Meningitist that Caused the Need for Psychiatric Procedures
Written by Czech Hospital Placements on Sunday, May 1, 2016
Meningitis Knick Psychiatry Venesection Mental Illness Serebrospinal Fluid Lumbar Puncture
The history of medicine can be quite interesting, as well as, threatening. As an educational healthcare program we want to enlighten you the reality beyond the Knick stories (a medical TV series). This time with meningitis treatment and methods used in psychiatric asylums. Pulling out teeth to treat mental illnesses? FACT! Performing venesection in hope to save a little baby’s life? FACT! Parents taking photos of their own dead children? FACT!
At first, let’s clarify what meningitis is and what the symptoms are. This disease means an acute inflammation of the meninges, the protective membranes that protect the brain and spinal cord. As a life-threatening disease, it is classified as a medical emergency condition and an infected person needs to find immediate care. It is caused by viruses, bacteria, or other microorganisms. According to the origin, the disease is called viral, bacterial, fungal, parasitic, or non-infectious meningitis.
In The Knick series, you can see a small baby named Lilian, a daughter of Eleanor and Everett Gallinger, infected with meningitis. The symptom how doctor Everett Gallinger recognized the meningitis, was a stiff neck. Perhaps unbelievable, but it is one of the main cognitive signs of meningitis. Furthermore, the patient goes to an opposition and has the head in a strange angle. The one they were talking about after they tried to cool her head. Other symptoms are headache, fever, confusion, vomiting, and light or noise phobia. To determine the disease, doctors today do a lumbar puncture.
A lumbar puncture is sampling the cerebrospinal fluid (CSF). The CSF circulates around our brain and spinal cord. It gives us information about metabolism and an inflammation of the nervous system structures such as meningitis. A Lumbar puncture is a very safe procedure, usually carried out by a neurologist. During the examination the patient lays down on their side. The doctor sits behind the patient and palpates the gap between the vertebrae of lumbar (low back) region. Then inserts a needle and the cerebrospinal fluid is collected for testing. After this procedure, the patient should lay down for a few hours to prevent from, so called, post puncture syndrome, that is characterized by a severe headache.
You can later find out in the episode that it was the father himself who brought the infection home as he was in contact with a patient bit by rats. Although, Everett did not have any symptoms and did not suffer from the disease, he could transmit the disease and carry antidotes. This is not unusual not only for meningitis disease, but also for others, as for example typhoid. From history, is the well known Typhoid Mary, who infected a lot of people in New York before she was determined as the disease vector. You can see her also in the Knick stories.
The treatment of meningitis has changed a lot since the 1900’s where the Knick series takes place. Whereas, before they tried to cool the head of the patient or treat him / her by venesection. Today the more effective treatment is: antivirotics, antibiotics, or steroids according to which the type of meningitis. Venesection meant decreasing the amount of blood in the system. With the blood also a part of toxins disappeared and the patient usually got better, at least for some time. Small Lilian died, as at this time there were no medications.
Do you remember the moment when Dr. Everett Gallinger and his wife Eleanor took a photo with their deceased baby daughter? That was nothing abnormal during that time! This habit, called Memento Mori, was supposed to remind to the survivors that death is a part of everyday life. When you think about the historical context, the mortality level was very high in the beginning of 20th century. The Memento Mori was one of the ways on how to cope with the death of beloved ones.
We all know what followed afterwards. Eleanor became mentally ill. Dr. Gallinger brought home an orphaned small baby, named Grace, hoping his wife Eleanor would deal better with their loss. Unfortunately it didn’t work. Eleanor killed her by submerging her in ice, as a procedure that their daughter had to undertake as a treatment of meningitis. Thereupon, Everett sent his wife to a psychiatric asylum for treatment. Once, he visited her and found that out her teeth had been taken out for a medical reason. Unbelievable, though, a commonly used practice!
Henry Cotton was not only Eleanor’s psychotherapist, but was also a real person who lived in the beginning of 1900s and claimed this is a successful treatment! He started with the teeth and proceeded in removing tonsils, adenoids, the colon, spleen, stomach, and other parts of human body. Most of his patients did not survive the surgery and if they did they were not in a condition to make any complaints. Don’t think that Dr. Cotton needed a psychotherapist as well. These procedures were actually based on a theory that the mind disorders might spread just like other diseases. They thought that by removing the assumed source of the infection, the mental illness would be cured. Henry Cotton believed in the theory so much that he removed the teeth of his wife and children as a precaution!