Lost Hospital Series — Carville Hospital (Gillis W. Long Hansen’s Disease/Leprosy Center), Carville, Louisiana

Hansen’s disease, also known as Leprosy, is caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. The disease, named after physician Gerhard Armauer Hansen, typically presents itself with visible skin lesions, and if left untreated, can progress and cause permanent damage to the skin, nerves, limbs and eyes.

Leprosy may be one of the oldest diseases in history, first documented in an Egyptian papyrus circa 1550 B.C.

In 1921, the United States Public Health Service established the nation’s first “leprosarium,” located in modern day Carville, Louisiana. The leprosarium was a sanctuary of sorts for leprosy patients, as well as an academic and treating hospital for leprosy.  What eventually came to be known as “Carville” was a refuge for leprosy patients and a premier center in the efforts to to find a cure for the disease.

Carville’s history predates federal intervention, however. Dr. Isadore Dyer, an established academic figure on the subject of leprosy, helped negotiate the acquisition in 1925 of an area near the Robert Coleman Camp on a tract of land he purchased and quickly converted into a sugar plantation. Around 1857 Dyer built an elegant home on the campus that he used before and after the American Civil War for various purposes, including the treatment of leprosy.

By 1902 the facility housed up to 62 patients. By 1905 the State of Louisiana purchased the property and made some necessary improvements.  By 1917, however, the U.S. Public Health Service was looking to establish a site as a treatment center for leprosy, and the federal government assumed operations of the hospital in January 1921.

By 1923 the hospital expanded to house 425 patients, although even with these modern changes, the disease had strong connections with isolation and hopelessness. The hospital was indeed  more like a prison in many ways.

By 1931, however, conditions at Carville transitioned from prison-like into a campus dedicated to treatment, research, and care for voluntary leprosy patients.

After World War II, a number of veteran patients were admitted to Carville. Indeed, the publicity generated by the American Legion on behalf of Carville was perhaps the most influential action in solidifying not only the work at, but the reputation of Carville.

In 1941, the discovery of Promin was shown to cure leprosy, although the treatment involved painful injections. Called the “Miracle of Carville,” Promin led to dapsone pills in the 1950s. Pioneered by Dr. R.G. Cochrane at Carville, dapsone pills eventually became the main treatment for leprosy. Although initially quite successful, the bacteria causing leprosy eventually developed a resistance to the treatment.

A treatment involving multiple drugs appeared in the 1970s, the results of drug trials on the island of Malti. The World Health Organization began recommending this treatment in 1981, which was a combination of three drugs: dapsone, rifampicin, and clofazimine. This treatment could take up to one year, and sometimes longer, depending on the severity of the leprosy infection.

In 1986, the Carville facility became known Gillis W. Long Hansen’s Disease (Leprosy) Center, named after a United States Congressman. During its 100 plus years of dedication to treating the disease, Carville was the home to patients who often spent a majority of their lives on its campus, and sometimes even marrying there.

Carville closed in 1998 after operating for 104 years. The buildings and grounds were transferred to the State of Louisiana in 1998, and a museum honoring the work at Carville remains open to the public.

Pedestrian Aggressiveness Syndrome

Dr. Leon James and Dr. Diane Nahl have written books and articles on the subject of driving psychology. The research conducted by Drs. James and Nahl is posted on their website HERE.  In addition to a vast collection of information about road rage (including news and legislation from around the nation), there is a discussion about Pedestrian Aggressiveness Syndrome.

The experts have prepared a 15-point self-assessment scale one can use to self-diagnose. The scale can be found HERE, and it includes the following:

  1. Feeling stress and impatience when walking in a crowded area (crosswalk, staircase, mall, store, airport, street, beach, park, etc.)
  2. Having denigrating thoughts about other pedestrians
  3. Acting in a hostile manner (staring, presenting a mean face, moving faster or closer than expected)
  4. Walking much faster than the rest of the people
  5. Not yielding when it’s the polite thing to do (insisting on going first)
  6. Walking on the left of a crowded passageway where most pedestrians walk on the right
  7. Muttering at other pedestrians
  8. Bumping into others
  9. Not apologizing when expected (after bumping by accident or coming very close in attempting to pass)
  10. Making insulting gestures
  11. Hogging or blocking the passageway, acting uncaring or unaware
  12. Walking by a slower moving pedestrian and cutting back too soon (feels hostile or rude)
  13. Expressing pedestrian rage against a driver (like insulting or throwing something)
  14. Feeling enraged at other pedestrians and enjoying thoughts of violence
  15. Feeling competitive with other pedestrians

The degree to which these 15 traits manifest themselves in individuals, and the resulting implications, can be explored in greater detail on the website.

Cat Euthanized After Contracting H1N1

The Influenza A (H1N1) virus is a subtype of the influenza A virus and was the most common cause of influenza last flu season. Now, a Wisconsin laboratory confirmed the first case of H1N1 influenza in a domestic animal since January 2010. A six year old Wisconsin cat tested positive for the virus after developing the respiratory disease.

The source of the H1N1 case was linked back to the pet’s owner who also had flu-like symptoms just before the cat presented with signs of the virus. In addition to cats, strains of H1N1 have been found in pigs, birds, ferrets, and a dog. In each instance it is presumed the pets contracted the virus from humans, and there have been no reported cases of pets infecting humans.

The American Veterinary Medical Association (AVMA) reminds pet owners that some viruses are contagious between humans and pets, and owners should be mindful of their pet’s health, especially during the flu season. Like with humans, symptoms of H1N1 in pets can include lethargy, loss of appetite, fever, running nose or eyes, sneezing, coughing, or difficulty breathing.

The cat was euthanized after it did not respond to treatment. The AVMA tracks all instances of pet H1N1 HERE.

Lost Hospital — Marlboro Psychiatric Hospital, Marlboro Township, New Jersey

On June 30, 1998, Marlboro Psychiatric Hospital closed, 67 years after it opened. Construction on the New Jersey State facility began in 1929, and the hospital finally opened in 1931. By 1995 the hospital treated approximately  780 patients and employed 1,157. Marlboro Hospital’s budget in 1998 was $68 million.

Designed to accommodate 500-800 patients, the hospital was built on a 468 acre campus, enclosed entirely by a perimeter fence. Although built in a primarily rural area, Marlboro Hospital replaced a large distillery previously on the property. There were  17 “state of the art” cottages and central buildings on the campus. Marlboro Hospital treated adults and children, but in 1978 the children were transferred elsewhere. Adolescent patients left in 1980.

Marlboro Psychiatric Hospital had a troubled history, including a food poisoning incident in 1973 that made 131 patients ill and killed four.  One female patient who disappeared  was found frozen to death outside. Another female patient choked to death on a peanut butter sandwich. A male patient died from blood clots after he was strapped to a bed for 80 hours over 5 days.

Marlboro Hospital finally closed after three years of opposition from unions, families of patients, and homeowners who did not want the hospital nearby. The hospital was also the first of its size to close pursuant to New Jersey’s plan to deinstitutionalize patients with schizophrenia, manic depression, and severe depression, among other things.

Greg Roberts, the chief executive of Marlboro, noted he was sad to see the hospital close, but not sad to see the patients moved elsewhere.  ’This is the kind of place people were talking about when they said someone had been ‘put away,’ ” Mr. Roberts explained. ”For a long time, that’s what happened — people were put here and all but forgotten.”

Carolyn Beauchamp, executive director of the Mental Health Association in New Jersey, was happy with the decision to close the hospital. ’For the most part, people go through the state hospitals rather quickly,” Ms. Beauchamp said. ”They are stabilized, they got some care and they were moved out. But the people who were in Marlboro a long time really suffered the most — they spent long periods of their lives locked away, not really learning anything new and getting just custodially cared for — and there is really no excuse for that.”

The Healing Power of St. Valentine

A survey of health care’s history underscores how far the practice of medicine has come. With a dark, bloody, and confusing origin, health care and Valentine’s Day share this historical bond.

There is some evidence tracing Valentine’s Day back to February 14, in the year 270, the date St. Valentine (the word “valentine” is derived from the Latin valens, meaning worthy, strong, powerful) was executed for not renouncing Christianity. Before he was put to death, St. Valentine supposedly sent a note, signed “from your Valentine.”

Emperor Claudius II actually executed two men (both with the name Valentine) on February 14, although in different years of the third century.Claudius II persecuted one of the St. Valentines as a Christian. In some historical doctrine Claudius attempted to encourage this St. Valentine to convert to Roman paganism.  Instead, St. Valentine tried to persuade Claudius to convert to Christianity.  As a result, St. Valentine was executed, but before his execution, he was reported to have performed a miracle by healing the blind daughter of his jailer.

These martyrs were later honored by the Catholic Church with the celebration of St. Valentine’s Day. Pope Gelasius I did eventually mix Valentine’s Day with Lupercalia in the fifth century.

Between February 13 and 15, the Romans celebrated the feast of Lupercalia, which may have actually originated as a pre-Roman pastoral festival. Lupercalia was designed to ward off evil spirits and purify the town, bringing health and fertility for all. Lupercalia has some historical connection in antiquity with the Greek festival of the Arcadian Lykaia. This may also bear some historical nexus to the Lupercal, the cave where Romulus and Remus (the founders of Rome) were supposedly raised by a wolf.

About fifteen hundred years later, in 1913, Hallmark Cards of Kansas City, Missouri began to manufacture valentine cards.  The rest is history, and an $18 billion annual business.

More Patients, Less Doctors in California Emergency Departments

In 2005, the California HealthCare Foundation (CHCF) voiced its concern over the growing challenges faced by California emergency departments in ensuing adequate and proper physician coverage to meet patient needs.

CHCF has now funded an updated study in an attempt to document the state of on-call coverage in emergency departments. In partnership with the California Hospital Association and conducted by The Performance Alliance and the University of Southern California Center for Health Financing, Policy and Management, this new study includes a 2010 survey of hospitals.

The study shows that California emergency departments continue to struggle in meeting the needs for specialty coverage, and in many instances coverage has simply deteriorated. Some examples include:

  • In comparison to other states in the U.S., California received a “D+” grade in emergency care  and an “F” in emergency department access;
  • Between 1997 and 2006, California has experienced a 29% increase in emergency department visits, resulting from more people living in the State and statewide emergency department closures;
  • California emergency departments continue to report that physician specialists do not want to take hospital call in light of the changes in patient insurance over the past decade;
  • California emergency departments have experienced a reduction in the number of specialty physicians willing to take emergency call in 10 out of 16 categories;
  • California has more than 66,000 practicing physicians across the state, but 60% live in just 5 of the state’s 58 counties; and
  • In 2008 alone, California hospitals paid more than $1.6 billion for on-call specialty coverage.

Providing adequate emergency department coverage in California continues to be a challenge. In a recent survey, 88% of hospital executives stated they accepted this expense as the cost of keeping an emergency department open. In this same survey, 80% have listed specialty coverage concerns in the list of top ten hospital priorities.

The entire article, Physicians on Call: California’s Patchwork Approach to Emergency Department Coverage, can be viewed at the CHCF Website.

Los Angeles Wants Condoms In Pornographic Films

When a actor in the pornographic film industry recently tested positive for human immunodeficiency virus (HIV), a local clinic responsible for the industry’s well being was shut down, sending pornographic actors elsewhere for testing.

And even though the clinic has recently reopened, Los Angeles City lawmakers voted unanimously last week to draft new legislation to require the use of condoms on the set of every pornographic movie made in Los Angeles.

According to City Councilman Bill Rosendahl: “We can’t keep our heads in the sand any longer. These people should be using condoms. Period.” This new law would be the first to impose such safety standards for the pornographic film industry. In fact, until the late 1990s, the industry was unregulated.

Industry representatives have relied upon a self-regulating system in the past, identifying just five cases of HIV infection among industry actors (although none were directly tied to on-set exposure) — none of them definitively tied to on-set exposure — since an outbreak in 2004.

“This has been working for years,” said Steven Hirsch, founder of Vivid Entertainment. “If we saw people getting sick, we would go to mandatory condoms.” Industry officials  oppose the new regulations, citing to a direct correlation between condom use and sales, not to mention actual use of condoms is difficult to enforce on set.

According to Jan Meza, a performer who contracted two sexually transmitted diseases before she left the industry in 2007:  “At first, I would ask about condoms, and they told me I’d never be able to find work. You do worry about the risk, but any girl desperate for money, like I was, is still going to do it.”

“Testing just acts as a fig leaf for producers, who suggest that it is a reasonable substitute for condoms, which it is not,” said Michael Weinstein, president of the AIDS Healthcare Foundation. “Syphilis and gonorrhea pose significant health risks, not only to the performers but to the rest of the community.”

Since 2004, California’s Division of Occupational Safety and Health has tried to mandate the use of condoms and other protections in the industry, but with little success. “It’s slow going,” said Deborah Gold, a senior safety engineer with the division. “We have a limited number of resources.”

Even if the law passes, enforcement may be challenging. California receives up to $13 billion in annual revenue from the industry, a much needed income source for the State’s struggling economy.  According to Jim South, a talent agent in the industry: “I tried many years ago to get everybody to go to condoms. Quite a few companies did, but sales fell severely. The switch would be very difficult.”

California Seismic Safety Standards 101

In light of a recent report on the status of seismic safety for California hospitals, as well as some discussion about the expense involved, the following is a summary of the structural performance categories (SPC) established by California’s Office of Statewide Health Planning and Development (OHSPD) for state-wide hospitals:

  • SPC-0 The hospital evaluated this building but did not provide any rating in its report to OSHPD.
  • SPC-1 These buildings pose a significant risk of collapse and a danger to the public after a strong earthquake. These buildings must be retrofitted, replaced or removed from acute care service by January 1, 2013 (or 2015 in some cases) for many hospital buildings.
  • SPC-2 These are buildings in compliance with the pre-1973 California Building Standards Code or other applicable standards, but are not in compliance with the structural provisions of the Alquist Hospital Facilities Seismic Safety Act. These buildings do not significantly jeopardize life, but may not be repairable or functional following strong ground motion. These buildings must be brought into compliance with the Alquist Act by January 1, 2030 or be removed from acute care service.
  • SPC-3 These buildings are in compliance with the structural provisions of the Alquist Hospital Facilities Seismic Safety Act. In a strong earthquake, they may experience structural damage that does not significantly jeopardize life, but may not be repairable or functional following strong ground motion. Buildings in this category will have been constructed or reconstructed under a building permit obtained through OSHPD. They can be used to 2030 and beyond.
  • SPC-4 These are buildings in compliance with the structural provisions of the Alquist Hospital Facilities Seismic Safety Act that may experience structural damage which could inhibit the building’s availability following a strong earthquake. Buildings in this category will have been constructed or reconstructed under a building permit obtained through OSHPD. They may be used to 2030 and beyond.
  • SPC-5 These buildings are in compliance with the structural provisions of the Alquist Hospital Facilities Seismic Safety Act, and are reasonably capable of providing services to the public following strong ground motion. Buildings in this category will have been constructed or reconstructed under a building permit obtained through OSHPD. They may be used without restriction to 2030 and beyond.

The following is a summary of non-structural performance categories (NPC): These ratings cover a building’s non-structural systems including communications, emergency power supplies, bulk medical gas, fire alarms and emergency lighting.

  • NPC-0 The hospital evaluated the building’s non-structural components but did not report any rating.
  • NPC-1 In these buildings, the basic systems essential to life safety and patient care are inadequately anchored to resist earthquake forces. Hospitals were required to brace the communications, emergency power, bulk medical gas and fire alarm systems in these buildings.
  • NPC-2 In these buildings, essential systems vital to the safe evacuation of the building are adequately braced. The building is expected to suffer significant nonstructural damage in a strong earthquake. Hospitals must meet this deadline by January 1, 2013 (or under new legislation (SB 499) apply for an extension through January 1, 2030).
  • NPC-3 In these buildings, nonstructural systems are adequately braced in critical areas of the hospital. If the building structure is not badly damaged, the hospital should be able to provide basic emergency medical care following the earthquake.
  • NPC-4 In these buildings, the contents are braced in accordance with current code. If the building structure is not badly damaged, the hospital building should be able to function, although interruption of the municipal water supply or sewer system may impede operations.
  • NPC-5 These buildings meet all the above criteria and have water and waste-water holding tanks—sufficient for 72 hours of emergency operations—integrated into the plumbing systems. They also contain an on-site emergency system and are able to provide radiological service and an onsite fuel supply for 72 hours of acute care operation.

Additional information can be found on OSHPD’s Website under seismic retrofit program.

The Power of Play

All work and no play makes Jack. . . sick.  At least according to Dr. E. Christine Moll, a leisure expert, professional counselor, and professor of counseling and human services at Canisius College in Buffalo, New York.

Leisure time or “play” is as important as exercise, Dr. Moll explains: ”It airs out our brain. It renews our spirit. It gives us clarity of thought. It’s a benefit to our blood pressure. It gives us life satisfaction. For all the dimensions of our lives: our physical, mental, spiritual and cognitive health, leisure time should be a necessity not a luxury.”

Moll defines leisure as just about anything that brings personal enjoyment, providing individuals an opportunity to recharge. “Work is the single activity we do most in our lifetimes. We work more than we sleep or eat. Our health and medicine are so much more improved than they were a century ago but we’re going to wipe ourselves out because we’re just working, working, working.”

David L. Farrugia, PhD, chair of the Counseling and Human Services Department at Canisius and also a professional counselor, notes that many patients see him after they visit an internal medicine doctor. Often, according to Dr. Farrugia, stress is to blame. ”Physiologically, the body is able to adapt and function at high levels of stress but eventually it begins to take its toll on a person’s mental and physical health.”

Known as General Adaptive Syndrome (GAS), a term first coined in the 1930s, this refers to the consequence of the failure of an organism – human or animal – to respond appropriately to emotional or physical threats, whether actual or imagined. Hans Selye, MD, pioneered research in this field and is known as the “father of the stress field.”

According to a study done by Summer M. Reiner under the supervision of Moll: “Findings show that people who nurture leisure activities throughout their lives have a much healthier outlook physically, mentally, emotionally, socially and in their sense of selves. Extra-curricular activities for school-aged children contribute a lot towards their development.”

The results of Reiner’s research was published in Counseling Today Magazine.

A Lost Art of Execution1

If you lived in England circa fourteenth century, and you also happened to be guilty of “high treason” (significant disloyalty to your own government through particular actions such as waging war against said government, and sometimes spying), there was a good chance your punishment would be severe. For those found guilty of such acts, the penalty was “to be hanged, drawn, and quartered.”

While recordings of this punishment date back as early as the reign of King Henry III (1216 to 1272) and his successor Edward I (1272 to 1307), to be hanged, drawn, and quartered was an official penalty in England as of 1351.

The process was quite simple: Individuals convicted of the requisite crimes were fastened to a wooden hurdle (a portable part of a fence, usually made from branches and in more modern times metal) and then dragged by horse to the specific location where the execution was set to occur.Then, the subject was hanged in traditional fashion — but only to the point of near death, not actual death – followed by punishments of emasculation (removal of the genitals), disembowelment (the removal of some key internal organs), beheading (an act which needs no explanation), and then finally quartering. By tying the individual’s four limbs to a different horse and then sending each horse in a separate direction, the act of quartering was complete. … Read more →