Friday, January 26, 2007

A shory history of the shaking palsy

Another Friday, another fascinating lecture on the history of medicine to the second-year medical students! Given by Dr. John Nutt, Director of the OHSU Parkinson Center of Oregon (and, incidentally, holder of the new world's record for Director of the Entity with the Biggest Acronym: PVAMC PADRECC), the lecture focused on the history of Parkinson's Disease.

Parkinson's Disease (PD) was first described in 1817
by James Parkinson, an English physician and polymath who also wrote the first book on English fossils, the first English language description of ruptured appendix, and several political tracts which got him into trouble with the law. (An interesting side note: no pictures of Parkinson are extant today; makes the labor we spend on our Historical Image Collection seem all the more worthwhile for the potential Parkinsons of tomorrow.)

He based his entire description of the disease on six cases--only three of which he saw in the office. The other three were people he'd observed on the streets of London. Finally, a way to make people-watching into a productive enterprise! Parkinson called his new disease the "shaking palsy" or paralysis agitans. It was Jean Charcot, the great French neurologist, who suggested it be renamed in Parkinson's honor. Gowers went on to write the first textbook of neurology, which compiled all contemporary knowledge on the disease--which was then often confused with multiple sclerosis. Lewy discovered his eponymous bodies in 1913, but it wasn't until Arvid Carlsson noticed the relationship of dopamine levels to akinesia that the groundwork for treatment of PD was laid. (Carlsson went on to win the Nobel for his work, in 2000.)

Since then, advances in genetics have shed more light on the nature of the disease. Heiko and Eva Braak, who developed the staging system for Alzheimers, have now turned attention to PD. Most recently (2002), researchers have shown reduced dopamine takeup in myocardial tissue in patients with PD, indicating that this may be not just a disease of the central nervous system, but a much broader disease, possibly systemic in nature.

Two hundred years later, Parkinson himself would be pleased!

Thursday, January 25, 2007

Story Wall opens

You heard it here first! (probably):

OHSU's Story Wall
has been installed on the ninth floor of the Kohler Pavilion, in the hallway leading from the tram terminus to the building exit onto Sam Jackson Park Road.

The Story Wall tells, well, the story of OHSU, from its inception in 1887 to the present. Using photographs (many from our collections here!), images of artifacts (all ours!), and text, the Wall charts the growth of the institution and its contributions to the community. (Caveat lector: some of the photo captions are slightly inaccurate; if you have any doubts or questions--or comments-- about what you see there, just send us a line at homref@ohsu.edu.)

So, on this misty morning, hop on over to KPV and check it out! And don't forget to head out onto the ninth floor terrace just next to the tram terminus: at the east end of the terrace, by the stairs heading down to the seventh floor terrace and the street below, there are two panoramic photographs showing the Portland riverfront circa 1920s and today.

Enjoy!

Wednesday, January 24, 2007

Food additives: not your grandmother's recipe

Going through a file today, I came across a snippet which I had torn out of a National Geographic magazine some years ago. It's a small article titled: "More than just a sugar buzz: original Coca-Cola really did use the real thing." While the fact that the manufacturer did once add cocaine to its popular soft drink is fairly widely known, perhaps less well known is how commonly cocaine was used in other products of that era. Widely embraced as a potent painkiller, cocaine was put into throat lozenges, suppositories, and medicines for fatigue, asthma, and a host of "women's illnesses." (for a complete history, check out Joseph Spillane's book Cocaine: from medical marvel to modern menace in the United States, 1884-1920.)

Nor was cocaine the only addictive substance used in popular medicines: the National Geographic goes on to list early uses for heroin (cough medicine), opium (asthma), and morphine (syrup for quieting infants--and I bet it worked like a charm.)

A researcher interested in studying the manufacture of pharmaceutical preparations through time would need to get his/her hands on some of the original compounds, since most contemporary advertising neglected to list all of the active ingredients in a given potion. That's where our Medical Museum Collection comes in. In addition to a large array of equipment, instruments, and apparatus, we have numerous drug kits, patent medicines, Japanese medicines from World War II, even something called "Standard Radium Solution for Drinking." Scholars can sample these early compounds to isolate active as well as inactive ingredients, clarifying the possible effects of the medications and charting pharmaceutical history.

If you'd like to get a sense of what we have here in the Medical Museum Collection, you can read item descriptions online--many of the materials in the MMC have already been included in the OHSU Digital Resources Library. A search on the phrase "Medical Museum Collection" will get you all the objects, while a search on the phrase "Pharmaceutical Preparations" will narrow your results to drugs in particular. Don't worry--we won't be slipping these into anyone's drink!

Tuesday, January 23, 2007

Doernbecher memorial trees

Today is a beautiful day here on Marquam Hill, the kind of day on which the "Mt. Hood factor" could easily shave thousands of dollars off the annual salary of an avid outdoorsman seeking employment at OHSU. Ah, what some will trade for clear skies, fresh powder, and day trips to the ocean shore!

Enjoying this sunny splendor, I again ran across as-yet unnoticed memorial plaques. One, planted below a tree in front of Mackenzie Hall, reads: "Donated to Doernbecher Memorial Hospital for Children in memory of our son Victor A. Llobregat." It bears no date or other identifying information, but the tree is certainly a lovely, living tribute.

Trees are lovely, and certainly in short supply now on this Hill. When there was more open space, there were more trees, and it's hard to imagine too many trees--especially if they came to campus free of charge. But history shows us that was not always the case...

A week or so back, when I was filing away lost remnants from unprocessed collections in our archival storage area, I came across a small file of correspondence related to some trees donated to the Doernbecher Hospital in 1932 by the Soroptimist Club. As it happened, the club women made the offer of trees to hospital nursing director Grace Phelps; Miss Phelps accepted the trees as a matter of course--good PR, new trees, volunteer labor to plant them.

Unfortunately, Miss Phelps failed to inform Dean Richard Dillehunt, who found out about the planting only after returning from a weekend out of town--returning to a plethora of trees on campus and unopened, unanswered mail from the women's group requesting his presence at the ceremonial planting on the Saturday previous. Dilly (as they called him) was understandably Not Pleased. Miss Phelps took full responsibility in a strong and impassioned reply. I can only assume that the matter was then put to rest and that the trees stayed (since the string of correspondence ends with Phelps' mea culpa). It would be nice to think that at least one remains somewhere, a partner to Victor Llobregat's tree....

Monday, January 22, 2007

Milestones in medicine: you make the call

For the start of the new year, the British Medical Journal decided to conduct a poll on the most important milestones in the history of medicine. Creating a short list of fifteen from which to choose, BMJ then opened the voting on its web site. Well, the results are in, and readers narrowly voted "sanitation" as the most important advance since 1840 (the year BMJ was established). It edged out antibiotics, which came in second, and anesthesia, which came in with the bronze. Medical imaging only received 4.2 percent of the vote, but if these voters had been at the history of medicine lecture on Friday, they might have thought twice before casting their ballots...

On Friday, Dr. C. Conrad Carter, professor of neurology here at OHSU, delivered a talk to the second-year medical students on the history of neuroradiology. Showing side-by-side comparisons of old-style x-rays versus modern MRIs, Carter illustrated the immense improvements in brain imaging that have developed just in the last sixty years. Back in the day, neurologists would remove cerebrospinal fluid from the brain (Carter assured the audience that, in fact, you could drain every last drop of CSF from the brain without killing the patient, who would nevertheless wind up with a really bad headache), and inject air into the subarachnoid spaces to provide contrast (cerebral ventriculography or pneumoencephalography). This was frequently done without any anesthesia--number three on the BMJ list--so there was no reprieve from that headache, either.

Back in the 1920s, a professor here at the University of Oregon Medical School wrote a paper on the use of methylene blue as a contrast medium; the idea was to inject it into one part of the spinal cord and then tap further down, to check for blockages. Various radioactive substances were later used with a fluoroscope, but these were often irritating to the meninges and would need to be "sucked back out" after the imaging was completed (and Carter's answer to a student's question on how this was done ended with, "Crude, I know." I'll spare you the details.)

Needless to say, these procedures are becoming lost arts. Good riddance, we may say, although we're also losing the art of physical examination apart from high-tech imaging. Carter cautioned the young medics: imaging technology is proceeding so fast that we're not even sure what we're looking at in those images, all those crannies and areas--what are the normal sizes for certain areas, for patients of a certain age? What is indicative of natural variation, and what of disease? The most important corollary to modern neuroimaging is extensive study of neuroanatomy. And did you know that many of our early anatomists here at UOMS were, in fact, neuroanatomists? But that's a topic for another day...