CBS News Online covered the Burns Archive with the story here. In this post I am featuring the images with extended descriptions.. The article became the most popular on cbsnews.com last week. Please check out the coverage
CIVIL WAR BULLET WOUND OF THE EYE, 1864
During the Civil War Reed B. Bontecou, MD Surgeon in Charge of Harewood US Army Hospital in Washington DC photographed wounded soldiers in artistic poses documenting their wounds. He was the first to apply photography to produce wounded and healed state photographs and it the first attempt to show the results of treatment and healing in soldiers. Bontecou is credited as being the largest contributor of photographs to the Army Medical Museum and to US government post war medical texts. His images of wounded soldiers can be found in Shooting Soldiers: Civil War Medical Photography by R.B. Bontecou in conjunction with an exhibit at New York’s Merchant House Museum.
RODENT CANCER, 1865
The most common skin cancer is Basal Cell Carcinoma/Epithelioma (BCE). It is a slow growing cancer that does not metastasis but spreads locally causing significant destruction. While today almost all patients survive the disease in the nineteenth century it was often a fatal condition as patients sought treatment only when the disease was advanced.
This 1865 photograph documents the locally destructive “rodent cancer,” the common name of the condition, as it appeared to observers as if a rodent had eated the flesh. The woman appears to have one area of her face cleanly cut out. it was actually treated with chemicals by London physician Charles Hewitt Moore (1821-1870). He published this photograph in one of the first medical textbooks (Rodent Cancer…1867) to contain photographs, and he was one of the first to describe a treatment for a particular cancer. Dr. Moore advised wide surgical excision to be followed by caustic agents and then, whenever possible, the transplantation of skin flaps to cover as much of the defect as possible. In most cases of advanced disease, a vulcanite mask was worn to cover the defect, allowing the patient to appear in public. Moore concluded this cancer “ is eminently a local disease: it is also eminently a curable disease.” His favorite caustic was chloride of zinc, which he noted if “applied to the cranium or the dura mater, an epileptiform fit ensues, in one or more days after the application. ”Moore advised surgeons to aggressively treat all but the most advanced cases.
Modern medical treatment of basal cell carcinoma still includes caustic agents; however, to assure no disease remains, surgical excision with clear margins after pathologic examination is the best therapy. Mohs micrographic surgery is preferred for some lesions . Curettage and electrodessication and other destructive procedures have been tried with success. At the turn of the century, the discovery of the x-ray and radiation and radium therapy provided dramatic results for a wide range of malignant neoplasms.
MAN WITH EYE TUMOR, 1906
Large facial tumors have always fascinated medical photographers. Facial tumors are particularly obvious and usually brought to a surgeon’s attention before other areas of the body that can be easily concealed by clothing. Eye tumors could simply be covered by an eye patch in early stages and were frequently advanced before patients sought relief; many were painless. Because large numbers of people were disfigured from a variety of eye diseases, eye patches were common accessories. Until the late nineteenth century growth of cancers were often accepted and left untreated until they were large and advanced. Surgery was a last desperate resort. By the end of the century with the establishment of medical sciences, the discoveries of anesthesia, antiseptic and aseptic surgical principles and the x-ray hospitals were no longer viewed s places to die. Teams of specialists were created that developed safe operative procedures for a wide variety of disease believed inoperable.
SMALLPOX NY CITY EPIDEMIC, 1881
Victims of the smallpox epidemic in 1881. More people died from smallpox than any other disease in history. During the twentieth century, up to 1979, an estimated 300 to 500 million died of the disease. In the 1950s about 50 million people worldwide were infected yearly. Due to a worldwide vaccination effort, in 1979. smallpox was declared conquered. The only infectious disease The last case in the US was in 1949. The disease was caised by two viruses. Skin signs were the key to survival. If the pustules coalesced together the death rate was 50%. Black smallpox so called because the pox pustules were internal was 100% fatal and killed in a few days.
ORBITAL ABSCESS WITH DISPLACEMENT OF THE EYE, 1908
In pre-antibiotic days orbital cellulitis and abscess could result from infections in the upper respiratory tract, sinusitis, furuncles or other infection on the face. This abscess has displaced the eye downward. As the eye is protected in a boney socket with little room for pus or tumor tissue hence it is easily forced from its socket. The infection easily spreads to the brain along the optic nerve or through blood vessels draining the eye. Death rate was high. Even an orbital cellulitis had a 20% mortality rate.
During the nineteenth century patients with multiple fibromas or von Recklinghausen’s disease were very popular photographic subjects in the medical community, This photograph was published in 1871 in America’s first medical photographic journal. In the nineteenth century the condition was often labeled ‘hypertrophic tumor. Surgeons and dermatologists treated the patients. In 1882 a pathologist published the classic description of the disease noted its skin and bone deformities. Today von Recklinghausen’s disease is recognized as an inherited disease with two major manifestations labeled NF1 and NF2. To this day no known cure exists and patients with the condition usually have the ‘fibroma’s removed. In some cases the number and size of fibroma’s excludes complete removal.
This photograph published in 1865 by British dermatologist Alexander Balmanno Squire in his text Photographs (Colored from Life) of the Diseases of the Skin demonstrates the British style of fully over-painting photographs to best show disease conditions. Impetigo a superficial skin infection caused by Staphylococcus aureus and Streptococcus pyoegnes. It is typically seen in children and may follow and abrasion, excoriation, insect bite or any cut in the skin. The face was particularly prone to infection the poor hygiene of the nineteenth century was a primary cause of the infection. Antibiotics in various forms are the modern treatment. The photograph show sthe typical pustules and vesicles of the disease.
HYPERTHYROIDISM – EXOPHTHALMOS, 1908
Hyperthyroidism - the same disorder that causes goiters - can also cause bulging eyes, as shown in this 1908 photograph. As the eyes protrude, the tend to dry out, sometimes resulting in scarring, infection, and blindness. Hyperthyroidism is also known as Grave's disease.
This photograph taken by ophthalmologist A. de Montméja in 1867 was published in French dermatologist Alfred Hardy 1868 text Clinique photographique de l’hopital Saint-Louis. Leprosy a disease misunderstood and dreaded for centuries was found to be caused by a bacterium in 1871 by Norwegian physician Gerhard Hansen. It was the first disease to be proven to be caused by bacteria. The condition is slowly progressive condition with several forms. Neurological damage causes numerous symptoms related to anesthesia of affected parts. In the eye, loss of sensation if untreated eventually results in blindness due to corneal disease and eyelid abnormalities. The patient in this photograph was diagnosed in the 19th century with “Elephantiasis des Grecs,” one of the forms of leprosy which resulted in enlargement of various parts of the body. In 2006 the World Health Organization lists 100 countries in which the disease is endemic. About 220,000 cases were reported worldwide in 2006.
EXAMINING THE EYE BY CANDLE LIGHT, 1910
Examining the interior of the eye was the key to conquering many serious eye diseases. It was not until the end of the second decade of the twentieth century that electric lights were powerful enough to be used for all aspects of eye examinations. In 1845 Vienna’s von Brucke developed an impractical way to see the inside of the eye through a candle flame which lead to the development of the ophthalmoscope. In 1855 German ophthalmologist Richard Liebreich devised a method of lateral illumination of the eye using a lens that concentrated the light and a magnifying glass to view the eye. His method seen here was practiced by most ophthalmologists until the first decade of the twentieth century. The development of the electric slit lamp to examine the eye, first described in 1911 didn’t become routine until the mid 1920s.
EARLY PHOROPTER, 1895
By the mid nineteenth century ophthalmologists recognized that errors of refraction could cause disease and visual difficulties. Correcting near and far sightedness was one of the great accomplishments of the century. Various refractometers, machines that held a series of lenses were developed that helped find the correct lens. In this photograph an early phoropter is show, circa 1895. This semi-automated refraction device became a standard tool of twentieth century ophthalmologists. It had a series of plus and minus lenses along with lenses for astigmatism correction and various other lenses to evaluate muscle disorders and other disease states.
TEACHING EYE SURGERY WITH CLOSE-UP PHOTOGRAPHY, 1870
In 1870, a French ophthalmologist named Edouard Meyer included a series of photos in his textbook on surgery. The film of the era was too "slow" to take photos of actual operations, so he staged photos using cadavers. In this photo, a clamp holds the eye open to show where a scalpel should be positioned to remove a cataract.
CUTTING THE IRIS –IRIDECTOMY, 1870
Edouard Meyer’s 1870 text of close-up photographs showed critical aspects of ocular operations. One of the important parts of many intra ocular procedures of the era was making a hole in the iris. The procedure can be done today by laser in seconds to create a hole without opening the eye as seen here. It took over two centuries to establish the necessity and methodology for the procedure after it was described in 1720 by London surgeon William Cheselden. He invented the iridotomy, the operation of incising the iris to produce a hole- a pupil performed as seen in this photograph- the eye is opened with a knife and the delicate iris gently grasped an cut. Iridotomy was the first major advance in intraocular surgery in centuries. His operation resulted in the creation of an artificial pupil which gave sight to those blinded by the infectious and inflammatory processes prevalent at the time. As the diseases resulted in scar tissue accross the natural pupil. It became a crucial part of the cataract operation when that was developed in the late 1740s. Iridectomy became recognized as a cure for narrow (closed) angle glaucoma in the 1860s. It is still the standard for most advanced cases of the condition when angle closure is threatened or present. In most cases Laser therapy is all that is needed. In advanced cases of angle closure with blockage of fluid dynamics iris procedures along with drainage operations may be necessary.