Waving the fag

During World War I, the commander of US forces, General John J “Black Jack” Pershing, was asked what he needed to win the war. 

His reply: “You ask me what we need to win this war. I answer tobacco as much as bullets. Tobacco is as indispensable as the daily ration; we must have thousands of tons without delay.” 

For decades to come, the First World War proved instrumental in entrenching the popularity of cigarettes.  

British medical journal, ‘The Lancet’, expressed indifference at the time: “We may surely brush aside much prejudice against the use of tobacco when we consider what a source of comfort it is to the sailor and soldier engaged in a nerve-wracking campaign … tobacco must be a real solace and joy when he can find time for this well-earned indulgence”.

In 1917, the colourful inventor of corn flakes, John Harvey Kellogg, predicted that more American soldiers would be damaged by the cigarette than by German bullets. 

Almost 100 years later, on March 14, 2014, Jonathan Woodson, US assistant secretary of defence for health affairs, issued the following memorandum:

“Prominence of tobacco products in [military] retail outlets, and permission for smoking breaks while on duty, sustain the perception that we are not serious about reducing the use of tobacco”.

Hot Docs

The annual Nathan’s Hot Dog Eating Contest started as a publicity stunt promoting Nathan’s Famous Hot Dogs. But it wasn’t the first successful marketing gimmick hatched by the company.

When co-founder Nathan Handwerker launched into the hot dog business with his wife in 1916, he set his price for a hot dog at five cents. Competitors were selling theirs at ten cents, creating the impression that Nathan’s food was low quality.

To change public perception, Nathan hired ordinary people—dressed them up in white coats and stethoscopes—and instructed them to eat hot dogs while stationed in front of his stand.

Hungry passers-by would see these ‘doctors’ munching on Nathan’s five-cent hot dogs and figured the cheap hot dogs must be healthy. Business boomed shortly afterwards.

Michelangelo’s Moses

Attention to detail: In the forearms there is one very small muscle that contracts only when lifting the pinky, otherwise it is invisible. Michelangelo’s Moses is lifting the pinky, therefore that tiny muscle is visible in the sculpture. Michelangelo’s Moses is contracting his Extensor Digiti Minimi displaying the artists extraordinary anatomical correctness.

Screamweaver

The film “A Nightmare on Elm Street” was inspired by newspaper reports (in the late 1970s and early 1980s) of Southeast Asian refugees dying in their sleep. The deaths were sudden and lacked a medical explanation. They mostly involved young men (Hmong refugees) who fled to the United States to escape persecution following the Vietnam War.

Even today, Sudden Unexplained Nocturnal Death Syndrome (SUNDS) remains a mystery. The typical finding is that these nocturnal deaths happen in young, healthy men, mostly from Southeast Asia. One fascinating hypothesis relevant to the movie “A Nightmare on Elm Street” is the possibility that victims experienced night terrors. This theory posits that night terrors flood the body with stress hormones, which overwhelm a pre-existing heart abnormality, leading to sudden death.

Automatons and Autistics

In the 1985 film "Rocky IV", protagonist Rocky Balboa buys his brother-in-law (Paulie) a robot for his birthday. But the robot's movie role as a seductively-voiced beer-fetcher is a far stretch from its original application. The robot was originally developed as a treatment for autistic children! When the founder of International Robotics, Robert Doornick, appeared on American talk-show to discuss the possibility of using a robot to help autistic children improve their communication skills, Doornick's creation caught the interest of actor and screenwriter, Sylvester Stallone. Stallone, who has an autistic son, was so impressed by the robot that he wrote it into his movie's script.

Tell me morse …

When naval aviator Jeremiah Denton was captured and became a prisoner of war in Vietnam, his captors filmed him as part of a staged propaganda video. During filming, Denton pretended that the lights bothered his eyes, but what he was really doing was surreptitiously blinking out the word “torture” in Morse code. 

Some patients who are otherwise entirely paralyzed can still move their eyes and eyelids. In one classic case, a Navy veteran with locked-in syndrome due to stroke communicated in Morse code using eyelid blinks. In another example, a motor vehicle crash left an editor of the Paris fashion magazine Elle, Jean-Dominique Bauby, in the locked-in syndrome. By blinking to an assistant, he dictated a short autobiography that was made into the film with the same title, The Diving Bell and the Butterfly

Source: Kaufman’s Clinical Neurology for Psychiatrists, Eighth Edition

Winnie the Who?

An article published in the Canadian Medical Association Journal took a stab at analyzing the mental illnesses of various characters described in “Winnie-the-Pooh” stories. After all, Winnie is short for Winnipeg, the home town of Canadian soldier Harry Colebourn (*Winnipeg is Cree for muddy water*). Colebourn had bought a black bear cub that would become a mascot of his Canadian Army Reserve unit. During Colebourn’s deployment in WWI, Winnie was left in the care of the London Zoo (to which she was later donated). Christopher Robin Milne, son of author A.A. Milne, visited Winnie at the London Zoo and named his teddy after her. The entertaining medical paper can be read through this link: https://www.ncbi.nlm.nih.gov/…/pdf/20001212s00009p1557.pdf

The voice actor responsible for the voice of ‘Tigger’ in Disney’s Winnie-the-Pooh films, Paul Winchell, was also the first person to build and patent a mechanical artificial heart. Winchell wanted to become a doctor but, living through the Depression, his family could not afford the tuition. Nevertheless, Winchell’s interest in medicine never dwindled. With the assistance of Dr. Henry Heimlich (the inventor of the Heimlich Maneuver), Winchell designed an artificial heart; became an acupuncturist; and even worked as a medical hypnotist. He died one day before the death of another Pooh character voice actor, John Fiedler, who voiced ‘Piglet’.

My soul caught a cold

Cultural norms define mental health and mental illness in society. During times of psychological distress, people exhibit specific behavioural patterns (“idioms of distress”). Cultures, however, are not static entities; they evolve. And symptomatic or help-seeking behaviours change with public attitudes. 

When SSRI antidepressants first became available in Japan in 1999, pharmaceutical marketers faced a daunting challenge. The clinical word for depression, (‘utsubyou’), carries a severe and negative connotation in Japan. For a new antidepressant drug to gain public acceptance in Japan, the pharmaceutical industry needed to destigmatize clinical depression. To do so, they ran awareness campaigns focused on mild depression, coining the catchphrase ‘kokoro no kaze’ which translates to “a cold of the soul”. 

Judging by an increase in antidepressant sales since the campaigns, patients may have felt more justified in seeking pharmacological treatment once depression suddenly became the common cold of mood disorders. But did the patients realize that–unlike cold and flu remedies–mental health medication is not a short-term treatment?

Source: Ihara H. A cold of the soul: A Japanese case of disease mongering in psychiatry. International Journal of Risk & Safety in Medicine. 2012;24(2):115-120. doi:10.3233/jrs-2012-0560.

Science used to read palms to predict Down syndrome

Can a palm reader diagnose Down syndrome and can a fingerprints confirm your parentage? Science used to read palms to diagnose disease. Harold Cummins was the founder of dermatoglyphics: the discipline of analysing patterns found in skin prints on the fingers, palms and soles. During the 1930s, research was focused on variation in fingerprint patterns. The arches, loops, and whorls were categorised into normal profiles, distinct for different racial populations. Cummins documented certain tendencies in the handprint patterns of people with ‘mongolism’. [Since the 1860s, ‘mongolism’ was the name used to describe Down syndrome when a doctor called John Langdon Down tried to classify different types of conditions by ethnic characteristics. In 1961, genetic experts sent a joint letter to the medical journal The Lancet urging the medical community to abandon its use of the term ‘mongolism’. The Mongolian People’s Republic also requested the term fall into disuse and in 1965, the World Health Organization (WHO) agreed

Using paediatric handprints, Cummins could diagnose Down syndrome with greater accuracy than experienced physicians who relied on physical appearance. Interest in dermatoglyphics soared and during the 1950s and 1960s, studies tried to identify the heritability of fingerprint patterns and attempted to develop fingerprint-based paternity tests. In the early 1960s when chromosomal studies were being developed, dermatoglyphics was used to support genetic research. Studies were underway to use dermatoglyphics to predict right versus left-handedness, schizophrenia, eye disease, and hereditary heart conditions. Ironically, the rise of human genetics as a field of study spelt the end for dermatoglyphics. 

Nevertheless, modern doctors still look for the signs of Down syndrome by looking at hands and feet. Apart from abnormal patterns on the fingertips, characteristic features include short hands and fingers, a single palmar transverse crease (simian crease), fifth finger clinodactyly, and a sandal gap deformity (a wide space between the first and second toes).

There is another inclusion to Cummins’ legacy: The longest English word with no repeated letters is subdermatoglyphic.