Amboceptor

Microbiological, virological, bacteriological, immunological, medical, epidemiological, historical, anecdotal

Month: April, 2014

Confusing movie science: S+H+E (1980)

She. A title familiar to millions, from H. Rider Haggard’s 1887 adventure novel that’s had a half-dozen film adaptations, giving actresses like Helen Gahagan and Ursula Andress a chance to be statuesque and intimidating as the titular 2,000-year-old sorceress worshiped by remote tribesmen.she-poster-1979

This is not one of those films. Having bought it along with other 1980s VHS tapes, I expected the 1982 adaptation of Haggard’s novel starring Sandahl Bergman of Conan the Barbarian and Hell Comes to Frogtown fame. Instead, it’s the acronymic S+H+E: Security Hazards Expert, which aired on CBS in February 1980. Filmed on location in “Italy and Berlin”, this was an ambitious attempted pilot for a Charlie’s Angels-esque series about a female secret agent played by Cornelia Sharpe, wife of producer Martin Bregman.

She is as effective as you could hope for as a “Diana Rigg type”. The whole movie is entertaining, despite the random elements that only make sense if there are subsequent episodes (like her Italian boyfriend who wants her to retire and settle down) and the soundtrack consisting of the same song over the opening credits, closing credits, every montage, and every action sequence. Adding to the enjoyment was the single trailer that preceded the movie, for another CBS TV movie starring Dyan Cannon as a madam who was elected mayor of Sausalito, California.

* * *

she-opening

The last thing I expected from this movie was microbiological blog fodder. But after hearing the characters talk about the science that underlies the plot, I had to stop and figure out exactly why it didn’t make sense.

* * *

First, we’re introduced to the wine scientists. The whole movie is on YouTube as of today; start around the 23-minute mark for this conversation. Charming wine magnate Cesare Magnasco (Omar Sharif) is showing our heroine Lavinia Kean around his sinister winery. Frau Doktor Biebling is played by sixties icon Anita Ekberg, in what I believe was her last English-language role.

  • Cesare: Miss Blake, this is our distinguished oenologist, Frau Doktor Biebling.
  • Lavinia: How do you do?
  • Biebling: (silence)
  • Cesare: Dr. Biebling is a genius. A Nobel Prize nominee in parasitology from the University of Heidelberg. Doctor, tell Miss Blake what we do here.
  • Biebling: We are approaching a very critical phase in our latest experiment, Barone. It requires concentration and my closest attention.
  • Cesare: Per favore. For her American readers. To make them drink more Magnasco!
  • Biebling: Our chief concern is to protect the vines. Particularly from a genus of insects of the family Phylloxera.
  • Lavinia: Which of the 32 known species do you specialize in?
  • Biebling: (silence)
  • Cesare: They destroyed millions of acres of grapes when first brought to Europe.
  • Biebling: (withering stare) From America.
  • Lavinia: (smirking) I’m terribly sorry! I won’t disturb you any longer.
  • As they leave Biebling’s lab, Magnasco points to two Petri dishes, saying “Experimental cultures”. Another scientist asks Biebling mockingly, “Why don’t you develop an anti-jealousy microbe?”

The issue here is the word “parasitology”. Although the Phylloxera family of aphids do act as parasites to grapevines, someone who studies them would be an entomologist. Parasitology generally refers to parasites of animals — especially worms or microscopic eukaryotes like malaria, Toxoplasma or Giardia. Wikipedia claims it also refers to organisms like fleas and lice, but even this only extends to parasites of animals, not plants.

It’s possible that instead of being an expert on aphids, she is an expert on microscopic parasites of aphids. This hypothesis is supported by the “experimental cultures”, which look like bacterial broth. However, I don’t think there are any such microbes, whether eukaryotic or bacterial. There are methods of aphid control using aphid parasites… but those parasites are tiny wasps. So either way, she’d be an entomologist!

Finally, calling someone a “Nobel Prize nominee in parasitology” sort of implies that there is a Nobel Prize in Parasitology, which there isn’t. And although it is prestigious to be nominated for a Nobel Prize, it’s not quite like the Academy Awards. The 2014 Nobel Prize in Physiology of Medicine had 263 nominees.

* * *

But this is mere pedantry. The really confounding exchange is near the end, around minute 73. By now, the good guys have learned that Magnasco & Co. are holding the world’s petroleum supply hostage with something called “A.P.M.” Lavinia Kean, and her assistant/minder/colleauge Lacey (basically Bosley from Charlie’s Angels), have snuck into Frau Doktor Biebling’s laboratory again. They snoop around, and when they’re discovered, Lavinia injects Biebling with some sort of sedative, injected via flying mechanical bug.

  • Biebling: You again!
  • Lavinia: Do unto others… darling.
  • Biebling: I should have put you to sleep permanently. (passes out)
  • Lacey: (points to page of notes) “Anti-Petroleum Microbe”?
  • Both together: A.P.M.!
  • (she smears the orange liquid from one of the cultures on a slide, and they look at it under a microscope. Wriggling animalcules are seen through the lens)
  • Lavinia: There it is. A simple amoeba-type microbe found in tide pools. Elsa’s a parasitologist, but she wasn’t working on Phylloxera. She was developing A.P.M.
  • Lacey: I’m lost.
  • Lavinia: She fed and refined the algae with special nutrients. Now it’s a virulent strain that devours petroleum.
  • Lacey: I’m still lost.
  • Lavinia: When A.P.M. is mixed with petroleum it multiplies like crazy. Gasoline is refined petroleum.
  • She goes on to demonstrate how gasoline is flammable, but when mixed with A.P.M. it goes all foamy and inert.

This makes it clear that Frau Doktor Biebling is an expert on microbes, not so much on aphids.

This is gasoline. This is gasoline on A.P.M.

This is gasoline. This is gasoline on A.P.M.

Her work for Magnasco has been a matter of encouraging a certain microbe to grow on different substrates, akin to the classic experiments in microbial evolution where bacteria start to thrive on some molecule that used to poison them. With “A.P.M.”, they have made a microbe which “devours petroleum”, rendering it a foamy mass of uselessness. The notion of microbes engineered to eat hydrocarbons has been invoked for decades, generally as a good thing (cleaning up oil spills). Here it’s presented as a sort of plague, which if it ever enters a pipeline will spread and spread until it consumes our entire inexorably interconnected petroleum supply.

dave-barry-oil-slicks

In a column from the 1980s, Dave Barry sees petroleum-eating microbes as neither plague nor panacea.

One problem here is that the new, oil-eating microbe is described as a “virulent strain”. That’s not what “virulent” means. A virulent strain would be one that is particularly harmful or deadly to the organism it infects. A.P.M., though scary, isn’t infecting anything — it’s just consuming certain nutrients.

And then there’s that word “parasitologist” again.

It seems that in the world of this movie, vines are protected against aphids by spraying them with an infectious agent that kills the bugs. So she could be a “parasitologist”, if the infectious agent is eukaryotic rather than bacterial.

A.P.M. under the microscope

A.P.M. under the microscope

Amoeba proteus (click for source)

Amoeba (click for source)

And indeed, it’s described as “a simple amoeba-type microbe”. Judge for yourself if that view through the microscope shows an amoeba-type microbe. What are some other possibilities? They appear filamentous, but not rigid enough to be filamentous bacteria, and I don’t see the branching that would indicate fungal hyphae. Maybe they are fragments of some larger structure. Could these be strands of filamentous algae, but photographed in a way that washes out the color?

Yes! In addition to being an amoeba, A.P.M. is described as “algae”. It normally lives in tidal pools, but has been acclimated to life in petroleum. And here I admit a misconception of my own: I thought algae would be a poor choice for evil scientists seeking speedy evolution of new abilities, compared to bacteria. But this might not be the case – Bradley Olson’s evolutionary biology lab at Kansas State, for example, uses algae as a model organism.

The question now has to be asked: Does Frau Doktor Biebling do any work at all related to grapevines? What did she promise to do in her grant proposals?

* * *

To read about a real-life salt-loving microbe that eats oil slicks, go to the MicrobeWiki entry on Alcanivorax.

To learn more about colorless algae that are also amoebae, infectious parasites of oil and studied by entomological oenologists, watch S+H+E.

Follow Amboceptor on Twitter: @AmboceptorBlog

"The only way to deactivate A.P.M. is to freeze it in CO2, put it in metal containers and sink it in the Artic Ocean."

“The only way to deactivate A.P.M. is to freeze it in CO2, put it in metal containers and sink it in the Artic Ocean.” William Traylor (Lacey) and Cornelia Sharpe (Lavinia Kean) in S+H+E

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Yellow fever stops at the Miami airport.

staining-mosquitoes-before-liberating

Initially, new infectious diseases could spread only as fast and far as people could walk. Then as fast and far as horses could gallop and ships could sail. With the advent of truly global travel, the last five centuries have seen more new diseases than ever before become potential pandemics. The current reach, volume and speed of travel are unprecedented, so that human mobility has increased in high-income countries by over 1000-fold since 1800. Aviation, in particular, has expanded rapidly as the world economy has grown, though worries about its potential for spreading disease began with the advent of commercial aviation. [1]

Podcasts are great. But in the world of science podcasts, many are simply boring because there is only one person talking, or one person interviewing another person. Unless it’s slickly produced and edited (the Nature or Science Times podcasts), I’ll quickly lose interest.

It’s better when the podcast is three or four people who know each other, having a conversation. This is is the format of the TWi[X] series, particularly the flagship This Week in Virology. TWiV co-host Dickson Despommier, though not a virologist, contributes a big-picture point of view when the show leaves its territory of basic lab science and moves into epidemiology and patterns of disease outbreaks. Here’s his lecture on how West Nile arrived in North America and spread from state to state, energized by a very hot summer at the Bronx Zoo.

More than once I recall Dr. Despommier pointing out that though it’s all well and good to model how a epidemic might spread by looking at the day-to-day movements of people and mosquitoes, the most powerful and mobile disease vector is… the airplane.

That fact has become ever more clear with the SARS and West Nile outbreaks, as we used genetic analysis to track them across the continents in real time. But you might be surprised at how long ago people recognized the airplane as a challenge to disease control.

* * *

80 years ago, yellow fever was the archetypal mosquito-transmitted disease. Particularly as the disease was endemic in some parts of the world (e.g. South America), but not in others (e.g. North America), despite both places being home to the vector, Aedes genus mosquitoes. A 1934 article [2] coauthored by Henry Hanson, veteran of battles against yellow fever on three continents, points out that dengue fever (also transmitted by Aedes) had reappeared in Florida after an eleven-year absence, and yellow fever could do the same at any time.

dengue-1922-1934-tampa-miami

Hanson and coauthor T. H. D. Griffitts go on to chide the cities of Florida and Georgia for their complacency in providing countless unsupervised water vessels in which the mosquitoes can reproduce.

Practically every urban community in the South has its array of artificial containers, from flower vases to catch basins, cuspidors and discarded automobile tires, producing Aedes aegypti. For example, the city of Tampa in eight weeks reported finding 1,091,823 containers (potential mosquito “hatcheries”). Of these, larvae were found in 20,864, or approximately 2 per cent. This was an unusually dry season (average rainfall of 1 1/2 inches a month for this period). It is interesting to note that in Miami for a like period only 56,598 potential breeding containers were reported, with 38,401, or 68 per cent, of the total actually breeding.

So I made an error above. The vessels aren’t quite “countless”. There are 1,091,823 of them in Tampa, give or take a dozen.

Though concerned that yellow fever could reach North America (again), Hanson and Griffitts are more concerned about India. The disease is only known in jungle areas of Brazil, Colombia and Bolivia (they claim); by comparison, Africa is its ancestral “home” and India, fairly nearby by plane, is virgin territory for yellow fever epidemics.

Today there is a feeling of concern … that Old World territory, where the vectors abound and where yellow fever has never before stalked, may experience widespread and devastating epidemics. One infective mosquito traveling in an airplane from the home of yellow fever (Africa) to India could be the spark to start the conflagration.

Thus there was considerable surveillance for mosquitoes and infected passengers at airports worldwide.

The earliest article I can find specifically discussing airplanes as disease vectors is from 1930, the first [3] of two identically titled 1930s editorials in the American Journal of Public Health. I don’t know if the international rules discussed here were enacted, but they show awareness that quarantine and disinsectization measures developed for ocean travel need to be multiplied and intensified to cope with passenger aircraft. Click for a bigger view.

airplane-and-yellow-fever-1930

* * *

For the purpose of determining whether or not mosquitoes are carried in airplanes, and, if so, to what extent, the distance of such transportation, the species of mosquitoes, and the type of planes on which they are carried, the United States Public Health Service began, on July 23, 1931, the inspection of all airplanes from tropical ports arriving at the airports of the Pan American Airways System at Miami. [4]

An anecdote from less than a year later illustrates how the search for mosquitoes had become a normal part of a plane’s arrival in the U.S. from South America.

A very Normal Rockwell scene of mosquito inspection. From LIFE Magazine, 5/27/40.

A very Normal Rockwell scene of mosquito inspection. From LIFE Magazine, 5/27/40.

The story of “the first international aerial hitchhiker” is as follows.

Paul Kaiser, 25, tried to immigrate from Czechoslovakia to America via a circuitous route. First, he got to the German port of Bremen, from which he sailed to Colón, Panama on an ocean liner. Sneaking into the nearby Canal Zone airport, he climbed into the baggage compartment of a “big 22-passenger Commodore plane”. The plane first landed in Barranquilla, Colombia, where he was not detected. It then landed in Kingston, Jamaica, where he was not detected. Finally, after Kaiser had spent 2 days without food, he landed in Miami. However, in Miami “a very thorough inspection is given every plane for mosquitoes, for there is always danger of the deadly yellow fever mosquito surviving the short trip and landing in the United States, a most undesirable immigrant”. Check out the April 1933 issue of Flying magazine for more details.

A few months earlier, T.H.D. Griffitts (coauthor of the aforementioned Henry Hanson article) performed the first experiments on mosquito transport by aeroplane. These were published in late 1931, in an enjoyably conversational article in Public Health Reports [4].

Dr. Griffitts, you don't really have to describe the experiments you WANTED to do but then decided were unnecessary.

Dr. Griffitts, you don’t really have to describe the experiments you WANTED to do but then decided were unnecessary.

T.H.D. Griffitts (and J.J. Griffitts — his son?) start out by describing all the mosquitoes observed on normal commercial flights between July and September of 1931. Most were Culex quinquefasciatus, but several other species were observed including Aedes aegypti. In fact, a later Griffitts paper [5] indicates that the historic first mosquito discovered on a Miami-bound plane was Aedes aegypti. (It’s somewhat confusing that the insect apparently arrived on a “ship from San Salvador, El Salvador”, but I think that at this time the word “ship” could be used for aircraft. And San Salvador is definitely not a port city.)

Griffitts also put mosquitoes on three planes departing from San Juan, Puerto Rico, and looked for them upon arrival in Miami. Today it takes 2.5 hours to fly from SJU to MIA, but in 1931 they stopped at three other airports along the way and the average travel time was over 10 hours. A total of 100 mosquitoes were labeled with eosin dye (to distinguish them from non-experimental and Miami-resident mosquitoes). 22 were observed upon arrival in Miami, after 1,250 miles of flying, opening of doors and hatches, loading and unloading of luggage, etc. It seems obvious that the insects can be imported… but these experiments prove it.

* * *

Eight years after 1930’s “The Airplane and Yellow Fever” editorial, the American Journal of Public Health published another one [5], describing the policies for infectious mosquito control in Khartoum, Miami, and “the French Colonies and Mandates”.

As the 1930s progressed and India remained devoid of yellow fever, public health doctors kept amplifying their alarms about how devastating such an epidemic would be. From the 1938 editorial:

greatest-menace-in-the-world-today

75 years after that was published, yellow fever still hasn’t swept through India.

In 1938, the number of people who’d been vaccinated against yellow fever was less than a hundred thousand, mostly in Brazil. It had taken a long time to make a vaccine strain of YFV that was weak enough that it could be given as a live vaccine, but the 1938 trial (run by the Rockefeller Foundation) was successful, and in 1942 the number of people vaccinated was over 10 million. For his two decades of work on the vaccine, which along the way required multiple basic science breakthroughs for it to be manufactured in large quantities, Max Theiler of Rockefeller University received the 1951 Nobel Prize in Physiology or Medicine. Read more here [6] about Theiler’s story; read more here [7] about the many problems and hurdles that were overcome to end up with a safe vaccine. (I think the second one is open-access and the first one isn’t.)

Within a decade, though complications from the vaccine were common and the virus stayed endemic in the tropics, Theiler’s YFV vaccine had eliminated yellow fever as a source of large-scale epidemics.

* * *

Coda: As early as the airplane was recognized as a vector for disease… it was harnessed as a weapon against disease.

From a 1932 report in Science (8), Joseph Ginsburg of the New Jersey Agricultural Experiment Station explains how large regions of standing water that previously were inaccessible to mosquito control workers can now be reached by plane, so that the surface can be coated with larvicidal pyrethrum or oil.

cheesequake-killing-film

 

* * *

1. Tatem AJ, Rogers DJ, Hay SI (2006). Global transport networks and infectious disease spread. Adv Parasitol 62:293-343.

2. Griffitts THD, Hanson H (1934). Significance of an epidemic of dengue. JAMA 107(14):1107-1110.

3. Editorial (1930): The airplane and yellow fever. Am J Public Health 20(11):1221-1222.

4. Griffitts THD, Griffitts JJ (1931). Mosquitoes transported by airplanes: Staining method used in determining their importation. Public Health Rep0rts 46(47):2775-2782.

5. Editorial (1938): The airplane and yellow fever. Am J Public Health 28(9):1116-1118.

6. Norrby E (2007). Yellow fever and Max Theiler: The only Nobel Prize for a virus vaccine. J Exp Med 204(12):2779-2784.

7. Frierson JG (2010). The yellow fever vaccine: A history. Yale J Biol Med 83(2): 77-85.

8. Ginsberg JM (1932). Airplane oiling to control mosquitoes. Science 75(1951):542.

 

Taiwau Bozu: The bald geisha plague of 1901

The strange disease which has produced so much hilarity came, it is said, from Formosa; and a person may conclude that he has been attacked by it when he gets up in the morning and finds a hitherto hairy poll as bare as a billiard ball. No other symptoms make their appearance. It is bad enough for the Japanese gentlemen, but the ladies are quite terrified at the prospect of losing those coiled masses of glistening, jet-black hair which are often veritable works of art.hairless-japan

In this light-hearted style, English-language newspapers noted of an “epidemic of baldness” which afflicted the rapidly-modernizing nation of Japan in 1900 and 1901. The Sydney Daily Telegraph‘s unnamed Tokyo correspondent, writing in March 1901, goes on to rhapsodize about the “long raven locks”, the “shiny coils and bride-cake intricacies”, which rested on the heads of “singing girls of the well-known type of Rudyard Kipling’s ‘O-Toyo, ebon-haired, rosy-cheeked, and made throughout of delicate porcelain’,” before revealing that “in at least three or four cases” prominent Japanese ladies have had their heads rendered egg-like and their status in society thereby ruined.

The article gives the impression that a lot more men than women have been afflicted, but “[t]he strong point of a Japanese [man] does not by any means lie in his hair, which generally sticks up on his head as bristly and as stiff as the hairs on a blacking brush.” Thus our sympathy should be directed at the “singing girls” or “dancing girls” who so prize their raven tresses. And the Japanese, led by their one famous bacteriologist (probably Shibasaburo Kitasato, though Hideyo Noguchi would soon achieve similar fame) can surely deal with this problem.

The study of medicine is pursued with great ardor and success in Japan, which claims the honour of having produced at least one bacteriologist of international fame; and it is not surprising, therefore, that the doctors are studying the new disease with the liveliest interest. It should be no difficult matter to get hold of the pestilent little microbe that is the cause of all the trouble.

* * *

The mysterious plague apparently originated on the island of Formosa (now called Taiwan), which was under Japanese military occupation, following the island’s relinquishment by China under the Treaty of Shimonoseki. Formosa was a poor place at the time, compared to Japan, and a plausible source for a tropical disease.

Also in 1901, the London Spectator gave a more clinical report of the outbreak, courtesy of Berlin correspondent Louis Elkind, probably summarizing German press reports. Evidently “there was an epidemic of baldness at Chiba last year, and there has been an even more serious one quite recently at Osaka, the same province where, as it will be remembered, an extensive epidemic of plague … prevailed in the last months of 1899 and at the very beginning of 1900.”

The effects of the disease exhibit several interesting peculiarities. The bald patches are irregularly spread over the head, but the first large one generally appears on the crown and extends down the back of the head instead of forwards towards the forehead; thus it may be that the back of the head is quite bald and the front covered with hair — the opposite of the course of baldness as we know it in Europe. Then, also, men’s beards are ravaged in a peculiar manner. The left cheek, say, may be completely bereft of hair while the rest of the beard is as usual, as also is the moustache, which, fortunately, is but slightly affected by the disease.

* * *

Elkind’s report sounds more plausible than the Sydney correspondent’s chatter about ladies “shedding their ebony tresses — and shedding at the same time tears large as eggs”.

Utamaro (1753-1806), Kami-yui (Hairdressing)

Utamaro (1753-1806), Kami-yui (Hairdressing)

But did this really happen?

No, according to Dr. Stuart Eldridge, friend of Ulysses Grant and longtime contributor of short dispatches from Japan to the ASPH journal Public Health Reports. Eldridge’s obituary suggests an interesting career, including at age 28 being part of “the scientific mission to Japan under General Horace Capron,” and staying in Japan until his death 30 years later.

After updating Public Health Reports on Japan’s plague outbreak of 1899-1900, Eldridge sent in two brief reports about the bald geisha plague (Report #1, Report #2). Here’s the first.

eldridge-japan-1

No source is cited, but Eldridge thinks the disease is spread quickly, is spread by barbers, originated in Osaka (though the Spectator claims it was in Chiba first), and there is evidence for all these assertions though we don’t know yet whether the baldness is permanent.

However… one week later, Eldridge has consulted with the leader of Japan’s bacteriological efforts, and now doubts that the outbreak ever happened.

I have communicated with Professor Kitasato, thinking that, if it was of the importance and malignity ascribed to it by the newspapers and common fame, the institution under his charge would have already begun the investigation of the matter. Professor Kitasato informs me that so far he has been unable to obtain proper material for study, and that the cause of the malady has not been, as yet, ascertained. I am now somewhat inclined to believe that both the number affected and the severity of the disease have been greatly exaggerated, and that it may eventually prove that the ordinary cases of alopecia, always rather prevalent in Japan, and neither contagious nor particularly severe, have been magnified by newspaper sensationalism into something new and alarming.

At the same time Kitasato published an article in the newspaper Jiji Shinpo. Given his stature in Japanese medicine, I’m guessing this was a decisive blow against the local baldness hysteria. Kitasato’s thoughts were summarized by Albert Ashmead in American Medicine — after first giving a sample of that hysteria.

albert-ashmead-taiwau-bozu

“In some villages the hair of all the women in the place has fallen out. The people call the hair plague ‘Taiwau Bozu.’ The disease has robbed several dancing girls of their beauty. It is said to have been imported from Formosa, and the health authorities have gangs of men at work disinfecting the poor quarters of the towns. The hair plague seems to be spreading over a large area.”

Allow me to observe that Taiwau Bozu is not a new disease. The words mean Formosan Priest. All Buddhist priests in Japan have the head shaved, and thus one who is completely bald is said to look like a priest, in fact is called “priest.” … Dr. Kitasao says that “it is not the first time the disease has been epidemic in Japan. It does not come from Formosa, although the people think so. It is not very contagious. It is the same disease which occurs all over Europe, etc.” Inasmuch as the syphilis of Formosa is fiercer than the syphilis of Japan, and the syphilis of Europe is fiercer than that of Formosa, so Taiwau Bozu’s ravages differ in different countries.

… The disease is simply epidemic Tokuhatz-fizo (bald disease); Alopecia areata of specific origin (syphilitic), and it is contagious.

So according to the experts, we have a minor urban flare-up of secondary syphilis. (“The classic alopecia of secondary syphilis is patchy with a “moth-eaten appearance” and has been reported in up to 7% of patients.”) Possibly associated with the return of military forces from Taiwan (or Taiwau), as outbreaks of venereal disease sometimes are. Albert Ashmead’s interest in Japanese history lets him put the whole thing into perspective.

I add that in 1967, when the licensing of prostitution went into effect in Japan, the professions for women of “Geisha” dancing, tea-house and archery-gallery keeping, became crowded with prostitutes (more or less syphilitic) to evade the payment of the government tax. Then the hospitals of Tokio had to do with a great number of cases of syphilitic alopecia in no way different from the present outbreak

Follow Amboceptor on Twitter: @AmboceptorBlog.

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Medical photography, Dorothea Lange style

There are six illustrations in this paper. The first two show the layout of the sinuses. The other four are haunting.

From M.H. Gill (1906), Diseases of the Maxillary Sinus, Yale Medical Journal XII(9):821-829:

maxillary-sinus-1

maxillary-sinus-2

maxillary-sinus-3

maxillary-sinus-4

These people (three adult men with abscesses and “a female aged ten” with cancer) got sick and came to St. Francis Hospital around 110 years ago. We hope they got better.