Ten Terrifying Knives from Medical History

I’m excited to announce that I’ve just finished filming the first episode of my new YouTube series, Under The Knife, and will be releasing it very soon (please subscribe to my channel for video updates). Unsurprisingly, that got me thinking about, well, knives. Here’s a list of some rather terrifying knives from our medical past.

  1. VALENTIN KNIFE, 1838. This knife was one of the few able to cut slices of organs and soft tissues for microscopic examination. The double-bladed knife worked best when the blades were wet – best of all when submerged in water. Named after its inventor, Professor Gabriel Valentin (1810-1883), a German-Swiss physiologist, the knife was invented in 1838. This example, however, dates from 1890.

  2. BISTOURY CACHÉ, c.1850. Invented in the mid-19th century, bistoury caché literally translates from the French as ‘hidden knife’. The device was used to cut internal organs or to open cavities, particularly during the surgical removal of a bladder or kidney stone – a practice known as lithotomy.
  3. CIRCUMCISION KNIFE, c.1775. Circumcision – the removal of the foreskin of the penis – is practised across the world often for cultural and religious reasons. In some countries it is also promoted for reasons of hygiene and health. This knife dates from the late 18th century.
  4. CATARACT KNIFE & NEEDLE, 1805. Georg Joseph Beer (1763-1821), an Austrian professor of ophthalmology, invented this cataract knife and needle around 1805. Cataracts cause blurred vision as the lens becomes cloudy and if left untreated can cause blindness. These instruments allowed for the surgical removal of some of the cloudy mass and, if necessary, part or all of the lens itself. Prior to effective anaesthetics, this was an excruciatingly painful process. This particular example dates from 1820.
  5. ORTHOPEDIC KNIFE, 1855. William Adams (1820-1900), an English surgeon, invented this type of knife for his new procedure called periosteotomy in 1855. This involved un-fusing the bones of the hip joint by cutting the neck of the femur (upper leg bone). He affectionately called it ‘my little thaw’, because the knife was used to cut through and ‘melt’ fused bones.
  6. LISTON KNIFE, c.1830. Robert Liston (1797-1847), a Scottish surgeon renowned for his speed and precision in surgery, invented this double-edged amputation knife in the 1830s. This particular example is made of steel with a nickel-plated handle. Nickel plating was introduced in the 1890s and meant that the knife could be boiled without it rusting and was therefore ideal for aseptic surgery. It was made by Down Bros, a leading surgical instrument maker, in the 1920s.
  7. SYRIAN SURGICAL KNIFE, c.900 AD. Most of the blade of this ancient surgical knife is rusty and part of it is broken. The steel blade is slotted into a brass handle. The loop at the end may have been used as a finger hole for gripping. This knife dates to a period when the Islamic world became a major centre for medical study and practice.
  8. PLAGUE LANCET, c.1600. Plague epidemics ravaged Marseilles in France throughout the 17th and 18th centuries. Lancets, such as the copy shown here, were used to open buboes in order to relieve pressure and also remove poisons from the body – an unsuccessful attempt to cure the patient. The lancet would have been stored in a brass case.
  9. DOUBLE BLADED LITHOTOME, 1812. This object was used to cut the bladder in order to remove stones – a practice known as lithotomy. Baron Guillaume Dupuytren (1777-1835), a French surgeon and pathologist, invented this double bladed lithotome for the bi-lateral lithotomy procedure he developed in 1812. This procedure became widely used from the 1850s onwards, and this example dates from 1825.
  10. FALCIFORM AMPUTATION KNIFE, c.1700. The curved shape of this amputation knife was common in the early 1700s. Amputation knives became straighter once the practice of leaving a flap of skin to cover the limb stump became the preferred amputation method. Ebony was a common material for handles as it is a hard-wearing wood. This knife was probably made by Eberle in Germany, as indicated by the inscription on the silver blade.

     

Disturbing Disorders: Sirenomelia (Mermaid Syndrome)

The sea king down there had been a widower for years, and his old mother kept house for him…she was an altogether praiseworthy person, particularly so because she was extremely fond of her granddaughters, the little sea princesses. They were six lovely girls, but the youngest was the most beautiful of them all. Her skin was as soft and tender as a rose petal, and her eyes were as blue as the deep sea, but like all the others she had no feet. Her body ended in a fish tail.

Hans Christen Anderson, The Little Mermaid, 1837.

Mermaids have teased our imagination for thousands of years. One of the earliest tales originated in ancient Assyria, where the goddess Atargatis transformed herself into a mermaid out of shame for accidentally killing her human lover. Homer called them sirens in the Odyssey, and described them as beautiful singing creatures who lure sailors to their deaths. Throughout history, these seductive beings have been associated with floods, storms, shipwrecks and drownings. They have been depicted in countless mediums: in Etrurian sculptures, in Greek jewelry, and in bas-relief on ancient Roman tombs. Christopher Columbus even reported seeing these mythical creatures on his voyage to the Caribbean in 1493.

But could our concept of what a mermaid looks like actually have originated from a real medical disorder?

M2Sirenomelia is a lethal condition characterised by rotation and fusion of the legs, resulting in what often looks like a fish tail (left). It occurs when the umbilical cord fails to form two arteries, thus preventing a sufficient blood supply from reaching the fetus. As a result, the single artery steals the blood and nutrition from the lower body and diverts it back up to the placenta. Due to malnutrition, the fetus fails to develop two separate limbs.

Sirenomelia, also known as ‘Mermaid Syndrome’, is extremely rare. It affects 1 in 100,000 babies and is 100 times more likely to occur in identical twins. Usually, those born with this condition die within days.

Over the course of my research, I’ve found very little about  the disorder’s history. There are snippets here and there which claim that fetuses born with sirenomelia were sometimes preserved in jars and put on display in ‘freak shows’ during the 19th century—but these sources are frustratingly vague. There is brief mention of the condition in a four-volume atlas published in 1891 titled Human Monstrosities, but nothing that hints at how medical practitioners understood sirenomelia in earlier periods.

Perhaps because the disorder is so rare, it’s also been hard for me to locate specimens in anatomical collections. My search in the Hunterian Museum at the Royal College of Surgeons in London came up cold. I did, however, find an early 20th-century example at the National Museum of Health & Medicine in Washington D.C. There are also three fetuses in the Anatomical Museum of the Second University of Naples, which have undergone 3D bone reconstructions (two pictured below).

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By far the largest number of fetuses comes from the Vrolik Museum in Amsterdam, which consists of more than 5,000 specimens of human and animal anatomy, embryology, pathology and congenital anomalies. The collection was founded by Gerardus Crolik (1755 – 185) and his son, Willem Vrolik (1801 – 1863), who both wrote extensively on anatomical deformities in the 18th and 19th centuries. The Vrolik Museum has both wet preparations and skeletal remains, all of which are on display to the public today.

Unlike the first disorder I examined in this series—Harlequin Ichthyosis—sirenomelia is extremely fatal. There are no accounts of anyone with this condition surviving in the past. Most died within days of being born due to kidney and bladder failure. Even today, the odds are against those with sirenomelia, though there are a handful of examples of children living past infancy.

In 1988, Tiffany Yorks underwent surgery to separate her legs before her first birthday. She continues to suffer from mobility issues due to her fragile leg bones, and compensates by using crutches of a wheelchair to move around. At the age of 26, she is the longest-surviving sirenomelia patient to date.

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Under the Knife – Sneak Peek!

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In my new YouTube series, Under the Knife, I will take you on journey into a curious past—one which is riddled with blood-sucking leeches, spring-loaded knives and rotting corpses. Together, we will visit a world where surgeons and executioners share a common goal; where colluding with murderers and thieves is a pre-requisite for gaining entrance into the dissection theater; and where ‘well-bred’ families are horrified at the thought of one of their own becoming a surgeon.

Thanks to the inexhaustible efforts of my talented friend, Alex Anstey, I’m thrilled to release the opener to Under the Knife. I know a lot of you have been waiting patiently for me to unveil this project. I hope you’ll agree it’s been worth the wait!

Please remember to subscribe to our YouTube Channel so you can receive updates when we post new videos. The first episode will be released once I hit my goal on Patreon – so kindly consider supporting my content.

Most importantly, please tweet, post and share this video so we can get people buzzing about Under the Knife! My friends and I can’t wait to show you more!

Click HERE to view video.

The Saddest Place in London: A Story of Self-Sacrifice

SS1Tucked away in a quiet area of East London is a peaceful place that goes by the unassuming name of Postman’s Park (left), so called because it once stood in the shadow of the city’s old General Post Office building. At first glance, you might mistake it for any green space in the city, with its manicured lawn, leafy trees and decorative water fountain. But if you took the time to venture through the gates, you would stumble upon something far from ordinary.

On a stone wall, underneath a makeshift overhang, are a series of ceramic plaques, each one painted beautifully with the names of people who died while trying to save the lives of others. One plaque reads:

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And another:

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And on and on they go. The first time I stumbled upon this memorial was on a walking tour given by Tina Hodgkinson. I was instantly overwhelmed with sadness. So many of the people listed on these plaques were children, like John Clinton, aged 10, who drowned ‘trying to save a companion younger than himself’. Or Henry James Bristow, aged 8, who ‘saved his little sister’s life by tearing off her flaming clothes’ only to catch fire himself and die later of burns and shock. And then there was Solomon Galaman, aged 11, who saved his little brother from being run over in Commercial Street on 6 September 1901. His plaque reads: ‘Mother I saved him but I could not save myself’.

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Unlike many valiant memorials dedicated to those in the armed forces, this was created entirely in honour of the everyday hero. It is a testament to the incredible sacrifices we, as humans, can and do make on a daily basis.

But how did this memorial come into existence in the first place? And why did we stop creating plaques for it?

On 5 September 1887, the painter and sculptor, Fredric Watts (pictured below), wrote to The Times, proposing a tribute of a different sort for Queen Victoria’s upcoming Golden Jubilee. Watts believed that art could act as a force for social change, and suggested a didactic monument celebrating ‘heroism in every-day life’. He wrote:

It must surely be a matter of regret when names worthy to be remembered and stories stimulating and instructive are allowed to be forgotten. The material prosperity of a nation is not an abiding possession; the deeds of its people are.

Watts referred to the case of Alice Ayres, a nursemaid who died on 12 September 1859 in a house fire after she saved the lives of her employer’s children by throwing a mattress out the window and dropping them to safety. She, herself, was overcome by the fumes and stumbled out of the window to her death.

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Watts proposed that a marble wall inscribed with the names of everyday heroes be built in Hyde Park. Sadly, his suggestion could not garner enough support, leading him to quip that if he had proposed a race course instead, he would have had plenty of sympathizers. In the years that followed, Watts continued to lobby for the memorial. Both he and his wife redrafted their wills to leave a bulk of their estate to its construction, and even considered selling their home to finance the project.

SS8Then, in 1898, Henry Gamble—Vicar of St Botolph’s Aldersgate and longtime friend of Watts—acquired the land which would later be called Postman’s Park, and Watts suggested that the memorial be built there. Although there was resistance to the idea of the park being used in this manner, construction began a year later after the necessary funds were secured (Watts himself donated the extraordinary sum of £700 to the cause).

On 30 July 1900, the 50 foot long wall with space for 120 ceramic plaques was unveiled to the public. Watts, who was then 83 years old, was too ill to attend the ceremony. He died 4 years later.

Over the course of several decades, plaques were added to the wall, many of the names chosen from Watts’s collection of newspaper clippings he had accumulated over the years about ‘everyday heroes’. In 1931, the 52nd plaque commemorating the life of Herbert Maconoghu—who died aged 13 while trying to rescue two drowning classmates—was placed. This would be the last name added to the wall in the 20th century.

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After Watts’s wife and lifetime advocate of the memorial died in 1938, the wall fell from fashion and it seemed that no names would ever be added to it again. Then in 2007, a man named Leigh Pitt died while rescuing a 9-year-old boy from drowning in a canal in Thamesmead. His colleagues and fiancée, Hema Shah, approached the Diocese of London to suggest Pitt be added to the wall. Despite opposition from the Watts Gallery to proposals that the memorial be completed, a new plaque commemorating Pitt’s heroic actions was added on 11 June 2009.

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Today, Postman’s Park remains an obscure destination, attracting only a handful of visitors who are drawn, perhaps, to the strangeness of the Victorian deaths chronicled on Watts’s wall. After all, not many people are trampled under the hooves of runaway horses, or die tragically in theatre fires these days. In this way, the plaques are as much a historical testament to an era long gone as they are to the lives of the people whose names adorn them.

To date, there are currently no plans to add further plaques to the memorial. I, for one, hope we don’t have to wait another 78 years before we see another ‘everyday hero’ commemorated in such a beautiful and thoughtful way.

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Become a ‘Patreon’ of The Chirurgeon’s Apprentice 

2Since I launched a donate button on my website several weeks ago, I’ve been overwhelmed by your generosity and support. Then, a few days ago, a friend of mine turned me onto a site called Patreon (no, that’s not a typo!) which would allow me to give a little something extra back to each and every one of you who donates to The Chirurgeon’s Apprentice.

Unlike Kickstarter or IndieGoGo which only allows you to fund one big project, Patreon allows people to support their favourite artists, writers, and musicians as they create free content online. The way it works: you donate a fixed amount of money (for example, 50 cents) each time I produce an article on The Chirurgeon’s Apprentice. In exchange, you get various perks. This can be anything from access to Morbid Minute—a video I’ll release each month revealing a weird/gruesome fact about our medical past—to the first chapter of a novel I’m currently writing called The Surgeon’s Tale.

So if you’d like to become a ‘patreon’ of The Chirurgeon’s Apprentice, please visit my page and watch my video by clicking HERE. I’m offering lots of fun perks which I hope you will like!

As always, I thank you greatly for your kindness.

*For those who’ve donated in the past several weeks, I’ll be in contact shortly to offer you a corresponding perk!

The Anaesthetized Queen & the Path to Painless Childbirth

L0058939 Clear glass shop round for Chloroform, United Kingdom, 1850-‘Did the epidural hurt?’ I ask Rebecca Rideal—editor of The History Vault—one morning as we sit outside the British Library.

‘Not really.’ She hesitates, clearly wanting to say more without divulging too much information. ‘I mean, it’s nothing compared to the labour pains. The hardest part was lying still while the anaesthesiologist administered the needle.’

Rebecca is one of many friends of mine who have now endured the pains of childbirth. Nearly all of them (with the exception of one) did so with the aid of anaesthetics and pain medication. Not one of them regretted it.

Of course, there was a time when women had no choice but to give birth naturally, and often did so while sitting up in a birthing chair. The experience was wrought with dangers, not least the risk of ‘childbed fever’ which claimed the lives of thousands of women, including Henry VIII’s wife, Jane Seymour.

But even if a woman escaped with her life, she couldn’t avoid the pain.

All this changed in November 1847, when Dr James Young Simpson—a Scottish obstetrician—began using chloroform as an anaesthetic. Earlier that year, Simpson started using ether to relieve the pains of childbirth, but he was dissatisfied with the smell, the large quantity needed, and the lung irritation it caused. Ether was also highly explosive, which made it dangerous to use in candlelit rooms heated by fireplaces. It was then that David Waldie, a chemist from Liverpool, recommended chloroform to Simpson.

On the evening of November 4th, Simpson and his two friends experimented with it. At first, they felt very cheerful and talkative. After a short time, they passed out. Impressed with the drug’s potency, Simpson began using chloroform as an anaesthetic, and indeed, the first baby born to a mother under the drug’s influence was named Anaesthesia.

M0003274 Sir J. Y. Simpson and two friends, having tested chloroform

It was soon after this that the Duchess of Sutherland sent a pamphlet on Simpson’s discovery to Queen Victoria who was then in her sixth pregnancy. The Queen’s distaste for pregnancy was well-known. She considered it ‘wretched’ and experienced ‘occasional lowness and a tendency to cry’ after the birth of her first two children. [1]

Unfortunately, it was also at this time that the first chloroform fatality occurred when 15-year-old Hannah Greener died within 3 minutes of inhaling the chemical. The Queen was hesitant, and decided to forgo the new drug during her delivery of Princess Louise in March 1848. But the labour pains were severe, and so when Victoria became pregnant again a year later, she wrote to the Duchess of Sutherland, enquiring after her daughter who had just given birth using chloroform. Further discussion followed amongst the Royal medical household, but the decision was made once more to abstain despite assurances from the the physician, John Snow, that chloroform was perfectly safe when administered correctly. And so on 1 May 1850, Victoria endured her seventh labour without the aid of anaesthetics.

L0000578 J. Snow, "Chloroform and other anaesthetics", title pageBy 1852—when Victoria became pregnant with Prince Leopold—attitudes towards the drug were beginning to change. Most importantly, the Queen’s husband, Prince Albert, had become an advocate of its usage. Albert, a long-time champion of the sciences and President of the Royal College of Chemistry, had had lengthy discussions with Dr Snow about the administration of chloroform and the distinctions between giving it to patients undergoing surgery (which required full unconsciousness) and women in labour. Wishing to ease his wife’s pains, Albert urged Victoria to submit to the drug.

On 7 April 1853, Snow was summoned to Buckingham Palace. A lot was at stake. If the good doctor were successful in using chloroform to ease the Queen’s delivery, he would silence critics of childbirth anaesthesia and help pave the way to painless labour for women everywhere.

Lucky for Snow, the birth was simple and uncomplicated. Prince Leopold was born within 53 minutes of his administration of the drug, which Victoria described as ‘that blessed Chloroform… soothing, quieting and delightful beyond measure’. [2] Snow later wrote in his medical casebooks that Queen was ‘very cheerful and well, expressing herself much gratified with the effect of the [drug]’. [3]

Not everyone was pleased with the outcome, however. Some protested on religious grounds; others for medical reasons. The Lancet questioned the veracity behind claims that the Queen had even used the drug in her last delivery.

A very extraordinary report has obtained general circulation [that]…Her Majesty during the last labour was placed under the influence of chloroform, an agent which has unquestionably caused instantaneous death in a considerable number of cases. Doubts on this subject cannot exist…In no case could it be justifiable to administer chloroform in perfectly ordinary labour…These facts being perfectly well known to the medical world, we could not imagine that anyone had incurred the awful responsibility of advising the administration of chloroform to her Majesty… [4]

These doubts aside, Queen Victoria’s use of the drug was overwhelmingly lauded, and led to a public fervour for painless childbirth. The editor of the Association Medical Journal called it ‘an event of unquestionable medical importance’, and hoped that this would remove ‘lingering professional and popular prejudice against the use of anaesthesia in midwifery’. [5] Women everywhere were requesting chloroform to ease their labour pains.

Dr Snow was discreet about the details of that fateful day in Buckingham Palace, though he was questioned often about the event. On one occasion, one of his patients refused to inhale the chloroform he was hopelessly trying to administer lest he tell her ‘what the Queen said, word for word, when she was taking it’. Snow cleverly replied that ‘Her Majesty asked no questions until she had breathed very much longer than you have; and if you will only go in loyal imitation, I will tell you everything’. [6]

Shortly after the lady gave birth, Snow slipped away, leaving his promise unfulfilled.

Queen Victoria was destined for one final pregnancy. In 1857, she gave birth to her ninth child, Princess Beatrice (pictured below with the entire family). Once again, Dr Snow successfully administered chloroform during the delivery, securing the path to painless childbirth for women everywhere.

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1. Roger Fulford (ed.), Dearest Child: Letters between Queen Victoria and the Princess Royal, 1858 – 61 (1964), p. 195, 162. Originally quoted in Stephanie Snow, Blessed Days of Anaesthesia (2008), p. 82.
2. Quoted in Matthew Dennison, The Last Princess: The Devoted Life of Queen Victoria’s Youngest Daughter (2007), p. 2.
3. Ibid.
4. Lancet I (1853), p. 453.
5. Association Medical Journal (1853), p. 318.
6. John Snow, On Chloroform and other Anaesthetics (1858), p. xxxi. Originally quoted in Snow, Blessed Days of Anaesthesia, p. 88.

*This article is dedicated to my dear friend, Marla Ginex, who any day will give birth to her second daughter. Good luck and lots of love.

Disturbing Disorders: A Brief History of Harlequin Ichthyosis

H2Last Saturday, I was lounging around on the couch watching 5 straight episodes of Forensic Detectives (don’t judge) when I heard my computer ping. Being the internet junkie that I am, I immediately checked my inbox and saw a message from my old school friend, Andy, who is currently studying medicine at Case Western. He had an idea for a blog post, he wrote, but worried it might be too disturbing for my audience. Naturally, my curiosity was piqued.

Turns out, Andy had reason to worry. In the next message, he attached a photo of a 19th-century fetus (left), which is now housed at Museum Vrolik in Amsterdam. The baby had died from a very rare genetic disorder known as Harlequin Ichthyosis, which causes the overproduction of keratin protein in skin. As a result, those with the condition are born with huge, diamond-like scales all over their bodies, and usually die young due to infections from cracks in the skin.

I have to admit, I’ve seen and researched many terrible diseases, and yet I had a gut reaction to this particular specimen. For me, there is always a deep sadness attached to a child’s death—and even more so when one considers the pain and suffering that brought on such a premature demise. But it wasn’t necessarily the fact that I was gazing upon a life cut short that most disturbed me. It was the extremeness of the deformity that gave me pause. Was this a subject I should tackle on my blog?

As you are reading this post, you will know what decision I finally made in the end. Although Harlequin Ichthyosis is a horrible condition, it is still part of our medical past, present and future (since we have yet to find a cure). For that reason, alone, it deserves contextualization here. More so, our own emotional reactions to the specimen above may help us understand why people in the past feared disfiguring diseases, like smallpox or leprosy, and why many people today continue to struggle when interacting with those who suffer from serious deformities and disabilities.

Harlequin Ichthyosis’s history begins on 5 April 1750, when Reverend Oliver Hart—a cleric from Charleston, South Carolina—became the first to document (but not necessarily observe) the condition. He wrote:

I went to see a most deplorable object of a child, born the night before of one Mary Evans in ‘Chas’town. It was surprising to all who beheld it, and I scarcely know how to describe it. The skin was dry and hard and seemed to be cracked in many places, somewhat resembling the scales of a fish. The mouth was large and round and open. It had no external nose, but two holes where the nose should have been. The eyes appeared to be lumps of coagulated blood, turned out, about the bigness of a plum, ghastly to behold. It had no external ears, but holes where the ears should be. The hands and feet appeared to be swollen, were cramped up and felt quite hard. The back part of the head was much open. It made a strange kind of noise, very low, which I cannot describe. [1]

Mrs Evans’s baby died 48 hours later.

Hart’s description was very accurate. Babies born with Harlequin Ichthyosis have poorly developed ears and nose (which are sometimes absent altogether). Their eyelids are turned inside out, leaving the eyes and area around them susceptible to trauma and infection. They often bleed when they are born, and their lips—pulled upwards by the dry skin—resemble a clown’s smile.

H1Those suffering from Harlequin Ichthyosis are also extremely susceptible to hyperthermia; and they are frequently dehydrated as their skin is not well suited to keeping water or heat in. They often have difficulties breathing due to their armor-like scales, which impede the chest wall from expanding and drawing in enough air. Sadly, this can lead to respiratory failure in many infants.

The disorder’s name alludes to the character Harlequin in the Italian Commedia dell’arte, which made its debut in the 1580s. The Harlequin is characterized by his chequered costume. As you can see, the disease mimics a similar pattern on the skin of the afflicted.

In the past, babies born with Harlequin Ichthyosis had no hope of living more than a few days. As a result, there is very little mention of it in 18th- and 19th-century medical books; and I have only come across two preserved specimens in anatomical collections: one from Museum Vrolik in Amsterdam (mentioned above), and the other from Musée Dupuytren in Paris (pictured below).

H3Advances in medicine, however, have made it possible for people with this condition to live into young adulthood. Improvements in neonatal care, combined with the use of topical retinoids such as Isotrex which enable the skin to shed cells faster than they are produced, are helping to make Harlequin Ichthyosis a chronic condition rather than a fatal disease.

Just last year, 20-year-old Stephanie Turner—who herself was born with the disorder—gave birth to a perfectly healthy baby boy. Hope springs eternal.

 

1. Qtd from J. I. Waring, M.D., ‘Early Mention of a Harlequin Fetus in America’, American Journal of Diseases of Children, Vol. 43 No. 2, February 1932.

*This is the first article in a series called Disturbing Disorders. If you would like to learn more about Harlequin Ichthyosis, or donate to research, please click here.