Tag Archives: bone disease

Stop, look, and listen

It’s been a busy few weeks here with exam marking, thesis writing, and all manner of things in between (including being interviewed by some students making a documentary about the history of psychosurgery – we’ll keep you posted). As a consequence, the blog has felt a little neglected, but we’ve put together a list of some great reading, viewing, and listening for you over the next couple of weeks that should make up for it!

Read

New issues of History of the Human Sciences and History of Psychiatry journals. The former includes a brilliant piece by Felix Schirmann on ‘Badness, Madness, and the Brain’ in the late 19th century and a free-to-all article by Chris Millard on self-harm in 20th-century psychiatry. In History of Psychiatry, Torbjørn Alm and Brita Elvevåg explore ergotism in Norway, and there is a timely consideration (after recent criticisms by the British Psychological Society) of classification in the DSM by Massimiliano Aragona, as well as – ahem – a piece on bone disease and insanity by Jennifer Wallis.

Understandings of ergotism are examined in the latest History of Psychiatry. © Wellcome Library, London.

Understandings of ergotism are examined in the latest issue of History of Psychiatry.
© Wellcome Library, London.

Whether or not you’re attending this year’s very exciting iCHSTM conference (International Congress of History of Science, Technology and Medicine)  in Manchester, the iCHSTM 2013 blog is definitely worth keeping an eye on, with posts so far on the science of selecting soldiers in WWII, to autopsies and asbestos.

Also on the blogs, check out this excellent post by Lisa Smith on ‘The Moon and Epilepsy in the Eighteenth Century’ over at The Sloane Letters Blog.

Watch

For those of you based in London, there’s still time to catch some of the seminars in KCL’s History of Health and Medicine series. This Wednesday promises a fascinating talk by Julie Anderson and Carole Reeves on ‘Imaging the Abnormal Body’, and the final seminar on 5 June welcomes Carin Berkowitz and David Hay to speak on ‘Educating the Body – Eye, hand, and imagination in (bio)medical education’. The seminars are free and open to all, starting at 6pm.

Pauline Norris promises an interesting take on the humble lettuce. © Efraim Lev/Zohar Amar.

Pauline Norris promises an interesting take on the humble lettuce.
© Efraim Lev/Zohar Amar.

And if you’re looking for some intellectual stimulation this Friday, I’m intrigued by Pauline Norris’s seminar as part of the Institute of Historical Research’s History of Gardens and Landscapes History seminar series: ‘The Lettuce Connection: The Ancient Egyptian Cultivation of Lettuce, the God Min and Aphrodisiacs‘. The seminar starts at 5.30pm at Senate House, and is free to attend.

Next week, also at the IHR, Roberta Bivins will be speaking on ‘Domesticating Medicine: Medical Technologies and the Home‘. Again, the seminar is free to attend, with a 5.30pm start.

On 10 June the annual Freud Memorial Lecture will take place at London’s Freud Museum. This year, it’s given by Allen Frances, who asks ‘How well does Freud’s work stand the test of time?’ For more details, including how to book, see the Museum’s website.

Listen

Today sees the first episode of a ten-part series by BBC Radio 4, ‘Disability: A New History‘ presented by Peter White. Examining the history of disability in the 18th and 19th centuries, the series will cover everything from ‘the only dwarf in Liverpool’ (today’s episode) to the facial disfigurements caused by diseases such as smallpox. It promises to be a fascinating set of programmes, with contributions from several key historians in the field, that I’m really looking forward to listening to.

© Wellcome Library, London.

© Wellcome Library, London.

Over on BBC Radio 3, a recent programme examined the cultural history of syphilis, a disease that frequently raises its head here on asylumscience. You can listen to the programme here.

I think that’s enough to keep you busy for the next week or so – and we’ll be back with our normal blog service in two weeks time!

A ‘new’ disease?

At the November and December meetings of the London Clinical Society in 1884, an interesting debate unfolded: was a ‘new’ disease appearing in England? A number of patients had been seen in hospitals and asylums in the preceding years who exhibited unusual joint affections. It was a sudden phenomenon, characterised by severely swollen but usually painless joints. Though any joints of the body might be affected, knees and ankles tended to fare worst. The lack of pain and generally dulled sensations that were experienced impacted on the everyday actions of sufferers, who dropped objects, frequently fell, or had difficulty walking. Other bodily manifestations appeared in the form of ulcers, often on the feet. Many patients also reported that they suffered from ‘neuralgia’, ‘flying gout’, and gastric crises.

Deformity of the knee in Charcot's disease. © Wellcome Images/St Bartholomew's Hospital Archives & Museum.

Deformity of the knee in Charcot’s disease.
© Wellcome Images/St Bartholomew’s Hospital Archives & Museum.

The condition was first properly identified by neurologist Jean-Martin Charcot in 1868, earning it the moniker ‘Charcot’s joint’ (Charcot noted that the condition had also received attention from J.K. Mitchell in the 1830s). In 1880s England, though, according to W. Hale White of Guy’s Hospital, ‘discussion about Charcot’s joint [had] waxed very warm’. Alienist interest in the condition stemmed from its appearance in tabes dorsalis (nerve degeneration in the spinal cord due to untreated syphilis) patients, who were often seen in asylums before the incidence of syphilis was vastly reduced with the use of penicillin in the 20th century. Charcot said he had only ever seen the condition in tabes dorsalis patients, and other asylum doctors related similar cases. Conolly Norman at Dublin’s Richmond Asylum hosted a meeting of the Irish division of the Medico-Psychological Association in 1896 at which delegates viewed two cases of Charcot’s joints on Richmond’s wards, both occurring in general paralytic (neurosyphilitic) patients. In syphilitic conditions, nerve degeneration impaired patients’ reflexes and sensations whilst muscle wastage reduced the natural protection around the joints. The result was that patients became increasingly vulnerable to injury (discussions of the disease often noted spontaneous fractures), or their bones literally ‘wore away’ as they ground together.

L0061441 Dissected knee joint, the subject of marked locomotor ataxy

Dissected knee joint exhibiting Charcot’s disease.
© Wellcome Images/St Bartholomew’s Hospital Archive & Museum.

Alongside syphilis, physical injuries were also cited by some as an immediate, exciting cause. (Whilst syphilis was the condition most commonly associated with Charcot’s disease by nineteenth-century doctors, it was gradually recognised as a condition with much wider aetiological factors. It may be present in diabetic neuropathies, for example, where nerve damage affects the weight-bearing joints.) J. Wallace Anderson related the case of a patient at Glasgow Royal Infirmary. Admitted to the hospital due to his difficulty in walking, the 45 year old gardener ‘ascribe[d] his complaint to a stroke of lightning … twelve years ago’, following which he began to experience ‘tingling’ pains and weakness in the hips, until finally his right hip “went out”. Though he was discharged from the hospital able to walk with the aid of sticks, he remained prone to ‘unusual variations in his general condition’. Charcot’s disease was, ultimately, untreatable, and little could be done for patients other than try to assist their mobility in various ways.

N0008052 Charcot's knee

X-ray of a Charcot’s knee.
© Wellcome Images.

Ascertaining if Charcot’s disease was indeed novel to the late nineteenth century was difficult. One stumbling block was the apparent lack of such specimens in pathological museums: if it wasn’t a new disease, why were there no samples from previous years? At the London Clinical Society meeting, Sir James Paget suggested that museum curators – even if they were able to secure a specimen of a comparatively rare condition – tended to collect normal rather than abnormal specimens for teaching purposes. Interpretations of the disease ranged from osteo-arthritis to ‘modified’ chronic rheumatic arthritis, though such diagnoses were complicated by the sudden onset of the joint affection.

Although W. Hale White said that discussion about the disease had ‘waxed very warm’ and ‘everyone [had] had an opportunity of expressing his opinion’, he doubted if ‘exact knowledge of the subject [had] been much advanced’. At a point in time when doctors were increasingly keen to pinpoint the physical lesions of disease, Charcot’s joint seemed a perfect opportunity to trace a visible physical deformity to minute changes in the nerves. This was complicated by its resemblance to other conditions, however: was it just a form of rheumatism? Was it a ‘new’ disease? Or a ‘new compound of diseases’? These were – and are – fascinating questions that bring to mind current historical debates about retrospective diagnoses, the ‘framing’ of disease, and how we assess medical knowledge of the past: giving a condition a name didn’t necessarily mean that its identity was static, or signal a ‘pinnacle’ of understanding.

Further reading

D. Ferrier, On Tabes Dorsalis: the Lumelian Lectures, delivered before the Royal College of Physicians, London, March, 1906 (London: John Bale, son & Danielsson, 1906).

W.J.M.A. Maloney, Locomotor Ataxia (Tabes Dorsalis): An Introduction to the Study and Treatment of Nervous Diseases, for Students and Practitioners (London: D, Appleton, 1918).

L.C. Rogers et al, ‘The Charcot Foot in Diabetes‘, Diabetes Care 34 (2011).

L.J. Sanders, ‘Jean-Martin Charcot (1825 – 1893): The Man Behind the Joint Disease‘, Journal of the American Podiatric Medical Association 92 (Jul./Aug. 2002).

H. Waldo, ‘A Case of Charcot’s Joint Disease, with Perforating Ulcer of the Foot in a Tabetic Patient‘, BMJ (1 Dec. 1894).

R. Waterhouse, ‘Remarks on the Arthropathies of Acquired Syphilis‘, BMJ (10 Oct. 1908).