Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Marcia Crocker Noyes
(1869 – 1946)

Further to my comment on old books and research that started with an interesting bookplate (Ex-Libris). I continued my research and found that the person in charge of the Osler library bookplate was a fascinating individual that today maybe a ghost in the MedChi library and building in Baltimore... This is certainly an article that can be called "A Moment in History"

Marcia Crocker Noyes was the librarian at The Maryland State Medical Society from 1896 to 1946 and was a founding member of the Medical Library Association.[1][2][3]

Sir William Osler, MD. a famous Johns Hopkins surgeon was a noted bibliophile and had a large personal collection of books on various topics. When he became the President of MedChi in 1896, he was dismayed at the condition of the library and knew that with the right person and some stewardship, it could become a significant collection. Sir William asked his friend, Dr. Bernard Steiner, a physician and President of the Enoch Pratt Free Library in Baltimore for suggestions of a librarian, and Dr. Steiner recommended Marcia Crocker Noyes. A native of New York, and a graduate of Hunter College, Marcia had moved to Baltimore for a lengthy visit with her sister, and took a “temporary” position at the Pratt Library, which turned into three years. Although she had no medical experience or background, she was enthusiastic, and most importantly, she was willing to move into the apartment provided for the librarian, who needed to be available 24 hours a day.

The image in this article is Ms. Noyes on her first year on the job. Marcia developed a book classification system for medical books, based on the Index Medicus, and called it the Classification for Medical Literature. The system uses the alphabet with capital letters for the major divisions of medicine and lower-case ones for the sub-sections. The system was used for many years, but it's now dated and the Faculty's original shelving scheme was never changed. The card catalogs still reflect her classification and many of the cards are written in Marcia's back-slanting handwriting.

Marcia knew enough to ask the Faculty's members about medical questions, terminology and literature. She gradually won over the predominantly male membership and they became her greatest allies; Sir William at the start, and then for nearly 40 years, Dr. John Ruhräh, a wealthy pediatrician with no immediate family of his own. She made a point of attending almost every Faculty function, and in 1904, under guidelines from the American Medical Association, Marcia was made the Faculty Secretary. For much of her first 10 years, she was the Faculty's only full-time employee, only being assisted by Mr. Caution, the Faculty's janitor. Later in life Marcia would say that she hired him because of his name!

Within ten years, the library had outgrown its space, and plans, spearheaded by Marcia and Sir William before his move to Oxford, were made to build a headquarters building, mainly to house the library's growing collection of medical books and journals.

Marcia was instrumental in the design and building of the new headquarters. She travelled to Philadelphia, New York and Boston to look at their medical society buildings, and eventually, the Philadelphia architectural firm, Ellicott & Emmart was selected to design and build the new Faculty building. Every detail of the building held her imprimatur, from the graceful staircase, to the light-filled reading room, and all of the myriad details of the millwork, marble tesserae, and most of all, the four-story cast iron stacks. She was on-site, climbing up unfinished staircases, checking out the progress of the building, which was built in less than one year at a cost of $90,000.

Among the features of the new building was a fourth-floor apartment for her. She referred to it as the "first penthouse in Baltimore" and it had a garden and rooftop terrace. The library collection eventually grew to more than 65,000 volumes from medical and specialty societies around the world. Journals were traded back and forth, and physicians eagerly anticipated the arrival of each new issue. At the same time, Marcia was involved in the Medical Library Association as one of eight founding members. The MLA promotes medical libraries and the exchange of information. One of the earliest mandates of the MLA was the Exchange, a distribution and trade service for those who had duplicates or little-used books in their collections. Initially, the Exchange was run out of the Philadelphia medical society, but in 1900 it was moved to Baltimore and Marcia oversaw it. Several hundred periodicals and journals were received and sent each month, a huge amount of work for a tiny staff. In 1904, the Faculty had run out of room to manage the Exchange, so it was moved to the Medical Society of the Kings County (Brooklyn). But without Marcia's excellent administrative skills, it floundered and in 1908, the MLA asked Marcia to take charge once again.

In 1909, when the new Faculty building opened, there was enough room to run the Exchange and with the help of MLA Treasurer, noted bibliophile and close friend, Dr. John Ruhräh, it once again became successful. Additionally, Marcia and Dr. Ruhräh combined forces to revive the MLA's bulletin, which had all but ceased publication in 1908, taking the Exchange with it. This duo maintained editorial control from 1911 until 1926. In 1934, around the time of Dr. Ruhräh's death, Marcia became the first “unmedicated” professional to head the MLA. During her tenure, the MLA incorporated, the first seal was adopted, and the annual meeting was held in Baltimore. Marcia wanted to write the history of the MLA once she retired from full-time work at the Faculty, but her health was beginning to fail. She had back problems and had suffered a serious burn on her shoulder as a young woman, possibly from her time running a summer camp, Camp Seyon, for young ladies in the Adirondack Mountains. In 1946, a celebration was planned to honor Marcia's 50 years at the Faculty. But she was adamant that the physicians wait until November, the actual date of her 50 years. However, they knew she was gravely ill, and might not make it until then, so a huge party was held in April. More than 250 physicians attended the celebration, but the ones she was closest to in the early years, were long gone. She was presented with a suitcase, a sum of money to use for travelling, and her favorite painting of Dr. John Philip Smith, a founder of the Medical College in Winchester, Virginia. It was painted by Edward Caledon Smith, a Virginia painter who had been a student of the painter Thomas Sully.[4] She adored this painting and vowed, jokingly, to take it with her wherever she went.

The painting was not to stay with her for very long, for she died in November 1946, and left it to the Faculty in her will. Her funeral was held in the Faculty's Osler Hall, named for her dear friend. More than 60 physicians served as her pallbearers, and she was buried at Baltimore's Green Mount Cemetery. In 1948, the MLA decided to establish an award in the name of Marcia Crocker Noyes. It was for outstanding achievement in medical library field and was to be awarded every two years, or when a truly worthy candidate was submitted. In 2014, the Faculty began giving a bouquet of flowers to the winner of the award in Marcia's name, and in honor of her work. Much evidence exists for this tradition, as we know that the physicians, especially Drs. Osler and Ruhräh, frequently gave her bouquets of flowers. Marcia also cultivated flower gardens at the Faculty and decorated the rooms with her work.

Today, the MedChi building is open for tours and if the rumors are to be believed Ms. Marcia Crocker Noyes is still at work in her beloved library as the "resident ghost" [1][5]

Marcia Noyes handwriting

NOTE: This article has been modified from the original Wikipedia article on Marcia Crocker Noyes. The article itself is well-written with interesting images of the subject. I would encourage you to visit it. The second insert is from book 00736 in my personal library and shows in pencil, the incredibly small handwriting of Marsha C. Noyes.

Sources:
1. "Marcia, Marcia, Marcia" MedChi Archives blog.
2. "Marcia C. Noyes, Medical Librarian" (PDF). Bulletin of the Medical Library Association. 35 (1): 108–109. 1947. PMC 194645
3. Smith, Bernie Todd (1974). "Marcia Crocker Noyes, Medical Librarian: The Shaping of a Career" (PDF). Bulletin of the Medical Library Association. 62 (3): 314–324. PMC 198800Freely accessible. PMID 4619344.
4. Edward Caledon BRUCE (1825-1901)"
5. Behind the scenes tour MedChiBuilding


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Did Andreas Vesalius really die from scurvy on the island of Zakynthos in 1564?
Evidence does not support this theory.

NOTE:  The following article authored by Theo Dirix, and Dr. Rudi Coninx, is a rebuttal of Pavlos Plessas' theory that Andreas Vesalius indeed died from scurvy. The original article entitled "Powerful indications that Vesalius died from scurvy" by Pavlos Plessas was presented in a meeting at the island of Zakynthos in 2014.


Theo Dirix and Dr. Rudi Coninx, authors of this article
Dr. Rudi Coninx, and Theo Dirix


For the first segment of this article, click here.

...continued...

We believe the arguments in favour of scurvy unfortunately are not sufficient to draw a conclusion. And for each of the argument in favour of the scurvy theory, there are strong counterarguments too.

We will examine the main arguments here

1. Travelers to the Holy Land did have not enough food to eat that contained vitamin C.

There is no evidence that Vesalius, a man of means with introduction letters from the King of Spain, was deprived of food during his travels in the Holy Land. He could certainly buy food, and probably stayed at monasteries, sharing the same food that protected the residing monks from developing scurvy. And while scurvy was not uncommon, residents did not die in large numbers because of lack of vitamin C. Dying from scurvy was, even then, was limited to a small segment of the population.

Minimal daily intake of vitamin C for an adult is 90 mg per day [aa]. Most of that intake comes from fruits and vegetables (oranges, grapefruits …) but liver and kidney are also sources of vitamin C. These are all foods that Vesalius would have consumed in Jerusalem.

2. The long sea voyage led to scurvy.

The sea voyage is too short (40 days) to develop scurvy. It takes about three months (120 days) for scurvy to develop [8]. In one study it took healthy volunteers four months to develop signs of scurvy when fed a vitamin C deprived diet [9] although some showed signs at day 29. The first sign to appear was petechial haemorrhage. In 1939, Johan Crandon, a surgical resident at Boston City Hospital, experimented on himself by eating a diet totally devoid of vitamin C [x]. Fatigue developed after 3 to 4 months, and the pathognomonic hyperkeratotic papules appeared on day 134 and the perifollicular haemorrhages on the legs on day 162. Symptoms appear after 3 to 4 months only, and there is no evidence of this in any description of Vesalius symptoms.

It has also been argued that the trip through the Sinai desert must have contributed to the presumed low intake of vitamin C. 
Vesalius’s entire stay in the Holy Land, including the Sinai desert trip –presumably lasting a month and a half- did not last for more than 4 months: he arrived in Jerusalem in May 1564 and boarded ship in Alexandria in September 1564. We believe this is not long enough to deplete all vitamin C and cause symptoms, even adding a 40 day sea voyage. And it is unlikely that his stay in Jerusalem was entirely free of vitamin C, as he was a respected guest of high authorities. We know that there was “no hint of shortages before their departure from Egypt” [Plessas]

Most studies indicate the earliest detectable change occurs after 120 to 180 days [xx] although there are studies where early signs appear earlier [xxx]. But in this study, which was stopped after 3 months, no serious effects occurred.

3. “Clinical description is typical for scurvy”.

This is simply not true. The clinical description we have, from second hand accounts, are vague and non-specific. The clinical signs and symptoms of scurvy are well known and clearly described today [10]. The typical clinical signs for scurvy are absent from all accounts: gingival bleeding, an early and typical sign, or the “rotten mound” is never mentioned. Subcutaneous bleeding [11] – ecchymoses - or joint pains, leading to difficulties walking, are never mentioned. Gum bleeding are typical signs, and so are swollen and painful legs, also leading to difficulties in walking [12]. They are all absent from the accounts. Non-specific signs such as laziness are also typical, with muscle pain in the legs as an initial sign, but they always evolve into bleeding, gum problems, putrid smell and other signs that Vesalius would have described. As a doctor, Vesalius would have been well placed to recognize these signs and to describe them. None of them appear in any account.

Authors claiming typical signs were present make a lot of the so-called melancholy and refer to the writings of the 16th century expert Johannus Echthius who wrote a treatise about scurvy in Latin, as was customary in these days, in 1541, although it was only published after his death in 1556 [13] Despite being considered an expert on scurvy, Echtihius –and all “experts” of his day could recognize the disease – they knew little about the causes of scurvy, its link with vitamin C and the treatment. In fact Echthius and his 16th century colleagues were dead wrong about the causes of scurvy. Echthius obtained his knowledge entirely from studying Greek and Roman classics, Celsus, Galen and others, and came to the conclusion that scurvy was caused by a blocked spleen, leading to an excess of black bile. The treatment therefore consisted in hot and wet medicines like oil and vitriol. The only useful cure, citrus juice, was considered a “cold” medicine, therefore of no use [14]. Doctors at the time recommended avoiding fruits and vegetables in case of scurvy! Knowledge about the causes of scurvy would have to wait till the work of James Lind, an officer of the British Royal Navy who published his now famous treatise on scurvy in 1753 [15]

But Echthius did know how to recognize the symptoms of scurvy: stomachache, a complaint of the mouth, and sceletyrbe, a complaint of the legs. Vesalius showed none of these symptoms. 

In another argument in favour of the scurvy theory, it is claimed that extreme fear and irrational behaviour … are well known early symptoms [Plessas ]. This is not the case. Lind was correct when he observed that “a listlessness to action … a lazy inactive disposition” that degenerates in “a universal lassitude” [Hisrchman] are typical signs. This is also the observation of one of the authors (RC) having observed scurvy patients in Ethiopian prisons.


Article continued here: Did Andreas Vesalius really die from scurvy? (3)


Sources:

1. https://circulatingnow.nlm.nih.gov/2014/10/15/the-death-of-andreas-vesalius/ accessed 27.12.2016
2. Matheson Cullen, G. Vesalius and the inquisition myth. Lancet, January 14, 1928, p 105-6.
3. Dirix Th. In search of Andreas Vesalius. The quest for the lost grave. Lannoo, 2014.
4. https://en.wikipedia.org/wiki/Andreas_Vesalius accessed on January 21, 2016
5. Biesbrouck M, Goddeeris Th, Steeno O. The last months of Andreas Vesalius. A coda. In Vesalius, Acta Internationalia Historiae Medicinae. 2012, 18 (No 2), 70-75.
6. Plessas P. http://www.parathemata.com/2014/09/pavlos-plessas-powerful-indications.html 2014. Accessed January 21, 2016.
7. https://www.clinicalanatomy.com/andreas-vesalius
Aa https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
8. Fain, O. La Revue de Médecine Interne, 2004; vol 25, Issue 12, 872-880.
9. Hodges RE, Hood J, Canham HE, Sauberlich HE, Baker EM. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr 1971;24:432-43.
x. Hirschman JV, Raugi GJ. Adult scurvy. Journal of American Academy of Dermatology, 1999, 41; No 6, 895-909.
xx. Bartley W, Krebs HA, O’Brien JRP. Vitamin C requirement of human adults. Medical Research Council Special Report Series No 280. London: Her Majesty’s Stationary Office; 1953. P 1-179. Quoted in Hirschmann et al.
xxx Hodges RE, Baker EM, Hood J, Saueberlich HE, March SC. Experimental scurvy in man. American Journal of Clinical Nutrition. 1969;22:535-48.
10. Harrisons Principles of Internal Medicine, 1998; p 484-85
11. Leung FW, Guze PA: Adult scurvy. Annals of Emergency medicine; 1981; 10:652-655
12. Bennet M, Coninx R. The mystery of the wooden leg: vitamin C deficiency in East African prisons. Tropical Doctor, 2005; 35: 81-84.
13. Carpenter K. The history if scurvy and vitamin C.Cambridge University Press 1986, p29.
11. Bown S R. 4he Age of Scurvy. How a surgeon, a mariner and a gentleman helped Britain win the battle of Trafalgar. Summersdale, 2003, p 96-99.
15. Lind J. A treatise of the scurvy. Containing an inquiry into the nature, causes and cure of that disease. Together with a critical and chronological view of what has been published on the subject. Edinburgh: Sands, Murray and Cochran: 1753.
16. Kinsman RA, Hood J: Some behavioural effects of ascorbic acid deficiency. The American Journal of Clinical Nutrition, 1971, 455-464.
17. Biesbrouck M, Goddeeris Th, Steeno O: ‘Post Mortem’ Andreae Vesalii (1514 – 1564). Deel II. Het graf van Andreas Vesalius op Zakynthos. A. Vesalius, nr.4 December 2015. [in Dutch].
18. Bruce M Rothschild. Scurvy imaging. http://emedicine.medscape.com/article/413463-overview