"What an Affliction": Mary Todd Lincoln's Fatal Pernicious Anemia.

To date, no single diagnosis has unified the psychiatric illness and the numerous poorly defined physical complaints that Mary Lincoln (née Todd, 1818-1882) suffered in adulthood. Here, I show that her physical ailments spanned 30 years and included sore mouth, pallor, paresthesias, the Lhermitte symptom, fever, headaches, fatigue, resting tachycardia, edema, episodic weight loss, progressive weakness, ataxia, and visual impairment. Long thought hypochondriacal, these findings, plus their time course and her psychopathology (irritability, delusions, hallucinations, with preserved clarity), are all consistent with vitamin B12 deficiency. Pernicious anemia most probably caused this deficiency: she lacked risk factors for other causes, and her consanguineous parents both derived from a region of Scotland having a high incidence of pernicious anemia. A diagnosis of chronic multisystem pernicious anemia would clarify the conduct of Mary Lincoln as First Lady and widow, and illuminate challenges faced by her husband, President Abraham Lincoln. Her case highlights many forgotten features of the natural history of untreated pernicious anemia and is unique in the medical literature in demonstrating such a course extending over a lifetime.

The medical history of Thomas Jefferson (1743-1826).

Thomas Jefferson, the third President of the USA, was often the victim of a panoply of disorders including episodic headaches, dysentery, rheumatism, multiple bone fractures, malaria, possibly tuberculosis, dental problems, diabetes and urinary tract obstruction. Intermittently he experienced anxiety, depression and insomnia; he was an anxious, striving perfectionist, a compulsively controlled man.

From Dental to Mental Institutions: Elmer McKesson's Secondary Saturation with Nitrous Oxide.

As popularized by Elmer McKesson, MD, "secondary saturation" with nitrous oxide could expose patients to a second burst of 100% laughing gas to relax their muscles to assist surgeons. On rare occasions, this technique could provide a second opportunity for hypoxic brain damage and possible admission postoperatively to insane asylums.

From Dental to Mental Institutions: A Quadruple Threat of Nitrous-Oxide Administration Before and During Mental Asylum Admission.

During the 19th century, patients undergoing anesthesia for surgical and dental procedures were at risk of being given hypoxic or dilute nitrous oxide on four separate occasions. Primary and secondary saturation during surgery could account for two administrations of 100% nitrous-oxide anesthesia, while both diagnostic and therapeutic doses of dilute nitrous oxide were frequently administered in mental asylums.

[Operation T4 or the implication of the German dental surgeons in the ideology of eugenics and the euthanasia of mental lunatics]. / L'opération T4 ou l'implication des chirurgiens-dentistes allemands dans l'idéologie d'eugénisme et dans l'euthanasie des aliénés mentaux .

Many things have been said about the T4 operation and the sad role played by Nazi doctors. But one could ask the same question about the dentists? They played an important role as they examined, diagnosed and denounciated patients with congenital diseases. Their in-house training serving this purpose was very specialised. Their implication is even more unquestionable when it came to removing dental gold from the mouth of the victims. Once it was collected this gold contributed on a financial level, to the course of the T4 operation.

A review of the new provisions for sanctioning mentally disordered offenders in China, in a broader historical context.

Reforms of the criminal justice system in China in recent years have included the 2012 Code of Criminal Procedure (CCP), which resulted in new disposals for mentally disordered offenders. From a Western perspective, changes in Chinese criminal law are sometimes clichéd as toothless window dressing, but they may represent a genuine step forward in safeguarding human rights. Taking a historical perspective, this paper reveals that in the East, as much as in the West, there is a 'moral tradition' of not punishing mentally disordered offenders who are not considered responsible for their acts. There are clear differences in disposal for those acquitted having been found 'not guilty by reason of insanity'. Whereas Western jurisdictions have offered (criminal) courts the opportunity for commitment in (forensic) mental hospitals from the early 19th Century, in China, disposal has remained, until the recent changes, the responsibility of the administration (mainly the police) or the family of the offender. A few high profile cases brought to light the inadequacy of these arrangements and the general disregard of obvious mental health issues when sentencing offenders. There was lack of clarity regarding who would take responsibility for treatment and issues of future public protection arising from a mental disorder. The 2012 CCP introduces the power of mental health commitment by the judiciary for those found non-responsible for an offense because of a mental disorder. Similar to provisions in Western jurisdictions there remain human rights concerns regarding aspects of 2012 CCP and the role of 'preventive detention' for mentally disordered offenders on indeterminate secure mental health detention. Nevertheless, the shift to judicial decision making in such cases and the possibility of mental health commitment are welcome steps in improving the human rights of this vulnerable population.

Medicine among the ancient Maya.

Medicine among the ancient Mayas was a blend of religion and science. It was practiced by priests who inherited their position and received extensive education. The Mayas sutured wounds with human hair, reduced fractures, and used casts. They were skillful dental surgeons and made prostheses from jade and turquoise and filled teeth with iron pyrite. Three clinical diseases, pinta, leishmaniasis, and yellow fever, and several psychiatric syndromes were described.