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The Admission of Women to Medical Degrees

In researching my post on Charles-Édouard Brown-Séquard, I came across this lovely gem of a letter published in The Lancet in 1878:

SIR,—I hope you will allow me to direct attention to the kind of examination-as shown by recent papers-which women will have to undergo, in company with young men, in order to gain admission to the medical degrees of the University of London. I ask this in the hope that many of the Arts, Laws, and Science graduates who read THE LANCET may be enlightened upon this particular point. On turning to the examination-papers for the last half-dozen years, I find, amongst others, the following questions, set by the examiners: [selected few to follow]

  • Second M.B., 1873.-" Give an account of the modes in which syphilis becomes propagated; the details by which the poison is diffused throughout the system, &c."
  • First M.B., 1873.-" Describe the connexion of the lower four inches of the rectum in the male, the naked-eye character of the coats of the gut for the same distance, &c."
  • First M.B., 1875.-" Give an account of the genito-urinary organs of the human male."
  • B.S., 1876.-"Describe in the order of their frequency the several growths which affect the testis, and mention the signs on which you would chiefly rely in the diagnosis of each."
  • Second M.B., 1875 (Honours).-" What constitutes rape. Mention the lesions which may result from rape (a) in the case of adults, and (b) in the case of children, pointing out the local affections of the genital organs which may simulate the effects of rape, &c."
Is it surprising that the great majority of the medical graduates view with "detestation" the proposal that women should be admitted to the same degrees as men ; the possibility that young women and young men should be subjected to a precisely similar examination, at the same time, and in the same testing-room, upon the topics dealt with in the above quoted questions, and that they should similarly undergo the necessary anatomical and clinical training to fit them for passing such an examination; and, lastly, that women should be encouraged and actively aided to enter the list in honours, in competition with young men at the same table, and, if possible, to carry off the palm for a more intimate acquaintance and superior knowledge upon such subjects as diseases of the testicles, rape, and the like. To my mind the thing is revolting in the extreme, and I believe that when the real facts of the case are known to them, very few non-medical graduates would countenance, in its present form, the proposal to admit women to medical degrees in the University. Yours faithfully, TILBURY FOX.
Well... how about that. Way to go Dr. Fox.


Brown-Séquard, spinal cord research, and sperm injections

Charles-Édouard Brown-Séquard

I should learn by now that any time I begin digging into the classic neuroscientific literature, I'm going to find weird stories. I've already covered Henry Head's self-experimentation and... penis dipping as well as Hans Berger's psychic experiments. Why should Charles-Édouard Brown-Séquard be any different?

This post was supposed to focus on how interesting it is that much of what was first learned about the organization of the input and output pathways of the spinal cord was due to the work by Brown-Séquard. But forget it. This post is taking a whole new direction. Honestly, I can't do any better than just quote what Brown-Séquard wrote. I won't even try. Apparently Dr. Brown-Séquard wasn't a stranger to self-experimentation himself; he says:

I have made use, in subcutaneous injections, of a liquid containing a small quantity of water mixed with the three following parts: first, blood of the testicular veins; secondly, semen; and thirdly, juice extracted from a testicle, crushed immediately after it has been taken from a dog or a guinea-pig. Wishing in all the injections made on myself to obtain the maximum of effects, I have employed as little water as I could.

At the time of this letter in The Lancet, Brown-Séquard was 72. His experiments were carried out in hopes of regaining vitality, because he believed that

...in the seminal fluid, as secreted by the testicles, a substance or several substances exist which, entering the blood by resorption, have a most-essential use in giving strength to the nervous system and to other parts. But if what may be called spermatic anaemia leads to that conclusion, the opposite state, which can be named spermatic plethora, gives as strong a testimony in favour of that conclusion. It is known that well-organised men, especially from twenty to thirty-five years of age, who remain absolutely free from sexual intercourse or any other causes of expenditure of seminal fluid, are in a state of excitement, giving them a great, although abnormal, physical and mental activity.

As odd as this sounds to us, this letter is often credited as the beginning of modern endocrinology.

There are some brilliant gems in this article about his other forays into self-experimentation:

While teaching at the Medical School of Virginia, in the Egyptian Building, he attempted to elucidate important functions of the skin. He coated himself with varnish from head to foot and was later found unconscious on the floor... In another example, during the cholera epidemic on Mauritius, Brown-Séquard personally volunteered to treat the victims. He had known from Magendie's work that opium might be effective. To prove the efficiency of the drug, he attempted to catch cholera by swallowing the vomit of one of his patients and taking a large dose of laudanum.

Then there was his use of meat enemas to feed his patients; he says:

The patient had a violent and persistent spasmodic contraction of the oesophagus, caused by an inflammation of the brain. Finding that it was impossible to force a tube down into the stomach, we resolved to feed the patient by enemas of meat and pancreas. The bowels having been cleansed by an injection of lukewarm water, a part of which was generally kept, a mixture of about two-thirds of a pound of raw beef, with one-fourth or one-third of a pound of pancreas (hog’s) was pushed into the rectum by means of a wooden syringe. This operation was repeated twice a day, and the patient was so well fed by that means that he had not visibly lost flesh when he died-after apoplectic symptoms- eight days from the time these enemas had been first used... It is essential that the pancreatic gland which is to be used be from an animal quite recently slaughtered, as the tissue and juice of that gland lose their property very quickly if the temperature of the surrounding air is at all high.

He then goes on to suggest that this method would be useful in asylums:

I would call the attention of alienists and of superintendents of lunatic asylums to the advantage they would find in employing such a means of feeding, instead of the usual plan of forcing food into the stomach of patients who obstinately refuse to eat. The difficulty of forced alimentation would thus be very much lessened.

For those of you not familiar, there term "alienist" is an archaic term for, essentially, a psychiatrist. The history of psychiatry and alienism certainly merits its own, in-depth series of posts here some day...

I could go on quoting Brown-Séquard all day, but really, just do some googling and pubmed'ing and check him out. Absolutely fascinating.


Star Wars, Avatar, and nostalgia

There's a fairly benign-seeming question over at Quora which of course has already generated some strong, opinionated responses:
Which was more groundbreaking in its time: original Star Wars (1977) or Avatar (2009)?

As of this writing, the top two answers are:
Definitely Star Wars.
Avatar is nothing more than an expensive tech-show, with no underlaying story or idea whatsoever; so that's not a fair fight.

Now let me be clear, I am a Star Wars fan through and through. When I was about 12 I played a Twi'leki in the (pre-Wizards of the Coast) Star Wars RPG. My shining moment was when I shot down a TIE fighter from the back of a speeder bike (TIE fighters aren't very aerodynamic... It shouldn't have been in an atmosphere, so lots of penalties, etc.).

With that fan-boy armor donned, I have to say that I very much disagree with the statement that "Avatar is nothing more than an expensive tech-show, with no underlaying (sic) story or idea whatsoever," at least as compared to Star Wars.

Actually, I would argue that Star Wars and Avatar are complementary story archetypes. Star Wars is essentially a classic magical story in a sci-fi setting. Avatar is in a lot of ways a sci-fi story in an old-fashioned naturalistic setting.

Now, if you can find someone who hasn't yet seen Star Wars (and they do exist) and show them A New Hope, Empire, and Jedi, you'll probably be surprised at their reaction. Once you remove the fine glaze of nostalgia that most of us have for the original trilogy, you'll see how bad parts of these movies really are. As seen through novel eyes C-3PO is an incredibly terrible character. While it's not quite as annoying as Jar Jar, 3PO is at least in the same ball-park. And Luke is frustratingly whiny (whingy, if you're a Brit). Seriously he's Shinji-level whiny.

Granted, the technology used in creating Star Wars was amazing for the time. And the story is definitely engaging. When the dialog isn't Lucas's, it can be poignant and even moving. I still believe that Han's "I know" response to Leia's "I love you" is probably the best in film (followed closely by Spike's "no you don't, but thanks for saying it," in response to Buffy's "I love you"). The story is a well-told one overall but it is improved by being set in a novel (for the time) sci-fi world.

Avatar's story is derivative, too. But it's also in a novel setting. I mean, you've got the whole transfer-of-consciousness tech that is used in a really cool way. The only other place I've seen idea fleshed out is in Richard K. Morgan's novels about his Takeshi Kovacs character.

Step away from your nostalgic, pre-curmudgeonly late 20s/early 30s self and look at Avatar through the eyes of your 9-year-old self. Up until Avatar, all you'd have seen are some crappy 3D gimmicky movies. But then Avatar takes the tech to a whole new level. What 9-year-old doesn't want to be a giant, strong, fast, tough, gun-toting cheetah monkey? That's just cool!

Now, I know it's all the rage these days for neuroscientists to try and connect some pop-culture thingy to the brain somehow. I could say that nostalgia reinforces pleasure circuitry through relived memories of a simpler, happier or some such, but that would be a bunch of crap. All I know is that nostalgia can be a very powerful lens through which we observe the world around us.


Sir Henry Head's self-experimentation

Sir Henry Head

There is a long, storied, mad science tradition of self-experimentation. On the fictional side there are several archetypes. The first one that comes to mind for many is Dr. Jekyll and Mr. Hyde. Personally, being a huge nerd, I tend to think first of the multitudes of comic book examples; both the hero and villain super types. There’s Doc Ock’s tentacle arms. There's Reed Richards, who launched his space ship too soon to try and prove that his scientific acumen was better than his short-sighted funding agencies. There's Ultimate Bruce Banner. The Beast. Norman Osborne. And so on. It’s an especially prevalent theme in the Marvel Universe.

However, self-experimentation is not limited to fiction. Real-world examples abound. The most well-documented pre-modern case of scientific self-experimentation is from the early 1600s with Sanctorius and his “weighing chair”. Sanctorius weighed himself, everything he ate and drank, every excretion, for 30 years, to study metabolism. Notably, while this is the most famous documented case, I’m quite sure there is also a fine history of people trying shit out just to see what happens. That’s science, too. Just ask my wife when I come home after a night of drinking with second degree burns.

Of course, there are more modern examples. Albert Hofmann found himself tripping one lovely Swiss afternoon during his famous bicycle ride. So what did he do? He tried LSD again to see if his experience was tied to the drug. Self-experimentation has even lead to a Nobel Prize (and an IgNobel Prize). Barry Marshall campaigned for years that peptic ulcers were bacterial in origin and not due to stress or other behavioral factors. Finally he proved this by drinking a petri dish of H. pylori. He is even quoted as saying, in proper mad science fashion, “everyone was against me... but I knew I was right...” On the IgNobel side, Donald Unger spent 50 years cracking only the knuckles of his left hand, and not his right, to show that knuckle-cracking does not lead to arthritis of the fingers.

Following in this fine scientific tradition is the brilliant and influential neurologist (not to mention appropriately named) Sir Henry Head. If that’s not a proper 1960s punny, alliterative, Stan Lee name for a neurologist, I don’t know what is. Anyway, the good Dr. Head published quite a ground-breaking article with his collaborator WHR Rivers in the journal Brain in 1908 titled A Human Experiment in Nerve Division. In this article, Head and Rivers sought to examine the course of recovery of somatosensation after peripheral nerve damage. It was known from observing patients with such damage that the touch senses often recover after peripheral nerve damage, but because the patients weren't properly trained, they couldn't give an adequate account of their own recovery. As they say:

It soon became obvious that many observed facts would remain inexplicable without experimentation carried out more carefully and for a longer period than was possible with a patient, however willing, whose ultimate object in submitting himself to observation is the cure of his disease.

So Head's solution? Cut open his arm and sever some nerves! Dr. Head enlisted the assistance of another doctor to surgically sever some of the peripheral nerves in his left arm and hand. In the figure below, you can see the outline where all initial sensation was lost on his arm. In this figure, eighty-six days post surgery, his pain sensations had returned to almost the entire region.

Sir Henry Head, left hand, Fig. 10

They continued their long-term testing and observations for four years and they were able to conclude fairly conclusively that different somatosensations are processed separately early on, but later combined higher up in the processing stream to give a unified sense of touch. What's especially amusing is their attempt to find a control region on the body that can sense pressure and pain but not soft touch:

We then discovered that the glans penis responded to cutaneous stimuli in that peculiar manner with which we were already familiar from our study of the first stage of recovery after nerve division.

They then went on to describe in amusing, medical detail their experiments on Dr. Head's... well... head:

In the case of [Head], the tip happens to be devoid of heat-spots but is sensitive to cold and to pain. When... it was dipped into water at 40° C, no sensation of heat was produced, but [Head] experienced an unusually disagreeable sensation of pain... But, as soon as the water covered the corona without reaching the foreskin, both cold and pain disappeared, giving place to an exquisitely pleasant sensation of heat.

Teenaged giggles aside, it's a fascinating sketch of early modern medical research. It's also an interesting account of how sometimes self-experimentation and observation can really offer insight into the workings of the brain and body. As my wife pointed out, there's an amazing contemporary example of this phenomenon: Dr. Jill Bolte Taylor's account of her own stroke.

There's a nice personal view of Dr. head that was written in the journal Brain in 1961 titled, Henry Head: A Man and his Ideas. It was written by Brain's long-time editor—and I'm not making this up—Dr. Russell Brain, 1st Baron Brain. Again, another excellent Stan Lee mad scientist name. And no, the journal wasn't named after him... it existed for many decades prior to his tenure as editor. All of the Brain articles I've linked to, by the way, are free and open access. Thanks Brain!


Hooray publications! (Shhhhhh...)

So I've been a bit quiet on here, I realize. But I've got a shiny new History of Weird Neuroscience post coming tomorrow, I promise.

Part of the reason why I've been quiet the last few weeks is because I've been totally enveloped by a new project. This was the fastest paper I've ever done: about 3 weeks from the first idea, all the way through coding the math and running the statistics, making the figures, and writing the paper. It's a method paper, so I didn't have to collect any new data, which saved a lot of time, but honestly I'm quite proud of the method and paper all around. We'll see what my boss/co-author thinks when he reads it this weekend.

The second reason I've been so quiet is that two of my papers have been accepted for publication! The first is on how the prefrontal cortex and basal ganglia interact during visual working memory and was accepted in PNAS (The Proceedings of the National Academy of Sciences of the United States of America). The second, accepted in Neuron, is on how the brains of people with strokes that have damaged the prefrontal cortex compensate for the cognitive deficits associated with that damage.

(Not so) amusingly, both papers are now under embargo and I'm not really supposed to talk about them yet. But as soon as the embargo period is over I'll do a longer post for each of them on here.