Levy Library

Mount Sinai and the Case of the (Almost) Disappearing Disease

In 1919 Mount Sinai researchers Leo Loewe and Israel Strauss described the first experimental transmission of encephalitis lethargica, or acute epidemic encephalitis¹, a disease first named in 1917 by the Austrian von Economo.  This disease had a brief moment of intense interest, but then disappeared by the 1940s.  Mount Sinai researchers treated many cases and were involved in the early efforts to describe its causation.  This was part of a larger, really New York based fascination with the disease.  This story is well told in a 2004 article by Kenton Kroker², who uses epidemic encephalitis as a way to look at how the field of neurology was trying to re-define itself as the medical world became focused less on signs and symptoms and more on laboratory proof.

Mount Sinai's involvement can be seen in articles on encephalitis lethargica (EL) by Isador Abrahamson, Associate Neurologist and chief of clinic from 1904-19; Leo Loewe, who was an Intern and then a Research Fellow; and Israel Strauss, a Resident who went on to become Director of our Department of Neurology from 1925-38 and was the founder of Hillside Hospital in Queens.  William Thalheimer, a former member of Mount Sinai's house staff, had a role in confirming Loewe and Strauss' research.  A new medical organization, the Association for Research in Nervous and Mental Diseases, as one of its first actions formed a group to study this disease and provide a consensus document on what was known³.  Involved in that publication was Dr. Strauss, as well as Bernard Sachs, then Director of Mount Sinai's Department of Neurology and known today for Tay-Sachs disease. Mount Sinai Hospital's own annual reports from 1919 into the early 1920s include information on our doctors' efforts in this area. 

Research here on epidemic encephalitis seems to have withered over the 1920s.  Simon Flexner, then at Rockefeller University, could not replicate Loewe and Strauss' findings, although it was replicated in Europe and by Thalheimer in Milwaukee.  Loewe left the staff and Strauss turned to new topics. Over the 1920s and 30s, the exact nature of epidemic encephalitis became less clear, and it fell by the wayside as a diagnosis. Today, encephalitis lethargica is described as:  "a CNS disorder that manifests with lethargy sleep cycle disturbances, extrapyramidal symptomatology, neuropsychiatric manifestations, ocular features and cardio-respiratory abnormalities.^4"  A quick search of PubMed today will bring up 44 articles on the entity from 2005-2011. As noted in a 2009 study:  "Although there have been no reported outbreaks of EL recently, a number of reports show that cases of EL are still encountered regularly.^4"

¹ Loewe, L and Strauss, I. “Etiology of epidemic (lethargic) encephalitis. Preliminary note.” JAMA, 1919, 73: 1056-57.

² Kroker K. Epidemic encephalitis and American neurology, 1919-1940. Bull Hist Med 2004 Spring;78(1):108-47.

³ Acute Epidemic Encephalitis (Lethargic Encephalitis): An Investigation by the Association for Research in Nervous and Mental Diseases; Report of the Papers and Discussions at the Meeting of the Association, New York City, December 28th and 29th, 1920.  New York: Paul P. Hoeber 1921.

⁴ Lopez-Alberola R, Georgiou M, Sfakianakis GN, Singer C, Papapetropoulos S. Contemporary Encephalitis Lethargica: phenotype, laboratory findings and treatment outcomes. J Neurol. 2009 Mar;256(3):396-404.

New History of Vaccines Website

  I recently was sent a notice about a new website dedicated to the history of vaccines.  It was created by the College of Physicians of Philadelphia.  Most of the images and information on the website come from the Historical Medical Library of the College, which is known for its rare books, manuscripts, and archives.  Here is the Mission Statement of the project:

The College has created The History of Vaccines to provide a living, changing chronicle of the compelling history of vaccination, from pre-Jennerian variolation practices, to the defeat of polio in the Western Hemisphere, to cutting-edge approaches to novel vaccines and vaccine delivery. The site aims to increase public knowledge and understanding of the ways in which vaccines, toxoids, and passive immunization work, how they have been developed, and the role they have played in the improvement of human health.

The site will also discuss some of the controversies about vaccination and some of the challenges, difficulties, and tragic events that have occurred in the use of vaccines.

 

There is a lot of good information and imagery here.  Well worth the look.

http://www.historyofvaccines.org/

 

I Found it in the Archives

    There have been quite a few news stories this past week about how an historian has brought to light an instance of American public health researchers experimenting on Guatemalan prisoners and mental patients without their consent.  (See, for instance, The New York Times, 10/1/10; link below)   The scientists infected nearly 700 people with syphilis to test how well penicillin worked against the disease and if it could be used to prevent the disease.

    What does this have to do with archives?  The only reason this story is known is because the historian who uncovered this, Susan M. Reverby, was doing research on the Tuskegee syphilis experiment in the archives at the University of Pittsburgh.  In an effort to be thorough, Reverby also consulted the papers of Dr. John Cutler, who was also involved at Tuskegee.  It was there that she found the information about this unknown experiment, which lasted from 1946-48, with very little result.  If the Cutler papers had not been preserved and made available by the archives, there is little reason to think we would have ever known about this awful lapse in medical ethics.

    The month of October is Archives Month in this country.  This year's theme of "I found it in the Archives" takes on added meaning when you consider this story.

 

Links:

http://www.nytimes.com/2010/10/02/health/research/02infect.html?_r=1&src=me&ref=health

http://www.hnn.us/articles/132082.html for an interview with Dr. Reverby

Army Medical Photographs

Say you are writing a serious paper about some topic in medical history and you need images, where should you look?  Or maybe you have some time to kill and you just want to look at some interesting photographs, where should you look?  Well, go to flickr.com!  Many archives and special collections are putting images online there, including several medical collections.  The collection I like comes from the holdings of the Army-run National Museum of Health and Medicine in Washington, D.C., a part of the Armed Forces Institute of Pathology.  If you search their collection online, http://www.flickr.com/photos/medicalmuseum/, you will find all kinds of interesting images: bones damaged by bullets, wounded soldiers from the Civil War to Vietnam, infectious diseases rarely seen today, nurses from the Spanish American War, and lots and lots of posters warning about veneral disease.  Some images are pretty gruesome and others are kind of funny now, such as the one shown here. Still, they are all worth the look.  And remember, Brother, she may be a Wasserman 4!

New Global Health Web Site

I recently looked at a new website devoted to global health.  It is still a work in progress, but it is of interest since it includes unique video interviews with the people who went into the field and worked on eradicating disease. 

The web site was created by the Centers for Disease Control and Prevention and Emory University in an effort to document and preserve public health history.  It is called The Global Health Chronicles: An inside look at public health efforts to prevent, control and eradicate global diseases. The content consists of oral histories, unpublished documents, photographs and artifacts.  The site is http://globalhealthchronicles.org.

The initial chronicle is devoted to the eradication of smallpox.  There are 50 oral history interviews and 30 presentations at seminars held in conjunction with two reunions of staff who worked in the field during the eradication program.  Two other chronicles are in the process of completion: Malaria and Guinea Worm disease.  The focus of the web site is somewhat limited, centering on the role of the CDC and the United States, and does not reflect the hundreds of thousands of health workers who were the backbone of the effort.  Still, the project is not static and will add materials as they becomes available from archives and medical facilities around the world.

Check it out.

Clinical Skills Week Resources

Last week was clinical skills week, when we got to meet all of the medical students entering their third year and learning some of the skills they'll need for their clerkships. One of those skills is being able to find the information necessary for patient care, so reference librarians Polly and Laura shared some of their favorite resources. Here they are, with a word about each:

PubMed: What library workshop would be complete with mention of PubMed? (OK, so there are a few). Specifically, remember MeSH searching, Boolean operators and the Limits tab, and try the Clinical Queries tool (found in the blue bar on the left side of the PubMed homepage) when you are looking for research studies for specific question types - e.g., therapy, diagnosis, prognosis, etc.

AccessMedicine, MDConsult, and the E-books database are good sources for textbook-style background information and sometimes images, videos, guidelines and more.

UpToDate (on campus only), eMedicine and PIER are full of clinical topic reviews that combine the latest evidence with expert recommendations.

ACP Journal Club and the Cochrane Library are evidence-based medicine resources: ACP Journal Club provides structured reviews and commentary on selected high-quality articles from 100+ journals, while the Cochrane Library publishes systematic reviews and meta-analyses of highly relevant topics. Search them separately using the above links, or together using EBM Reviews.

And, as always, you can Ask a Librarian. Happy third year!

The Swine Flu and Mount Sinai

The current news about the growing swine flu outbreak brings to mind an earlier epidemic in 1976 that saw a Mount Sinai physician playing a lead role.  Edwin D. Kilbourne, MD was Chairman of Mount Sinai's Dept. of Mirobiology at the time, and was known as the first to develop a genetically engineered vaccine (1970).  An infectious disease expert, Kilbourne was sought out by the federal government when it seemed that an epidemic of swine flu was beginning.  Kilbourne and colleagues developed a vaccine for the new strain and millions of people were vaccinated.  Unfortunately, hundreds of new cases of Guillain-Barré syndrome were soon reported, and the question then became: was the vaccine the cause? 

ScienceInsider has just published a little interview with Kilbourne where he talks about the events of 1976 and his current thoughts on what happened. http://blogs.sciencemag.org/scienceinsider/2009/04/retrospective-w.html  It provides a little window on infectious disease control and public health policy. The photo here shows Kilbourne getting his own vaccination in 1976.  The media attention was such that camera crews turned out to film him in the Annenberg lobby getting his shot.

Looking for information about swine flu?

Most of the articles I’ve read in the past couple of days mention that experts and policy-makers at places like the CDC and the WHO don’t have nearly as much information as they would like, but the information they do have they are making available in a variety of ways. The CDC and WHO websites are always good sources of information, and they have both set up specific sites to communicate with the public about these swine flu outbreaks.

Because the outbreak is so recent and information is still emerging, newspaper articles can be a good place to look. Of course there are newspaper websites like nytimes.com and washingtonpost.com, but for a broader look try our LexisNexis database – a search for “swine flu” retrieves articles from New York, Toronto, Tokyo, London and more. For a more academic look, try the news portions of journals like Science and Nature.

If you’re searching PubMed for articles, be aware that there isn’t a MeSH heading for swine flu exactly, and a search of the term “swine flu” won’t map specifically to articles about this particular strain. You can use the MeSH heading “Influenza A Virus, H1N1 Subtype”, but be aware that this will retrieve articles about both human and swine H1N1 strains, and remember that very recent articles won’t necessarily have had MeSH headings assigned to them yet.

There is also a lot of information being made available by various public health agencies and media outlets. As always, if you need any assistance finding information, please ask us!

Harvard History of Medicine Site

If you are interested in a broad summary of medical concepts and catastrophes of the past by topic or just want browse for odd tidbits about our medical forefathers, "Contagion: Historical Views of Diseases and Epidemics” is a good place to start.  In January Harvard launched this new collection of digital images in the history of epidemiology and infectious disease.  "Contagion” includes more than 500,000 pages of digitized books, serials, pamphlets, incunabula, and manuscripts and contributes to the understanding of the global, social history, and public policy implications of disease.  It also offers important historical perspectives on the science and the public policy of epidemiology today.  The website, http://ocp.hul.harvard.edu/contagion, contains historical documents on a myriad of topics including the 19th Century Cholera Epidemics; The Great Plague of London, 1665; The Boston Smallpox Epidemic, 1721; Spanish Influenza in North America, 1918-1919; Syphilis, 1494-1923; Tropical Diseases and the Construction of the Panama Canal, 1904-1914; Tuberculosis in Europe and North America, 1800-1922; The Yellow Fever Epidemic in Philadelphia, 1793; as well as general materials on people of note.  E. Du Rocher

Polio: Never Really Gone

There was an item in the newspaper the other day about a new polio case that was found in Uganda. Today it is hard to imagine the impact polio had on people’s lives around the world, up to a short fifty years ago. But we should never forget, because clearly, the threat of this disease is not really gone. 

To get a sense of what having polio can mean, please visit the website of The Science Museum. The address is: www.sciencemuseum.org.uk/broughttolife. On the homepage is a link to an online exhibit about the iron lung, a breathing apparatus that allowed millions of people to live with polio.  For the full impact, make sure the sound on your computer is turned on and let the page stay open for a while.  That is one of the sounds of polio.

I have to note that that sound was also a part of The Mount Sinai Hospital for many years.  Mount Sinai opened the first polio center in New York City in 1953, the Jack Martin Polio Respirator Center. It closed in 1960 when the success of the Salk and then Sabin vaccines made it obsolete.  The image here shows Dr. Avron Y. Sweet, Director of the Center, talking with two nurses on the unit.