Fading from the vernacular, the Latin phrase vulnus sclopetarium is a quaint, mystifying, and fascinating term that is translated as gunshot wound. There is a fulminating paucity of published information regarding the meaning of this term and the etymology. Trauma surgeons, military surgeons, and scholars of the medical aspects of the civil war may be familiar with the term. Vulnus is easily deciphered from ancient Latin as wound, whereas the origin of sclopetarium proves more difficult to discern. No guns were present in ancient Rome because guns were not invented until around the 13th century; hence, no Latin word for them existed. Thus, sclopetarium is classified as neo-Latin, and deconstruction of the word reveals that sclopeta means gun, but that destination was arrived at via a convoluted path. The suffix -arium implies a place. Remarriage of the two parts suggests that the gun is an instrument of injury, which is typically incurred on a battlefield. An alternative explanation may be that -arium may also refer to the anatomical location of the wound.
In 2008, the NIH launched an undiagnosed diseases program to investigate difficult to diagnose, and typically, multi-system diseases. The objective of this study was to evaluate the presence of psychiatric symptoms or psychiatric diagnoses in a cohort of patients seeking care at the Emory Special Diagnostic Service clinic. We hypothesized that psychiatric symptoms would be prevalent and associated with trauma exposure, and a decreased quality of life and functioning. This is a cross-sectional, retrospective analysis of 247 patients seen between February 7, 2014 and May 31, 2017. The sources for data included the Emory Health History Questionnaire (HHQ) that had the work and social adjustment and quality of life enjoyment and satisfaction questionnaire–short form (QLSQ) embedded in it; medical records, and the comprehensive standardized special diagnostic clinic forms. Primary outcomes were presence of any psychiatric symptom, based on report of the symptom on the HHQ or medical record, or presence of a confirmed preexisting psychiatric disorder. Seventy-two percent of patients had at least one psychiatric symptom while 24.3% of patients had a pre-existing psychiatric diagnosis. Patients with any psychiatric symptom had significantly diminished Q-LES-Q scores (45.27 ± 18.63) versus patients with no psychiatric symptoms (62.01 ± 21.57, t = 5.60, df = 225, p<0.0001) and they had significantly greater functional disability. Patients with a psychiatric disorder also had significantly diminished Q-LES-Q scores (45.16 ± 17.28) versus those without a psychiatric diagnosis (51.85 ± 21.54, t = 2.11, df = 225, p = 0.036) but did not have significantly increased functional impairment. Both patients with psychiatric symptoms and ones with psychiatric disorders had an increased prevalence of trauma. Psychiatric symptoms are prevalent in patients evaluated for undiagnosed disorders. The presence of any psychiatric symptom, with or without a formal psychiatric diagnosis, significantly decreases quality of life and functioning. This suggests that assessment for psychiatric symptoms should be part of the evaluation of individuals with undiagnosed disorders and may have important diagnostic and treatment implications.
In the pages of The Southern Medical Journal, in 1919, William Osler’s colleague Lewellys Barker published a piece entitled “Osler and the South.” Using glowing terms but with startling inaccuracy, Barker described Osler’s relationship with the South and Southerners. Essentially, the brief communication was a happy birthday letter. If Osler had any thoughts on the Civil War, Reconstruction, or the Southern agrarian mindset, he never wrote them down, and a paucity of published information is available to support Barker’s comments. Even though William Osler lived in Baltimore when he worked at Johns Hopkins, he was never particularly fond of that city. He rarely traveled further south. When Osler departed Baltimore for the Regius Professorship in England in 1905, H. L. Mencken eventually published an exquisitely written and fond remembrance of Osler. On several occasions when Osler did venture south, he left a momentous literary or academic footprint. He gave his famous address, “The Fevers of the South,” at the American Medical Association meeting in Atlanta in 1896. From this oratory comes the iconic and oft-quoted line: “Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.” On another excursion, he and two colleagues traveled to the Dismal Swamp, in Old Comfort Point, Virginia. Osler’s fascination with Thomas Moore’s poem “The Lake of the Dismal Swamp” inspired the outing. During their lunch break, Osler composed a whimsical tale, intended for his son Revere, about the swamp. Osler wrote the story on blank pages in the back of a copy of The Anatomy of Melancholy. That particular volume came to rest in a library in Christ Church and, when discovered, the “added contents” were quite a philological mystery until a letter, written by T. B. Futcher, describing the visit to the swamp, illuminated the activities of that outing. Despite Osler’s limited travels in the South, he left an Oslerian legacy there.