In September 1913, two physicians exchanged letters about a case they were both working on. The patient, a seven-and-a-half-month-old boy named Arnold, had died. While the initial diagnosis was spasmophilia—a disease characterized by muscle spasms and seizures—the direct cause of death was in fact intense and prolonged fever. The physician who was there for Arnold’s last days, Dr. Oestmann, described his symptoms with clinical efficiency. “On June 24th he took sick with Pneumonia, 106º,” he noted, but ”the high fever kept on”: “I treated him with frequent baths of 95º, cooled down to 90º, and even 85º, when he had 106º, and wrapped him up in a warm moist towel with dry flannel around it. 4 days before his death he had even 107º.” Though there were two brief reprieves when “he had 99º for 6 hours,” by July 2 the patient “lay in a collapse without any hope of recovery, but took milk from a spoon. On July 4, the 11th day of his sickness, he died.”
Dr. Ostermann then recorded the results of an autopsy conducted on the young child. This examination revealed that his brain was “far too soft and degenerated,” that his lungs were filled with “Severe Lobar Pneumonia,” and that his abdomen contained interchanging segments of collapsed and ballooned guts. Finally, his kidneys also showed signs of chronic interstitial indurative nephritis, which caused the organs to become “very hard to the digging-in finger tip.” Taken together, these findings indicate Arnold was a profoundly ill little boy. Spasmophilia, the initial diagnosis, is a symptom often associated with rickets, itself the result of prolonged Vitamin D deficiency. This in turn affects calcium absorption, leading to spasmophilia—better known today as hypocalcemic tetany.
The recipient of Ostermann’s 1913 letters was Henry Leber Coit, a highly influential American pediatrician. Early pediatrics was largely concerned with infant feeding, and Coit was considered a specialist in the subject, consulting widely with patients and physicians across the country on difficult feeding cases. His archive, housed at the NLM, contains multiple letters such as this one from Oestmann. What makes this letter unique is Oestmann himself, who attended Arnold’s death as a physician and also as a father. His letter contained not only the clinical description of his son’s death but, in his own hand, the bare factual recitation of little Arnold Oestmann’s autopsy, digging in fingertip and all.