to English over fifty years after his death, says a lot about how valuable it was considered.  We have copies of both the original, and the translation.

Le Vestibule est une cavité presque ronde, creusée dans I’os pierreux et d’environ une ligne et demie de diamètre. II est scitué derrière la fenestre ovale, et revestu par dedans d’une membrane parsemée de plusieurs vaisseaux : on y remarque neuf ouvertures dont il y en a une de laquelle il a déja esté parlé, sçavoir la fenestre ovale qui donne entrée de la quaisse du tambour dans le vestibule ; les huit autres lont dans la cavité de ce vestibule. La première mene dans la rampe superieure du limaçon ; il y en a’cinq qui donnent entrée dans les trois canaux demi-circulaires ; et les deux dernieres laissent passer deux branches de la portion molle du nerf auditif.

Je donneray des noms aux conduits demi – circulaires pour les distinguer, et je les nommeray par rapport à leur situation.  J’appelle le premier Supérieur parce; qu’il embrasse la partie superieure de la voute du vestibule ; le sécond Inferieur, parce qu’il entoure partie inferieure ; et le troisième qui est plus en dehors et sîtué entre les deux autres seranommé le Mitoyen. (1683, p.32-3)

The Vestibulum is a Cavity almost round, formed out of the Os Petrosum, and about a Line and a half in diameter. It is situated behind the Fenestre Ovalis, and covered on the Inside by a Membrane, furnished with a great many Vessels.  There are nine Foramina in it, of which one has been already described, viz. the Fenestre Ovalis, which forms an Entrance from the Tympanum into the Vestibulum; the other eight are in the Cavity of the Vestibulum: The first leading into the upper Range or Scala of the Coclea; there are five more which afford Entrance to the three Semi-circular Canals; and the two last through which two Branches of the Portio Mollis of the Auditory nerve pass.

I shall give Names to the  three Canales Semicirculres to distinguish them, and I shall take those Names from their situation: The first  I call the Superior, because it takes up the upper Part of the Arch of the Vestibulum; the second Inferior, because it surrounds lower Part; and the third, which is placed more towards the Outside, and is situated betwixt the other two, Medius. (1737, p.32)

Hawkins says that Du Verney “was a true forerunner of Helmholtz, putting forward a resonance theory before its time” (Hawkins, p.9).  It seems that he also dissected an elephant, in front of King Louis XIV in 1681.  The book is full of beautiful plates, some reproduced here.  I showed it to a UCLH otologist, and he was amazed by their quality.  Unfortunately no portrait of him appears to survive.

Du Verney, Traité de l’organe de l’ouie, contenant la structure, les usages & les maladies de toutes les parties de l’oreille. A Paris, : chez Estienne Michallet, ruë S. Jacques à l’image S. Paul. 1683

Traité de l’organe de l’ouie… on Google Books

Du Verney, A treatise of the organ of hearing: : containing the structure, the uses, and the diseases of all the parts of the ear./ Translated from the French of the late Monsieur Du Verney, of the Royal Academy of Sciences, Counsellor Physician in Ordinary to the late King of France, and Professor of Anatomy and Surgery in the Royal Physick-Garden at Paris. Translated by John Marshall. 1737

Desai, Sapan S & Dua, Anahita, History of Research in the Vestibular System: A 400-Year-Old Story.  Anatomy &  Physiology 2014, 4:2 DOI: 10.4172/2161-0940.1000138

Hawkins, Joseph E., Auditory Physiological History: A Surface View. Chapter 1, p.1-28, in  Santos-Sacchi, Joseph R., Physiology of the Ear. 2001

Weir, N. and Mudry, A., Otorhinolaryngology: an illustrated history, 2013

https://fr.wikipedia.org/wiki/Joseph-Guichard_Du_Verney

How Do Storms Affect Asthma?

By H Dominic W Stiles, on 18 June 2018

by Abir Mukherjee

D’Amato and colleagues discuss the idea that thunderstorms in pollen season can induce severe asthma attacks in susceptible pollinosis patients.
The scientific background to this observation is that that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20-30 minutes of a thunderstorm, a large amount of pollen is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack
A key message for susceptible patients is increasing awareness of being outdoors during a thunderstorm in the pollen season could trigger an asthma attack.
Davies et al in the BMJ (2018) also discuss the phenomenon of epidemic thunderstorm asthma. They suggest proactive measures to identify and pre-emptively protect susceptible people are critical to mitigating the effects of thunderstorm asthma. Whilst known previous asthma seems to be an inadequate predictor of risk, seasonal allergic rhinitis (hay fever) from grass pollen allergy, and degree of sensitisation, appears to be a universal risk factor among affected patients.

References

How Do Storms Affect Asthma?
Author(s) D’Amato G; Annesi-Maesano I; Vaghi A; Cecchi L; D’Amato M
Source Current Allergy and Asthma Reports; Mar 2018; vol. 18 (no. 4); p. 24

Thunderstorm asthma: controlling (deadly) grass pollen allergy
Author(s) Davies, J.M., Thien, F. and Hew, M., 2018.
Source BMJ: British Medical Journal (Online), 360.5

“there is nothing, as I have said, in this mortal life except inanity, emptiness, and dream-shadows” – Girolamo Cardano 1501-76

By H Dominic W Stiles, on 1 June 2018

Girolamo Cardano (1501-76), or Hieronymus Cardanus, or Jerome Cardan, to use the Italian, Latin and English forms of his name, was born in Pavia.  His family lived in Milan during its occuption by the French.  His father was a lawyer.  Jerome was a sickly child, and seems to have had more than his fair share of accidents.  He attended the academy at Pavia, now the university, where he first lectured on Euclid (Cardano, p.11-13).  When he was twenty-five he became a doctor of medicine in Padua.

Attempting to make money from gambling, Cardano was the first person to work out the science of probability, though he did not get the credit for being first as he wanted the advantage of keeping the information to himself, and did not publish it in his lifetime.

Rejected by the Milanese College of Physicians (until 1539), he felt snubbed and was forced to make his reputation  in the provinces (see Hannam, p.238).  His philosophy was to allow patients to heal naturally so he did not introduce invasive and painful treatments to patients, rather prescibing rest & sensible eating.  This meant he was more successful than his fellows.  He was invited to Scotland by John Hamilton the archbishop of St. Andrews in 1551, who was very ill, and the archbishop recovered, and was full of praise for Cardano (ibid p.239).

He was rather obsessed by horoscopes, predicting he would die aged 45.  He prepared horoscopes of historical figures, including Jesus, though that later got him into trouble with the Inquisition.

We have a French version of De subtilitate rerumOn natural phenomena, whence the illustrations here.

He was a remarkable and fascinating man, and his memoir makes for a lively and vivid read.  He is resonably honest and certainly phlegmatic.  The behaviour of his sons might have crushed a lesser man, one being a violent criminal, and the other in an unhappy marriage poisoned his wife and was executed.

“I am by no means unaware that these afflictions may seem meaningless to future generations, and more especially to strangers; but there is nothing, as I have said, in this mortal life except inanity, emptiness, and dream-shadows.” (p.83-4)

Below we see the page on the beaver.  For some reason, perhaps connected with the use of Castoreum, according to Aesop’s Fables and then Pliny the Elder, mediaeval tradition said beaver’s would chew off their own testicles to escape hunters.  As a beaver’s testicles are internal, perhaps that contributed  to the myth.

Cardano, Girolama, The Book Of My Life. Translated by Jean Stoner (2002)

Les livres de Hierosme Cardanus medecin milannois: intitulez de la subtilité, & subtiles inuentions, ensemble les causes occultes, & raisons d’icelles. Traduits… Richard Le Blanc, Paris, Pour Pierre Cauelat ruë S. Iaques, à l’enseigne de l’escu de Florence (1584)

Hannam, James, God’s Philosophers (2009)

“Brandy for giddiness, 2s” – Jonathan Swift’s Meniere’s Disease

By H Dominic W Stiles, on 13 April 2018

One of the great writers of English, Jonathan Swift (1667-1745) was plagued for much of his life by bouts of giddiness, and by increasing deafness, though in many other respects he was healthy and lived to the age of seventy-seven.  It sometimes incapacitated him for long periods.

In August 1727 he wrote to Lady Henrietta Howard,

About two hours before you were born, I got my giddiness by eating a hundred golden pippins at a time at Richmond, and, when you were five years and a quarter old, baiting 2 days, I got my deafness, and these two friends, one or other, have visited me, every year since: and being old acquaintances, have now thought fit to come together.

It seems to have begun when he was twenty, according to the autobiographical notes in Forster’s biography (p.27),  but there, there is a footnote inserted that says Swift had added, “in 1690.”  The word ‘hours’ in the letter to Henrietta Howard may be an error for, or misreading of, ‘years,’ or it could be he had forgotten precisely when it happenened.

At first he self-medicated – on the 16th of November, 1708, he wrote “Brandy for giddiness, 2s.”

Bucknill (p.495-6) quotes Swift’s ‘Journal to Stella’ for October 1710: “This morning, sitting in my bed, I had a fit of giddiness; the room turned round for about a minute and then it went off leaving me sickish, but not very.  I saw Dr. Cockburn to-day, and he promises to send me the pills that did me good last year; and likewise has promised me an oil for my ears, that he has been making for that ailment for somebody else.”  The diagnosis seems to be that he had Ménière’s disease (see Bucknill and Bewley).

Some years after the letter, several newspapers published a poem that Swift had written about his illness, both in Latin and in English (Grub Street Journal, Thursday, November 14, 1734; Issue 255), although the version with the answers seems to be later –

Vertiginosus, inops, surdus, male gratus amicis;
Non campana sonans, tonitru non ab Jove missum,
Quod mage mirandum, saltem si credere fas est,
Non clamosa meas mulier jam percutit aures.

DOCTOR: Deaf, giddy, helpless, left alone.
ANSWER: Except the first, the fault’s your own.
DOCTOR: To all my friends a burden grown.
ANSWER: Because to few you will be shewn.
Give them good wine, and meat to stuff,
You may have company enough.
DOCTOR: No more I hear my church’s bell,
Than if it rang out for my knell.
ANSWER: Then write and read, ’twill do as well.
DOCTOR: At thunder now no more I start,
Than at the rumbling of a cart.
ANSWER: Think then of thunder when you fart.
DOCTOR: Nay, what’s incredible, alack!
No more I hear a woman’s clack.
ANSWER: A woman’s clack, if I have skill,
Sounds somewhat like a throwster’s mill;
But louder than a bell, or thunder:
That does, I own, increase my wonder.

Although he lived to a good age, Swift’s final few years seem to have found him the victim of what Bewley calls, ‘terminal dementia’ (p.604).
Bewley, Thomas, The health of Jonathan Swift.  J. R. Soc. Med. 1998;91 :602-605

Bucknill JC. Dean Swift’s disease. Brain 1881;4:493-506

Forster, John, The Life of Jonathan Swift, Volume 1

The Works of the English Poets. With Prefaces, Biographical and …, Volume 40

Tinnitus Awareness Week – Patient Information

By H Dominic W Stiles, on 8 February 2018

By Abir Mukherjee @ClinicalLibUCLH

Tinnitus Week is an international event raising global awareness of this condition taking place from 5-11 February 2018. The aim of the week is to raise awareness of the condition. This blog post gives a quick overview of some patient information sources, all of which meet NHS England’s patient information standard.

The Action on Hearing Loss website has a number of free factsheets on its website in addition to a tinnitus helpline number: https://www.actiononhearingloss.org.uk/hearing-health/tinnitus/

The British Tinnitus Association believes the condition affects approximately 1 in 10 of the population in the UK. Other details about tinnitus awareness week, information sheets, and a helpline can be accessed at their website: https://www.tinnitus.org.uk/h-blog

The website also has a case study of living with tinnitus which is now on BBC news.

NHS Choices defines tinnitus as ‘hearing sounds that come from inside your body, rather than from an outside source’ with sufferers describing ‘ringing in the ears’ or ‘buzzing; humming; grinding; hissing or whistling.’ As a starting point for most patient information it can be accessed at: https://www.nhs.uk/conditions/tinnitus/

An overview of symptoms and treatment options is also available from the Patient.co.uk website at: https://patient.info/health/tinnitus-leaflet

ENT UK, a professional membership body that represents Ear, Nose and Throat and its related specialities also has patient information on tinnitus that can be downloaded from: https://www.entuk.org/sites/default/files/files/ENT/About%20Tinnitus%206pp%20DL%20%2809028%29_7_16.pdf.

“No one can conceive the agony, the unutterable sorrow I was plunged into” – Charles H. Hassall, ‘herbalist’

By H Dominic W Stiles, on 8 December 2017

The herbalist ‘doctor’, Charles H. Hassall F.S.Sc. was born in Stoke in 1848, and in his youth he lived with his grandfather, who was himself a herbalist.  As a boy Charles lost both his sight to some inflammation, and his hearing in his left ear, and partly lost hearing in his right ear.  The interview in The British Deaf-Mute does not tell us if it was known exactly what caused that, but at any rate it was not permanent and he eventually regained hearing in his right ear, and his vision.

Abraham quotes a pamphlet by Hassall on ‘Care of the Eyes’ where he explains his loss of sight:

A physician was consulted who professed to know all about it and prescribed accordingly, with the result that soon the inflammation rapidly spread to the other eye, still he continued to see and proscribe until I was completely dark-blind as it is called.  He then very coolly gave up the case as hopeless, so I was to be blind through all my earthly life for all he seemed to know or care.  No one can conceive the agony, the unutterable sorrow I was plunged into – an earnest, energetic mind just beginning to enquire and expand suddenly checked and held back in chains of darkness.

[…] I then consulted another Doctor.  This gentleman had weak and sore eyes and felt for me; he soon opened the closed pupils so that I could see like the man whose eyes Jesus opened and said that he could “see men as trees walking.” (p.188-9)

Abraham tells us that some twenty-seven or twenty-eight years earlier, Hassall “had the rare and happy experience of being able to restore the speech of a young girl, with a a mixture of oils and various other ingredients.

He went to work for a Dr. Garner in Staffordshire, but to the disappointment of the doctor, Hassall was determined to follow the herbalist path rather than what he termed the allopathic (p.189).  ‘”Well Hassall,” said the Doctor after one of his argumentative conversations, “seeing that you are determined to make a name as a herbalist I would advise you to get a case or two and demonstrate your theories.’

Abraham gives him the title of ‘doctor’ and says Hassall ‘had obtained many diplomas’ including The General Council of Safe Medicine Limited (Incorporated), London; The National Association of Herbalists of Great Britain; The Society of United Medical Herbalists of Great Britain; The British School of Eclectic Medicine; The British Association of Eclectics and Medical Botanists; The Medical Herbalist Defence Union Limited; The International Association of Medical Herbalists (p.189).  One of these must be The National Institute of Medical Herbalists and it would be interesting to see if there are any archival records of him.  The proliferation of diplomas and claim to use the title ‘doctor’ smacks of a desperation for legitimacy, but today we might term him a quack.

He moved to Farnworth, Bolton, in 1881, which is probably where Earnest Abraham met him, when Abraham was a missioner there.  He expanded his premises from 78 Peel Street to include 76 and 80.  By 1911 he called himself a ‘Pharmacy Proprietor’ on the census, rather than ‘herbalist.  Hassall died in Bolton in 1923.

1891 Census – Class: RG12; Piece: 3093; Folio: 88; Page: 25; GSU roll: 6098203

1911 Census -Class: RG14; Piece: 23256

E.J.D.A. [Ernest Abraham], Charles H. Hassall, The British Deaf Mute, 1895-6, Volume 5 p.188-9

[I contemplated whether or not I should write about Hassall, but as Ernest Abraham interviewed for The British Deaf-Mute I think we can cover him, and though his hearing loss was partial he is an interesting example of nin-standard 19th century medicine.]

“Deafness, like gutta serena, is sometimes produced by inordinate seminal discharges” Antoine Saissy 1756-1822

By H Dominic W Stiles, on 22 September 2017

Saissy FrenchBorn on the 2nd of February 1756, in Mougins, near Grasse in Provence, Jean Antoine Saissy had originally intended to become a planter, but coming across some medical books, he determined on a medical career, travelling to Paris to study (Montain, p.8ff).  He was then twenty two years old, with only a village education, combined with his own book-learning (ibid.p.9).  From 1777 to 1782 he studied under various famous professors, including Chopart and Pelletan.  He went on to serve as a physician and surgeon major with the Compagnie royale d’Afrique on the Barbary coast.  He attended to a child of the ‘Dey of Constantinople’ (possibly an error for Bey of Constantin?), who wanted him to stay.  Saissy however, returned to France, and in 1789 (the English version says 1798 which seems to be an error) defended his thesis on inoculation for small pox before the ‘Chirugical College of Lyons,’ and became a Doctor of Medicine with the University of Valence.  He married the daughter of M. Thenance, a doctor who had invented some obstetric forceps, and devoted himself to that area of medicine for a time.  In 1810 he wrote an essay on Croup, one of the first to do so.

He seems to have been a polymath, in 1811 presenting at the Institut de France a ‘memoir’ on the extraction of light by the condensation of gas.  Quite what that means I am not sure.  He also worked on a study of hibernation, with dormice and marmots (ibid p.12 -13).

It was not until the last twelve years of his life that he devoted himself to diseases of the ear.  Weir and Mudry tell us that Saissy was “the first person to propose introducing a piece of catgut into an artificial perforation of the tympanic membrane to avoid its closure.”

In his introduction to deafness, he repeats this curious form of treatment;

A Bavarian bath-keeper, mentioned by Sckinkius,* devised a singular method of curing deafness.  He plunged the patient into a warm bath, to produce turgescence in the little veins which run behind the ear.  When these were sufficiently apparent he opened them with the point of a lancet and drew a considerable quantity of blood, to the great relief of the patients on whom he practised the evacuation.  This remedy may have some success in cases of sanguineous plethora of the organ of hearing. (p.24-5)

As his 4th of 15 listed causes of deafness, Saissy says

Deafness, like gutta serena, is sometimes produced by inordinate seminal discharges.  Sylvaticus cites a remarkable instance of deafness supervening upon excessive indulgence in venereal pleasures. (p.21)

In other words, it makes you deaf as well as blind!  I suppose that he is not thinking of veneral disease, which can have those effects.

Saissy died on the 5th of March, 1822.  He seems to have been rather forgotten but is deserving of better treatment than I have space or time to give him here.

head section LaissyAbove, the only illustration in his book, a section of the head showing it is a vertical section.

As an addendum, it is interesting to note the protection of copyright notice given by the U.S.A. in the front of the English translation from Maryland.

US copyright*Schenkius, a Swiss doctor (1530-98)

Saissy, J.A., Essai sur les maladies de l’oreille interne.  Paris, (1827) [first published in a briefer essay in 1819]

Saissy, Antoine, An Essay on the Diseases of the Internal Ear.  Baltimore, (translated, 1829)

Montain, Biographic Notice, in An Essay on the Diseases of the Internal Ear, p.9-15. 

Mudry, Albert.  The tympanostomy tube: An ingenious invention of the mid 19th century.  International Journal of Pediatric Otorhinolaryngology Volume 77, Issue 2, February 2013, p. 153-157

Weir, Neil, & Mudry, Albert.  Otorhinolaryngology, An Illustrated History, 2013.

 

“The patient bore the operation with great fortitude” – Lochland Shiel’s facial exostosis

By H Dominic W Stiles, on 28 April 2017

In Guy’s Hospital Reports for September 1836, there is an article, “Cases of exostosis of the bones of the face, disease of the cranium, and fractures of the frontal and parietal bones requiring operation, by Mr. Morgan.”   Mr. John Morgan was a pupil of Sir Astley Cooper.  Plarr’s lives of the Fellows, tells us that Morgan “showed an intense interest in natural history, and began to stuff birds and small animals almost as soon as he could use a knife and his fingers.”   We also discover there, that he dissected an elephant named ‘Chum,’ took an awful lot of snuff, and was one of the founders of the Zoological Gardens in Regent’s Park, now London Zoo.  His brother-in-law William Gosse who was a surgeon and was related to Philip Henry Gosse, emigrated to Australia.

The case we are looking at, Case 1. Exostosis of the Bones of the of the Face, (the notes taken by Mr. Collin), covers an unfortunate Irish labourer, Lochland Shiel, admitted on the 1st of August, 1835 (Guy’s Hospital Reports, p.403-6).  At the time he was 24 years of age.  Shiel told the doctors that until he was fifteen he had good health, when he noted a small tumor in his right nostril.  He was told by ‘a medical man’ that it was ‘of no consequence.’  However, as we can see in the plate, after nine years it had grown greatly, distorting his face,

the right nostril being enormously expanded and closed by the enlargement of the tumor, which, from its size, completely concealed the eye on that side, and extended downwards into the mouth, being there connected with the palatine and alveolar processes of the right superior maxillary bone; projecting also forwards, so as to press the lip beyond the teeth, to the extent of two inches.  The bones apparently implicated in the disease were the ossa nasi, superior maxillary bone, vomer, and the inferior turbinated and malar bones.
[…]
The poor fellow, when admitted, complained of no pain; and I could not find that his sufferings had given him much inconvenience, during the whole of his disease.The general health appeared good; but he was greatly emaciated, more, I believe, from want of proper food, than from the constitutional effects of his disorder.

Deciding that the tumor was common exostosis, an opinion in which Morgan was supported by Sir Astley Cooper and Dr. Hodgkin, he “removed the morbid excrescence” on the 6th of November.  He first made an incision over the right nostril, to ascertain that it was indeed exostosis.

A semilunar incision was then made, extending over the nostril, from the internal angle of the right eye to the centre of the the upper lip.  A similar incision was made on the outer side, commencing at the angle of the eye, and joining with the other, at the lip.  The integuments were then dissected from around the tumor, , and a metacarpal saw was used for its removal; and as it was of a spongy texture, it offered little resistance to the instrument.  No great quantity of blood was lost during the operation , the exostosis not being very vascular; and it was only found necessary to secure one  vessel, a superficial branch of the transverse facial.  all further disposition to haemorrhage was easily restrained by pressure.

After the tumor had been thus removed, the integuments were brought together by an uninterrupted suture; a dossil of lint was placed over the wound, and confined by adhesive plaster; and over all, a light bread-and-water poultice was applied.

The patient bore the operation with great fortitude; and said afterwards, that he suffered but little pain, excepting when the first incision was made.
[…]
Up to the the present time, the patient has been going on well; all discharge from the face has almost entirely ceased: hardly any exfoliation  of bone has taken place; his general health is restored.  The present appearance of his face is correctly represented in the accompanying plate.  (Guy’s Hospital Reports, 1836)

Shiel

Unfortunately I cannot locate any record of Lochland Shiel on family history records or census returns, though a Locklin Sheels married a Margaret Boyle in Newcastle-under-Lyme on the 22nd of December, 1834.  That might be him.  It could be that he was missed, it could be he spent time in Ireland, or it could be that his name has been wrongly transcribed. If you have any ideas about where in Ireland he was from, or any family, do contribute in the comments.  In the spring of 1842 Shiel died in Birmingham.

We have been unable to learn the particulars of the termination of the case. It may, however, be observed, that his death did not take place til nearly seven years after the operation; so it may fairly be said to have been prolonged by it for nearly that period. It is, however, impossible to look at the cast taken after death without marvelling that life could have been prolonged to such a period. The growth appears to have been simply enormous — larger indeed than the head itself. (Guy’s Hospital Reports, 1842)

I have been unable to find a death record for anyone of his name. Someone must have dissected his remains to make a cast of the tumor – and presumably, his skull. Below is the cast that shows the tumor.  As you can see, it had grown enormously in the following years.  The dotted line points to the tiny space through which Shiel ingested food.

Skull ShielGuy’s Hospital Reports, No 2, September 1836 p. 403-6

Guy’s Hospital Reports, No 15, October 1842 p. 491

A System of surgery v. 3, 1882, p.259

[minor updates 15/10.2018]

 

 

Syphilis and Deafness – “A Tragic Case”

By H Dominic W Stiles, on 25 January 2013

Treponema pallidum is the bacterium that causes syphilis.  Until 1905 there was no effective treatment.  It is not always sexually transmitted and can be congenital as seems to be the case in the paragraph  below.  It can cause deafness, but whether the deafness in this example was a result of syphilis or from some other cause we cannot of course say.

In the memoirs of Fred Gilby we come across the following story (dated ca. 1889), entitled ‘A Tragic Case’;

Here I may tell […]about the saddest case I have ever come across, and I am now looking back over something like fifty years and more, – there was, in the Bow and Bromley Workhouse Infirmary a poor deaf and dumb woman, her husband was the same and they had deaf and dumb children – so far the case was distressing enough – – (we will not disclose the name.  It would be unkind to the children who are now living).  Then this poor creature began to develop syphilitic symptoms in the wrists and ankles, and one by one her arms and legs had to be amputated.  I remember that at the last she was reduced to catching a piece of slate pencil which dangled from above, between her teeth and then writing with it upon a slate – the slate of course had been fixed at a convenient angle.  We however could be understood by her easily enough through the sign language which she could see us using.  Her faith held out to the end.  The sins of her parents had indeed been visited upon her.  She was mercifully taken not long after.  R.I.P.  Quite an appreciable proportion of deaf people owe their affliction to the disease indicated. We veil it under the name of Hutchinsonian symptoms. If the reader wishes to pursue the subject further he should read Dr. Kerr Love’s Lectures on Deaf Mutism procurable from the National Institute for the Deaf.  I have come across some who refused to believe that this disease is ever inherited among the deaf.  A member of the committee of a school for the deaf in the north of England denied it with his heart, while the head master of the school quietly pointed out to me a score of such cases.

The ‘Hutchinsonian symptoms’ are named after Sir Jonathan Hutchinson. He “was the first to describe his triad of medical signs for congenital syphilis: notched incisor teeth, labyrinthine deafness and interstitial keratitis” (Wikipedia).  The discovery of penicillin greatly reduced the disease in the 1940s but the last decade has seen it begin to increase again. There is increasing concern in medical circles about the overuse of antibiotics which are our only effective tools against many diseases that are now becoming resistant through their wasteful or pointless overuse.

In his book The Diseases of the Ear, regarding hereditary syphilis, Toynbee says that deafness from that had at Guy’s Hospital

furnished more than one twentieth of the aural patients. […] The patients present the now familiar aspect of hereditary syphilis and have, in every case I have met with, suffered from impaired vision before the deafness has arisan.  This makes its appearance generally between the 10th and 16th year; about, but not precisely coinciding with, the perion of puberty.  The great majority of cases that I have seen have been in females.  […] I know of no other affection, except fever, which in a person under 20 brings on a deafness so prapid or nearly complete. (Toynbee, p.461)

Of course we are talking about “the poorer classes of the community” here (ibid).  He adds later, “In the wealthier ranks the symptoms are often much lkess marked” (p.462)!

[Post updated 24/11/2016 with Toynbee quotes]

F.W.G. Gilby, Seventy-two years among the deaf and dumb

Dr. Kerr Love,  Lectures on Deaf Mutism

Jospeh Toynbee, The Diseases of the Ear, their Nature, Diagnosis and Treatment. 1868 edition

Mary Ingle Wright, The pathology of  deafness, MUP 1971