January 2, 1819 Time Me, Gentlemen

Florence Nightingale explains in her Notes on Nursing, “there are many physical operations where ceteris paribus (all else being the same) the danger is in a direct ratio to the time the operation lasts; and ceteris paribus the operator’s success will be in direct ratio to his quickness”.

With the invention of gunpowder in the year 142, the Chinese of the Eastern Han Dynasty had a handy if somewhat noisy way, to scare off evil spirits.

The first millennium of the common era was a time of ever improved and more efficient ways for humans to slaughter one another, from the gunpowder slow match of 919 to the fire bombs and gunpowder propelled fire arrows of the Southern Tang, of 975.

The Wuwei Bronze Cannon of 1227 may be the first such weapon in all history.  By 1453, the terrifying bombard of the Ottoman Turks were capable of hurling stone balls up to 24.8-inches in diameter, more than enough to shatter the formerly impregnable Theodosian Walls of Constantinople.

Huge siege cannon used in the final assault
Ottoman siege cannon, 1453

For a thousand years, gunpowder weapons large and small businesses and a inflicted massive injury to the human frame, resulting in damage beyond even the skills of the modern surgeon.  Often the only answer was amputation, seemingly by the bushel basket.

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General Dan Sickles leg, destroyed by a 12-pound ball at Gettysburg, 1863

The carnage of the gunpowder era experienced something of a golden age in the 19th century.  Projectiles traveled at a bone-shatteringly slow pace compared with the high velocity weapons of today while innovations such as percussion caps, shrapnel shells and breech loading weapons geometrically increased the rate of fire.

It’s been said the most common objects removed from the bodies of front-line soldiers, were the shattered bones and teeth of the next man in line.

This was a time before anesthesia, when the speed of the surgeon’s knife spelled the difference in the pain experienced by the patient, to say nothing of the poor unfortunates’ chance of survival.  Florence Nightingale explains in her Notes on Nursing:  “there are many physical operations where ceteris paribus” (everything else being the same) “the danger is in a direct ratio to the time the operation lasts; and ceteris paribus the operator’s success will be in direct ratio to his quickness“.

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Robert Liston’s surgical instruments

First came the burly assistants, to hold down the writhing victim


.  In skilled hands the surgeon’s knife could cut all-round in a single stroke, through skin and muscle and sinew clear down to the bone before the saw completed the work of separation.  Screams of agony rent the air as veins, flesh and arteries were cauterized with red-hot irons, vitriol (sulfuric acid) or boiling hot tar.  Should the victim survive the experience the wound would then be sewn shut.  God help the poor soul if there was any infection left after all that.

During the Franco-Prussian War of 1870 –’71, one surgeon amputated 200 shattered limbs in one 24-hour period, a nearly unbelievable average of one every seven minutes.  Perfectly healthy fingers were occasionally severed in the gore and confusion.

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A 19th-century surgical illustration detailing amputation at the thigh. Credit: Wellcome Library, London. H/T Military-History.org

This was the world of the “Fastest Knife on West End”, a Scottish-born physician who, on this day in 1819, had just embarked on the first year of a medical career which would last until his death, in 1847.

Robert Liston, always the showman, would stride into the operating theater and call out, “Time me Gentlemen.  Time me”.  English surgeon and author Richard Gordon, an expert on Robert Liston, describes what that looked like:

“He was six foot two, and operated in a bottle-green coat with wellington boots. He sprung across the blood-stained boards upon his swooning, sweating, strapped-down patient like a duelist, calling, ‘Time me gentlemen, time me!’ to students craning with pocket watches from the iron-railinged galleries. Everyone swore that the first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seemed simultaneous. To free both hands, he would clasp the bloody knife between his teeth”. 

16944174-0-image-a-45_1565084128752Liston once amputated a leg in 2½ minutes from incision to suture but accidentally severed the poor bastard’s testicles, in the process.

On another occasion, he amputated a leg in 2½ minutes while severing the fingers of one assistant and piercing the coat of an observer.  The spectator was so terrified at the blood and so certain that his own vital organs had been pierced, he died right then and there from heart failure.

Both patient and assistant later died from hospital gangrene, a common problem in the days before Joseph Lister.  To the best of my knowledge, Robert Liston remains the only surgeon in history to achieve 300% mortality, on a single procedure.

November 29, 1918 A Medical Mystery

Further study is needed but, perversely, such study is only possible given more cases of the disease. For now, the lethal pandemic of 1915 – 1924 remains one of the great medical mysteries. An epidemiological conundrum, locked away in a nightmare closet of forgotten memory.

The Great War was in its third year in 1917, with another year to go. Before they had numbers, this was the most cataclysmic war in living memory, destroying the lives of some thirty-six million on all sides and leaving untold millions more, maimed.

In March of the following year, a new batch of trainees cycled through Fort Riley in Kansas, fresh recruits destined for the “War to End All Wars”. On reporting for breakfast one morning, none could know that an enemy lurked among them, more lethal than the war itself.

Private Albert Gitchell was coming down with cold-like symptoms: sore throat, fever and headache. Never mind breakfast. Pvt. Gitchell was headed for the base hospital.  More than one-hundred reported sick by noon, with similar symptoms.

file-20180109-36019-q61srvOrdinary flu strains prey most heavily on children, elderly, and those with compromised immune systems. Not this one. This flu would kick off a positive feedback loop between small proteins called cytokines, and white blood cells. This “cytokine storm” resulted in a death rate for 15 to 34-year-olds twenty times higher in 1918, than in previous years.

The young and healthy immune system of the victims, were what killed them.

The armistice was a bare two weeks in the past on November 29, 1918.  Formal peace negotiations would occupy the whole of 1919.

History has a way of swallowing some events, whole. Like they never happened. The Spanish flu afflicted some five hundred million worldwide, killing an estimated fifty to one hundred million.  Two to three times the number killed by the war itself and yet, the story was overshadowed by the end of the war.

Small wonder it is then, that such an event would itself eclipse a pandemic far smaller but in some ways more terrifying, than the worldwide calamity of the Spanish flu. To this day, nobody knows where this enemy came from. Or where it left to, when it went away.

In 1915, Austrian psychiatrist and neurologist Constantin von Economo described the signs and symptoms of a strange new condition which came to be called Von Economo’s Disease. The illness was labeled Encephalitis Lethargica, literally “Inflammation of the brain which makes you tired”.

“We are dealing with a kind of sleeping sickness, having an unusually prolonged course. The first symptoms are usually acute, with headaches and malaise. Then a state of somnolence appears, often associated with active delirium from which the patient can be awakened easily. He is able to give appropriate answers and to comprehend the situation. This delirious somnolence can lead to death, rapidly, or over the course of a few weeks. On the other hand, it can persist unchanged for weeks or even months with periods lasting bouts of days or even longer, of fluctuation of the depth of unconsciousness extending from simple sleepiness to deepest stupor or coma,” Die Encephalitis lethargica, Constantin von Economo, 1917

Encephalitis Lethargica is also known by the deceptively benign name of “Sleepy Sickness”. Von Economo distinguished three phases of the illness. Symptoms of the somnolent-ophthalmoplegic include paralysis of the cranial nerves, leading to expressionless faces and involuntary eye movements, with overwhelming sleepiness leading to coma. Fully one-third of E.L. sufferers died during this phase, of respiratory failure. The hyperkinetic form manifested itself with restlessness and motor disturbances leading to facial contortion, anxious mental state and an inability to sleep, often leading to death by exhaustion.

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Dr. Constantin von Economou top left, described the plight of E.L. sufferers, in 1917

The amyostatic-akinetic form frequently resulted in a chronic state resembling Parkinson’s disease, called Postencephalitic Parkinsonism.

Autopsies revealed this third phase to result from localized neurodegeneration of the Substantia Nigra, the basal ganglia structure of the mid-brain which plays a role in reward and associative learning as well as bodily movement. Unknown to the sufferer, this neurodegeneration takes place over an interval of a few days to thirty years, consigning the sufferer to a trance-like state in which the patient is rendered speechless and motionless, fully aware but, for all intents and purposes, a statue.

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Substantia Nigra

The 1973 non-fiction book Awakenings by Oliver Sacks, describes what that looks like:

“They would be conscious and aware – yet not fully awake; they would sit motionless and speechless all day in their chairs, totally lacking energy, impetus, initiative, motive, appetite, affect or desire; they registered what went on about them without active attention, and with profound indifference. They neither conveyed nor felt the feeling of life; they were as insubstantial as ghosts, and as passive as zombies”.

It is hard to imagine a more terrifying condition.   Worldwide, Encephalitis Lethargica afflicted some five million between 1915 and 1924.  The disease preyed mostly on young victims, between 15 and 35.  Early symptoms include high fever, headache, fatigue and runny nose. Sufferers would take to bed believing it to be nothing more than a severe cold, or flu. Meanwhile, the unknown enemy within quietly spread to the brain.

j8zjvpoiOne-third of sufferers died in the acute phase, a higher mortality rate than the Spanish flu of 1918-’19.  Many of those who survived never returned to pre-disease states of “aliveness” and lived out the rest of their lives institutionalized, literal prisoners of their own bodies.  Living paperweights.

A bare 14% emerged from the condition, with no lasting effect.

140297_patient_from_20s_300_24-7-98_grab.jpgProfessor John Sydney Oxford is an English virologist, a leading expert on influenza, the 1918 Spanish Influenza, and HIV/AIDS. Few have done more in the modern era, to understand Encephalitis Lethargica: “I certainly do think that whatever caused it could strike again. And until we know what caused it we won’t be able to prevent it happening again.”

Doctors Russell Dale and Andrew Church discussed 20 new cases in 2004, published in the Oxford University medical journal Brain. The two hypothesize infection leading to a massive auto-immune response, possibly brought on by an unusual Streptococcus bacterium.

Further study is needed but, perversely, such study is only possible given more cases of the disease. For now, the lethal pandemic of 1915 – 1924 remains one of the great medical mysteries. An epidemiological conundrum, locked away in a nightmare closet of forgotten memory.

We can only hope it stays that way.

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April 22, 1915 From Trench Warfare to Modern Chemotherapy

Mustard gas is a cytotoxic agent, capable of entering the system via skin, eyes and respiratory tract and attacking every cell type with which it comes into contact. First comes the garlic smell, as the yellow-brown, heavier-than-air cloud creeps along the ground. 

According to Greek mythology, the malevolent centaur Nessus attempted to force himself upon Deianeira, wife of Hercules (Herakles).  Seeing this from across a river, Hercules shot Nessus with an arrow, poisoned by the venom of the Hydra.  In a final act of malice, the dying centaur convinced Deianeira his blood would make her husband, faithful for life.  Deianeira foolishly believed him, coming to realize her error only as her husband lay dying by the tainted blood of his victim.

Bauer_-_Hercules_Nessus_DeianiraBoth sides in the battle for Troy used poisoned arrows, according to the Iliad and the Odyssey of Homer.   Alexander the great encountered poison arrows and fire weapons in the Indus valley of India, in the fourth century, BC.  Chinese chronicles describe an arsenic laden “soul-hunting fog”, used to disperse a peasant revolt, in AD178.

The French were first to use poison weapons in the modern era, firing tear gas grenades containing xylil bromide against German forces in the first month of the Great War: August, 1914.

1D7Imperial Germany was first to give serious study to chemical weapons of war, early experiments with irritants taking place at the battle of Neuve-Chapelle in October 1914, and with tear gas at Bolimów on January 31, 1915 and again at Nieuport, that March.

The first widespread use of poison gas, in this case chlorine, came on April 22, 1915 at the second battle of Ypres.

The story of gas warfare is inextricably linked with that of WW1.  124,000 tons of the stuff was produced by all sides by the end of the war, accounting for 1,240,853 casualties, including the agonizing death of 91,198.

Had the war continued into 1919, technological advances promised a new and fresh hell, unimaginable to contemporary and modern reader, alike.

Gas

Today we think of chemical agents in WW2 as being limited to the death camps of the Nazis, but such weapons were far more widespread.  The Imperial Japanese military frequently used vesicant (blister) agents such as Lewisite and mustard gas against Chinese military and civilians, and in the hideous “medical experiments” conducted on live prisoners at Unit 731 and Unit 516.  Emperor Hirohito personally authorized the use of toxic gas during the 1938 Battle of Wuhan, on no fewer than 375 occasions.

The Italian military destroyed every living creature in its path during the 1936 Colonial war with Ethiopia, in what Emperor Haile Selassie called “a fine, death-dealing rain”.

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Nazi Germany possessed some 45,000 tons of blister and nerve agents, though such weapons were rarely used against western adversaries.  The “Ostfront” – the apocalyptic race war pitting the Teuton against the Slavic states of the Soviet Union – was a different story.  Russian resistance fighters and Red Army soldiers were attacked, most notably during the assault on the catacombs of Odessa in 1941, the 1942 siege of Sebastopol, and the nearby caves and tunnels of the Adzhimuskai quarry, where “poison gas was released into the tunnels, killing all but a few score of the (3,000+) Soviet defenders”.

Animals in World War1

The official American policy toward chemical weapons was enunciated by President Franklin Roosevelt, in 1937.  

“ I do not want the Government of the United States to do anything to aggrandize or make permanent any special bureau of the Army or the Navy engaged in these studies. I hope the time will come when the Chemical Warfare Service can be entirely abolished”. – Franklin D Roosevelt, in a letter to the United States Senate

None of the western allies resorted to chemical warfare in WW2, despite having accumulated over twice the chemical stockpile as Nazi Germany.  The policy seems to have been one of “mutually assured destruction”, where no one wanted to be first to go there, but all sides reserved the option.

main-qimg-6cec6b7ffb5cac17681e9f4e14d99d61-cGreat Britain possessed massive quantities of mustard, chlorine, Lewisite, Phosgene and Paris Green, awaiting retaliation should Nazi Germany resort to such weapons on the beaches of Normandy.  General Alan Brooke, Commander-in-Chief of the Home Forces, “[H]ad every intention of using sprayed mustard gas on the beaches” in the event of a German landing on the British home islands.

dog_gas_masks_02The Geneva Protocols on 1925 banned the use of chemical weapons, but not their manufacture, or transport.  By 1942, the U.S. Chemical Corps employed some 60,000 soldiers and civilians and controlled a $1 Billion budget.

In August 1943, Roosevelt authorized the delivery of chemical munitions containing mustard gas, to the Mediterranean theater. Italy surrendered in early September, changing sides with the signing of the armistice of Cassibile.

The liberty ship SS John Harvey arrived at the southern Italian port of Bari in November, carrying 2000 M47A1 mustard gas bombs, each containing 60 to 70-pounds of sulfur mustard.

Bari was packed at the time, with ships waiting to be unloaded.  It would be days before stevedores could get to her. Captain John Knowles wanted to inform port authorities of his deadly cargo and request that it be unloaded immediately, but secrecy prevented him from doing so. As it was, John Harvey was still waiting to be unloaded, on December 2.

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For Luftwaffe Generalfeldmarschall Albert Kesselring, the traffic jam at Bari was an opportunity to slow the advance of the British 8th army on the Italian peninsula.

The “Little Pearl Harbor” began at 7:25PM, when 105 Junkers JU-88 bombers came out of the East.   The tactical surprise was complete, and German pilots were able to bomb the harbor with great accuracy. Two ammunition ships were first to explode, shattering windows 7 miles away. A bulk gasoline pipeline was severed, as a sheet of burning fuel spread across the harbor, igniting those ships left undamaged.

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43 ships were sunk, damaged or destroyed including John Harvey, which erupted in a massive explosion.  Liquid sulfur mustard spilled into the water, as a cloud of toxic vapor blew across the port and into the city.

Mustard gas is a cytotoxic agent, capable of entering the system via skin, eyes and respiratory tract and attacking every cell type with which it comes into contact. First comes the garlic smell, as the yellow-brown, heavier-than-air cloud creeps along the ground.  Contact first results in redness and itching, resulting 12-24 hours later in excruciating, untreatable blisters on exposed areas of the skin.  Sufferers are literally burned inside and out, as mucous membranes are stripped away from the eyes, nose and respiratory tract.

Mustard_Gas-_Sketch_to_Illustrate_the_Effect_of_Mustard_Gas_on_Horses_Art.IWMART4942.jpgDeath comes in days or weeks.  Survivors are likely to suffer chronic respiratory disease and infections. DNA is altered, often resulting in certain cancers and birth defects. To this day there is no antidote.

A thousand or more died outright in the bombing.  643 military service personnel were hospitalized for gas symptoms.  83 of those were dead, by the end of the month.  The number of civilian casualties is unknown.  The whole episode remained shrouded in secrecy.

At the time, the chemical disaster at Bari was all but unknown.  Everyone with any knowledge of John Harvey’s secret cargo was killed in the explosion.  Lieutenant-Colonel Stewart Francis Alexander, an American physician from New Jersey, was sent by the Deputy Surgeon General of the US Army to find out what happened.

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Dr. Alexander identified mustard as the responsible agent.   In the process of testing, Dr. Alexander noticed the unknown agent first went after rapidly dividing cells, such as white blood cells. Alexander wondered if it might be useful in going after other rapidly dividing cells.  Like cancer.

Based on Dr. Alexander’s field work, Yale pharmacologists Louis Goodman and Alfred Gilman developed the first anti-cancer chemotherapy drug, in the treatment of lymphoma.

Dr. Sidney Farber of Boston built on this work, producing remission in children with acute Leukemia using Aminopterin, an early precursor to Methotrexate, a chemotherapy drug still in use, today.

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Dr. Sidney Farber, regarded by many as the “Father of Modern Chemotherapy”

Writers have labeled SS John Harvey a Savior of Millions, due to the vessel’s role in the pioneering era of modern chemotherapy drugs.

The claim may be a bit of an exaggeration, but not entirely so.  The American Cancer Society estimates that there were 7,377,100 male cancer survivors in the United States as of January 1, 2016 and another 8,156,120, females.

 

A Trivial Matter
German chemist Albert Niemann discovered cocaine in 1859, and went on to document the poison effects of sulphur mustard around the time of the American Civil War. In 1913, British and German civilian researchers were accidentally exposed to mustard and had to be hospitalized. The German military obtained notes about the incident and promptly went about weaponizing the stuff.

April 10, 1951 A Dark Secret

In an age of informed consent and medical ethics review boards, it’s hard to imagine that human beings were once experimented upon, like lab mice.  

In 380BC, Plato’s “Republic” described a societal group possessed of Reason and destined to govern the ideal society, comprised of a second class ruled by “Spirit”, and a third in the thrall of “Appetite”.  This was the Greek philosopher’s “Guardian Class”, an elite and early prototype of a latter-day “Ubermensch”.

In the 19th century, Francis Galton studied the theories of his cousin Charles Darwin on the evolution of species, and applied these ideas to a system of selective breeding intended to bring “better” human beings into the world.  He called this his theory of “Eugenics”.

Eugenics gained worldwide respectability in the early 20th century, when nations from Brazil to Japan adopted policies concerning involuntary sterilization of certain mental patients, the socially “undesirable” and various collections of misfits and outcasts.

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“Better Babies” competitions sprang up at state fairs across the United States, where babies were measured, weighed, and “judged”. Like livestock. By the 1920s, such events had evolved into “Fitter Family” competitions.

The darker side of the Eugenics movement involved separating those deemed “inferior”, lest such persons be suffered to breed. By the height of the movement, some 30 states had passed legislation, legalizing involuntary sterilization of individuals considered “unfit” for reproduction. All told, some 60,000 American citizens were forcibly sterilized in state-sanctioned procedures.

The oldest public institution for the mentally disabled in the Western Hemisphere is the Massachusetts School for the Feeble-Minded, built in 1848.

Today, the place stands empty.  At its height, the 196-acres and 72 buildings of this place were home to some 2,500 “feeble minded boys”, a model for the education of the mentally disabled.  The institution’s third Superintendent Walter E. Fernald was a strong proponent of Eugenics.  The place was renamed in his honor in 1925,  the Walter E. Fernald State School later known as the Walter E. Fernald Developmental Center.Walter_E._Fernald_State_School_-_IMG_1860-700x525

“Fernald” served a large population of the mentally disabled, along with a number of others who’d simply been abandoned by their parents.  The Boston Globe has reported as many as half the population, tested in the normal IQ range.

In an age of informed consent and medical ethics review boards, it’s hard to imagine that the government once experimented on its citizens, like lab mice.

The 40-year Tuskegee syphilis experiment begun in 1932 is an infamous example of unethical clinical research, in which 600 impoverished Americans of African ancestry were “studied” for the effects of untreated syphilis. Beginning in 1955 and continuing for fifteen years, medical researchers from NYU and Yale University intentionally infected mentally disabled children of the Willowbrook State School in Staten Island New York with Hepatitis A, in order to study disease progression and potential treatments.

At Fernald, the Massachusetts Institute of Technology and the Quaker Oats Company came together in the study of radioactive oatmeal.  No, Really!

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Quaker Oats had been battling it out with Cream of Wheat since 1900, for a share of the lucrative hot cereal market. In the post WW2 period, Quaker alone rang up sales of $277 million. The Federal government’s dietary guidelines of 1943 elevated whole grains as an ideal source of nutrition, but there was a problem. Studies suggested that a naturally occurring cyclic acid called phytates contained in grains like oats, might inhibit the uptake of iron. Farina did not seem to have the same effect.

It was game, set and match to the Cream of Wheat people, and the stakes could not have been higher.

Enter, the “Science Club”.  Conditions were brutal at the Fernald School.  Boys were often deprived of meals or forced to do hard manual labor.  There have been allegations of physical and sexual abuse, forced solitary confinement and threats of lobotomy.

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74 boys joined the Science Club beginning in 1946,  more for the goodies than any idea of Science. There were parties and trips to watch Red Sox games, Mickey Mouse watches and lots of hot breakfasts with Quaker Oatmeal, laced with radioactive tracers.

It was the dawn of the nuclear age.  Some 210,000 civilians and GIs were subjected to nuclear radiation, without their knowledge or consent.

So it was that Quaker provided the oats, MIT received funding for the research, and the Fernald School supplied the…er…”Mice”.  By this day in 1951, such experiments were only half-way through.

“In the three experiments, the boys at Fernald ate oats coated with radioactive iron tracers, milk with radioactive calcium tracers (radioactive atoms whose decay is measured to understand chemical reactions happening in the body), and were given injections of radioactive calcium. The first two experiments’ results were encouraging to Quaker: Oatmeal was no worse than farina when it came to inhibiting absorption of iron and calcium into the bloodstream. The third experiment showed that calcium entering the bloodstream goes straight to the bones, which would prove important in later studies of osteoporosis”. – Hat tip, Smithsonian.com

Secretary of Energy Hazel O’Leary declassified a number of Atomic Energy Commission documents in 1993, resulting in a lawsuit in ’95.  In a hearing before the United States Senate, MIT’s David Litster claimed the experiment exposed the boys to no more than 170 – 330 millirems of radiation, about the same as 30 consecutive chest x-rays.

In January 1998, 30 former “students” settled with the Quaker Oats Company and MIT, for $1.37 Million.  President Bill Clinton apologized on behalf of the Federal Government, and the AEC.

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By 2001, the Fernald School was home to only 320 mentally disabled adults, aged 27 to 96 years.  By the time it closed, the cost to the Massachusetts taxpayer was $1 million per year,  per resident.  The last patient was discharged on November 13, 2014, following a protracted legal battle which cost Massachusetts taxpayers another forty million dollars.

Today the place stands empty.  A dark and crumbling monument, to the legacy of government “Health Care”.

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A Trivial Matter
Ten experiments, some genius thought would be a good idea.

April 1, 1961 Wonder Drug

Despite documented cases of fetal alcohol syndrome, scientists believed no drug could pass the placental barrier, passing from mother to unborn child. Within three years, the new compound was licensed to 14 pharmaceutical companies under 37 different trade names and sold in 46 countries.

In 380BC, Plato described a system of state-controlled human breeding in the Socratic dialogue “The Republic”, introducing a “guardian class” to watch over over his ideal society.

In the 19th century, the British statistician Francis Galton studied the theories of his cousin Charles Darwin on the evolution of species, applying them to a system of selective breeding intended to bring “better” human beings into the world.  He called this his theory of “Eugenics”.

Eugenics gained worldwide respectability in the early 20th century, when countries from Brazil to Japan adopted policies regarding the involuntary sterilization of certain mental patients.

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1935 Sterilization map. H/T PBS.org

In the United States, 30 states passed legislation at the height of the movement, legalizing the involuntary sterilization of individuals considered “unfit” for reproduction. All told, some 60,000 individuals were forcibly sterilized in state-sanctioned procedures.

The race to perfect worldwide “genetic hygiene” reached its zenith with the “sterilization law” enacted in Nazi Germany on July 14, 1933. The German measure borrowed heavily from the statutes of American educator and Eugenics Record Office (ERO) Director Harry H. Laughlin, taking such measures a step further by allowing compulsory sterilization of any citizen displaying one of a long list of supposed genetic disorders, not just those confined to institutions.

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Two-Step Thalidomide Synthesis

In the wake of World War II, West German authorities were loath to apply such strict congenital examination. Pathologist Franz Büchner would go on to propagate his theories of Teratology, stating that healthy nutrition and behavior of expecting mothers was more important for the health of the child, than genetic considerations. The idea would prove to be a disastrous oversight.

The German company Chemie Grünenthal (now Grünenthal GmbH) was established to address the urgent need for antibiotics. and other pharmaceuticals. In 1953, company scientists developed a two-step procedure for synthesizing a new molecule. The compound underwent rodent testing and further revision, the new drug “Thalidomide” introduced in 1956, as a sedative.

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Life Magazine

Researchers at Chemie Grünenthal found the drug an effective remedy for vomiting and nausea, an important remedy for morning sickness in expectant mothers. It was a “wonder drug”, a cure for ailments from insomnia to coughs and colds, claiming to cure “anxiety…gastritis, and tension”.

Despite documented cases of fetal alcohol syndrome, scientists believed no drug could pass the placental barrier, passing from mother to unborn child. Within three years, the new compound was licensed to 14 pharmaceutical companies under 37 different trade names and sold in 46 countries.

Thalidomide acceptance was far from universal. Regulatory authorities in East Germany refused approval. In the United States, the U.S. Food and Drug Administration (FDA) denied widespread marketing and distribution though large quantities were released, for testing.  Approximately 875 people were involved in such trials, including a number of pregnant women.

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Phillipa Bradbourne, a Thalidomide baby born without arms. 1963. H/T allthatsinteresting.com

The drug first arrived in Canada on this day in 1961. Several variants entered the Canadian market, the most common sold under the name, Talimol. Within two months, pharmaceutical companies were warning physicians of the risk of birth defects. Canadian authorities banned all variants within a year, instructing physicians to destroy stockpiles.

The first birth defects began to appear around 1958, peripheral nerve palsies or Phocomelia, a malformation or entire absence of arms and/or legs, hands & feet.  Some cases showed malformation of eyes, ears and internal organs, others born with no anus and no genitals and doomed to die.  Some five to seven thousand children were born with such birth defects in West Germany alone, four-in-ten of whom, survived.  Worldwide, some 10,000 “Thalidomide babies” were born with such defects, half of whom survived infancy.  An estimated 123,000 others miscarried, or were stillborn.

“Today, fewer than 3,000 are still alive. In Britain, it’s about 470. Among the nearly 50 countries affected are Japan (approximately 300 survivors), Canada and Sweden (both more than 100), and Australia (45). Spain’s government only recently acknowledged the drug was ever distributed there. No-one knows how many Spanish survivors there are. It could be hundreds”. H/T BBC

Despite such egregious side effects, Thalidomide remains in use today, albeit under conditions of strict birth control.  Thalidomide is in fact a “wonder drug” for the treatment of certain skin conditions related to leprosy, and is useful for treatments relating to HIV, Crohn’s Disease and certain cancers.

Sadly, Brazilian strictures are not so severe, leading to the birth of a whole new generation of “thalidomiders”, as adult survivors call themselves.  Research has uncovered circumstantial evidence connecting Thalidomide’s origins to Dr. Otto Ambros, the “Devil’s Chemist”,  alleging Dr. Ambros helped develop the nerve agent sarin, while experimenting on thalidomide as an antidote on concentration camp inmates.

Eight years ago, German survivors’ marked the fifty-year mark, in the Thalidomide debacle. Spokesman Gernot Stracke quipped:

“On 26 November – 50 years on – we, the German survivors, will march, waddle, limp or roll in wheelchairs from the Brandenburg Gate to the Federal Chancellery in Berlin.  To celebrate that we are still alive, and to remember those who never lived”.

Feature image, top of page:  Survivors tell tales of frequent falls leading to scores of stitches as the armless and legless attempt navigation with contraptions like the British prosthesis, on the left.  Right, young German girl uses crude boxing glove-like prostheses, in place of hands.  H/T Life Magazine.

 

A Trivial Matter
In the United States, federal regulator Dr. Frances Oldham Kelsey denied no fewer than six applications to bring Thalidomide to market, on the basis of insufficient testing.  Thanks to her stubborn refusal, such cases were held to seventeen in this country, a fact which earned Dr. Kelsey a Presidential award for distinguished service from the federal government.

March 19, 1227 The Catapocalypse

The effect of the papal Bull, was as a commandment.  “Thou shalt not suffer a cat, to live”.

In the early 1330s, a deadly plague broke out on the steppes of Mongolia. The gram-negative bacterium Yersinia Pestis preyed heavily on rodents, whose fleas would transmit the disease to people, the infection then rapidly spreading to others. High fever would precede the appearance of “buboes”, a painful swelling of the lymph glands, especially in the armpit, neck and groin. Spots appeared on the skin turning from red to black, often accompanied by necrosis and gangrene in the nose, lips, fingers and toes.

In some cases, bubonic plague will progress from the lymphatic system to the lungs, resulting in pneumonic plague. Y. Pestis can progress to the blood system as well, a condition known as septicemic plague. In medieval times, septicemic mortality rates ran as high as 98%-100%.

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H/T Historythings.com

Plague broke out among a besieging force of Mongols on the Black Sea city of Caffa, in 1346. Italian merchants fled with their ships in the Spring of 1347, carrying in their holds an untold number of rats and the fleas which came with them.

The disease process unfolded with horrifying rapidity. The Italian writer Boccaccio wrote that plague victims often “ate lunch with their friends and dinner with their ancestors in paradise.”

This was the experience of individual sufferers.  So, what allowed the pandemic to spread with such rapidity?

The story begins one-hundred years earlier.  On this day in 1227, eighty-year-old Cardinal Ugolino di Conti was elected Supreme Pontiff, taking the name Pope Gregory IX.  Gregory’s papal ordination came at a time of spreading heresy, the earliest reverberations of what came to be known some three hundred years late, as the Protestant Reformation.

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Pope Gregory IX, H/T Historythings.com

The Waldenses, founded in 1170 by Peter Waldo, claimed that individuals could commune with directly with God. Other sects such as the Cathars followed similar beliefs. Such heresies challenged the authority of the One True Church, and could not be left unchecked.

Today, Gregory is best remembered for his organization of Canon law, the formalization of practices later forming the basis of the medieval inquisition. At the time, a more immediate problem was the rise of what were seen as satanic cults.

The German priest and nobleman Conrad of Marburg was an early leader in the persecution of heretics, claiming to have rooted out a number of Luciferian cults around the cities of Mainz and Hildesheim. The first Bull of the new papacy, the Vox in Rama, beseeched the bishops to come to Conrad’s aid, and went on to describe in some detail, the depraved rituals of such cults.

The devil at the center of it all was a shadowy figure, half man and half cat.

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A witch and her cat. Weird Tales, Vol 36. Public Domain. Wikimedia Commons

From the mists of antiquity, the cat was worshiped as some kind of deity. The Vox reshaped the European view to where cats were now seen, as agents of hell.  The French theologian Alain de Lille piled on, falsely claiming the Cathar sect took its name from the animal and not the real source, the Greek katharoi or ‘pious ones’.

The effect was as a commandment.  “Thou shalt not suffer a cat, to live“.

The orgy of cruelty which followed, makes for some tough reading.  Cats were hurled from high cathedrals and set on fire, ritually tortured or summarily stomped or clubbed, to death.

In Denmark, the festival of Fastelavn held at the start of Lent, held that Spring would not come until evil, was banished from the land. Black cats were ritually beaten to death, to purge evil spirits. Cat killing became a folk practice all over Europe. During the festival of cats or Kattenstoet held in the Belgian city of Ypres, the custom was to hurl cats from the belfry of local churches, before setting them on fire. The hideous practice carried on until 1817 with live cats and continues to this day, only now, they’re stuffed.

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So it is that nature’s most efficient hunter of rodents was all but exterminated from the land, paving the way for the rat-borne apocalypse, to come.

One-third of the world’s population died in the rat-borne plague of 1347-’52.  It’s as if  over two billion were to sicken and die, today.

Feature image, top of page:  Hat tip historythings.com

 

A Trivial Matter
The term ‘Black Death’ was not adopted until some time later. For years, the plague was known as “the Pestilence” or simply “the Great Mortality”.

March 6, 2006 There’s an RPG in Me

Explosives expert Staff Sgt. Dan Brown.  Two surgeons, Major John Oh and Major Kevin Kirk and the whole team at the aid station.  Three surgical staff.  All did their jobs knowing that, at any instant, the whole team could be vaporized.

Paktika Province is a wild and lawless region in the east of Afghanistan, a border crossroads with the west of Pakistan and home to a number of Taliban and Al Qaeda units. An article from Time magazine describes the U.S. base:

“The U.S. firebase looks like a Wild West cavalry fort, ringed with coils of razor wire. A U.S. flag ripples above the 3-ft.-thick mud walls, and in the watchtower a guard scans the expanse of forested ridges, rising to 9,000 ft., that mark the border. When there’s trouble, it usually comes from that direction.”

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Channing Moss, second from right

The morning of Thursday, March 16, 2006 dawned bright and clear, as a force rode out from the 10th Mountain Division.  Their mission was to seek out a remote mountain village, and meet with village elders. They were twenty-four American soldiers in five Humvees and a handful of Afghan National troops, riding a pickup truck.

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Paktika is a trackless wilderness of ragged hillsides and wadis, seasonal riverbeds flowing southwest from the mountains of Sar Hawza, to the north.  The land appears custom made for an ambush, with dangerous high spots in nearly every direction.

Gunfire broke out from above, some four hours into the mission.  First small arms, then came the rocket-propelled grenades.  One gunner, twenty-three-year-old Private Channing Moss, remembered it sounded like rattling spoons.

RPGs were soon raining down.  The pickup exploded, killing two Afghan soldiers.  The rest scrambled to get out of the “kill zone”, as three rocket propelled grenades struck Private Moss’ Humvee.  Staff Sergeant Eric Wynn, 33, felt one slice through his face.  Channing Moss, standing with his upper body out of the Humvee, felt something and smelled smoke.  He looked down to see it was himself.  He was smoking.

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RPG ammunition, found on the outskirts of Basra

A rocket propelled grenade is exactly what it sounds like, a weapon roughly the size of a baseball bat, propelled at the speed of a bullet.  Standing as he was, Channing Moss had taken one of these things in the hip, leaving nothing but the fins, sticking out of his body.  The weapon inside of him was capable of turning everyone in the vehicle into a “pink mist”.

What happened next, is beyond belief. When every human instinct says “get the hell away from that thing”, Moss had a whole team by his side, throughout the ordeal. Company medic Spc. Jared Angell, 23, working to stabilize that thing for transportation. Lieutenant Billy Mariani came over once the fighting had died down: “I grabbed his hand and I just said, ‘Hey, buddy, we’re gonna get you out of here.'” Badly wounded himself, Wynn held his own face together while reporting casualties over the radio, and holding Moss’ hand.

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Private Channing Moss

The MEDEVAC crew arrived escorted by an Apache attack helicopter, they knew what they were dealing with. Army regulations say it’s too dangerous to carry such a human bomb. It could take out every man on the chopper and blow the bird out of the sky: four MEDEVAC crew members, and three wounded soldiers.

Pilot CW2 Jorge Correa spoke with his team: “I asked my crew, you know, ‘Are you guys comfortable with this?  Because I wasn’t gonna put my crew in jeopardy if they weren’t comfortable with it.”  Co-pilot Jeremy Smith recalled the moment:  “We all said, ‘Yeah, let’s get him on board and let’s get outta here.'”

It was the same thing, back at the aid station.  Explosives expert Staff Sgt. Dan Brown.  Two surgeons, Major John Oh and Major Kevin Kirk and the whole team at the aid station.  Three surgical staff.  All did their jobs knowing that, at any instant, the whole team could be vaporized.

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Channing Moss was well beyond the “golden hour” with expectations of survival, growing dim.  The man’s heart actually stopped and the surgeons administered epinephrine, knowing that physical heart massage could detonate the ordnance still inside the man’s body.

Private Moss survived, despite massive injury to his body.  There were four more surgeries back at Walter Reed and an endless hell of physical therapy as the man progressed from bed to wheel chair to crutches, to a cane.  Moss had a Purple Heart coming and then some and refused to receive it, until he could stand on his own two legs and walk to receive his medal, himself.

Explosives expert Dan Brown spoke for the whole team, I think, in explaining what they had done:  “He was American, he was a solider, he was a brother and he was one of us. And there was nothing gonna stop us from doing what we knew what we had to do … We knew we did right. In that screwed up world we did something right.

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Channing Moss and his wife Lorena, reunited with Majors Oh and Kirk

A Trivial Matter

While rare, unexploded ordnance has been lodged inside living human bodies on no fewer than thirty six occasions between WW2 and the modern era, requiring surgical removal.  All but four, survived.