WhiteCoat

Archive for the ‘Medical History’ Category

What Will They Find?

Thursday, August 12th, 2010

Catching up on the news and saw an article about a construction crew in Flint, Michigan that was expanding the hospital emergency department when they came upon two time capsules buried deep within Hurley Hospital.

At least one of the time capsules is more than 100 years old.

I had a bunch of humorous ideas for what I thought they’d find inside.

What do you think will be in there?

A Classic Dr So-and-So Patient

Saturday, September 26th, 2009

ERP from ERstories.net  here again today and tomorrow… You know, WC needs a weekend off now and then…..

Why is it that certain doctors (usually primary care) attract a certain subset of patients? Our community is very heterogenous but I still find that several MD’s have tapped into certain subpopulations whether intentionally or unintentionally. Often, I find myself guessing (usually correctly) about who a patient’s doctor is before asking them. Clues like the med list, the last name, the insurance (or lack of it) they have, and PMH all give clues. I chuckle to myself when I ask them who the MD is and find I am correct. For example:

One doc seems to have about 90% of all the living Holocaust survivors in the US as his patients. (and he was not one himself) – usually on BP meds and Coumadin for Afib.

Another guy seems to have only patients with chronic pain, nebulous psychiatric diagnoses, and poorly controlled hypertension and diabetes. They often have Medicaid (which is honourable of him). However, even those with private insurance tend to be extremely challenging to deal with. Most are on Oxycontin, Wellbutrin, benzos, and Metformin.

One group sees only super rich entitled people who never have serious emergencies. However they often seem to have diagnoses of fibromyalgia and IBS way above the national prevalence. Hmmmm. Usually on Cymbalta, Xanax and something for chronic diarrhea.

One guy sees 90% patients from South America with no insurance – but they all have money and pay him cash. Often on random drugs they purchased on their last trip to Columbia.

One woman has a large non-English speaking, Russian population. They always seem to have some major issue going on. Often on no meds despite the acute MI they are having.

Another guy who is Asian seems to have all the really sick Koreans and Chinese in the area. Usually they are on dialysis and have a med list a mile long.

Another Asian doctor seems to only have the healthy ones. They tend to be on ziltch.

Of course none of this really matters since they ALL eventually become my patients! But thankfully they don’t REMAIN my patients until their next visit when I am on!

Surgery Circa 1930

Saturday, September 19th, 2009

A subscription to Wired Magazine is about the best ten bucks I spend every year.

A recent post on their blog shows some wild videos from 1930s British archives demonstrating brain surgery, removal of a large ovarian tumor, sterile technique, and how to deliver a baby by Caesarean section. Probably not something to watch if you have a weak stomach.

The baby coming out of the C-section is looking a little floppy to me, by the way. Also strange to think that the baby being delivered – if alive – is almost 80 years old now.

Whiskey Prescriptions and the Prohibition Act

Thursday, February 28th, 2008

Scalpel made a suggestion to post pictures of some of my medical memorabilia, so I figured “what the heck.” I have a couple of other rants ready to post, but figured I’d give everyone a break from my craziness for a day or so.
One of the historical displays I have in my office is about the Prohibition Act. I purchased some old alcohol prescriptions off of eBay a while ago. I also purchased some a lot of old medication labels. Then I did some research on the internet about Prohibition. I printed out the information below and put it all in a frame that is now hanging on my wall. Some facts, including those about the pharmacist and drug store, came from the person who sold the prescriptions to me, so I can’t vouch for the accuracy of those facts.
I made this display long enough ago that I don’t have the sources for what I wrote, so don’t blast me if what I have down there isn’t precisely accurate. If you have some other interesting facts about prescribing alcohol during the Prohibition, feel free to add them in the comments.
I left the prescription and medication label at high resolution, so they may take a minute to display. If you click the images, you can download copies that should print out pretty well. I removed the last name of the patient on Photoshop.
Enjoy.

——————————————————————————–

1929-whiskey-rx.jpg

By the 1830s, the Temperance Movement had turned increasing public attention toward abstinence from alcohol. Temperance societies nominated their own candidates – “DRIES” — to serve in public office. There were over 1.5 million DRIES in 1830 and they were known to write the letter T next to their names on membership rolls, hence the term “Teetotalers.”
According to “Alcohol, Hygiene and Legislation,” written in 1915 by Dr. Edward Huntington Williams, “we should expect to find that all human beings have an instinctive craving for such substances as alcohol, tea, coffee, tobacco, or narcotic drugs.” Dr. Williams considered drinking to be inevitable for certain mentally impaired persons:

The vast majority of persons do not crave excessive quantities . . . in case of the dipsomaniac, we have, theoretically, a person whose brain structures are weakened in a certain part, just as in any other form of mental unsoundness. Indeed, this is the generally accepted view of modern clinicians — that the inebriate is a person whose brain is structurally different from that of the normal man.

What originally began as a Temperance Movement became a Prohibition Movement when the Anti-Saloon League declared war on any alcohol consumption. On January 16, 1919, less than a year after the end of World War I, the Prohibition Act became the 18th Amendment to the US Constitution.
The National Prohibition Act, also known as the Volstead Act after the Minnesota congressman who sponsored it, passed on October 28, 1928 despite Woodrow Wilson’s veto. After 36 states ratified this Amendment, the new law officially took effect. Penalties were strict for breaking this new law. Selling alcohol without a permit could bring up to five years imprisonment and fines as high as $10,000!
Fortunately, for many there was a loophole. The law prohibited sale of alcohol, but did not criminalize the possession of alcohol. Further, sacramental wines and alcohol prescribed by a physician for medicinal purposes was also excluded.
In order to avert the law, proprietors manufactured medicinal agents containing high amounts of alcohol in order to comply with the law. These included:spirt-of-nitre.jpg
Bitters
which contained up to 100% alcohol with a sprinkle of herbs, and
Nostrums in which other medical agents – sometimes narcotics – were added to highly concentrated alcohol in order to intensify intoxication from the liquor.
The creation of new “medicinal” agents was so common that from 1914 to 1930, there were 287 preparations registered with the United States Internal Revenue Department that contained from 30 to 90 per cent alcohol. These “medications” were created to cure ills such as rheumatism, nervousness, kidney ailments, dyspepsia and “biliousness.”
For those wine or whiskey connoisseurs, there was always the option of seeking out a physician for a legal prescription.
The prohibition prescription was found hidden in the basement of Krause’s Drug Store, in Covington, Kentucky. Krause’s Drug Store opened for business in 1899. When alcohol became illegal in 1919, prescriptions for “medicinal liquor” became more popular. Krause’s Drug Store was known locally as “The Bootleg Drug Store” because the owner had a “No Questions Asked” policy when it came to filling these prescriptions. He also kept a still in the basement of his pharmacy. Many pharmacists refused to fill liquor prescriptions, instead referring the patients to Mr. Krause. Krause’s store was open on Thanksgiving, Christmas, New Year’s Eve and New Year’s Day — he was never too busy to fill a prescription for “medicinal liquor”!
The Prohibition cat-and-mouse game came to an end in 1933. By that time Franklin Roosevelt had launched the “New Deal” to invigorate the US economy. On December 5, 1933, the 21st Amendment to the US Constitution repealed the Prohibition Act.

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