August usually signals the slowing down of the perennial flower garden.  Temperatures stay high and rains diminish.  Gardeners also seek a slower pace in August.  Just as I am dreaming of cool autumn fires, the asters, sedums, and mums hit their stride in the late summer garden.

The one plant I debate every year whether to keep or rip out – now suddenly takes center stage.  The black leaves on burgundy stems and rampant but benign, spreading habit of Eupatorium ‘Chocolate’ has filled my borders all summer, but in the role of a supporting player – easy to ignore.  But when the white fluffy flowers emerge against the black foliage in August’s sticky heat – I always think “Why don’t I prize this plant more – it’s gorgeous!?” 

So over coffee this morning I decided to read up on Eupatorium ‘Chocolate’, and I was shocked to discover its highly toxic properties and deadly history.  Perhaps I should have been forewarned by its common name – snakeroot!

In the wild, eupatorium (a member of the aster family) prefers the partial shade of the woodland and is native to the eastern and central parts of the United States and Canada.  As the settlers moved away from the eastern seaboard, they worked hard to carve grazing land from the woods for their horses, sheep, and cattle.  But in times when grazing was sparse the animals often wandered into the woods and ate eupatorium where they found it growing along with other forage.  It was noticed that animals that ate it somewhat continuously got what they called the “trembles”.  Often the young nursing animals of otherwise healthy appearing adults would die from the snakeroot poison passed through the mother’s milk.

Finally, this brings us to the medical connection between what was known historically as the “milk sickness” in humans and eupatorium.  People who drank milk or ate milk products from cattle or other animals that had been feeding on snakeroot came down with symptoms similar to the animal trembles.  Affected individuals had loss of appetite, listlessness, muscle stiffness, severe constipation, vomiting, abdominal discomfort, weakness, bad breath and finally could slip into a coma and die.  In addition to “milk sickness” the condition was also known by descriptive names as “the puking fever”, “sick stomach”, and the ‘slows”.  People did not know the connection between what their animals were grazing on and the sickness.

In the fall of 1816, Thomas Lincoln moved his family to the Little Pigeon Creek area of southern Indiana where there was a small but growing settlement.  Two years later, in the fall of 1818, people in the settlement began to die from milk sickness.  Thomas’s wife, Nancy Hanks Lincoln, came down with the trembles after nursing a sick neighbor and suffered for a week before finally succumbing to the same milk sickness.  She passed away at age 34, leaving behind a son named Abraham Lincoln, age 9.

As an adult, Abraham Lincoln recalled carving the pegs for his mother’s coffin.  Milk sickness killed thousands of people in the early 1800s, until the cause was fully understood and the means existed to keep grazing animals adequately and securely pastured.  It is said that the cause was not fully understood until the 20^th century!

A search of PubMed finds a current 2015 article on “Milk Sickness” [below], leading me to agree with Percy Bysshe Shelley that “History is a cyclic poem written by Time upon the memories of man.”

It is not unusual to see more traffic in the Library during this upcoming period as students from across the University are also preparing for exams.  Unlike the Law Library, the Health Sciences Library receives state funding, so most space in the Library is available to all when we are open.

However, the ground floor group study rooms and the study rooms on the second floor are available for reservation by Health System affiliates only – so please take advantage of that policy and reserve the rooms for your use.   It is best to reserve in advance,  but same-day reservations are available for the first floor study rooms. Please reserve rooms in person at our Service Desk or call 434-924-5444.

After-Hours Library Access

When the Library closes, only patrons with a valid Health System ID can use the after-hours space.  Anyone in this space without a Health System ID is in violation of Health System policy.  Please report any violations to Health System security at 982-3500 PIC# 1647.

If you have any concerns or questions while using the Library, please speak to Service Desk staff on duty. You may also contact me, especially if your concern doesn’t require immediate action. Karen (kknight@virginia.edu)

Harriet and Asa form a dynamic and very talented partnership, and I can guarantee that you will enjoy their film.

The topic and underlying  foundation of the piece is incredibly sad – “Why do doctors commit suicide?” prompted, in part, by the recent suicides of two medical residents in New York City. Pranay is now at Yale, so the proximity of circumstances with the residents being recent grads like himself and working so close by – must have really spoken to him.

I hope that reading the piece will help all of you know that if you have a feeling – good or bad – trust me, others are having the same feelings.  You need to share them.

Pranay writes:

“A medical culture that encourages us to share these vulnerabilities could help us realize that we are not alone and find comfort and increased connection with our peers. it could also make it easier for residents who are at risk to ask for help. And I believe it would make us all better doctors.”

The Agency for Healthcare Research and Quality (AHRQ) has now created a wonderful app that delivers these USPSTF’s recommendations to your phone or ipad.  It has a name that is hard to remember – ePSS!!  This application provides a short form [see image below] to enter variables such as age, sex and more.  Based upon your entries, you receive a list of “graded” recommendations: A & B (recommended),C (uncertain), D (not recommended) or I (uncertain).

For more information about ePSS, please visit their site: http://epss.ahrq.gov/PDA/index.jsp

Medical Students, please consider joining my closed Facebook group  – updates will appear more in “real time” :  https://www.facebook.com/groups/fromkarensdesk/

 Valves:  As mentioned, the names of the pulmonary and aortic valves make sense given the destination of the blood flowing through them, but what about the other two?  The Tri-cuspid valve is also fairly intuitive once we recognize that “cuspid” come from the Latin cuspis, meaning “point.”  (Think of being on the cusp of a new idea.)  “Tri,” of course, refers to three, with the name thus describing the three leaflets of the valve.

Mitral valve is a bit more obscure.
While discovered around 300 BC, the valve did not obtain its modern name until the 16^th century.  The simultaneous rise of anatomical study and the prominence of the Catholic Church in that era jointly contributed to a new name:  being bicuspid, the mitral valve looks like a miter, or the ceremonial headgear of a Catholic bishop (see figure below).

Blood Supply:  The main blood supply for the heart are the Coronary arteries, so named because they surround the heart like a crown (see figure below).  The word coronation and the Mexican beer Corona derive from same Latin root, corona, meaning wreath or crown (hence the gold crown on all the beer labels). 

The Thebesian veins, which are minute, valve-less veins in the walls of all four heart chambers that drain the myocardium, are named for their discover, Adam Thebesius, who first noted their existence in 1708 – while still a medical student!!

Capillaries and the noodle capellini (aka “angel hair”) have the same root – capill, meaning hair or hair-like.  (see figure below)  

 Other:

Vagus ( as in the vagus nerve) literally means wandering, thus describing its course.  The English word “vagrant” has the same origin.

Digitalis comes the Latin word digitus, meaning finger (like digits), and comes from the plant Digitalis purpurea with finger-like corollas.  (see figure below)

With the exception of eponymous terms (i.e. named for someone, as in the example of Thebesian veins above), most medical words were invented to make sense by describing the anatomy or function of the structure.  As Greek and Latin have become less familiar to most physicians, such nuances are lost and the terminology can become needlessly abstruse.  But with a little investigating, it all (or mostly) really does make sense!

Justin Barr is currently a 4th year medical student who recently defended his PhD in the History of Medicine at Yale.

]]> http://blog.hsl.virginia.edu/karen/?feed=rss2&p=1255 0 http://blog.hsl.virginia.edu/karen/?p=1235 http://blog.hsl.virginia.edu/karen/?p=1235#comments Tue, 15 Jul 2014 13:54:24 +0000 http://blog.hsl.virginia.edu/karen/?p=1235

You are a young doctor in the late 1800s setting up your first practice in a small Iowa farm town.  You are trying to outfit your office with state-of-the-art equipment that will reflect your exclusive east coast training and instill confidence in your new neighbors.  But in an age when there is no Internet marketing, very few newspapers and glossy catalogs, and travel to the big capital city of Des Moines is out of the question – how do you even know what is available to purchase?

Word of the new “doc” soon spreads far and wide, as such exciting news of new teachers or other learned individuals tended to do in rural communities, and soon a traveling salesman lands on your doorstep.  He has brought with him miniature “samples” of his goods to tempt you with.  The one that catches your eye is a small wooden examining table (the first thing you really need to buy!) with leather cushions – the height of style and comfort!  You immediately place an order for one and after months of waiting it arrives and your practice takes off!

That is the story I imagine behind this tiny salesman’s sample (above; just inches long) that resides in our Historical Collections. It has always been one of my favorite items because it delights me to think of this being the “wow” fashion of its day.  What sets this apart as a salesman’s sample and not a toy or miniature is the fact that it is functional.  As a sample it had to show exactly what it could do, as in this case, the head and foot boards raise and lower.

Salesman samples were miniature replicas of the full-size items for sale, but that could easily be transported from town to town and are today an antique collecting specialty.  There is even a Pinterest Board dedicated to “Antique Salesmen’s Samples and Miniatures”.

Take a look at this sample bathtub, bed, and buggy (below). The really fancy examining table is one that our rural doc could never have afforded.  It was valued in 2011 for over $15,000!

Please consider joining my closed Facebook group  – updates will appear more in “real time” :  https://www.facebook.com/groups/fromkarensdesk/

Psychiatryonline is a wonderful resource for those doing their Psychiatric Clerkship or any work that is specific to the field.  This collection of e-books, journal articles, and news is published by the American Psychiatric Publishing (APA) group – the same group that publishes the famous Diagnostic and Statistical Manual of Mental Disorders (DSM).

The latest edition of the Manual is DSM-5 and Psychiatryonline not only contains the main text but also related books, such as:

• DSM-5 Clinical Cases
• DSM-5 Handbook of Differential Diagnosis

There is a “Book of the Month” that can be downloaded as a PDF and many other books such as:

• Gabbard’s Treatments of Psychiatric Disorders
• Dulcan’s Textbook of Child and Adolescent Psychiatry
• Manual of Clinical Psychopharmacology

In addition to the books, you can easily browse the current and past issues of APA journals such as The American Journal of Psychiatry.

The Library offers unlimited simultaneous use of Psychiatryonline.  You can easily get to it from the Medical Student Portal by clicking on “E-Books: Search E-Books by Collection” or search for individual book titles from the “E-Books A-Z Title list”.

You might just find yourself exhibiting compulsive behavior by returning to it time and again!

A woman taking a new prescription of Lisinopril for routine hypertension reports back to her doctor in a month with severe lower abdominal pain.  A workup for gynecological and gastrointestinal disorders comes back negative.  The doctor is asked whether the abdominal pain could be caused by the Lisinopril and the answer is “Well, I prescribe this all the time, and I have never heard of that.”  The patient happens to be a medical librarian and she checks the Micromedex drug database and abdominal pain is not listed under common or serious side effects.  A MEDLINE literature search, however, does discover several compelling “case reports” of similar problems from the drug.

This is the value of “case reports” – to build the evidence on a topic – one case at a time. Once we know that there may be a trend through multiple reports, then perhaps larger studies and trials can be conducted.  But it is the initial case report that waves the flag and says – “Hey, notice me, something is going on!”

Ten years ago, several residents came to me asking if the Library could pay for a license to a new journal from the British Medical Publishing Group called BMJ Case Reports, so that they could publish in it.  It seems that there had been a serious decline in scholarly medical journals accepting case reports in favor of large multi-center trials and reviews – often what publishers call more “Scholarly Communication.”  Case Reports have been the mainstay for residents and junior clinicians to enter the world of medical publishing for the first time.  They are relatively short and easy to write and for a long time almost every journal published them. So imagine my chagrin to discover that there was a trend away from them.

BMJ was one of the first that I knew about to take a new approach – not adding them back into their main journal but starting a new journal dedicated to case reports.  But their publishing model was different – you or your Department had to pay THEM to get published!  This trend has caught on and now there is a flourishing marketplace of medical journals that publish only case reports: BMJ Case Reports, Journal of Medical Case Reports, Case Reports in Surgery – just to name a few.

We could long discuss the merits of who should pay for content – the reader or the author?  But the important thing is to welcome back the lowly case report with open arms for they clearly enable the creation of new medical knowledge.

The observations and thoughts in this piece are my own – in a sense – a case report based upon my limited experience and observations.  I have not conducted a formal study on the demise and revival of the case report – but perhaps someday maybe someone will!

Now, back to our patient – she stopped taking the drug with more confidence because of the existence of reports showing a few other similar cases – and luckily all her pain went away. The main article – “ACE-inhibitor-induced intestinal angioedema: rare adverse effect of a common drug” was published in our old friend – BMJ Case Reports!

A new week and the library re-carpeting gets back underway! Here is the plan so you have an idea for how the week will unfold, as it involves the top floor:

Today the lobby and old reference computer area (center space as you come in) will be carpeted, one side at a time.

Tomorrow the 6 study rooms and the beginning of the large 24-hour room will be started.

The Hamlin Room (oval room with windows), Pinkney Room (where the EPIC computers are), Detmer Room (small room with built-in bookcases facing the Link) and old Davis book room (where the staircase goes down to Cabell) will still be accessible for your use during this process. These rooms will be done later in the week.