Posts tagged history

Cotton Mather, you dog, dam you! I’l inoculate you with this; with a pox to you!
The semi-literate quotation in the title comes from a note attached to a bomb thrown into Cotton Mather’s house in Boston, Massachusetts on 14 November 1721 because of Mather’s public advocacy of the most important healthcare improvement of the colonial American era—smallpox inoculation. 
On March 27, 1897, whilst eating some soup, [J.W.] aspirated a bone. This accident was followed by attacks of violent cough and dyspnoea, which, however, became gradually less… On direct laryngeal examination by mean of Kristein’s spatula, the patient being seated with his head strongly deflected to the left, I saw in the right principal bronchus a white mass. On the following day I introduced, under cocaine anaesthesia, a straight tube of 9 millimeters diameter and of 25 centimeters length through the larynx and the trachea until I came near the foreign body. The curvature of the trachea was thus removed, and the foreign body could be seen distinctly. I had great difficulty in catching hold of the foreign body, using a pair of slender forceps which had specially and quickly been made. The difficulties were great, as at that time…I was still without the necessary practice which enables one to look easily, and even more to operate, through long tubes. Eventually I succeeded in catching the bone and in extracting it. The patient was able to return home the following day.

Gustav Killian, 1902.

Direct endoscopy of the upper air-passages and oesopghagus; its diagnostic and therapeutic value in the search for and removal of foreign bodies. J Laryngol Rhinol Otol 17:461, 1902.

Today in History

Fifty years ago today, Dr. Luther L. Terry, Surgeon General of the U.S. Public Health Service, released the first report of the Advisory Committee on Smoking and Health. 

The report concluded on the basis of 7,000 articles available at the time relating to smoking and disease that cigarettes were a cause for chronic bronchitis as well as lung and laryngeal cancer.

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Cigares De Joy, Wilcox and Company (1881).

During Prohibition, Your Doctor Could Write You a Prescription for Booze

Take two shots of whiskey and call me in the morning.

Opioid medication is a controlled substance because of its abuse potential. It requires a separate, more rigorous prescription pad to be dispensed and many regulations apply. The count is checked and double checked to ensure that everything is always accounted for. 

During the prohibition, liquor graduated to the same class of controlled substances. Used for “medicinal purposes,” it became one of the few legal ways you could have alcohol in your home. The price for the privilege? 6 to 7 dollars in the 1920s, or roughly 70-80 dollars today when adjusted for inflation.

Wound Man circa 1400s.

Before medical anatomical studies flourished in the Renaissance period, the physician had a Wound Man diagram. First appearing in European surgical texts of the Middle Ages, it was a schematic diagram that outlined the various wounds a person might suffer in battle or in accidents and served as a quick reference for treatment approaches.

It is the duty of a doctor to prolong life. It is not his duty to prolong the act of dying.
Lord Thomas Horder, 1936.

Nazi Science Is Still Haunting Anatomy and Fueling Conservatives

In 1941, Charlotte Pommer graduated from medical school at the University of Berlin and went to work for Hermann Stieve, head of the school’s Institute of Anatomy. The daughter of a bookseller, Pommer had grown up in Germany’s capital city as Hitler rose to power. But she didn’t appreciate what the Nazis meant for her chosen field until Dec. 22, 1942. What she saw in Stieve’s laboratory that day changed the course of her life—and led her to a singular act of protest. 

On the eve of Remembrance Day, I feel compelled to take a moment to reflect on the meaning and purpose of our work in the medical field. Medicine strives to do good by those we treat and by society as a whole. It is a standard we swear an oath to uphold. However, medicine is also an institution whose legacy spans recorded time and includes some of our greatest and worst moments.

No wound is fresher in our minds than the atrocities performed in the name of science and medicine in World War II. It was an era where we learned the effects of hypothermia, the physiological effects of healing, the effects of wound infection and gangrene et cetera under the worst possible circumstances: via human experimentation. The list goes on. Much of this knowledge, and much of the anatomical studies performed, still pervade modern medicine today.

It is unsettling in many respects. I do not know if, when, or how we can come to terms with the ethical dilemma of using such information. In the interim, I will reiterate what Hubert Markl, president of the Max Planck Society said:

I beg you, the surviving victims, from the bottom of my heart to forgive those who, no matter what their reasons, failed to ask you themselves.

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The Art of Pimping by Dr. Detsky

The term “pimping” was popularized by Brancati in 1989. As he defined it, pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. Among surgeons, pimping may occur when students and residents are a captive audience observing a patient undergoing an operation. Brancati described the origins of the term, which date back to 17th-century London. Koch’s series of “Pümpfrage” (pimp questions) were used on his rounds in the 19th century. The practice migrated to North America in the 20th century and was documented by Flexner while observing Osler making rounds at Johns Hopkins. Brancati outlined suggestions for attending physicians to further hone their pimping skills and methods for students to defend themselves from it. He posited that the art of pimping would disappear in the future with increased specialization and educational reorganization. This commentary revisits the art of pimping 20 years later and provides an update for faculty members and students alike on modern methods in this important skill.

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Gas Masks Tested for Babies. England, 1940.

Let us take a look back at a moment in history. 63 years ago today marks the beginning of the Battle of Britain, a purely aerial campaign waged between the British Royal Air Force and the German Luftwaffe. 

At the time, factories and other ground infrastructures were targeted and much of London and southeast England were razed during the campaign. The threat of chemical warfare still loomed great following the Great War and every precaution was taken. 

In this series of pictures you see gas mask and respirators being fit tested for infants during a drill at a London hospital.

Vaccine Infographic by Leon Farrant.
I often speak with patients who tell me that they do not wish to be vaccinated because they do not see the point, that it is a farce, that it can cause autism (it does not), despite educating and informing them of the reasons behind it. 
In the same way that people who did not grow up during the great wars of the mid-twentieth century have little frame of reference as to what the toll of total war can be, neither can a newer generation of people who have never seen the effects of polio, smallpox, and measles ravage humanity. For many people in the developed world, these are just distant, faded memories captured in the pages of medical textbooks. 
I sincerely hope that the understanding of why we vaccinate does not become lost over time, that people need not fall victim to these preventable diseases; otherwise, the suffering, the challenges, and the research that went into developing these vaccines were all for nothing.

Vaccine Infographic by Leon Farrant.

I often speak with patients who tell me that they do not wish to be vaccinated because they do not see the point, that it is a farce, that it can cause autism (it does not), despite educating and informing them of the reasons behind it. 

In the same way that people who did not grow up during the great wars of the mid-twentieth century have little frame of reference as to what the toll of total war can be, neither can a newer generation of people who have never seen the effects of polio, smallpox, and measles ravage humanity. For many people in the developed world, these are just distant, faded memories captured in the pages of medical textbooks. 

I sincerely hope that the understanding of why we vaccinate does not become lost over time, that people need not fall victim to these preventable diseases; otherwise, the suffering, the challenges, and the research that went into developing these vaccines were all for nothing.