>> From UPS.EDU!EMBLEN Tue Oct 5 15:48:01 1993 >> Subject: Diseases Part I >> Jodi Emblen OLD DISEASE NAMES AND THEIR MODERN DEFINITIONS WITH DISCUSSIONS GENERATED BY THE SUBJECT Part I (A-L) Original list compiled by Joyce Hall. Discussions added by Jodi Emblen. Some of the discussions stray a bit from their headings, but make more sense when presented this way than if they were chopped up. Because of his many contributions to these discussions, perhaps the reader would like to know Tom Lincoln's full title. He is: Thomas L. Lincoln MD Professor, Pathology, Univ. of So. Cal. We greatly appreciate his sharing of his knowledge (as well as all the time he spends on MELVYL) ACUTE MANIA: Severe insanity Julia Webb asks: There has been quite a thread on the topic of illness and causes of death. I've got one that makes my imagination run a muck - Acute Mania. One of my ancestors Samuel Morgan who died 1873, died of Acute Mania. What is it ? Roger Scanland responds: In a word, they're talking about insanity. "Mania" was the nineteenth- century term. I have a relative who spent most of her adult life in a mental hospital, and the only diagnosis for her that is shown in the existing records is "Mania." AGUE: Used to define the recurring fever & chills of malarial infection APHONIA: Laryngitis BILIOUSNESS: Jaundice or other symptoms associated with liver disease Tom Lincoln: also any upset leading to vomiting bile.. George Thurston: When I was a kid, my grandmother often said someone was "bilious" when the victim was feeling nauseous and/or maybe a little feverish without really being ill. BLACK JAUNDICE - Wiel's Disease Linda Jones asks: My gggrandfather, John Henry Jones, died 16Jan1850, 52 years old, of a liver complaint, in Brazos County. In addition, a great uncle, Wesley Jones, died 26Jan1875, 42 years old, of black jaundice, in Brazos County. Also, an uncle, Albert Jones died ?????1870, 8 years old, of black jaundice in Brazos County. What would be the current terminology for these causes of death? Tom Lincoln, after a session with Melvyl: Brazos county is along the Brazos river. Lots of hot and humid weather..The two diseases associated with black and yellow are malaria (black water fever is the deadly form) and black vomit with the bilious yellow fever.. that same yellow fever in its worst form. Both are carried by mosquitos. References would indicate that yellow fever was much more widespread and much more of a problem (which we know from other evidence as well). It was particularly associated with low lying ports and river travel... In the last century most people lived along the river. Thus I opt for "black jaundice" (which brought up no hits in the search) to be a fatal form of yellow fever. Justin Sanders: Tom is right that yellow fever was very, very common in the coastal south and along the rivers (esp. the Mississippi) in the 1800's. There was an outbreak somewhere every year. However, the yellow fever season is limited to the months when mosquitoes are active-- mainly summer and early fall. My impression is that July-September were the big months. The problem with the Joneses of Brazos Co, TX is that the two diagnosed as dying of black jaundice died in January-- the date of the average first freeze in Brazos Co is 30 Nov (per "Texas Almanac"), so yellow fever or malaria are very unlikely. Stedman's Medical Dictionary says black jaundice is 1) an obsolete term for icterus neonatorum and 2) an obs. term for icterus melas. Icterus melas is a form of jaundice in which the skin assumes a dirty dark brown color. Icterus neonatorum ("jaundice of the newborn") can be caused by a congenital blockage of the bile duct and is often fatal. Basically, the color of jaundice is usually yellow but it can range to olive-bronze or green-black giving rise to "black jaundice". Now, jaundice is a symptom of several diseases, so we are really just speculating about what might have been the Jones' disease, but simple hepatitis seems a likely candidate to me. >From what I could tell, Stedman's Medical Dictionary is pretty good at giving obsolete terms, so it (or another medical dictionary) is probably the first place to go for these genealogical diseases. Tom Lincoln: Killed off by the season! I didn't check the freeze. If one takes the "black" seriously, that leaves malaria. Yellow fever, in season, had about a 10% death rate if light cases were included, but you either died or got better. Malaria is another matter. The fatal form (50%) is (was) caused by the falciparum parasite (less common than its cousin vivax) - -but malaria is a chronic disease.. get it now, die of it later, so the winter would make little difference. Stress brings out the serious episode, and cold could be the stress. The black water is from hemoglobin iron pigment in the urine due to the massive destruction of red cells in the blood. This only occurs in a few diseases. Jaundice neonatorum is the jaundice caused by Rh incompatibility at birth. You don't see this in hepatitis - but the label for the more dramatic disease condition might have got carried over without the actual presence of the symptom... Stedman's is fair... the older the edition the better - also medical textbooks from the 1950's or before (I favor Cecil and Loeb). Medicine has moved so dramatically in the last 40 years that the names and descriptions of classic diseases are given short shrift. In Hurst's huge textbook for the for the practicing physician (2000 pages 1983) the only mention of Yellow Fever is to the vaccine. What we need is a textbook of genealogical diseases.. {;-) Linda Jones reported: Ted Swift suggested I: look it up in Merks (sp?) Handbook, which is a practitioners reference to all sorts of conditions and terms. AND Knowing only that (yellow) jaundice is caused by liver dysfunction, come to the rather alarming conclusion that human males with livers should not live in Brazos County! :-). I have no idea whether jaundice is hereditary, but your Joneses and their livers jus' don' seem to get along :-). In order to salvage my Jones ancestry reputation it seemed further research was necessary. I took quite seriously the notion of using medical dictionaries - the older the better. Someone on this net provided us with a list of libraries and the telnet commands. It seemed to me a medical research library would have collections of medical dictionaries. I believe it is a genealog file now and there are three university medical centers and one consortium (including medical centers) listed. The University of Texas Southwestern Medical Center, Dallas, TX, had a list of 75 medical dictionaries, at least 13 of them are over 75 years old. Some are quoted below with the publication date on the right. 1. Lippincott's new medical dictionary, a W L765 1911 2. Dictionary of practical medicine: compr WB C784d 1852-59 3. The Philadelphia medical dictionary: co W 13 C879p 1817 4. American illustrated medical dictionary W 13 D711i 1907 5. A Dictionary of medical science: contai W D916d 1846 6. New medical dictionary: with the formul 313d 1849 8. A Dictiocal terminollogy, de W 13 H313d 1855 9. A dictionary of medical terminology, de W H313d 1855 10. Dictionary of terms used in medicine an WZ 13 H683d 1846 11. Lexicon medicum, or, Medical dictionary WZ 13 H787L 1841 12. Lexicon medicum, or, Medical dictionary WZ 13 H787L 1836 13. A New medical dictionary: or, general r WZ 260 M918n 1795 However, all the books are in a non circulating collection. I do believe though that a call to the medical libraries with a request would get some information. In the meantime, I looked for an answer in "my own back yard" and, wouldn't you know, found an answer. I consulted Dr. Chris Armstrong-Esther, a professor in the School of Nursing, University of Lethbridge. He immediately recognized the term and following is a summary of his comments. Black Jaundice is a common term for Wiel's Disease. It is quite common in northeast England (Chris is from England) near mines, farms and sewage and floats about in water. It is caused by a micro- organism and thus is a bacterial infection (of the liver) and not a virus, as in hepatitis. It is carried by rats and secreted in their urine. It is usually not fatal, in present time, to humans. It is, however, rapidly fatal to dogs and cats, who can eventually gain a resistance, but either way can pass it on. Wiel's Disease turns the skin dark yellow; compound this with coal dust and/or the sun and it can make a skin look very dark. Since it does affect the liver, any alcohol consumption would impede recovery and feed the disease. Chris also mentioned that historically in Texas and Colorado there have been "pocket" areas of bubonic plague and, often, the two are confused. One way of determining which a person had died of was to ascertain the rate of decomposition of the body. At this point he had reached my threshold for "gross" and I asked no further questions! BRIGHT'S DISEASE: Joyce Hall asks: I just got a death certificate for my g-grandfather Neal (after searching for him for four years) and it states he died from "Bright's Disease." Does anyone know what that is? Lee Weller says: At the time he died (I'm guessing) it probably only meant kidney disease of some sort. Now it refers to a specific kind of kidney disease. Shirlene Pearson adds: Bright's disease is a catch-all for kidney diseases/disorders. It was used as late as 1913, which is when my g-grandfather James Logan H[o]uston died of it. It is no longer used by physicians. CAMP FEVER: Typhus Tom Lincoln adds: ... typhus was never seen (for example, in the Civil War) in the United States. The reasons are obscure. Thus Camp Fever here usually referred to typhoid D.G. Gardner states: Tom Lincoln says that typhus was unkown in C19 America; at least that is what I think he means to say. Actually, it was an American physician, William Gerhard, who first made clear the distinction between typhoid fever and (epidemic) typhus. Medical historians know this as Gerhard's distinction. Gerhard had become familiar with typhoid while studying in France, and when he saw a typhus epidemic in Philadelphia in the 1830s, recognized it as a different disease. It took 20-30 years for others It must not have been uncommon in C19 America. Since typhus is to some extent a crowding disease--the lice that carry the germ can infect more people in cities, jails [why it was sometimes called jail fever], military camps [camp fever], and so forth--I have to believe typhus was a problem during the Civil War, though I admit I can think of no specific cases off the top of my head, and am not interested to make a special trip to a library right now. Tom responds: What I believe I said is that it did not take root here. Typhus has appeared in the ports, but it was NOT a disease of the Civil War... to pick a simple source that did not send me to the library: Encyclopedia Britannica under Typhus Fever: "It was repeatedly introduced into Canada and the United States by the arrival of immigrant ships... In spite of repeated introductions from Europe and from Mexico, this form of typhus [epidemic] failed to form a permanent foothold in either Canada or the United States. The American Civil War of 1861-65 was one of the few wars of any magnitude in which typhus was not epidemic among the military camps, prisons, and refugee camps." See: N. H. Topping et al, Studies of Typhus Fever, National Institute bulletin no 183 (1945). A good rule for genealogy and medicine: If you read something that does not agree with what you think... Top of the head is a poor way to go.for yourself and for others. Susan Arday posted a story which said, in part: The doctor said I had 'Typhus' which I now understand to be typhoid fever. While all this stuff sounds a bit melodramatic, even to me, what my mom said happened was that the doctor, a Russian soldier, gave me a direct blood transfusion from himself and saved my life. I've no idea why the blood transfusion, maybe some nourishment and other care really did the job. Fred Rump responds: I suspect there is some confusion in the Dx (diagnosis) typhus or typhoid, though the Russian medical establishment is known do things that Western medicine considers or perceives to be unorthodox. It is likely you were malnourished and anemic, given your personal account of the immediate post-WWII conditions in Berlin. A blood transfusion might have some transient benefit in ameliorating that situation in your body. The doctor may have also been attempting to confer immunity to you by transfusing blood from himself (assuming he had just recovered from the infectious disease you had) into to you while you were suffering from the presumed same illness. This is called a reciprocal transfusion, because simultaneously the doctor should have been transfusing an equal amount of your blood (the sick person) back into himself. The doctor may not have had any antibiotics available to give to you that would be effective in treating typhoid fever. That's a possible explanation for why he gave you a direct blood transfusion. Apparently, your blood and the doctor's was antigenically similar (ie: your body did not adversely react to his blood type. Thus your and his blood types were compatible.) I don't know if the doctor tested your and his blood groups before transfusing you with his blood. There would have been a risk of a transfusion reaction. A transfusion reaction is a cytotoxic (cell killing) reaction that accompanies or follows administration of blood or blood components. Its severity varies from mild (fever or chills) to severe (acute renal failure or complete vascular collapse and death) with the amount of blood transfused, the type of reaction in the patient, and the patient's general health. Your general health at the time was poor. Most severe transfusion reactions occur with whole blood. The use of blood components radically decreases the possibility of a reaction. Transfusion reactions can be hemolytic, caused by administration of mismatched blood (ABO group, Rh incompatibility), or nonhemolytic, caused by patient sensitivity to infused components. To prevent transfusion reactions, before giving a blood transfusion, a doctor or nurse must be certain of the hospital policy about giving blood, then, MAKE SURE THAT THEY HAVE THE RIGHT PATIENT AND THE RIGHT BLOOD FOR THAT PATIENT! Sorry I don't mean to yell, it's just that is soooooo critical. It sounds as if you had protein-calorie malnutrition (PCM), which is one of the most prevalent and serious depletion nutritional disorders. PCM occurs as marasmus (protein-calorie deficiency), characterized by growth failure and wasting, and as kwashiorkor (protein deficiency), characterized by tissue edema (swelling due to fluid accumulation) and damage. Both forms of PCM vary from mild to severe, and may be fatal depending on accompanying stress (particularly systemic infections, severe burns and injuries, and cancer) and duration of deprivation. PCM increases risk of death from pneumonia, chicken pox, or measles. Chronic kwashiorkor typically occurs in children after age 1, after a child is weaned from breast milk to a protein-deficient diet of starchy gruels or sugar water. Kwashiorkor can develop at any time during the formative years. Chronic Kwashiorkor allows the patient to grow in height, but adipose (fat) tissue diminishes as fat is metabolized to meet energy demands. Edema often masks severe muscle wasting (that's why starving children often have swollen bellies - they also usually have a gut full of intestinal parasites, such as worms); dry, peeling skin and hepatomegaly (liver enlargement) are common. To help eradicate PCM in developing countries today, prolonged breast feeding is encouraged, mothers are educated about the nutritional needs of children, and supplementary foods are provided, as needed. In addition, prolonged breast feeding prevents consumption of contaminated water used in reconstituting baby formula. The pathogens in contaminated water can cause a whole host of fatal illnesses in an infant and toddler, or in anyone who is immunocompromised. Some of these fatal water-borne illnesses include typhoid and cholera. High infant mortality rates in developing countries, often more than ten-fold greater than in industrialized countries, are attributed in good part to inadequate water supply and sanitation. That some 1.5 billion people are estimated to lack reasonable access to safe water led the United Nations on 10 Nov 1980 to inaugurate the International Drinking Water and Sanitation Decade. It is frequently assumed that the only cause of malnutrition is a failure to consume an adequate diet because of the unavailability of food. This unwarranted assumption may result in overlooking the primary factor responsible in many cases of malnutrition. Poverty, famine, ignorance, lack of money to buy food, poor dietary habits, and infectious diseases lead to widespread malnutrition in some population groups, even in the presence of an apparently adequate food supply. Obesity is frequently due to malnutrition. Typhus does not equal typhoid, of course, but it is common to confuse the two diseases due to the similarity in their names. With disruption of usual water supply and sewage disposal, as would occur under disaster situations of war, earthquake or hurricane, and concomitant disruption of controls on food and water, transmission of typhoid fever may occur if there are active cases or carriers in a displaced population. There were probably both active cases and carriers of typhoid at the time and place you became ill. Efforts to restore safe drinking water supplies and excreta disposal facilities are more appropriate than massive typhoid vaccination. Vaccination of such populations is generally not recommended. Occurance of typhoid fever is worldwide. The number of sporadic cases of typhoid fever has remained relatively constant in the USA, with fewer than 500 cases annually for several years (compared to 2,484 reported cases in 1950). With development of sanitary facilities, typhoid fever has been virtually eliminated from many areas of the USA; most cases are now imported from endemic areas. Strains of the typhoid bacillus bacteria that are resistant to recommended antiobiotics used in the treatment of typhoid fever have appeared in several areas of the world. Multi-resistant strains have been reported in Asia, the Middle East, and Latin America. The reservoir of typhoid fever is humans. Mode of transmission of typhoid fever is by food and water contaminated by feces and urine of patients and carriers. Important vehicles for transmission in some parts of the world include shellfish taken from sewage-contaminated beds; raw fruits; vegetables fertilized with human feces (also called night soil); contaminated milk and milk products (usually by the hands of carriers); and missed cases of typhoid fever. Flies may infect foods in which the organisms then multiply to achieve an infective dose. In endemic areas, typhoid fever is most common in preschool and school aged children. The usual case fatality rate from Typhoid fever is about 10% but that can be reduced to <= 1% with prompt antibiotic therapy. CANINE MADNESS: Hydrophobia CHLOROSIS: Iron deficiency anemia Tom Lincoln enlarges the definition: ... but also a number of confounding diseases -- like leukemia -- that were not recognized at the time COMMOTION: Concussion CONSUMPTION: Tuberculosis R.P. Gordon asks: What is dying from "Consumption"? Tom Lincoln replies: Tuberculosis - The effect of the disease was that of wasting away. George L. Thurston adds: Yes. TB was often referred to as "consumption," but so was dysentery and other "wasting" diseases that rendered their victims a bag of bones before delivering the coup d' grace. CORRUPTION: Infection CORYZA: A cold Tom adds: the present technical term COSTIVENESS: Constipation CRAMP COLIC: Appendicitis CROUP: Croup George L. Thurston says: Exists today under that name: my kids had croup when they were small. It's a congested cough that babies get. DEATH FROM "TEETHING" J.C. Newman asks: Has anyone heard of someone passing away from "teething?" My uncle's death certificate stated this was the cause of his death. Does anyone know anymore about this and what complications might have been caused by teething? Tom Lincoln replies: In "The Diseases and Casualties this Week", a tally published in London at the time of the great plague, there are lots of surprising causes of death, as well as some familiar ones. There were for, example, 134 cases of childbed (fever), and 134 cases of consumption, with 7165 of plague....Among others, 49 died of "surfeit" and 121 of "teeth". Three died of fright, and one was killed by a fall from the Belfrey at Allhallows the Great.... Tooth infections with inflammation and cellulitis were clearly important causes of illness and death before there was adequate dentistry. DISEASES FROM DISTURBED GRAVES Ann McWilliams commented: I notice that no one mentioned under this topic the problem of getting diseases from disturbing graves. Many diseases don't die with the corpse. In the Toronto area there was a small cemetery that was known to contain some people who had died of scarlet or typhoid fever. Regardless, the graveyard was not disturbed and the major freeway (401 & 427) were built around the cemetery. When the St. Lawrence Seaway was built, many small towns were destroyed. The Canadian government built Upper Canada village in Morrisburg and moved many of the buildings to this site. In addition the gravestones were moved and are now displayed as part of the perimeter walls. The stones were kept grouped by cemetery/town. Tom Lincoln responds: Well, I have a bit more experience than the average (as a pathologist). You have to be very careful during a post mortem, but one of two things happens when a corpse is buried: a) Beginning with the Civil War, bodies have been embalmed, i.e. filled with formalin (formaldehyde). This kills everything, and preserved the body. Why we want to do that is a bit obscure, but it makes shipping possible, which was why it was done in the first place. b) Otherwise the body digests in its own juices, aided by the bacteria in the intestine so that there are only bones and hair left. Half way through this process , which takes a number of weeks, things are a little messy. Doing a post mortem on someone who has been dead more than a couple of days is more unpleasant than dangerous. In any case, there is little likelihood of exposure to disease except from some dangerous spores like anthrax -- which is not likely at all It is possible to get spore like disease from unwrapping mummies.. but you have to look in a very big encyclopedia to find this disease (Scientific American Medicine CD ROM) The issues are symbolic and refer to the very great importance that we give to interment in this country. It also helps genealogists :-) DOMESTIC ILLNESS Elizabeth.Milewicz asks: I'm interested in whether your list or that of Joyce's has 'domestic illness'. No one I know has any idea what it could be. Neither did, but I asked Tom Lincoln, who said: My suspicion would be that if it is a disease of women that it is related to urinary incontinence... the bane of women's existence before modern birthing methods and the result of torn tissues at birth. What it required was the then equivalent of "Depends".. some kind of diaper. The tendency was to "speak around" such problems, rather than describe them directly. When this response was forwarded to Elizabeth, she replied: Unfortunately the diagnosis of 'domestic illness' was used to describe the condition of a male, rather than female ancestor. He - The Hon. William Prichard Weston - retired from Tasmanian politics in the early 1860s due to 'domestic illness'. He spent the rest of his life- the next 20 years or so - in a semi-depressive state. I have wondered if it was a a polite way of saying 'mental breakdown' but ... I have no idea. Back to the drawing board? Nope, back to Tom - whose response was: Aha! Nobody said that it was a political euphemism rather than a description of a disease! Could have been depression, could have been Alzheimers, could have been the after effects of a stroke, could have been Parkinsonism... I would say that it describes an illness that kept him housebound and probably in need of nursing support. If the description came from the political arena, I would suggest that its real meaning was (as usual) "Not OUR Fault!" DROPSY: Edema (swelling) often caused by kidney or heart disease >From Tom: ... caused by heart failure or kidney failure (as in nephrosis, following scarlet fever) Frank Deis: I believe that dropsy would be called congestive heart failure today. It's an accumulation of fluid around the heart, for a variety of complex reasons, and one treatment is administration of digitalis (foxglove leaves). Dropsy was NOT one of Peter Cottontail's siblings (those were Flopsy and Mopsy). John R. Stephens, Jr: Congestive Heart Disease-----my wife is an RN, when we were first married 25+years ago, I said "...died of dropsy." That's what I had always been told, I just repeated it. She, being the RN, replied "Never heard if such." Since she worked in a hospital emergency room, she started asking all the doctors what was "dropsy"....finally, one of the oldest if not the oldest doctor in town, told her that was the "old name" for congestive heart failure. Timothy Noonan writes: I think that defining dropsy as "congestive heart failure" is being too specific. Dropsy is edema, that is, fluid buildup in some tissue or cavity. I am not a medical person, but it seems reasonable that pulmonary edema (i.e., fluid buildup in the lungs) could cause congestive heart failure. But edema in the feet (for example), though no doubt painful and possibly life-threatening (if followed by gangrene, say), would not. As an aside: in the late 18th century, obituaries of people who died of dropsy often included the amount of fluid "tapped" from them, especially if that figure had reached, say, many gallons. (Presumably, in the absence of treatment for the condition, "tapping" the excess fluid was all they could do.) DYSPEPSIA: Acid indigestion Tom again: ... still very much it use... "My doctor said..." EXTRAVASATED BLOOD: Rupture of a blood vessel Tom: ... blood outside the circulation due to a cut or tear or rupture of a blood vessel.. FALLING SICKNESS: Epilepsy John Hoban starts: I have a cause of death I haven't been able to identify. I have an ancestor who was a miner and his cause of death was from Jacksonian Epilepsy caused by trauma I've asked several friends in the medical industry and none of them have heard of this specific type before. Any ideas? Richard Somer replies I once had a friend who suffered from epilepsy, and it was at first diagnosed as something the doctor called "Jackson's March"--a disturbance in the temporal area of the brain. I don't recall that it was identified at that time as being epilepsy. But then, my friend may have chosen not to reveal that detail at the time. Carol Botteron adds John Hoban asked about Jacksonian epilepsy. Taber's Cyclopedic Medical Dictionary is now 3 for 3 -- everybody go find one of these! Epilepsy: (various other types deleted) e., Jacksonian: E. in which convulsions tend to be restricted to certain groups of muscles, or limited to one side of the body, due to disease involving the cortex. Also called cortical or symptomatic e. Apparently trauma to the cortex could also cause this. Disclaimer: I'm not an M.D., just one of (apparently) about three people who have books. Not picking on John Hoban, because J.E. is obscure, but many of the diseases that have recently prompted questions and (sometimes incorrect) answers, e.g. Bright's disease, are listed in ordinary dictionaries -- check them first! Lee.Weller responds Old, but not ancient! ... a form of epileptic seizure described by J. Hughlings Jackson (1835- 1911), that arises from damage to the cerebral cortex of the brain. After the initial damage, scar tissue may form and be responsible for periodically triggering more seizures. Dean Johnson enters the discussion with: My grandfather had "Bright's Disease" when he was young. From what I understand, it is diet-controlled Diabetes. He was on a special diet for a while and it went away (for 70+ years). This doesn't dismiss it being used for general kidney problems. FLUX OF HUMOUR: Circulation FRENCH POX: Venereal disease Tom's input: ... or the Spanish disease or the German disease, etc. GENETICS - Corinne H. Smith starts the ball rolling with: Much has been written about the Amish here in Pennsylvania regarding genetic problems compounded by intermarriage. Among the Amish, first cousins are not permitted to marry (and that's against PA law as well), but second cousins often do. Certain genetic diseases like dwarfism appear among Amish populations and have been traced to a few of the first Amishmen to immigrate to America. The problems continue because of the closed gene pool available to the followers of the religion, who must marry within their faith and within the same local geographic region... much as Mary Anne recently mentioned about the communities of the Blue Mountains. If anyone wants a list of sources about genetic problems of the Amish, I'd be happy to provide one. Tom Lincoln says: There is another way to look at genetic relatedness in genealogy (unless I have missed some postings). First, genes come in chunks as chromosomes. Although there is some crossing over, this is not a very common event, and can be ignored to get a feeling for the problem. Likewise, spontaneous mutations occur, but they are not common either. Genetic sharing through the viral inclusion of genes in the DNA by reverse transcriptase (similar to the information sharing in bacteria via plastids and a characteristic of both the HIV virus and proposed modern genetic patch mechanisms) can also be ignored. Thus, to a first approximation over a limited number of human generations, genes can be considered inherited in 46 paired packages plus the sex chromosomes, half of a pair coming from each partner at each generation. The presence of a Y sex chromosome from the father defines the sex as male, and each partner has one X sex chromosome. (We will also ignore the RIts a wise child that knows its own father's problem.) There is also DNA in the cytoplasm, which is inherited from the mother. The above leads to the following observations: 1) The Y male chromosome (and its genes) go back all the way on the male side. (The ignored factors alter the genetic makeup of this chromosome over a very long time period, so that the genes on all Y chromosomes are not alike.) 2) The cytoplasm goes back all the way on the matrilineal side. (Cytoplasmic DNA appears quite stable, giving rise to the Reve hypotheses that we are all traceable to a single first woman, and that this can be verified by DNA homology studies.) 3) In six generations 64 chromosomes would be needed to capture one chromosome from the gene pool of each of these ancestors, if all of the ancestors were different and if only one chromosome came from each. However, we only have 47 chromosomes. Thus at least 17 family lines are left out, unless there are some multiple family linkages so that the number of different chromosomes over this interval is, in fact, smaller. (Cross overs would lessen the genetic loss somewhat, but the other factors, such as mutations, would increase it.) 4) Point three implies perfect mixing, with an even division of chromosomes from the members of the prior generations, but mixing is imperfect. For example, from the perspective of ones grandparents, it would be possible, but very very rare, to have the full complement of chromosomes of one grandparent passed through to a grandchild. Because some imperfect mixing can be expected, it is most likely that more than 17 genetic lines are dropped in 6 generations. (In a formal sense, this is similar to the way that probabilistic branching processes have been used to describe how names die out over generations. These same methods can also be used to model the elimination of genetic lines -- which is of practical value in animal breeding, where mating is controlled to enhance certain specific yraits and encourage others to die out.) 5) Thus, biologically, we are an incomplete and nearly totally unknowable sample of our distant genetic and genealogical past. Moreover, nothing can be said about the potential importance of one chromosome over another (except in obvious cases where they carry genetic diseases). Moreover, it is the interaction among genetic entities from these multiple sources that defines the biology of the individual. More than anything else, I think genealogy gives us a sense of cultural continuity and richness, but attempting to trace how values filter down from one individual to the next through many generations leaves even more unknowns than genetic inheritance. Helmut J. Jungschaffer quotes Tom Lincoln: ->The Amish are a small, well studied group with very good family records that appear highly accurate. They have clarified many genetic relationships because of their self imposed isolation over many generations. As a culture, they remain robust, in spite of almost no recruitment. and then comments: As a pediatrician familiar with the Amish I would certainly have to disagree with any assessment denying a vastly increased number of genetic diseases in this population, if this should be the intent of this statement. The Amish do run a greatly increased risk for a variety of diseases when compared to an outbreak population. I guess it depends on your outlook, whether you personally can still be happy with your robust culture when eight of your ten children have PKU. The Amish happen to be very community oriented and very strong in their religious beliefs, under such circumstances almost any personal tragedy can somehow be seen as fitting into God's grand picture. I do, however, have my doubts that you will find many other families willing to accept potential outcomes such as in the above mentioned example. My paternal grandparents were first cousins, and I certainly would not be the one to use Tay-Sachs disease in Ashkenazy Jews or the multitude of genetic diseases in the Amish to categorically oppose first-cousin marriages. After all, for most people the situation is different from these highly inbred populations. But I would certainly be wary if there were a number of certain diseases running in the family. In response to a posting regarding Abraham Lincoln and Marfan's Syndrome (remainder extracted under Marfan's Syndrome), Susan Arday writes: For hereditary or congenital defects, one can look to the following figures of history and culture. Steinmetz was a congenital cripple and Toulous Lautrec was afflicted with hereditary osteochondritis fragilis. The Empress Alexandra (granddaughter of Queen Victoria and wife of Tsar Nicholas II of Russia), was a carrier of the hemophilia-A (or Royal hemophilia) mutation, and her son, Tsarevich Alexis, was afflicted with hemophillia. As a matter of fact, Queen Victoria's son, Leopold Duke of Albany (1853-1884), was afflicted with hemophilia A. Hemophilia is found among some later descendants of Leopold. Where Queen Victoria's hemophilia-A mutation came from is not known. She herself was carrier, but her father was completely normal and nothing in her mother's pedigree suggests that the hemophilia gene was present. In the 5 generations since Queen Victoria, 10 of her male descendants have had the disease. Virtually all died very young. Those who survived childhood often died in their 20's or early 30's usually from excessive bleeding following injuries. The Tsar and Empress were very preoccupied with Alexis' health (remember Rasputin?). Some historians argue that the Tsar's preoccupation with Alexis' health contributed to the neglect of the Russian empire that ultimately brought on the Bolshevik Revolution in 1917. Human genetics is a subject of personal interest to many people, especially those who are affected with some inherited disorder or who have affected relatives. Disorders that can be traced in part to genetic factors are relatively common. Indeed, few families are entirely free of such common conditions as high blood pressure, diabetes, schizophrenia, mental retardation, epilepsy, stuttering, certain forms of deafness, and color blindness --- conditions that are caused in at least in part, if not in whole, by genetic factors. The occurrence of an inherited disorder in a family often evokes feelings of guilt or personal inadequacy on the part of the parents, and it often creates anxiety in the unaffected relatives because they might be carriers of the same genes. Such guilt and anxiety can be counteracted only by an adequate understanding of the principles of human genetic inheritance together with the facts pertaining to the genetic basis of the particular condition in question (for example: Marfan's syndrome). Not only is human genetics of interest to each of us as individuals, but the subject has wider social implications. In the early years of the 20th century, genetic knowledge was misused. In those years, there developed a politically powerful eugenics movement -- a pseudoscientific movement that aimed to "improve" the "genetic quality" of human beings. The eugenics movement demonstrated its political clout in the United States with the passage of the Immigration Restriction Act of 1924, which was designed to limit the immigration of ethnic minorities from southern and eastern Europe on the grounds that the "Nordic" types from northern and western Europe were genetically superior. I thank God that my relatives and in-laws managed to immigrate here before 1924, because many of them would have been deemed less desirable "non-Nordic" types by the US in 1924. That designation would have meant that the US would not have received persons eager to be citizens and who would go on in the US to practice medicine, establish successful small businesses, raise responsible children, gain college educations, fight for the US in war time, and contribute to the arts and culture as photographers shown in the National Gallery, and as first chair violists in various cities' symphony orchestras. I cannot begin to imagine or estimate the losses suffered by the US after the 1924 IR act was in place. In US state legislatures, eugenicists pushed for the passage of laws for the forcible sterilization of "hereditary defectives", "sexual perverts", "drug fiends", "drunkards", "prostitutes", and others. In 1907, Indiana became the first state to adopt such a compulsory sterilization law, but by 1930, the majority of states had adopted such measures. Luckily, these laws were largely ignored by public officials in most of the US. In California, however, where the eugenics movement was particularly influential, at least 10,000 men and women were involuntarily sterilized. The eugenics movement was worldwide, with centers of activity in Japan and Western Europe, as well as the US. The Eugenics Sterilization Law of 1933 in Nazi Germany ultimately led to the compulsory sterilization of at least 250,000 men and women deemed "hereditarily defective". Toward the end of the Nazi regime, compulsory sterilization was dispensed with, and millions of people were killed, including some of my ancestors and my in-laws who were unable to escape the concentration camps. It reminds us today of the "ethnic cleansing" in Bosnia-Hertzogovenia. In the US and elsewhere, reputable geneticists were cowed into silence by the power of the eugenics movement and were rendered ineffectual. Ordinary citizens were largely ignorant of the principles of human genetics, so the eugenecists controlled events. Even today, a surprising amount of eugenics nonsense is found in the public press. Hopefully, an educated public (including us genealogists) will prevent a recurrence of the tragedies that grew out of the eugenics movement. In short, a knowledge of human genetics serves a social function in allowing people to recognize and thwart those who would misuse genetics for their own ends and prejudices. As mentioned above, knowledge of genetics also satisfies a private interest. Who has never wondered (or indeed worried) about his or her own personal hereditary endowment? As it happens, much of what is known about human genetics has come from the study of genetic abnormalities and diseases. No family is "immune" from actual or potential genetic misfortune. Sometimes when you read an example of a genetic disease, it may remind you of situations in your own family, among your relatives, or among your friends. Here are some patterns of transmission in genetic disorders: AUTOSOMAL RECESSIVE Hartnup disease Xeroderma pigmentosum Congenital afibrinogenemia Congenital virilizing adrenal hyperplasia Fabry's disease Galactosemia Niemann Pick disease Retinitis pigmentosa Thalassemia Cystic fibrosis Familial emphysema Tay-Sach's disease Cystinuria Cretinism Phenylketonuria (PKU) Albinism Fanconi's syndrome Sickle cell anemia CHROMOSOMAL Turner's syndrome (XO syndrome) Trisomy 13 (Patau syndrome) Trisomy 18 (Edward's syndrome) Trisomy 21 (Down's syndrome) Klinefelter's syndrome (XXY) Trisomy X (XXX) Hermaphroditism Cri du chat syndrome (5p-syndrome; Lejeune syndrome) Double-Y syndrome (XYY) 18p- syndrome 18q- syndrome AUTOSOMAL DOMINANT Achondroplastic dwarfism Colorectal polyposis Familial nonhemolytic jaundice Renal glycosuria Spherocytosis Pituitary diabetes insipidus Hyperlipidemias / familial hypercholesteremia Polydactyly (extra fingers) Brachydactyly (very short fingers, relative to thumb) Neurofibromatosis Huntington's disease Osteogenesis imperfecta Retinoblastoma Marfan's syndrome Hereditary hemorrhagic telangiectasia Target-cell anemia Periodic paralysis Otosclerotic deafness X-LINKED Some immunodeficiencies Pseudohypoparathyroidism G 6-PD deficiency (favism) Hemophilia Duchenne-type muscular dystrophy Lesch-Nyhan syndrome (HGPRT deficiency) Red-green color blindness Testicular-feminization syndrome Andrenogenital syndrome MULTIFACTORIAL (POLYGENIC) Rheumatoid arthritis Diabetes mellitus (some cases) Congenital heart anomalies Neural tube anomalies Mental retardation (some cases) Cleft lip (harelip)/palate Hypertension Bronchial asthma Cancer (some forms) Manic-depressive psychosis Gout OTHER COMMON GENETIC ABNORMALITIES (probably MULTIFACTORIAL): Psoriasis Hydrocephalus Exomphalos Epilepsy Rheumatic fever (risk thereof - greater susceptibility to infectious agent) Situs inversus viscerum Celiac disease Patent ductus Clubfoot Anencephaly Spina bifida aperta Pyloric stenosis Strabismus Congenital dislocated hip Multiple sclerosis Deaf-mutism Microphthalmos Hirschsprung disease Osteogenesis imperfecta Some relatively common simple genetic traits found in humans: Common baldness (Pres. Eisenhower, Pres. John Adams) - M-shaped hairline receding with age Chin fissure (Kirk Douglas) - vertical cleft or dimple in chin Ear pits - tiny pit in external ear Darwin tubercle - Extra cartilage on rim of external ear Ear cerumen (wax) - wet and sticky ear wax versus dry and crumbly ear wax Congenital ptosis - droopy eyelid Epicanthus - fold of skin near bridge of nose leading to almond- shaped eyes Camptodactyly - crooked little finger due to a too short tendon Mid-digital hair - hair growth on middle segment of fingers Phenylthiocarbamide tasting - ability to taste phenylthiocarbamide; tasters report it as bitter. S-methyl thioester detection - detection of smell of odeferous substances excreted in urine after eating asparagus ABO blood group - Type A versus Type B versus Type O versus Type AB Rh blood group - Type Rh+ (positive) versus Rh- (negative) Hairy ears - a Y-linked trait; growth of stiff hair an inch or longer on outer rim of the ears of males after age 20. Free versus attached earlobes Hitch-hikers' thumb (curving versus straight thumb when thumb is extended) Robert Wier writes: Many of us perhaps carry some resistance to the Plague in our genes since we are the descendents of the survivors... And Steve Oberste answers: I don't mean to nit-pick, just to correct a factual error: Acquired immunity, as to plague, measles (...) is not genetically transmitted. It is good only for the individual who becomes immune. Whereupon Jean Paul Rigaut says: Of course, Steve is absolutely right, in terms of ACQUIRED immunity. But... It has been shown for smallpox that individuals of blood group A are GENETICALLY more sensitive, i.e. a much larger proportion of them die of the disease when they catch it (or, rather, did, as smallpox has now been eradicated). For a long time, scientists believed that the larger proportion of blood groups B and AB observed in many ethnic groups was just one of their genetic characteristics. (Incidentally, all this had been used by the Nazis as a further "proof" of the inferiority of some so-called "races".) Until other scientists realized that this larger proportion was observed in all the underdeveloped countries where smallpox had existed. The explanation, in fact, is that smallpox has been eradicated later in underdeveloped countries than in industrialized ones and that, by then, a larger proportion of families with people of blood group A had disappeared. It is also well known that (black) people with sickle-cell anemia have, genetically, a better resistance to malaria. They are better off than other people in countries with malaria, at least when their sickle-cell anemia is heterozygotous. When homozygotous, it is statistically worse than malaria; the fact that such a disease, grave (homozygotous) in 25% of offsprings when the two parents are heterozygotous, has not disappeared by Darwinian selection, is due to the resistance to malaria, a "compensating" factor | The reason why Anglo-Saxon populations die much more frequently of measles than others is probably genetic as well. So, genetic differences do account for resistance to diseases. And, well, some of us ARE the survivors of a better resistance to (at least) smallpox, malaria and measles. However, many others survived as well... luckily for some of us || I do not think that anything such has been reported for the plague, but I don't know whether it has really been studied. Lucy Rowland says: The dialog regarding genetic predisposition and resistance to various diseases has been quite interesting, albeit somewhat far removed from genealogy. In spite of the Germ Theory of Disease, in which particular microorganisms (bacteria, viruses, rickettsias, etc) are proven to be the cause of infectious diseases, there is a confounding factor. This is that not everyone, even those exposed to big doses of the etiological agent(s), gets sick. There is a theory that the ORGANISMS don't actually create the illness--the body does. I have discussed this with many infectious disease specialists and they all seem to recognize the phenomenon. It may have to do with stresses that cause the adrenals to pump out lots of endogenous goody (adrenaline) that in turn suppresses the immune system. Bingo. There goes your resistance. Genetically linked? Don't know. But I suspect that people who survived the Black Death had better functioning immune systems, and that Charles Darwin's theory of survival of the fittest would bear out a gene connection. Lyle Davis writes: Several days ago there was some interesting discussion on the affects or lack thereof of genetic damage due to interbreeding/intermarriage between first cousins (or closer family members). The concensus seemed to be that it was an old wife's tale and wasn't really worth worrying about. Apparently that is not the case. It appears, based on substantial documentation, that interbreeding is *not* a real swell idea. [ Long study of mental retardation in children of closely related parents deleted to save space.] (Sadly, Jodi was unable to dredge this one out of files.) One key line was: The incidence of mental retardation increases about 5% with first- cousin marriage, in agreement with other studies. The decline of IQ with inbreeding appears to be due entirely to rare recessive genes, not to dominance deviations of polygenes. Teri Pettit responds: Actually, the discussion started with an observation that marriages between first and second cousins are not all that uncommon in certain culturally isolated populations, and that most of these consanguinous families do not appear to deviate from normal patterns. The poster asked how this could be. The consensus was that it was a myth that cousin marriages *necessarily* or even *usually* produced abnormal or genetically defective offspring, but that they do produce such offspring at a greater rate than unions of unrelated couples, for precisely the reason of recessive genes that you describe and that the referenced studies document. The way it can be both true that cousin marriages are "not a good idea", and also true that they do not usually show any deleterious effect, is that the effect which is strong enough to be statistically significant (e.g., 5%), but low enough to not be characteristic of a typical consanguinous union. Here is an example which may be a little easier to understand than the medical studies: Let's say that individual A carries a gene G which is otherwise rare in the community, rare enough that we can discount the chance of someone inheriting it other than through descent from A. Then each of A's children has a 50% chance of carrying the gene G. A's grandchildren have a 25% chance of carrying it. More exactly, the grandchildren descended from the children (if any) who inherited G have a 50% chance of carrying it, and the grandchildren descended from the children (if any) of A who did not inherit it have the same negligible chance as the community at large. But we don't know which is which, so we'll just say 25% across all grandchildren. In the same way, each great- grandchild has a 12.5% chance of carrying the gene, assuming no first cousin marriages, and if there are no second cousin marriages, each great-great-grandchild has a 6.25% chance of carrying the gene. Now if two first cousins who share grandparent A marry, then there is a 25% chance that the wife carries the gene, and a 25% chance that the husband carries the gene. In other words, out of 16 such first cousin marriages, in 1 of them, both spouses will carry the G gene, in 6 of them, one spouse will carry the G gene but not the other spouse, and in 9 of them, neither spouse carries the G gene. In the first case, where both cousin-spouses carry the gene, their children have a 25% chance of inheriting two copies, one from each parent, a 50% chance of inheriting a copy from one parent but not the other, and a 25% chance of not inheriting G. In the second case, where one spouse carries the gene but not the other, their children are exactly like children of A, that is, they have a 50% chance of carrying one copy of the gene, and a 50% chance of not carrying it. The third case is just like the general populace. So the child of a first- cousin marriage related through grandparent A, not knowing which of the three cases the marriage falls into, has a 1/64'th chance of carrying two copies of gene G. Now these statistics hold for any gene, regardless of whether it is good or bad, recessive or dominant. But getting two copies is most relevant for recessive genes, as otherwise the paired dominant gene will keep it from being expressed. And "bad" genes are more likely to be recessive, since if they are dominant, they are usually expressed early enough to diminish the likelihood of successful reproduction. (There are, though, some diseases carried on dominant genes which are expressed late in adulthood, and thus, although "bad" to us, do not have a negative impact on reproductive success, so that they are not "bad" in an evolutionary sense.) And of course there are many many recessive genes which are neutral, and even some which are beneficial. Prohibiting cousin marriages thus encourages rare genes to stay sufficiently diluted that inheritance of two copies is exceptionally rare. But even allowing first cousin marriages only yields one family out of 16 who will have ANY children with two copies of any particular rare gene carried by the grandparents they share, and that family will only have 1 child out of 4 who inherits two copies of any one rare gene. (On the average, of course.) How "dangerous" a particular cousin marriage is thus depends on how many "bad" recessive genes are carried by the grandparents they have in common. If none, the marriage is as "safe" as any marriage. If one, you get the 1 out of 64 case outlined above. If the common ancestors carried several bad genes, then their descendents should be particularly careful not to intermarry. If the common ancestors carried several recessive "good" genes, and no bad ones, then intermarriages between their descendents might be especially likely to produce paragons of health and talent! In practice, the good/bad mix in recessive uncommon genes is enough towards the bad side to keep cousin marriages in disfavor, but benign enough that most of them appear no different than other families in the community. In response to Denise Inglis's comment about genetic factors in contracting diabetes, Elizabeth Harris wrote: I think in both these cases you're dealing with more than one genetic factor. Diseases that are the result of simple, single gene mutations give a statistically predictable inheritance pattern, but a lot of things that definitely have inherited components probably result from the combination of several factors. Even with a simple pattern you can't guarantee that every family will show the same ratio, but averaged over a population it will come out to a certain proportion. One case where you would indeed see apparent skipping of a generation with a single gene would work like this: Suppose Jane has a genetic disease that's inherited as a simple recessive gene. She marries John, who is normal and not carrying the recessive gene. All their children will get one good gene from John and one bad one from Jane, but they'll all appear to be normal because the gene is recessive. In the next generation, John and Jane's daughter Mary marries Bill, who is also a carrier of the same disease. Their children will have a one in four chance of having the disease. Any given child will have the following possibilities: the good gene from each parent - normal, not a carrierthe bad gene from Mary but the good one from Bill - a carrierthe bad gene from Bill but the good one from Mary - a carrierthe bad genes from both parents - has the disease On the other hand, if John and Jane's other daughter Susan marries Frank, who is not a carrier, all her children will be apparently normal, and only half of them on the average will themselves be carriers. You can see that if you're dealing with multiple genes in something like diabetes (which is almost certainly the case) that it gets complicated very fast! On the same subject, David Kausch : I know there are many theories on this, but an aspect of the question that fascinates me is how different cultures have different rates of diabetes. For example, Japan has one of the lowest rates of diabetes in their population. Finland has one of the highest. In fact, European countries in general have a higher rate than the rest of the world. I view this as genealogical evidence, others may claim it's environmental. GOUT: Gout George L. Thurston says: Also still called that today by some doctors. A friend of mine had gout. Apparently it's an inflammation of an extremity - usually the foot resulting from some fatty blood vessel/circulation problems. Not dissimilar to arthritis, but not involving the joint in the same way. A clarification on the definition of "gout". It refers to any inflammation, not just in a joint or an extremity, caused by the formation of crystals of oxalic acid when it accumulates in the body. It most often occurs in joints where circulation is poor but can even cause gallstones or kidney stones. Another rare form is when the crystals form on the inside of the eyelid, though that usually gets subsumed under all the things that can accumulate there and cause problems. I don't have any further details -- I'm not a biochemist. Frank Deis : Finally, a Biochemistry question on ROOTS-L! :-) Gout is a disease caused by a build up of urate or uric acid in the body. Uric acid is not very soluble in water or blood -- thus it crystallizes out in areas without much rapid blood flow -- and the needly crystals can cause damage when, for example, you stub your toe. Uric acid is a purine -- one "prong" of treatment for gout is to diminish purine intake, hence no coffee (caffeine), tea (theophylline), or chocolate (theobromine) in the diet. Also no sweetbreads or other organ meats with high levels of DNA and RNA -- half of the nucleotides in DNA and RNA contain purines (Adenine and Guanine). A second "prong" of gout treatment is often administration of drugs, either inhibitors of purine oxidation or inhibitors of cell division. There is a very extreme version of Gout known as Lesch-Nyhan syndrome. People with this syndrome are generally institutionalized, since their behavior is violent and selfdestructive -- evidently the joint pain etc. is so bad that people chew their fingers etc. as a counter- irritant. I believe that both gout and Lesch-Nyhan are hereditary diseases, but don't know that for a fact. Lee.Weller expands: Lesch-Nyhan disease is a specific form of gout that, unlike ordinary gout, seriously affects the brain. It is what is known as a single gene disorder and is inherited like hemophilia (it is an "X-linked recessive trait"), so it shows up mostly in men. Ordinary gout is not always due to the same cause, so its hereditary nature is difficult to pin down in any particular circumstance - it can be different in different families. That's why geneticists must also be genealogists. (No, I'm not a geneticist, but for my sins I do _teach_ some genetics.) The ordinary gout that some people suffer from may be inherited as a single gene disorder, but as an "autosomal dominant trait" that is "sex influenced" (shows up in men because of the effect of male hormones - like baldness in young men). Hippocrates (remember our doctors' Hippocratic oath?) is credited with first observing that "eunuchs neither get gout nor grow bald". Other people suffer forms of ordinary gout which may be inherited in more complicated ways, ways that involve more than one gene and that may be significantly influenced by a range of environmental factors. This is known as "multifactorial inheritance" and is the way many medical problems are inherited and most of our interesting bits (eye color, hair color, skin color, body shape, height, fat distribution - viva la difference!). Dr. Robert R. Wier (doesn't specify if he is a M.D.) says: As a personal note, I had gout for awhile (so did my dad, although not as bad as I)--- A couple of observations - Most common gout manifests itself as a swelling in the big toe joint (either foot). As I understand it, high uric acid levels in the blood cause uric acid crystals to form in the joint linings. As the joint moves, then, it's equivalent to having sandpaper rubbing against the joint linings and bone - This is amazingly, incredibly painful. Most people think that somehow since the pain is in your foot, you can somewhat mentally "isolate" it from the rest of your body and thus have some control over it. However, the only analogy I can submit which comes anywhere close is a "toothache in your foot". It's hard to imagine a sensitivity where you can't even stand the pressure of a sheet against your foot, but that's the case. Typical uncontrolled attacks (at least in my case) came on very suddenly without warnings. Within a space of about 6 hours I would be pretty much totally crippled. Neither heat nor cold packs seemed to make much difference. The area back of my big toe joint would have a hot, red appearance and would swell up to about the size of and shape a turkey leg. Gout being a "rich man's disease" probably comes from the fact that anything which aggravates the acid level in the blood may bring on an attack, including eating lots of red meat - since that was expensive until modern times, only the well to do might be exposed to the trigger... Treatment these days is pretty effective. An attack can be calmed within 12 hours or so to the point where it's possible to walk again. Without treatment, I found the attacks to gradually diminish over a week or 10 days... Unfortunately one of the treatments used 10 to 15 years ago was with an anti-inflammatory drug which could (and in my case probably did) cause liver damage. More recent steroid medications are effective without the bad side effects. Strangely enough I gradually "outgrew" the problem and haven't had a major attack for 15 years or so (eat much healthier than in my younger days - but I do carry around medication for an attack when I travel since if one came on I wouldn't be able to drive (since I have a manual transmission which requires the use of clutch, brake, and gas pedals). There is also SOME thought that gout MIGHT be related to high iq's (I kid you not...). Course a number of people would advance me as a counter example :=) In response to Frank Deis's comments, David Kausch asks: Does alcohol count too? In reading about the Civil War and/or the War of 1812 I recall coming across several officers (generals mainly) who drank heavily, had gout, were overweight and virtually useless. (Please forgive that last editorial comment.) Should I assume that heavy drinking was just a way of easing the pain? Or is there a correlation? Denise Inglis adds: Victims of childhood polio run the risk of getting severe gout as middle aged adults that can become very crippling. I am also wondering about the genetic factors in contracting diabetes. It seems to skip generations in my family. (My mother has it. Her grandmother had it.) I also heard that if there is a tendency in a family to have twins that tendency showed up every other generation. But in my family, by grandmother had a brother and a sister who were twins and then later my grandmother had twins herself (both sets of twins were fraternal, a boy and a girl). However there are no twins among my cousins or their children. In answer to David Kausch, Frank Deis says: I think that before the true basis of gout was known, especially in England there as an assumption that heavy drinking, especially of port, was a causative factor. Port is a heavy sweet red wine -- probably those who were wealthy enough to lay in a supply of vintage port also tended to eat the sort of rich food which DOES contribute to gout. I'm not a physician, just a biochemist, but I would think that heavy drinking might make one gain weight and thus be more likely to have an attack of gout, even though the alcohol itself wouldn't increase the level of uric acid. To David, Bill Waggoner says: David, as one who has suffered with gout, "useless" is not an insult. The pain can be so consuming that you think of nothing else. ANYTHING to ease the pain may be tried. Luckily I had modern drugs to help, in past times a few hundred bourbons would be seriously considered. GREEN SICKNESS: Anemia HALLUCINATION: Delirium HEREDITARY ANGIOEDEMA Dave Chasey says: Several of my ancestors on my father's side have a blood condition called Hereditary Angioedema. It is quite rare, and I feel there is a reasonable chance that others with this condition may be related to me. The problem can cause internal or external swelling, usually from a bump or other trauma. It can be as minor as mild swelling in a hand or foot, to internal swelling causing flu-like symptoms, to fatalities if the airway is blocked. One ancestor died in the dentist's chair after receiving an injection prior to having dental work done. It was not a reaction to the medication, but from the trauma from the injection causing his airway to be obstructed by the swelling and he suffocated, so I am told. BTW, if anyone currently has HAE, there is a drug to treat this condition called Winstrol. It is very effective and virtually eliminates the problems associated with the disorder. HIP GOUT: Osteomyelitis Tom Lincoln says: but only of the hip... osteomyelitis (usually a staphlococcal infection at that time) could occur in many bones, causing chronic drainage and often death... JAIL FEVER: Typhus - see the discussion under camp fever. Tom adds: not in the US KING'S EVIL: Scrofula, a tubercular infection of the throat lymph glands Tom's comment: also sometimes syphilis by a quite separate cynical reference LA GRIPPE: Flu Bob Wyman says: "La Grippe" is french for the English word "grippe." In modern days, we know this disease as either "influenza" or simply "the flu". The flu used to be a pretty deadly disease, and still can be for people with immune systems weakened either by other diseases, age, or bad health. Get your flu shots and your great-great-grandchild won't be wondering what you died of! LUES VENERA: Venereal disease Tom says: .later, specifically syphilis D.G. Gardner continues on from his response to Tom's first comments on typhus with: Also, lues refers specifically to syphilis, though again even the better physicians of 150 years ago may have trouble telling it from gonorrhea. Tom answers: Using the same source [Encyclopedia Britannica] for Syphilis: "In the 300 years following the post Columbian outburst much was learned about syphilis: signs and symptoms were recognized; its infectiousness was proved; means of transmission were clarified; the duality of syphilis and gonorrhea was reaffirmed; the lesions of congenital syphilis; and the treatment with mercury was widely used. In 1834 potassium iodide was introduced into the treatment of syphilis.." Although medicine labored under many difficulties in the 19th century -- as it does today -- physicians were good observers and could make diagnostic distinctions. Where they had the means, they could be quite successful. We tend to smile indulgently on their failures -- as others in the future will smile indulgently on ours. For example, our reliance on tests in circumstances where history and observation is more powerful and much cheaper... You don't need a light meter to know that the sun in shining... In Johnson on Cancer, Phila. 1813 the detailed observations are striking, partially because examinations were done with the bare hands. Prognosis of the diseases that could be reached in this manner was sound. For cancer of the breast: the treatment was radical removal of the breast including the contents of the axilla -- with the patient seated in a chair and her arm on the stretch, aided by two to four helpers and some whiskey and belladonna. The procedure took less than 5 minutes, and the prognosis was guarded... Surgery got much better with anesthesia.. but the prognosis in the large was little better until mid 20th century. The results have been improved with radiation and chemotherapy.. but I venture to say that these latter two modalities will look as primitive to the physicians in the next century as "cupping" does to us... Bleeding looks very arbitrary and stupid to us as a mode of treatment, but I suspect that it followed some very suggestive observations. One can show, for example, that after giving blood on a tight schedule that an endorphin high (runner's high) comes quicker than otherwise. As people injured themselves and bled a lot in previous centuries, and exercised as part of life and labor more than we do, this was certainly observed on a less formal basis. My hypothesis (unsubstantiated by any historical literature, but I would be interested in any out there) is that physicians were trying to promote this effect.. and probably sometimes succeeded -- often enough, in fact, to continue the practice. That the therapy had serious side effects, including death -- well... so do ours when we are faced with diseases that we can't control elegantly... LUMBAGO: Back pain LUNG FEVER: Pneumonia LUNG SICKNESS: Tuberculosis -0-0-0-0-0- End Part I -0-0-0-0-0-