Speaker 1: Welcome to Stuff You Missed in History Class, a production
Speaker 1: of iHeartRadio. Hello and welcome.
Speaker 2: To the podcast.
Speaker 1: I'm Tracy V. Wilson and I'm Holly Frye.
Speaker 2: On April twenty second of twenty twenty five, that is,
Speaker 2: this year, the US Department of Health and Human Services
Speaker 2: had a press conference about a plan to phase eight
Speaker 2: synthetic food dies out of the US food supply by
Speaker 2: the end of twenty twenty six. Now that that's like
Speaker 2: a whole can of worms, it's not really what this
Speaker 2: episode is about. We're not really going to get into it.
Speaker 2: But at this press conference for this announcement, Secretary of
Speaker 2: Health and Human Services Robert F. Kennedy Junior, gave a
Speaker 2: speech in which he described a long list of diseases
Speaker 2: and conditions as injuries, and he claimed he had never
Speaker 2: heard of them when he was a kid. Now. Rfk
Speaker 2: Junior was born in nineteen fifty four, so he was
Speaker 2: kind of implying that these diseases weren't really around in
Speaker 2: the fifties and the sixties, and that they are in
Speaker 2: fact injuries caused by things like synthetic food dies. The
Speaker 2: diseases and conditions that he named in this speech included narcolepsy,
Speaker 2: which was first described in writing in sixteen twenty one.
Speaker 2: We did a two part episode on narcolepsy in twenty fifteen.
Speaker 2: Also included was what he called juvenile diabetes, which is
Speaker 2: now called type one diabetes. That was, of course a
Speaker 2: big part of our two parter on the discovery of insulin,
Speaker 2: which came out in twenty twenty. Diabetes was first described
Speaker 2: in the ebers Papyrus, which dates back to about fifteen
Speaker 2: hundred BCE, so almost thirty five hundred years before RFK
Speaker 2: Junior was born. If it's not obvious, I gotta be
Speaker 2: in my bonnet about this speech. None of these diseases
Speaker 2: from the beach are new, and while the prevalence of
Speaker 2: some of them does seem to be increasing in a
Speaker 2: lot of cases, that's a global trend, not something unique
Speaker 2: to the United States and its food supply, and we
Speaker 2: don't necessarily know the reasons behind this particular, any particular increase.
Speaker 2: Some of it, though, is definitely more about expanded definitions
Speaker 2: and better testing, diagnosis, and treatment than we had half
Speaker 2: a century ago. Though also some of it is just
Speaker 2: about people living longer and surviving things that would have
Speaker 2: killed them in earlier eras, so I thought about doing
Speaker 2: something called six Impossible episodes. Diseases RFKA Junior says he
Speaker 2: has never heard of, but some of the things he
Speaker 2: listed off weren't really diseases. They were more like generic
Speaker 2: descriptions or whole categories. And also that seemed like too
Speaker 2: much for one episode, so I narrowed this down to
Speaker 2: three autoimmune diseases that he mentioned in this speech. They
Speaker 2: are rheumatoid arthritis, lupus, and Crohn's disease. This is not
Speaker 2: a thorough history of all of them. This is really
Speaker 2: about when and where these diseases were first recognized and described.
Speaker 1: So all three of these diseases have some things in common,
Speaker 1: and rather than repeating those commonalities every time, we're going
Speaker 1: to start with some of them. So As Tracy just said,
Speaker 1: they are all autoimmune diseases, meaning they all involve the
Speaker 1: body's immune system attacking healthy tissue, and there is no
Speaker 1: one definitive, exact known cause for any of them. It's
Speaker 1: likely a combination of genetic and environmental factors such as
Speaker 1: exposure to things like pollution or tobacco smoke, as well
Speaker 1: as possibly hormones. All three of these diseases are more
Speaker 1: prevalent in women, in some cases much more prevalent in women.
Speaker 1: It is also possible that viral infections may be involved
Speaker 1: in triggering all of these illnesses, or triggering flare ups
Speaker 1: of the illnesses after they've developed.
Speaker 2: In terms of that genetic element, there is no single
Speaker 2: gene or gene mutation that conclusively causes any of these
Speaker 2: Rheumatoid arthritis, for example, has at least forty six different
Speaker 2: genes that are known to contribute to it in some way.
Speaker 2: These diseases all tend to run in families, but having
Speaker 2: an immediate family member with one of them means that
Speaker 2: a person is more likely to develop it, not that
Speaker 2: they are guaranteed to develop it.
Speaker 1: If one identical twin has one of these diseases, the
Speaker 1: other twin is more likely to have it as well,
Speaker 1: but the rate of both identical twins having the disease
Speaker 1: is in anywhere close to one hundred percent. Studies vary somewhat,
Speaker 1: but generally speaking, if one identical twin has rheumatoid arthritis,
Speaker 1: the other twin develops it only about fifteen percent of
Speaker 1: the time. With Crohn's disease, that number is thirty percent,
Speaker 1: and it's less than fifty percent with lupus. Identical twins
Speaker 1: have the same DNA, and if they grew up in
Speaker 1: the same household, they would likely have very similar, if
Speaker 1: not identical, environmental factors affecting their health. So the fact
Speaker 1: that rate is nowhere near one hundred percent suggests that
Speaker 1: it's more complicated and that there are other factors going on,
Speaker 1: or that some elements are just random.
Speaker 2: Social determinants of health probably play a part in these
Speaker 2: diseases as well. Those are non medical factors like a
Speaker 2: person's income, wealth, education, and where and how they grew up.
Speaker 2: These social determinants may be connected to some of the
Speaker 2: racial disparities that do exist for some of these diseases.
Speaker 2: For example, rheumatoid arthritis is most prevalent in white women,
Speaker 2: but in the United States, Black, Hispanic and Latina, Indigenous, Alaska, Native, Asian, American,
Speaker 2: and Pacific Islander women are all disproportionately more likely to DEVELOPUS.
Speaker 2: There's some suggestion that social determinants are connected to these disparities. Similarly,
Speaker 2: Crohn's disease is less prevalent in the tropics, which has
Speaker 2: led to a hypothesis that it might be connected to
Speaker 2: exposure to sunlight or to a person's vitamin D levels.
Speaker 1: There is also no one single diagnostic test for any
Speaker 1: of these. They all require some combination of family history,
Speaker 1: physical exams, lab work, and imaging or biopsies. So while
Speaker 1: the diseases themselves are not new, some of the tools
Speaker 1: used to detect them are. That also means getting a
Speaker 1: diagnosis can be time and labor intensive, and in the US,
Speaker 1: where we don't have universal health care, that means it's
Speaker 1: also often very expensive. Each of these can also be
Speaker 1: mistaken for other similar diseases, both in living people and
Speaker 1: in the archaeological record, So all of this together means
Speaker 1: that it could be really really tricky to tell when
Speaker 1: humans first started experiencing these diseases, but in all of
Speaker 1: them it was definitely before the twentieth century.
Speaker 2: Of these three diseases, Crone's disease was the one that
Speaker 2: was named and thoroughly described the most recently, so we
Speaker 2: will start there. This is an inflammatory bowel disease that
Speaker 2: causes symptoms like abdominal cramps, pain, and diarrhea, which can
Speaker 2: be bloody. These can happen as flare ups with periods
Speaker 2: of feeling relatively well in between those flare ups. As
Speaker 2: this condition progresses, it can cause thickening and some of
Speaker 2: the tissues of the digestive tract, as well as perforations
Speaker 2: or fistulas in the intestinal tissue. It commonly affects the ilium,
Speaker 2: which is the last part of the small intestine.
Speaker 1: The severity of Crone's disease can vary from person to person,
Speaker 1: and it can also vary over time and eventually cause
Speaker 1: complications in other systems of the body. Treatments include diet
Speaker 1: and lifestyle modifications, anti inflammatory drugs, corticosteroids, immune system suppressors,
Speaker 1: monoclonal antibodies, and antibiotics. If infections develop, damage to the
Speaker 1: intestine can lead to a need for surgery, and sometimes
Speaker 1: more than one surgery.
Speaker 2: Crohn's disease is not caused by stress or diet, but
Speaker 2: both of those things can affect a person's symptoms, including
Speaker 2: contributing to flare ups. Since the disease can affect a
Speaker 2: person's ability to absorb nutrients, some people have to carefully
Speaker 2: manage what they eat, and for some people that just
Speaker 2: becomes kind of exhausting over time. This disease can also
Speaker 2: be really life altering. The symptoms that it can cause
Speaker 2: can be incredibly uncomfortable and embarrassing, and sometimes people have
Speaker 2: a hard time leaving the house to do things they
Speaker 2: enjoy or to travel during a flare because they might
Speaker 2: not have acts us to a bathroom when they need it.
Speaker 2: A lot of people with Crone's disease and with the
Speaker 2: other autoimmune diseases that we're talking about today also talk
Speaker 2: about how hard it can be socially, as their friends
Speaker 2: and family members just assume that they're flaky or that
Speaker 2: they don't care when they have to turn down invitations
Speaker 2: or cancel their plans last minute. And they also talk
Speaker 2: about things like bosses assuming that they are lazy or
Speaker 2: unreliable rather than understanding the realities of their medical condition.
Speaker 2: It's really tricky to know when people first started experiencing
Speaker 2: Crone's disease, because there are a lot of different diseases
Speaker 2: and conditions that can cause chronic diarrhea and abdominal pain.
Speaker 2: Greek physician Aretaeus of Cappadocia, who lived in the first
Speaker 2: century CE, described a young man who was having recurring
Speaker 2: bouts of diarrhea and abdominal distress. But we don't have
Speaker 2: a way to know whether this was Crone's disease. Specifically. Similarly,
Speaker 2: Saxon King Alfred the Great, who lived in the the
Speaker 2: ninth century, had recurring, debilitating abdominal pain in diarrhea, but
Speaker 2: we don't know the exact cause. King Louis the thirteenth
Speaker 2: of France died in sixteen forty three at the age
Speaker 2: of forty two after experiencing recurring chronic diarrhea and other
Speaker 2: abdominal issues for years. An autopsy was conducted after his death,
Speaker 2: and that showed that he had perforations in his small intestine,
Speaker 2: which can be indicative of crones, but he also had
Speaker 2: signs of tuberculosis, which can lead to some similar abdominal
Speaker 2: issues as well.
Speaker 1: In seventeen sixty one, Italian anatomis Giovanni Battista Morgagni wrote
Speaker 1: about a twenty year old man who had died. Morgagni
Speaker 1: conducted an autopsy and found lesions in the man's large
Speaker 1: and small intestines, including perforations and ulcerations, which again could
Speaker 1: have been from Crohn's disease. A century later, Albert von Sachsen, Coburg,
Speaker 1: Prince consort of Queen Victoria, died at the age of
Speaker 1: forty two of what was described at the time as
Speaker 1: typhoid fever, but modern researchers examining his medical records have
Speaker 1: found evidence that he had some kind of chronic intestinal
Speaker 1: disease that was like crones.
Speaker 2: In eighteen seventy five, Samuel Wilkes and Walter Moxon published
Speaker 2: a case report in which they described a young woman
Speaker 2: who had died after experiencing severe bloody diarrhea. They performed
Speaker 2: an autopsy and they found that she had ulcerations and
Speaker 2: inflammations throughout her colon. This is often cited as the
Speaker 2: first very clear clinical description of ulcerative colitis. Alterative colitis
Speaker 2: and Crohn's disease are very similar, and they are generally
Speaker 2: differentiated by exactly where in the digestive system the damage
Speaker 2: is occurring. In nineteen thirty two, Burl Crone, Leon Ginsberg,
Speaker 2: and Gordon D. Oppenheimer published a paper in the journal
Speaker 2: the American Medical Association called regional iliitis a pathological and
Speaker 2: clinical entity. They reported on fourteen patients who had what
Speaker 2: they called regional iliitis. All fourteen had abdominal cramps, diarrhea, fever,
Speaker 2: and weight loss, and they had been treated with surgery.
Speaker 2: They all had evidence of fiscialiformation, and they were all
Speaker 2: emaciated and anemic. At least half of them.
Speaker 1: Had previously had their appendix removed, possibly because doctors had
Speaker 1: mistaken their symptoms for appendicitis. The paper included radiological images
Speaker 1: and ruled out abdominal tuberculosis as the cause of these issues.
Speaker 2: These authors presented regional iliitis as a new disease, but
Speaker 2: there had been several other papers published in the first
Speaker 2: decades of the twentieth century that had also reported very
Speaker 2: similar patterns of intestinal inflammation, perforations, and fiscialiformation. Even so,
Speaker 2: though this is considered a landmark paper, and even though
Speaker 2: the authors had used the name regional iliitis, soon people
Speaker 2: were calling it Crone's disease after author Perl Crone. While
Speaker 2: Crone was listed first among this paper's authors, that was
Speaker 2: just because their names were alphabetical on the paper, he
Speaker 2: actually preferred the name regional iliitis.
Speaker 1: So Crone's disease got its name in nineteen thirty two,
Speaker 1: but it's very likely that it existed long before that.
Speaker 1: Its prevalence does seem to be increasing worldwide, not just
Speaker 1: in the United States, but we really do not know
Speaker 1: exactly why.
Speaker 2: We will talk about rheumatoid arthritis after we take a
Speaker 2: quick sponsor break. All three of the diseases that we're
Speaker 2: talking about today are inflammatory autoimmune diseases. In rheumatoid arthritis
Speaker 2: or RA, the inflammation is in the synovial membranes that
Speaker 2: line the joints. This causes joint pain, swelling, and loss
Speaker 2: of function. Other symptoms can include fatigue, fever, and weight loss.
Speaker 2: This inflammatory process damages the joints over time, and it
Speaker 2: can also damage other body systems. Rheumatoid Arthritis is the
Speaker 2: most common chronic inflammatory joint disease in the world, and
Speaker 2: in the United States it's the third most common type
Speaker 2: of arthritis after osteoarthritis and gout. Juvenile RA also affects
Speaker 2: children and can start an infancy.
Speaker 1: As with Crohn's disease. The prevalence of rheumatoid arthritis does
Speaker 1: seem to be increasing again globally, not just in the US,
Speaker 1: although rates of RA vary dramatically from one part of
Speaker 1: the world to another. Some of this apparent increase is
Speaker 1: because of changing definitions, though the American College of Rheumatology
Speaker 1: and the European Alliance of Associations for Rheumatology issued revised
Speaker 1: definitions for RA in twenty ten, and these new definitions
Speaker 1: focus on symptoms that are present at the earliest stages
Speaker 1: of the disease, which was not the case before.
Speaker 2: A range of treatments exists to help manage RA, and
Speaker 2: a lot of them are targeting the symptoms. These include
Speaker 2: over the counter pain relievers, steroids, and disease modifying anti
Speaker 2: rheumatic drugs or d MARDs. Occupational therapy and lifestyle modifications
Speaker 2: can be involved, and surgeries can as well.
Speaker 1: D MARDs are part of the treatment for a lot
Speaker 1: of autoimmune diseases, and many of them started out as
Speaker 1: anti malaria drugs. In many cases, it's not fully understood
Speaker 1: why these can be helpful for autoimmune diseases, but it
Speaker 1: is likely connected to the way they affect the immune system.
Speaker 1: One of them, hydroxychloroquine, became sought after in the early
Speaker 1: days of the COVID nineteen pandemic after a paper was
Speaker 1: published suggesting that it could be helpful for both treatment
Speaker 1: and post exposure prophylaxis. Experts raised serious concerns about this
Speaker 1: paper almost immediately. Among other things, it included only thirty
Speaker 1: six people, and eventually that paper was retracted. The FDA
Speaker 1: issued an emergency use authorization for hydroxychloroquin as a COVID treatment,
Speaker 1: and then revoked that authorization just a couple of months later,
Speaker 1: as it became increasingly clear that hydroxychloroquin did not treat
Speaker 1: or prevent COVID, but by that point President Donald Trump
Speaker 1: had called it a game changer, which had spiked huge
Speaker 1: demand for it. Some people, including Robert F. Kennedy Junior,
Speaker 1: continued to promote hydroxychloroquin as a COVID treatment for years
Speaker 1: after it was shown not to work for that purpose.
Speaker 1: Kennedy also spread the bay faceless conspiracy theory that hydroxychloroquine
Speaker 1: and iverbectin were effective against COVID, but that the FDA
Speaker 1: was barring people's access to them because it was in
Speaker 1: cahoots with the vaccine industry. This is demonstrably untrue, and
Speaker 1: all of this caused serious problems for people who were
Speaker 1: using hydroxychloroquin to manage their RA or their loopus, which
Speaker 1: we're going to talk about shortly, or other autoimmune diseases.
Speaker 1: People could not get access to their necessary medication because
Speaker 1: people who did not need it and were not going
Speaker 1: to benefit from it, were taking it for something it
Speaker 1: was not effective against. Some people with autoimmune diseases couldn't
Speaker 1: get access to hydroxychloroquine anymore and had to start taking
Speaker 1: other medications that were not as effective for them, or
Speaker 1: weren't effective for them at all, or which had much
Speaker 1: more pronounced and serious side effects. People can experience flare
Speaker 1: ups when stopping hydroxychloroquine even if they're moving to other medications,
Speaker 1: So these needless shortages demonstrably harmed people.
Speaker 2: In terms of when people started experiencing RA. There is
Speaker 2: more debate about that than about either of the other
Speaker 2: two diseases we're talking about today. There are three overarching theories.
Speaker 2: One is that RA is an ancient disease all around
Speaker 2: the world which people have experienced for millennia. Another is
Speaker 2: that RA didn't appear until far more recently, sometime in
Speaker 2: the eighteenth century, and was triggered by something that was
Speaker 2: part of the Industrial Revolution, like maybe something involving pollution
Speaker 2: or industrial chemicals, something like that. But a third idea
Speaker 2: is that RA was an ancient disease in the Americas
Speaker 2: and then was introduced to Europe through exploration and colonization
Speaker 2: starting after the fifteenth century. The idea here is that
Speaker 2: there is more older archaeological evidence that suggestive of rheumatoid
Speaker 2: arthritis in the Americas than there is in other parts
Speaker 2: of the world. So maybe there was some kind of
Speaker 2: disease trigger involved that Europeans did not encounter until that
Speaker 2: exchanged with the Americas. Or maybe RA is related to
Speaker 2: tobacco consumption or tobacco smoke. Tobacco is native to the Americas,
Speaker 2: and it was introduced to Europe by Christopher Columbus's expeditions.
Speaker 2: A counterpoint to that idea is that there's at least
Speaker 2: some suggestion that ARA was present in Europe prior to
Speaker 2: Columbus's voyages.
Speaker 1: Supporters of each of these three hypotheses point to various
Speaker 1: details to back up their claims. Like Greek physician Hippocrates
Speaker 1: described a type of arthritis that appeared by the age
Speaker 1: of thirty five and spread quickly from the feet to
Speaker 1: the hands, then the elbows and knees, than the hips.
Speaker 1: That sounds more like rheumatoid arthritis than osteoarthritis, which can
Speaker 1: happen more than one joint but typically doesn't affect that
Speaker 1: many joints in that many parts of the body that quickly.
Speaker 1: Roman physicians Scribonius Largest also described a form of arthritis
Speaker 1: that mostly affected women, and he did that around one
Speaker 1: hundred BCE. Michael Celis's Chronographia, written in the eleventh century,
Speaker 1: describes Roman emperor Constantine the ninth as experiencing a disease
Speaker 1: that affected his feet, and then his hands, and then
Speaker 1: his shoulders and then his whole body. Given medical understanding
Speaker 1: at the time, it's described as humors attacking these parts
Speaker 1: of his body.
Speaker 2: There are also some possible examples of ra in works
Speaker 2: of art from before the Industrial Revolution. One example is
Speaker 2: Reuben's The Three Graces, which was painted in the sixteen thirties.
Speaker 2: This painting features three nude women, and the one on
Speaker 2: the far left has her hand on the upper arm
Speaker 2: of the woman next to her. Her wrist is flexed
Speaker 2: laterally and her fingers appear to be bent in a
Speaker 2: way that resembles somebody whose hand has been damaged by ra.
Speaker 2: This model may be Rubens's wife, Helena Formant, and there
Speaker 2: are some other portraits of her that have similar depictions
Speaker 2: of her hands.
Speaker 1: All of this could be describing or depicting rheumatoid arthritis,
Speaker 1: but we don't know for sure since there are also
Speaker 1: other diseases and conditions that can cause joint damage. This
Speaker 1: is also true of joint damage that's suggestive of RA
Speaker 1: in the archaeological record. RA can leave evidence on the bones,
Speaker 1: but so can other diseases, including ankylosing spondylitis or AS,
Speaker 1: which primarily affects the spine. It wasn't until the twentieth
Speaker 1: century that researchers started differentiating between RA and AS, which
Speaker 1: led to some earlier RA findings in the archaeological record
Speaker 1: being reinterpreted as AS or as some other condition.
Speaker 2: By the seventeenth century, though, physicians in Europe were starting
Speaker 2: to differentiate between different types of arthritis and different inflammatory
Speaker 2: diseases and processes. For example, in sixteen seventy six, physician
Speaker 2: Thomas Sydenham published Observationist Medicaid, which differentiated between rheumatism and gout.
Speaker 2: Gout is an inflammatory arthritis that today we know is
Speaker 2: caused by uric acid build up in the blood. Gout
Speaker 2: often affects the big toe, but it can occur in
Speaker 2: any joint. In the eighteenth century, William Heberdon the Elder
Speaker 2: also described rheumatism and gout as two different diseases. In
Speaker 2: seventeen eighty two, Joan Paterson of Iceland described a chronic
Speaker 2: arthritis happening on both sides of the body that seemed
Speaker 2: to be systemic. It was more prevalent in women, and
Speaker 2: the incidents seemed to peak around the EA of forty.
Speaker 1: This sounds a lot like ra but the person who
Speaker 1: is usually cited as providing the first clear clinical description
Speaker 1: of RARE is Augustine Jacob Lancre Beauvais. In eighteen hundred,
Speaker 1: he was a twenty eight year old resident physician at
Speaker 1: the Saint Pitrier Asylum in France. He described a set
Speaker 1: of patients, most of them poor women, who had severe
Speaker 1: joint pains not caused by osteo arthritis. He thought this
Speaker 1: was a type of gout, and he called it gut
Speaker 1: astanique primitive or primary asthenic gout.
Speaker 2: In eighteen fifty three, French neurologist Jean Martine Charcaut wrote
Speaker 2: a doctoral thesis in which he described arthritis, muscular atrophy,
Speaker 2: and muscular and skeletal malformations. This condition, as he was
Speaker 2: describing it, seemed to go into remission spontaneously, but that
Speaker 2: it would recur. Six years later, English physician Alfred Berengarrett
Speaker 2: wrote Treatise on the Nature of Gout and Rheumatic Gout,
Speaker 2: which again differentiated between gout caused by excess uric acid
Speaker 2: in the blood and what he called rheumatic gout, which
Speaker 2: was a different thing. Garret's son, Archibald, also became a
Speaker 2: doctor and coined the term rheumatoid arthritis and his Treatise
Speaker 2: on Rheumatism and Rheumatoid Arthritis in eighteen ninety.
Speaker 1: Archibald Garred was one of the people who thought there
Speaker 1: was archaeological evidence of rheumatoid arthritis going back to the
Speaker 1: ancient world. But in the twentieth century, American physician Charles
Speaker 1: Short looked back at some of the same reports that
Speaker 1: Archibald Geron had used and concluded that they were describing
Speaker 1: a range of different diseases and conditions and not rheumatoid arthritis.
Speaker 1: This included ankylosing, spondylitis, osteoarthritis, and gout, so Short argued
Speaker 1: that are was a modern disease and not an ancient
Speaker 1: one as we said earlier. There continues to be debate
Speaker 1: on this today.
Speaker 2: The debate is not about it starting in the nineteen
Speaker 2: fifties and sixties, though all of the debate is centuries
Speaker 2: earlier than that. We will have one more sponsor break,
Speaker 2: and then we will talk about lupus. The last autoimmune
Speaker 2: disease we're talking about is lupus. The word lupus is
Speaker 2: part of the name of several diseases today, but when
Speaker 2: people say lupus, they are usually talking about systemic lupus, erythematosis,
Speaker 2: or sle I have heard people say the word arithmatosis
Speaker 2: and arithmatosis a number of different ways of pronouncing that
Speaker 2: last word regardless. It comes from the Greek word erythros,
Speaker 2: meaning red, and that's a reference to the rashes that
Speaker 2: are often a part of this disease.
Speaker 1: This is another inflame amatory autoimmune disease, with lots of
Speaker 1: possible symptoms, depending on which parts of the body the
Speaker 1: immune system is attacking. There is also neonatal lupus, which
Speaker 1: is a rare condition that occurs when a person's antibodies
Speaker 1: passed to their fetus through the placenta. Drug induced lupus,
Speaker 1: and discoid lupus arithmetosis, which affects mostly the skin. The
Speaker 1: term lupus vulgaris is also used to describe cutaneous tuberculosis,
Speaker 1: so we're really focused on sl here, but the use
Speaker 1: of the term lupus to describe a lot of different
Speaker 1: conditions goes way back in history. The first known use
Speaker 1: of the term lupus in medicine was in reference to
Speaker 1: a tenth century Catholic bishop named Eraclius. He had an
Speaker 1: ulcerous condition that mainly affected the area around his buttocks,
Speaker 1: and this was described as lupus because it devoured.
Speaker 2: His tissue the way that a wolf wood.
Speaker 1: The word loopis went on to be used to describe
Speaker 1: a lot of different rashes, ulcers, and even cancers for centuries,
Speaker 1: by at least the thirteenth century. This included using the
Speaker 1: term loopis to describe facial rashes and lesions, specifically on
Speaker 1: the face. A malar rash or rash shaped like a
Speaker 1: butterfly across a person's cheeks is associated with SLE today,
Speaker 1: although other conditions, including roseacea, can cause similar rashes, and
Speaker 1: not everyone with SLE has this rash.
Speaker 2: It can also look a little different depending on what
Speaker 2: a person's skin color is. Other typical symptoms of SLE
Speaker 2: include unexplained fevers, painful or swollen joints, and kidney problems.
Speaker 2: It can also lead to heart failure, and then there
Speaker 2: can be a range of additional symptoms as well that
Speaker 2: can really vary from person to person, including hair loss,
Speaker 2: chest pain, and pale or purple fingers and toes. When
Speaker 2: somebody gets cold or is under a lot of stress,
Speaker 2: this is known as Reynod's phenomenon. As with Crohn's disease
Speaker 2: and ra, SLE can cause recurring periods of illness and
Speaker 2: relative health or flares and remission. Treatments include non steroidal
Speaker 2: anti inflammatory drugs, cordic asteroids, and d marts, and there
Speaker 2: are also various treatments that are focused on minimizing the
Speaker 2: skin irritation and rashes.
Speaker 1: Of course, the broad use of the word lupus to
Speaker 1: describe things other than SLE complicates the conversation about exactly
Speaker 1: when SLE was first described. But beyond that, like the
Speaker 1: other diseases we've talked about today, SLE share symptoms with
Speaker 1: other diseases and conditions. It wasn't until the nineteenth century
Speaker 1: that descriptions and definitions started to become more precise. So
Speaker 1: in the eighteen teens, Robert Willin and his mentee, Thomas
Speaker 1: Bateman wrote a book called Delineations of Cutaneous Diseases. Willin
Speaker 1: died in eighteen twelve, and Bateman finished the book and
Speaker 1: published it in eighteen seventeen. This book laid out a
Speaker 1: systemic way to categorize different skin diseases, along with engravings,
Speaker 1: illustrating those diseases under tuberculous diseases, meaning diseases that cause tubercules,
Speaker 1: not necessarily tuberculosis. Specifically, they used the term loupis to
Speaker 1: describe rashes and lesions affecting specifically the face. Over the
Speaker 1: course of the nineteenth century, doctors started drawing distinctions between
Speaker 1: types of loopus, with some conditions primarily affecting the skin
Speaker 1: and others also involving other organs the way SLE does.
Speaker 1: The first detailed modern description of sle is usually cited
Speaker 1: as coming from French dermatologist Pierre Kazenev in eighteen thirty three.
Speaker 1: Kasenev had a six xt year career as a doctor,
Speaker 1: and during that time he also differentiated between discoid lupus
Speaker 1: and systemic lupus, and in eighteen forty seven he described
Speaker 1: the differences between lupus vulgaris caused by tuberculosis and what
Speaker 1: he called lupus de res Matteau. Two years later, Viennese
Speaker 1: physician Ferdinand von Hebra described the butterfly like rash that's
Speaker 1: seen as often characteristic of sl today that In eighteen
Speaker 1: sixty eight, physician and surgeon Alexander John Balmanos Squire used
Speaker 1: the term vespertilio or bat like to describe the same rash.
Speaker 1: In eighteen seventy two, Hungarian dermatologist Maurite's Caposi continued to
Speaker 1: refine definitions for lupus, including drawing a distinction between discoid
Speaker 1: lupus primarily affecting the skin, and disseminated lupus, which was
Speaker 1: a systemic lupus that could sometimes be fatal. He described
Speaker 1: the other potential symptoms of this sumtime times fatal systemic
Speaker 1: lupus as including swollen lymph nodes, joint pain, pain in
Speaker 1: the long bones, fever, and weight loss.
Speaker 2: In eighteen seventy nine, Emil Vidal, who worked at Opitdal
Speaker 2: san Lui in Paris, further distinguished lupus arithmetosis from lupus
Speaker 2: vulgaris caused by tuberculosis. Later, Robert Coch's discovery of the
Speaker 2: tuberculosis bacillis in eighteen eighty two helped doctors conclusively diagnose
Speaker 2: lupus vulgaris as caused by TB. At that point, it
Speaker 2: quickly became clear that lupus vulgaris was far more common
Speaker 2: than lupus arithmatosis.
Speaker 1: In eighteen ninety four, J. Pain delivered a postgraduate lecture
Speaker 1: in which he reported that quinine could be useful in
Speaker 1: the treatment of lupus, likely the earliest use of an
Speaker 1: anti malarial drug in the treatment of an autoimmune disease.
Speaker 1: From this point, doctors continued to develop new methods for
Speaker 1: diagnosing slee and for trying to treat it and manage
Speaker 1: its symptoms. Then, in nineteen forty eight, Malcolm McCallum Hargraves
Speaker 1: discovered what came to be known as the lupus arithmetosis
Speaker 1: cell or le E cell. It is also sometimes called
Speaker 1: the Hargraves cell. This is a cellular indication of an
Speaker 1: autoimmune process going on inside the body. This discovery apparently
Speaker 1: came about by happenstance. There was a hematologist at the
Speaker 1: Mayo Clinic who was drawing the blood from patients and
Speaker 1: treating it with an anticoagulant and then just walking over
Speaker 1: to the lab a few blocks away. This window of
Speaker 1: time to.
Speaker 2: Walk for the lab allowed the process that made these
Speaker 2: cells visible to take place, and without that little time window,
Speaker 2: it probably would not have been noticed. Lee cells are
Speaker 2: specific types of white blood cells that have been engulfed
Speaker 2: by the denatured nuclear material from US. Their cells and
Speaker 2: the presence of these cells can be indicative of sl
Speaker 2: as well as of other autoimmune diseases.
Speaker 1: As with RA and Crohne's disease. It does seem like
Speaker 1: lupus rates are increasing, but as with those this is
Speaker 1: a global trend, not just in the US, although there
Speaker 1: is a lot of regional and demographic variation in how
Speaker 1: prevalent it is. But again, none of these diseases are
Speaker 1: post twentieth century developments.
Speaker 2: Kay man, I'm sorry, not sure how you got to
Speaker 2: be the Secretary of Health and Human Services having not
Speaker 2: heard of juvenile diabetes, but that's where we are.
Speaker 1: Well, it's like it's that thing that I've never heard
Speaker 1: of it so it doesn't exist. Thing is just wild
Speaker 1: to me. There's so many things I've never heard of, Yeah,
Speaker 1: but they are real. A lot of people never heard
Speaker 1: of spasmodic dysphonia until RFK Junior became a public figure
Speaker 1: yep while experiencing it. YEP. Anyway, I have.
Speaker 2: Some listener mail before we you know, we're going to
Speaker 2: go on from this to record our Friday behind the scenes.
Speaker 2: I'm sure we'll have plenty more things to say. This
Speaker 2: is from Kristen. This is the subject line of this
Speaker 2: email is Cecilia Paying Gaposhkin in horrible handwriting. Kristin wrote, Hi,
Speaker 2: Holly and Tracy. When I listened to your Saturday Classic
Speaker 2: episode on Cecilia Paying Gaposhkin, I heard you mentioned your
Speaker 2: difficulty with handwriting, and you're musing that maybe you should
Speaker 2: have been taught to write with your left hand. My
Speaker 2: son also has tremendous difficulty with handwriting, and his schoolwork
Speaker 2: was greatly affected. He was failing everything in sixth grade.
Speaker 2: We requested that the school test him for specific learning
Speaker 2: disabilities as a last resort because we were at our
Speaker 2: wits end as most of his trouble was in literature.
Speaker 2: I suspected he had dyslexia. It turns out there is
Speaker 2: another SLD related to dyslexia called dysgraphia that is characterized
Speaker 2: by difficulty with handwriting. I often describe it to people
Speaker 2: unfamiliar with this condition that if dyslexia is trouble getting
Speaker 2: written information into the brain, dysgraphia is trouble getting written
Speaker 2: information out of the brain. Of course, it's a lot
Speaker 2: more nuanced than that simple explanation. Since his diagnosis and
Speaker 2: subsequent IEP to allow him to give typed or oral
Speaker 2: answers another support, he has completely turned his education around
Speaker 2: in tenth grade. Now he is an honor student, taking
Speaker 2: two ap math courses and honors wind ensemble. He plays
Speaker 2: tenor sacks in the jazz band. Also, he says he
Speaker 2: wants to study science communication in college. Just wanted to
Speaker 2: bring awareness to this SLD because not many people even
Speaker 2: know it exists. I sure hadn't heard of it until
Speaker 2: my son's diagnosis. Thank you for being a bright spot
Speaker 2: in these gloomy times and making me laugh four times
Speaker 2: a week. Kristen Kristin has also included had some pet tags.
Speaker 2: There is a thirteen year old Golden Retriever mix named Hass.
Speaker 2: There's a Lab mix named Midnight, newly adopted little sister
Speaker 2: to Hass. Trip is the Tripod ginger rescued from the
Speaker 2: side of the road as a kitten who thinks he
Speaker 2: is a hoss. And then Rascal is a blue smoke
Speaker 2: tabby found in an abandoned shed. And then Stella born
Speaker 2: to a feral managed barn colony, but brought into the
Speaker 2: house for health reasons as a small kitten. Stella is
Speaker 2: a torty, so is obviously in charge.
Speaker 1: Oh my goodness, I think I got the one torty
Speaker 1: that has no in chargedness. Yeah, well, it just has
Speaker 1: none the tourty I used to have. Cestina was also
Speaker 1: never in Yes, she was not a sassy cat.
Speaker 2: She was not sassy. She desperately wanted to play with
Speaker 2: Villanell when I got them both, and Villanell did not
Speaker 2: want this at all. She couldn't seem to retain that
Speaker 2: Villainel was never going to want to play with her,
Speaker 2: which was said. They eventually learned to tolerate each other well enough.
Speaker 2: Thank you so much for these pat pictures. My goodness,
Speaker 2: so cute, all of them so cute. Thanks also for
Speaker 2: this email. I had heard of dysgraphia also discalcula. I
Speaker 2: think we have gotten some emails about before dyscalcula involving
Speaker 2: struggles with mathematics. Some of these things are sort of
Speaker 2: they can be connected to other things that are also
Speaker 2: going on, and sometimes they are it's like that's this,
Speaker 2: this is the thing that the person is sort of experiencing.
Speaker 2: I have like family members who have struggles with different
Speaker 2: things that all relate to like the same motor planning
Speaker 2: issue in their mind that sort of evidences itself in
Speaker 2: multiple ways.
Speaker 1: And then I.
Speaker 2: Also, dyslexia in particular runs broadly in my family. Would
Speaker 2: I have been diagnosed with dysgraphia as a child who
Speaker 2: can say yeah? So, thank you so much Kristen for
Speaker 2: this email and the pictures. If you would like to
Speaker 2: send us a note, We're at History Podcasts at iHeartRadio
Speaker 2: dot com and you can subscribe to our show on
Speaker 2: the iHeartRadio app and anywhere else you get your podcast.
Speaker 2: Stuff you missed in History Class is a production of iHeartRadio.
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