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Sir Frederick Treves first showed Joseph Merrick, the
famous Elephant Man, to the Pathological Society of London in 1884. A diagnosis of neurofibromatosis was suggested in 1909
and was widely accepted. There is no evidence, however, of cafe au lait spots or histological proof of neurofibromas. It is
also clear that Joseph Merrick's manifestations were much more bizarre than those commonly seen in neurofibromatosis.
Evidence indicates that Merrick suffered from the Proteus syndrome and had the following features compatible with this diagnosis:
macrocephaly; hyperostosis of the skull; hypertrophy of long bones; and thickened skin and subcutaneous tissues, particularly
of the hands and feet, including plantar hyperplasia, lipomas, and other unspecified subcutaneous masses.
 Queen Victoria, Queen of England from 1837-1901, was
the longest reigning monarch in English history. She established the monarchy as a respectable institution while it was losing
its place as an important part of the British governing system. Victoria was a carrier of hemophilia, a genetic disease that
causes the patient to have severe hemorrhages. Were it not for Queen Victoria, the marriage of her nine offspring to other
noble houses would not have transmitted the hemophilia gene throughout European Royalty. One of the most famous heirs was
Tsarevich Alexis, the only son and heir of Nicholas II, Russia's last Tsar.
 The U.S. experienced unprecedented declines in mortality
during the 20th century. The age-adjusted death rate declined by 74%, and life expectancy increased by 56%, or 30 years Seventy
percent of the increase in longevity occurred during the first half of the century, driven by improvements in infectious-disease
mortality, the leading cause of death at the time. What caused these rapid gains is the subject of great debate and has important
policy implications for developing countries today where infectious disease mortality remains high. The prevailing view is
that medical advances played a negligible role in the mortality decline between 1900 and 1950. The gains, instead, are attributed
to rising living standards, better nutrition, and public health measures that improved water supplies, sanitation systems,
and household hygiene. This view seems uncontroversial for the first thirty years of the 20th century. There were few effective
medicines or therapies available to combat infectious diseases before the mid-1930s, so medical care is indeed unlikely to
have played an important role during this period. Starting in the mid-1930s, however, there were major medical advances that
could have contributed to mortality declines.
 Dr. J. Hostetter’s Stomach Bitters originated
in Lancaster County, Pennsylvania. Dr. Jacob Hostetter invented the concoction and used it in his practice until his retirement
in 1853. Upon retiring he gave his son, David, the formula. David, after an unsuccessful business venture in San Francisco,
returned to Pennsylvania and went into a patent medicine partnership with longtime friend, George W. Smith. Smith provided
the $4,000 needed to produce the first batches of Dr. J. Hostetter’s Stomach Bitters, and otherwise get the business
started. The firm was successful and advertised widely – or most likely it was the other way around. The Civil War further
ensured success for the product when the Union army began to order the bitters by boxcar load. The army, no doubt, found the
product useful in encouraging soldiers before a battle – Hostetter’s Bitters was 47 per cent (94-proof) alcohol.
 Polio is caused by a virus that infects the intestinal tract.
Most infections do not cause seriousillness. However, some people may develop meningitis or become paralyzed. Since 1979,
the only polio disease cases reported in the United States have been imported from other countries or associated with the
oral polio vaccination, which is no longer offered in the United States. Most persons infected with polio do not develop symptoms
at all or may have mild symptoms.Symptoms usually occur 3-35 days after exposure. Mild symptoms include fever, tiredness,
headache, sore throat, nausea, and vomiting. In some cases, the illness becomes more severe,and symptoms include severe muscle
pain and stiffness in the neck and back. Muscle paralysis may occur in a small percentage of cases, and death may occur if
breathing muscles becomeparalyzed. Polio is spread through contact with the stool or throat secretions of an infected person.
Poliovirus
must be swallowed to cause infection. This can happen easily when contaminated hands or objects are put into the mouth.
Polio (poliomyelitis) is a potentially dangerous viral ailment. To combat this disease, researchers developed two polio vaccines
(inactivated and live) grown in cultures made from monkey kidneys. Beginning in the 1950s, these vaccines were administered
to millions of people in the United States and throughout the world. Officially, the polio vaccine is considered safe and
effective, and has been credited with singularly reducing the incidence of this disease. These tenets are not supported by
the data. A cancer-causing monkey virus–SV-40–was discovered in polio vaccines administered to millions of people.
SV-40 has been found in brain tumors, bone cancers, lung cancers and leukemia. SV-40 is transmitted through sexual intercourse,
and from mother to child in the womb. Monkeys that were used to make polio vaccines were infected with simian immunodeficiency
virus (SIV), a virus closely related to human immunodeficiency virus (HIV), the infectious agent associated with AIDS. Some
researchers question whether HIVs may simply be SIVs “residing in and adapting to a human host.” Polio vaccines
also contain calf serum, glycerol and other parts of the cow that may have been infected with bovine spongiform encephalopathy
(BSE), or mad cow disease, a fatal brain-wasting ailment that some researchers link to Cruetzfeldt-Jakob disease (CJD), its
human equivalent. Current disease reduction techniques that emphasize short-term gains over long-term health consequences
need to be reevaluated and discontinued while new and safer health paradigms are researched and implemented.
In 1905, Wickman published
his doctoral thesis on polio in German and was instrumental in naming the disease Heine-Medin disease. He thought that the
Heine’s term for polio, spinal infantile paralysis, and Medin’s work on polio only referred to parts of the disease
and hence, he came up with a new name for the disease. However, Wickman’s name did last in the long run because we call
the disease polio even today.
 The HIV virus is very similar to a virus that is found
in some kinds of chimpanzees in west-central Africa. That virus is called SIV. Some researchers say that the virus crossed
species from chimps to humans many years ago.
Scientists
have known for a long time that certain viruses can pass between species. The most commonly accepted theory is the 'hunter
theory'. According to this theory, humans were infected with SIV when they killed and ate chimps who had the virus. Or
maybe the infected blood got into cuts or wounds on the hunter. Normally the hunter's body would have fought off SIV,
but maybe the SIV virus changed into HIV. An article published in The Lancet in 2004, also shows how the transfer of other
viruses from monkeys and chimps to hunters is still occurring even today. Researchers tested 1,099 people in Cameroon and
discovered about 1% were infected with SFV (Simian Foamy Virus), an illness that people used to think only infected some kinds
of monkeys. Researchers think that people catch thse viruses through butchering and eating monkey and ape meat. Discoveries
such as this make many people think there should be a ban on bushmeat hunting to prevent simian viruses being passed to humans.
By 1980, HIV had spread to North America, South America,
Europe, Africa and Australia. The epidemic continues to spread. In this course we will be learning about many reasons why
the virus continues to infect 11,000 people and cause nearly 8,000 deaths every day.
 A person with Capgras’ Syndrome suffers from the
delusion that one or more of their close friends or family members have been replaced with exact duplicates, and they cannot
be shaken from this belief in spite of an otherwise clean bill of mental health. In some instances, the person believes that
they themselves are, in whole or in part, a duplicate. Unlike the paranoia expected from such a condition, there is never
a motive assigned for the appearance of the duplicates – the patients do not believe someone is “out to get them,”
but they are at a loss for an explanation why anyone would want to replace their loved ones.
This odd misperception is named after the French psychiatrist Jean Marie Joseph
Capgras, who described the case of a Madame M. in 1923. The woman insisted that identical-looking persons had taken the place
of her family. Over time her delusion expanded to include neighbors, friends and acquaintances. But Madame M. never bothered
to get to know these impostors because it was her belief that each one regularly left to make room for the next double. In
all, she eventually claimed to have had more than eighty husbands. People suffering from Capgras’ Syndrome can sometimes
even doubt their own identity after seeing their reflection in a mirror. One man pinched himself on the arm after seeing his
reflection at the doctor’s office, and wondered aloud whether he and the man in the reflection were the same person.
There was also a woman who flew into a jealous rage every time she caught sight of her own reflection, believing this “other
woman” was trying to lure her husband away from her. Her husband eventually covered every reflective surface in the
house in an effort to keep her from hurting herself. Oddly enough, she had no problem recognizing herself in the mirror of
her makeup compact, but anything larger resulted in an assault on the imaginary impostor. Her doctor tried a novel solution:
he gathered a number of mirrors of varying sizes, and had the woman view herself in each one. He started with the smallest
and gradually moved to the next larger as soon as she recognized herself. Ultimately she was able to see herself in a full-length
mirror, and she was cured from then on.
 Every day, patients in u.s. Hospitals are killed
or crippled because they are given the wrong medication or the wrong dose of medication. And because hospitals aren't
required to share that information and don't often voluntarily do it, the same mistakes are made over and over again.
An investigation by the pittsburgh post-gazette shows the same medication errors are repeated, day after day, in one hospital
after the other, all over the country. The mistakes often involve the same medicines, the same devices, the same misreadings
and the same disastrous results. For example: -- the same feeding tube mix-up that killed 75-year-old retired steelworker
joseph orlinski at mercy hospital jan. 20 has killed at least nine other patients from virginia to arizona in the past eight
years.
The same confusion between dilute and concentrate lidocaine syringes that killed edward d. Wolf jr., 61,
at st. Clair memorial hospital in mt. Lebanon in 1990 has caused at least 42 hospital deaths nationwide since the late 1970s.
Similar mix-ups between potassium chloride and other clear liquid medications that killed two elderly women patients -- one
at north hills passavant hospital in 1988 and one at st. John's mercy health and hospital center in 1989 -- have been
recorded for as long as the last 30 years, resulting in at least five other deaths in pennsylvania alone in the past six years.
Why don't hospital personnel learn from each other's mistakes? Because they usually don't hear about them.
Only a fraction of the errors are ever published in professional journals and even when they are, it's hard to know where
to look, since they may appear in any of the thousands of such journals now published. In rare instances, the local media
learn of a serious medication error and disseminate the information. But then, usually only in the local area. Otherwise,
the errors remain the hospital's deadly secret.
"my impression is that hospitals do
a pretty good job of detecting errors," said don ruwe, a hospital pharmacist in edgewood, ky., and member of the kentucky
board of pharmacy. "they just don't tell anybody."
And
they don't have to. There are no requirements for hospitals in most states -- including pennsylvania -- to share or analyze
information on errors. Sometimes a medication error might be referred to a licensing board for discipline against a pharmacist,
doctor or nurse. Or a coroner's office will be told about a death. But those agencies have narrow responsibilities, such
as the revocation of a license or determination of criminality. It isn't their job to look for patterns among errors.
And even when mistakes are reported there's no central agency -- governmental or private -- that systematically seeks
out and analyzes the information to alert other hospitals.
Without
formal oversight, the hospitals are left on their own to share information about errors. But they're not likely to. "it's
something we don't want to talk about, and I've always been troubled by that," said r. David anderson, former
president of the american society of hospital pharmacists.
"it's
just been sort of a sin committed by hospital administrators to hide that type of information to avoid any potential suit.
It's a defensive measure to prevent it from getting into court, which then becomes public knowledge." such secrecy
contributes to a growing number of horror stories, experts believe. And mounting evidence gleaned through anecdotes and research
is revealing a staggering picture. In a nationwide study of hospital pharmacists conducted by the post- gazette, 250 pharmacists
estimated there were 16,000 medication errors in their institutions last year alone, 106 of them resulting in patient deaths.
And while the typical response from individual pharmacists was 12 errors that caused death, disability or harm in 1992, one
pharmacist estimated 3,400 errors in one hospital that year. In 1952, dr. Forest dodrill, a surgeon at wayne
state university’s harper hospital and president of the michigan heart association, was absolutely confident that a
machine could be developed to temporarily replace the human heart’s blood-pumping function and make open heart surgery
possible. Several previous devices had been used during surgery with animals. But the issues of how to preserve red corpuscles
when blood was pumped through a machine as well as how to prevent blood clotting, hemorrhaging, and infection had to be addressed
before a machine could be used for heart surgery on humans.
Dr. Dodrill and his medical team turned to a team of
scientists and engineers at the general motors research laboratories, then located in the gm building annex in detroit, to
help develop and then build a mechanical heart that would address all these issues.
The result was the dodrill-gmr
mechanical heart, built by the gm research laboratories at no cost, in the public interest. It measured 10 inches by 12 inches
by 17 inches and was described as resembling a 12-cylinder engine, with 6 separate chambers (looking like cylinders). With
parts made of stainless steel, glass, and rubber, it used air pressure and vacuum pumps to circulate blood from the 12 chambers
through the patient’s body while the heart was being operated on.
The dodrill-gmr mechanical heart (often
called the artificial heart or heart pump) was used successfully for the first time in a surgery performed on 41-year-old
man at harper hospital in the fall of 1952.
As dr. Dodrill modestly noted in his report for the journal of american
medicine, "to our knowledge, this is the first instance of the survival of a patient when a mechanical heart was used
to take over the complete body function of maintaining the blood supply of the body while the heart was open and operated
on."
The operation lasted 80 minutes and the mechanical heart kept the patient alive for 50 minutes while
his own heart was repaired. Its success soon made open heart surgery a common practice.
General motors left the
reporting on the dodrill-gmr mechanical heart’s success to the michigan heart association and did not even issue a news
release.
With more sophisticated heart-lung machines under development by other medical engineering teams, gm donated
the device to the smithsonian institution in 1954.
1900s British obstetrician James Blundell performs transfusions
on women hemorrhaging from post-partum child birth. Advises that only human blood should be used, admonishing the transfusion
of animal blood in humans. 1900s Australian botanist Gregor Mendel publishes his studies outlining the principles of heredity
thus genetics. 1900 Austrian-American Karl Landsteiner describes blood biocompatability and rejection, presents the ABO system.
1901 the Japanese American chemist and pharmacologist
Jokichi Takamine isolated the powerful vasoconstrictor adrenaline valuable in the treatment of bronchial asthma and cardiac
conditions. 1903 Willem Einthoven invents the expounding on Augustus Waller's work invents the electrocardiograph by using
a string galvanometer. 1906 Pathologist James Homer Wright proved conclusively that platelets constituted a third type of
blood element produced in the bone marrow. 1908 First successful transfusion using Landsteiner's ABO typing technique.
1908 New York, Alexis Carrel, a French surgeon sewed
a father's artery to the vein of his newborn daughter who was hemorrhaging. Both survive the procedure. 1910 Hooker, idea
that pulse pressure was a necessary factor in perfusion. 1911 Madame Curie discovers radium.
1911 Scottish physician Thomas Addis suggested that the key to hemophilia lay in
the faulty conversion of pro- thrombin to thrombin. 1912 Polish biochemist Casimir Funk identifies vitamins. 1914 Dr. Paul
Dudley White, becomes one of the country's first cardiologists by placing an EKG machine in the basement of Massachusetts
General Hospital, observing over 27,000 EKG's and publish his findings. 1914 W.H. Howell, physiologist at Johns Hopkins
University the first to see a clot's network through a microscope with ultraviolet light.
1916 McLean isolated
heparin making controlled anticoagulation possible. 1917 British physician Dr. Ivan Magill invents the endotracheal tube.
1920 Scientist/ aviator Charles A. Lindberg first oxygenation of perfusion fluid driven by compressed oxygen gas. 1920 Belt,
Smith and Whipple wrote about factors relevant to perfusing living organs and tissues. 1921 German physiologist Otto Loewi
expounds on Galvani's work and isolates acetylecholine and epinephrine. 1923 Boston surgeons Dr.'s Elliott Cutler
and Claude Beck and cardiologist Samuel Levine operate on an 11 year old girl for mitral stenosis. First use of a valvulotome.
1925 May 6. Dr. Henry Soutter performs a "digital" mitral commissurotomy. 1926 American physicians George Richards
Minot and William Parry Murphy discover in liver an effective control for pernicious anemia. 1928 Dale and Schuster working
at the National Institute for Medical research in Hempstead, England developed a double perfusion pump intended to carry out
whole-body perfusion. It did not but was, however adopted by Dr. J.H. Gibbon, Jr. in his first heart-lung machine prototype.
1929 Penicillin, the action of this antibiotic was first
observed by British bacteriologist Sir Alexander Fleming. 1929 Gibbs developed an artificial heart while working at Dalhousie
University in Nova Scotia. Consisted of two bellows within a round brass container. 1929 German surgeon, Werner Forssman develops
the technique of cardiac catheterization. Inserts the catheter into his arm and himself becomes the first subject. 1930s Werner
Forssman uses a catheter to inject opaque dye into his heart in an attempt to outline the organ's chambers on X-Ray photographs.
1930s University of Wisconsin biochemist Karl Paul Link helps discover dicumarol, a long-term anticoagulant. 1930s Andre Cournand
and D.W. Richards, American cardiologists spend ten years exploring the potential of the angiocath. 1931 Dr. John H. Gibbon,
Jr., Massachusetts General Hospital, Boston, conceives the idea of the heart-lung machine for extra-corporeal circulation
to remove pulmonary emboli from moribound patients. 1931 Gibbon and Churchill, first use of phenobarbitone for anesthesia.
1934 Dr. Michael DeBakey invents the DeBakey pump. 1935 Danish biochemist Henrik Dam discovers Vitamin K and it's effect
on bleeding problems. He names it Koagulation-Vitamin. 1935 May 10, Dr. John H. Gibbon, Jr., first successful application
of the heart-lung machine for extracorporeal circulation in an animal (cat).
1937 Bernard Fantus starts the first blood bank at Cook
County Hospital in Chicago using a 2% solution of sodium citrate. Refrigerated blood lasted ten days. 1939 Second generation
Gibbon heart-lung machine incorporating DeBakey pumps thus abandoning the Dale- Schuster pumps. 1938 August 26. Boston surgeon
Dr. Robert Gross ligates the patent ductus in a human. Performs over 1,500 similar cases. 1939 Charles Drew, a Ph.D. candidate
at Columbia University reports to the National Blood Transfusion Committee that the use of plasma is preferred over whole
blood for the treatment of shock, burns and open wounds. 1940s O.H. Robertson, a Canadian medical officer during World War
I, discovered that a solution of citrate glucose could preserve blood for as long as twenty-one days. 1941 Dr. Andre'
Cournand performs the first cardiac catheterization on a human at the Bellvue Hospital, New York. 1941 Paul Owen, a hematologist
in Oslo, noted the correlation between diet and coronary thrombosis.
1940s Dr. Alfred Blalock, former surgical resident at
Vanderbilt University, and Dr. Helen Taussig, a heart specialist at Johns Hopkins Hospital co-design the surgical technique
for treatment of Tetrology of Fallot (pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy).
1943 Russian-born American microbiologist Selman Abraham Waksman discovered the antibiotic streptomycin used in the treatment
of tuberculosis and other diseases. 1944 Dr. Alfred Blalock performs the first Blalock-Taussig procedure, end to side anastamosis
of the subclavian artery to the pulmonary artery. 1944 October. Clarence Crawfoord of the Karolinska Institute in Stockholm
surgically repairs coarctation of the aorta in a human. 1944 Kolff and Berk, rotating kidney made from cellophane for dialysis;
observed how venous blood became arterialized when exposed to aerated dialysis fluid. 1946 Cortisone produced by the cortex
of the adrenal glands was synthesized and proved to have therapeutic value in rheumatoid arthritis and a variety of inflammatory
diseases. 1948 American physicians Minot and Murphy isolate antianemic factor, vitamin B-12. 1948 National Heart Institute
enacts the Framington (Massachusetts) study. Initial enrollment of 28,000 subjects to study the effects of factors influencing
coronary artery disease. The project is ongoing. 1949 Dr. John H. Gibbon, Jr. uses protamine to reverse the anticoagulation
effects of sodium heparin. 1949 IBM develops the Gibbon Model I heart-lung machine, delivered to Jefferson Medical College,
Philadelphia, PA. Consisted of DeBakey Pumps and film oxygenator.
At first, blood transfusion was done via direct connection
between donor and recipient. George Washington Crile (1864-1943), an American surgeon, developed a standard surgical method
of blood transfusion. After surgically exposing a recipient's vein and a donor's artery, a physician clamped shut
the vessels and attached a small tube as a conduit between them. When the surgical clamps clamps were opened, blood flowed
from donor to recipient. Edward Lindeman took the procedure out of the operating room in 1913 with a simple needle puncture
technique. This method also allowed exact measurement of the amounts of blood being transfused. With all these advances in
place, blood transfusion spread rapidly and became firmly established during World War I (1914-1918).
Once blood transfusion was in wide use, storage of donated blood
became a problem. The first "blood bank" was set up by Dr. Bernard Fantus in 1937 at Cook County Hospital in Chicago,
Illinois. A method of preserving red blood cells for up to 21 days with acid citrate dextrose was developed in the 1940s.
African-American surgeon Charles Richard Drew studied in depth a way to preserve and store blood ready for instant use. He
discovered that plasma could be processed and reserved for a long time, and transfused without regard to blood type or matching
in place of whole blood. Drew established blood banks in England and the United States during World War II (1939-1945). These
banks saved thousands of lives by making blood transfusion available to the wounded.
Today, blood transfusion remains a widely used and critical medical procedure.
After World War II, methods were developed for separating the various constituents of blood. As a result, in addition to whole
blood, a patient may receive "packed" red cells, granulocytes (white cells), platelets, plasma, or plasma components.
Both natural and artificial blood substitutes are also used. Perhaps most serious of the remaining risks of blood transfusion
is the possibility of transmitting disease via the donor's blood. Of special concern is the transmittal of the HIV virus
and hepatitis. For this reason, donated blood is carefully screened.
Chronic fatigue syndrome was first identified as a distinct
entity in the 1980s. (A virtually identical illness had been identified in Britain three decades earlier and called myalgic
encephalomyelitis.) The illness, which afflicts more women than men, causes overwhelming fatigue, sleep disorders and other
severe symptoms. No consistent biomarkers have been identified and no treatments have been approved for addressing the underlying
causes, although some medications provide symptomatic relief.
Patients say the word "fatigue" does not begin to describe their condition. Donna Flowers of Los Gatos,
Calif., a physical therapist and former professional figure skater, said the profound exhaustion was unlike anything she had
ever experienced. "I slept for 12 to 14 hours a day but still felt sleep-deprived," said Ms. Flowers, 51, who fell
ill several years ago after a bout of mononucleosis. "I had what we call ‘brain fog.’ I couldn’t think
straight, and I could barely read. I couldn’t get the energy to go out of the door. I thought I was doomed. I wanted
to die." Studies have shown that people with the syndrome experience abnormalities in the central and autonomic nervous
systems, the immune system, cognitive functions, the stress response pathways and other major biological functions. Researchers
believe the illness will ultimately prove to have multiple causes, including genetic predisposition and exposure to microbial
agents, toxins and other physical and emotional traumas. Studies have linked the onset of chronic fatigue syndrome with an
acute bout of Lyme disease, Q fever, Ross River virus, parvovirus, mononucleosis and other infectious diseases.
The 20th century teemed with progress. Horse and buggy,
boat, and rail travel were, to all intents and purposes, replaced by the automobile and jet plane. Communication by telegraph
and mail service was replaced by telephone, satellite, the World Wide Web, and more efficient mail service (though junk marl
is a twentieth century phenomenon).
Live entertainment
was to a significant degree replaced by the radio, phonograph, audio and video tape, CD, and television. Home heating, air
conditioning, lighting, water and toilet facilities were all improved or introduced during the last century.
Health care was no exception to the amazing progress made during the last
one hundred years. During the 20th century, the age adjusted death rate declined by 74% and life expectancy increased 56%.
This is considered a triumph of public health and biomedical research.
These hundred years saw changes in health care that included the widespread use of immunizations, vast improvements
of sanitation, surgical milestones that included sterile techniques, safer anesthesia, miniaturization of many surgeries,
less invasive methods of surgery, and the transplantation of organs.
Much safer and more varied medications, including the introduction of antibiotics and antiviral therapies, became
available. Diagnostic tools now used routinely that were unavailable 100 years ago include a wide variety of sophisticated
blood tests, X-rays, and imaging studies such as bone scan, thyroid scan, CT and MRI. The ECG, EMG, and EEG are products of
the last century.
"Scoping," such as arthroscopy
and endoscopy, was introduced as well as the medical (and industrial) use of laser technology. The list could go on and on.
There were many vital statistics that changed during the last 100
years. Life expectancy went from the mid 40s to the high 70s. In the early part of the previous century respiratory infectious
diseases accounted for almost a quarter of all deaths. Pneumonia and influenza remained the second leading cause of death
overall until 1933 when cancer replaced it. In 1998, the two leading causes of death overall were heart disease and cancer.
Pneumonia and influenza have dropped to numbers six and seven on the list.
We often hear the term "baby boom." The peak years of the baby boom occurred in 1950 to 1957 when 123 out
of every 1000 women aged 15 to 44 gave birth (actually very similar to the birth rate in the 1920s). To compare, the birth
rate during the last quarter century has stayed relatively flat at about 65 births per 1000 women of childbearing age.
Maternal mortality slowly declined early in the twentieth century.
Maternal deaths is defined as the number of deaths during pregnancy and the following 42 days. Beginning in 1935, the mortality
rate of 582 deaths per 100,000 live births began a precipitous decline so that by 1956 it was 40 deaths per 100,00 live births
and in 1998 7.1 deaths per 100,000 live births. There was an overall drop in maternal mortality of 90%.
Infant mortality also declined. In 1915, about 100 white infants per 1000 live
births and twice as many black infants died in the first year of life. In 1998, the infant mortality rate was 7.2 overall,
6.0 for white and 14.3 for black infants. Several important advances in neonatology have been instrumental in significantly
reducing infant mortality over the last twenty years.
For
children older than one year old, the decline in mortality was even greater. In 1900, about 30 children in a thousand died
between ages one and twenty. In 1998, the number had reduced to less than two. The leading causes of death in children in
1900 were infectious diseases (diarrheal diseases, diphtheria, measles, pneumonia, influenza, scarlet fever, tuberculosis,
whooping cough, typhoid fever, etc.). Infectious disease as a cause of death declined from 61.6% to 2% over the last century.
Accidents now account for 43.9% of childhood deaths. Even accident
as a cause of death (now called unintentional injuries) dropped from 47.5 to 15.9 per 100,000 children. Common accidental
causes of death in children early this century were injuries on the farm, fires and burns, and injuries in factories and shops.
The most common cause of accidental death in children now is motor
vehicle-related. Deaths from unintentional injuries, such as homicide and suicide, accounted for 9.8% of deaths in this age
group in 1998, with firearms accounting for 7% of all accidental deaths in children.
The major declines in child mortality that occurred in the first third of the last century have been attributed to
a combination of improved socioeconomic conditions and public health strategies, including improvements in water treatment,
food safety, solid waste disposal, and public education.
In
the middle of the century, the impact of vaccinations became apparent. Deaths from diphtheria, pertussis, and measles, common
early this century, are almost unheard of today. Deaths from polio, tetanus, and H. Influenza disease have also been virtually
eliminated by mass vaccinations.
The percent of the population
that is elderly is slowly increasing because of the combination of a relatively low birth rate and a longer life expectancy.
This provides a societal challenge to provide the necessary resources to deal with the issue of balancing the needs of children
with the demands of a growing aging population. Since the aging population has much more political clout than children, it
is feared that our youngsters will be left behind.
The
voices of parents must be raised, despite the time and economic constraints imposed by parenthood, or the fate of our children
will be left in the hands of others. The strength of our advocacy for this vulnerable population will determine how well children
will fare in this new century.
Happy New Century!
 Scurvy, a disease of dietary deficiency of vitamin C,
is uncommon today. However, among diseases, scurvy has a rich history and an ancient past. The Renaissance period (14th to
16th centuries) witnessed several epidemics of scurvy among sea voyagers. In 1747, James Lind, a British Naval surgeon, performed
a carefully designed clinical trial and concluded that oranges, lemons and limes had the most antiscorbutic effect. Eventually,
with the provision of lemon juice and lime juice to the sea voyagers, scurvy became rare at sea. Infantile scurvy appeared
almost as a new disease toward the end of the 19th century and has been attributed to the usage of heated milk and proprietary
foods. Thomas Barlow described the classic clinical and pathological features of infantile scurvy in 1883. Between 1907 and
1912, Holst and Frolich induced and cured scurvy in guinea pigs by dietary modification. In 1914, Alfred Hess established
that pasteurization reduced the antiscorbutic value of milk and recommended supplementation of fresh fruit and vegetable juices
to prevent scurvy. Such pioneering efforts led to the eradication of infantile scurvy in the United States.
 Although President Franklin D. Roosevelt had been profoundly
affected by paralytic polio, he overcame great odds to become the president of the United States in 1935. In the early years
of his presidency, he was diagnosed with persistent hypertension. He was also treated with digitalis for congestive heart
failure. His blood pressure shortly before the Yalta Conference (February l945) had grown alarmingly high, and it was evident
that he had developed cardiac cachexia. Cachexia increases with cardiac failure similar to the increased cachectin of chronic
inflammatory diseases and far-advanced malignancies. This results in the acceleration in the patient's metabolism with
a wasting syndrome. The patient develops anorexia, weakness and weight loss. Churchill and Stalin were able to take advantage
of Roosevelt at Yalta because of his hypertensive cardiac failure and cachexia. Thus, Roosevelt's cardiac cachexia profoundly
affected the outcome of the Yalta meeting, and the most likely, the course of world history.
 The 20th century saw significant changes in the practice
of medicine. From an increasingly solid scientific base came striking discoveries, while, at the same time, patients became
progressively more overtly demanding and distrustful of their doctors. Retreating from a besieged “paternalistic”
identity, physicians, applying the ‘latest’ findings of scientific and pharmacological research, adopted new roles
as impersonal, sometimes distant, technicians and became enforcers of governments’ health agendas. Patients, feeling
generally abandoned, often criticized, frequently confused and never satisfied, insisted on playing a greater role in their
own health care.
It was into the midst
of these tectonic shifts that the sub-discipline of health psychology emerged. Back in the 1970’s, in those early days
when it first called itself “new,” it exuded promise as it spawned a bio-psycho-social model, championed the fervour
for “wellness,” and rose rapidly to become a thriving aspect of the “psychology industry. Assuming the popularized
public image of psychology as a science, it aligned itself both with medicine as a purveyor of medical knowledge and with
patients (and potential patients) as a consultant and coach in healthy living. It was prepared to fill the interpersonal void
in the doctor-patient relationship by offering a listening ear and caring presence as it empathized with the multi-layered
aspects of sickness.
 The origin of the 1918 pandemic has always been disputed
and may never be resolved. However, the observations of trained observers at that time are worth noting because they may bear
on later genomic analysis of the recently resurrected 1918 virus nucleotide fragments and the abortive “swine
flu” epidemic of 1976. In Richard Shope’s Harvey lecture of 1936 , he reviews evidence that in the late summer
or early autumn of 1918, a disease not previously recognized in swine, and closely resembling influenza in humans, appeared
in the American Middle West. Epidemiologic-epizootiologic evidence strongly suggested that the causative virus was moving
from humans to swine rather than in the reverse direction. Similar observations were made on the other side of the world and
reported in a little-known paper in the National Medical Journal of China . In the spring of 1918, influenza in humans spread
rapidly all over the world and was prevalent from Canton, China, to the most northern parts of Manchuria and from Shanghai
to Szechuan. In October 1918, a disease diagnosed as influenza appeared in Russian and Chinese pigs in the area surrounding
Harbin. Thus, epidemiologic evidence, fragmentary as it is, appears to favor the spread of virus from humans to swine, in
which it remained relatively unchanged until it was recovered more than a decade later by Shope in the first isolation of
influenza virus from a mammalian species.
Leprosy or Hansen's disease (HD), is a chronic disease
caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen,
Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions
are the primary external sign. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs
and eyes. Contrary to folklore, leprosy does not cause body parts to fall off, although they can become numb and/or diseased
as a result of infection.
Although
the mode of transmission of Hansen's disease remains uncertain, most investigators think that M. leprae is usually spread
from person to person in respiratory droplets, The minimum incubation period reported is as short as a few weeks and this
is based on the very occasional occurrence of leprosy among young infants, The maximum incubation period reported is as long
as 30 years, or over, as observed among war veterans known to have been exposed for short periods in endemic areas but otherwise
living in non-endemic areas. It is generally agreed that the average incubation period is between three and five years. Leprosy
is now known to be neither sexually transmitted nor highly infectious after treatment. Approximately 95% of people are naturally
immuneand sufferers are no longer infectious after as little as 2 weeks of treatment.
Leprosy has affected humanity for over 4,000 years, and was well-recognized in
the civilizations of ancient China, Egypt, and India DNA taken from the shrouded remains of a man discovered in a tomb next
to the Old City of Jerusalem shows him to be the earliest human proven to have suffered from leprosy. In 1995, the World Health
Organization (WHO) estimated that between 2 and 3 million people were permanently disabled because of leprosy at that time.
In the past 20 years, 15 million people worldwide have been cured of leprosy. Although the forced quarantine or segregation
of patients is unnecessary in places where adequate treatments are available, many leper colonies still remain around the
world in countries such as India (where there are still more than 1,000 leper colonies), China, Romania, Egypt, Nepal,
Somalia, Liberia, Vietnam, and Japan,Leprosy was once believed to be highly contagious and sexually transmitted, and was treated
with mercury—all of which applied to syphilis which was first described in 1530. It is now thought that many early cases
of leprosy could have been syphilis
Lepers
were forbidden to enter churches or to go into any assembly of people: they had to wear a specific dress, so as to be recognized
by the 'clean'. They were not permitted to have sexual intercourse and they were forbidden to touch people or any
of their possessions. Each leper was separated from the community after a precise religious ceremony in which he or she was
declared dead to the world and was treated very much like a corpse is before burial.
 Thalidomide was originally developed in Germany
in 1954 by the pharmaceutical company Chemie Grunenthal. It was used in the UK from 1958, commonly to treat morning sickness
in early pregnancy. In 1961, doctors realised that the drug was the cause of severe congenital disabilities and it was withdrawn
from sale.
In the United Kingdom, the most
commonly prescribed drug containing thalidomide was called Distaval, manufactured by Distillers (Biochemicals) Ltd. It was
given for nausea in pregnancy, nervous tension, migraine headaches, and as a general sedative. Thalidomide was described
as completely atoxic - it was said to be almost impossible to take an overdose. Considered, therefore, a valuable drug, particularly
for use in the geriatric field, it was exempt from purchase tax and available under the National Health Service. Distillers
took it from the German manufacturers, Chemie Grunenthal in 1958 as a tried and tested product, not requiring research on
their part. Following reports of what amounted to an epidemic of births of malformed babies, and side effects of peripheral
neuritis in adults in Germany, Chemie Grunenthal reluctantly withdrew the drug in November 1961 and Distillers followed suit
in December of that year. A UK Government warning was not issued until May 1962. Also, the drug was present in a number
of medications, including some cough mixtures, but the labelling did not use the word thalidomide, so it inevitably remained
in some home drugs cabinets. At least 20 children were born during and after September 1962 showing typical thalidomide impairments
- more than nine months after Distaval was withdrawn, the story of thalidomide in the USA is very different from the European
experience. Fortunately, Dr. Francis Kelsey of the US Food and Drug Administration was more alert and would not accept that
the drug had been adequately tested for manufacture and distribution there. As a result, only about 20 malformed babies
were born in America and these were as a result of limited clinical trials that were carried out.
 Josef Mengele was born, the eldest of 3 children, to
Karl and Walburga Mengele in Günzburg, Bavaria, Germany. Mengele's father was a founder of Karl Mengele farm machinery
for milling, sawing, and baling, which produces major farm machinery under the name Karl Mengele & Sons. In 1935, Mengele
earned a Ph.D in Anthropology from the University of Munich. In January 1937, at the Institute for Hereditary Biology and
Racial Hygiene in Frankfurt, he became the assistant to Dr. Otmar Freiherr von Verschuer who was a leading scientist mostly
known for his research in genetics with a particular interest with twins. From this association, Mengele probably developed
his life-long fascination with the study of twins. In addition Mengele studied under Theodor Mollison and Eugen Fischer, who
had been involved in medical experiments on the Herero tribe in (what is now) Namibia.
In 1937 Mengele joined the Nazi Party. In 1938 he received his medical degree and
joined the SS. Mengele was conscripted into the army in 1940 and later volunteered to the medical service of the Waffen-SS,
the combat arm of the SS, where he distinguished himself as a soldier. In June 1941 he was awarded the Iron Cross Second Class
for his efforts at the Ukrainian Front. In January 1942, while serving with the SS Wiking Division deep behind Soviet lines,
he pulled two German soldiers from a burning tank, and was awarded the Iron Cross First Class as well as the Black Badge for
the Wounded and the Medal for the Care of the German People. Mengele was wounded during this campaign; since he could not
return to combat, he was posted at the Race and Resettlement Office in Berlin. He resumed an association with his mentor,
von Verschuer, who was at the Kaiser Wilhelm Institute for Anthropology, Human Genetics and Eugenics in Berlin. Just before
he was transferred to Auschwitz, Mengele was promoted to the rank of SS captain in April 1943.
 In May 1943, Mengele replaced another doctor who had
fallen ill at the Nazi extermination camp Birkenau. On May 24, 1943, he became medical officer of Auschwitz-Birkenau's
"Gypsy camp". In August 1944, this camp was liquidated and all its inmates gassed. Subsequently Mengele became Chief
Medical Officer of the main infirmary camp at Birkenau. He was not, though, the Chief Medical Officer of Auschwitz —
superior to him was SS-Standortarzt (garrison physician) Eduard Wirths. During his 21-month stay at Auschwitz, Mengele earned
the sobriquet "Angel of Death" for the cruelty he visited upon prisoners.[citation needed] Mengele was referred
to as "der weiße Engel" ("the White Angel") by camp inmates because when he stood on the platform
inspecting new arrivals and directing some to the right, some to the left (the gas chambers), his white coat and white arms
outstretched evoked the image of a white angel. Mengele took turns with the other SS physicians at Auschwitz in meeting incoming
prisoners at the camp, where it was determined who would be retained for work and who would be sent to the gas chambers immediately.
In one instance, he drew a line on the wall of the children's block 150 centimetres (about 5 feet) from the floor, and
sent those whose heads could not reach the line to the gas chamber. "He had a look that said 'I am the power,'"
said one survivor. When it was reported that one block was infested with lice, Mengele ordered the 750 women assigned to it
to be gassed.
Mengele used Auschwitz as
an opportunity to continue his research on heredity, using inmates for human experimentation. He was particularly interested
in identical twins; they would be selected and placed in special barracks. He also recruited Berthold Epstein, a Jewish pediatrician.
As a doctor, Epstein proposed to Mengele a study into treatments of the disease called Noma that was noted for particularly
affecting children from the camp. While the exact cause of Noma remains uncertain, it is now known that it has a higher occurrence
in children suffering from malnutrition and a lower immune system response. Many develop the disease shortly after contracting
another illness such as measles or tuberculosis Mengele took an interest in physical abnormalities discovered among
the arrivals at the concentration camp. These included dwarfs, notably the Ovitz family - the children of a Romanian artist,
of whom seven of the ten members were dwarfs. Prior to their deportation, they toured in Eastern Europe as the Lilliput Troupe.
Mengele often called them "my dwarf family"; to him they seemed to be the perfect expression of "the abnorm".
 Mengele's experiments also included attempts to
take one twin's eyeballs and attach them to the back of the other twin's head, changing eye colour by injecting chemicals
into children's eyes, various amputations of limbs, and other brutal surgeries. Rena Gelissen's account of her time
in Auschwitz details certain experiments performed on female prisoners around October 1943. Mengele would experiment on the
chosen girls, performing sterilization and shock treatments. Most of the victims died, because of either the experiments or
later infections. "Once Mengele's assistant rounded up 14 pairs of Roma twins during the night. Mengele placed them
on his polished marble dissection table and put them to sleep. He then injected chloroform into their hearts, killing them
instantly. Mengele then began dissecting and meticulously noting each piece of the twins' bodies." At Auschwitz,
Mengele did a number of twin studies. After the experiment was over, these twins were usually killed and their bodies dissected.
He supervised an operation by which two Romani children were sewn together to create conjoined twins; the hands of the children
became badly infected where the veins had been resected, this also caused gangrene. The subjects of Mengele's research
were better fed and housed than ordinary prisoners and were, for the time being, safe from the gas chambers.[ When visiting
his child subjects, he introduced himself as "Uncle Mengele" and offered them sweets. Some survivors remember that
despite his grim acts, he was also called "Mengele the protector"
Medical advances such as blood transfusions and improved anesthesia, developed
in the treatment of soldiers during World War II, paved the way for the first heart surgeries. By 1950, closed heart surgery,
in which a small hole was cut into a beating heart, was a viable procedure. However, several heart conditions, including congenital
heart disorders and damage from rheumatic fever, could not be corrected through a small hole in the heart. Unfortunately,
doctors could not cut open a beating heart without the patient bleeding to death. Temporarily stopping the heart only allowed
for four minutes in which to perform the surgery before the patient began to suffer from oxygen deprivation. In 1950, Canadian
surgeon Dr. Bill Bigelow noticed that hibernating animals could survive the extreme winters of Northern Canada by slowing
down the beat of their heart. Intrigued by the relationship between cold and circulation, Bigelow performed experimental surgeries
on animals in which he used extreme cold to slow down the heart, lessening the body's need for oxygen and extending the
amount of time possible for performing surgery. On this day in 1952, two surgeons from the University of Minnesota, Dr. Walton
Lillehei and Dr. John Lewis, successfully used Bigelow's techniques, known as the hypothermic approach, on a human. Using
a special blanket, they brought her body temperature down to 81 degrees F, clamped the inflow to her heart to empty it of
blood and corrected several small defects. For the first time, a human had successfully been treated by open-heart surgery.
Lewis, Lillehei and their colleagues went on to develop the "heart-lung" technique of maintaining oxygen in the
bloodstream while the heart is shut down. Modern open-heart surgeries continue to rely on an improved heart-lung technique.
Christiaan Neethling Barnard, who made medical history
and was thrust into the international limelight almost instantly in 1967 after performing the first human heart transplant,
died on September 2, 2001, in his hotel room while vacationing at the coastal resort of Paphos, Cyprus.
Barnard was born in the small town of Beaufort West on South Africa's
Great Karroo plateau on November 8, 1922. His father, Adam Hendrik Barnard, was a Dutch Reformed minister. His mother, the
former Maria Elizabeth de Sewart, played the church organ. Barnard was one of five boys. One of his brothers, Abraham, died
at the age of 5 years of heart disease. This may have been the reason for Barnard's future walk in life. The family was
by no means rich and the young Christiaan Barnard had a modest upbringing. He matriculated from the Beaufort West High School
in 1940, and in 1946 he completed his bachelor of medicine and bachelor of surgery degrees (MB, ChB) at the University of
Cape Town. Barnard served his internship at the Groote Schuur Hospital in Cape Town. In 1948, he married Aletta Louw and moved
to the town of Ceres, in the Western Cape, where he served as a family physician. The Barnards had two children, Andre, who
later committed suicide at 31 years of age, and Deirdre. The couple divorced in 1969. In 1951, Barnard returned to Groote
Schuur Hospital to serve as the resident medical officer and registrar in the department of medicine. He continued to study
in the evenings and received the degree of master of medicine followed by a doctor of medicine degree from the University
of Cape Town in 1953. He then served as a registrar in the department of surgery under Professor J. Erasmus.
In 1956, Barnard received a scholarship for a 2-year study
abroad. Leaving his small family behind, he traveled to the United States, where he studied general surgery with Owen H. Wangensteen
at the University of Minnesota, then chose to train in cardiothoracic surgery under the tutelage of C. Walton Lillehei. He
received a master of science in surgery degree in 1958 and in the same year was awarded a doctor of philosophy degree. Barnard
returned to South Africa to work at Groote Schuur Hospital, this time as a specialist in cardiothoracic surgery. Three years
after his return, he was appointed head of the department of cardiothoracic surgery and was promoted to the rank of associate
professor. For the next few years, Barnard worked on conducting experimental heart surgery on animals in Cape Town, visiting
transplant laboratories worldwide, and assembling a surgical team before he felt he was ready to undertake his new task.
On December 3, 1967, Barnard stunned the world
when he led the surgical team that performed the first human-to-human heart transplant. The transplanted organ was sustained
for 18 days with intense immunosuppression. Fiction had become scientific fact and the distinctions between life and death
had become blurred and rearranged. The concept of human heart transplantation, conceived in the corridors of the laboratories
of transplant pioneers such as Norman Shumway, Richard Lower, James Hardy, and Adrian Kantrowitz, became a reality and the
seeds that were planted across the Atlantic gave birth in South Africa.
Christiaan Barnard became a household name and the unknown surgeon became an international superstar overnight. "On
Saturday, I was a surgeon in South Africa, very little known. On Monday I was world renowned," Barnard recalled on a
weekend in 1967. He was celebrated around the world for his daring accomplishment. Handsome and only 45 years old at the time,
he graced the covers of magazines, toured the world visiting dignitaries and heads of states, and became a popular figure
even to the layman on the street. He enjoyed his fame quite well. "Any man who says he doesn't like applause and
recognition is either a fool or a liar," Barnard once told an audience. "You learn from mistakes, but success gives
you the courage to go on and do even more."
In 1970, Barnard married Barbara Zoellner, then 19 years old, and together they had two boys: Christiaan, Jr, and
Frederick. Their marriage, too, ended after 12 years. During these years, Barnard developed an interest in writing. He wrote
and edited several books on medicine and health and authored and coauthored several novels and articles in scholarly journals.
He published his autobiography, One Life, in 1970 and followed it later with his memoirs in The Second Life (1993). His books
sold worldwide and allowed him to generously donate his royalties to the Christiaan Barnard Foundation to support research
on heart disease and transplantation. In 1972, he was promoted to professor of surgical science at the University of Cape
Town.
Barnard continued to practice medicine
till the age of 61. In 1983, he took an early retirement from his clinical practice, in part due to
the painful rheumatoid arthritis that was diagnosed when he was in Minneapolis. He spent 2 years in Oklahoma City as
the scientist-in-residence at the Oklahoma Transplantation Institute of the Baptist Medical Center. He
returned to South Africa in 1988 and remarried, this time to 23-year-old Karin Setzkorn, a beautiful
young model, and together they had two children, Armin and Lara. That marriage also ended in divorce
last year. In his later years, Barnard had skin cancer on his face and underwent painful laser procedures
and skin grafts at a clinic in Parow (South Africa). More recently, he had been spending most of his
time in Austria. His most recent book, Fifty Ways to a Healthier Heart, was published in May 2001.
Beside performing the first human heart transplant, Barnard is
also credited with being the first to choose as heart donor a brain-dead accident victim. The Uniform
Brain Death Act was passed in 1978, expanding for the first time the traditional definition of death.
He is also credited with performing the first heterotopic piggy-back human heart transplants.
1950s English biochemist Rodney Porter and the American
biochemist Gerald Edelman expand the knowledge of the body's immunization system by detailing the structure of the antibody
molecule. 1950s Researchers isolate urokinase, an enzyme that helps clear the urinary tract of blood clots from human urine.
1950s C. Walton Lillehei of the University of Minnesota successfully applies cross circulation technique. The surgical community
is not impressed and describes it as the only technique with a potential 200% mortality. 1950s Toronto's Wilfred G. Bigelow
performs laboratory experiments with animals using hypothermia at 86 degrees C. 1951 Dr. Clarence Dennis performs the first
human open heart surgery cases involving extracorporeal circulation. The patient did not survive. 1951 IBM develops the Gibbon
Model II heart-lung machine, delivered to Jefferson Medical College Hospital on June 19, 1951.
1951 Karlson, evaluation of a cellulose membrane oxygenator. 1951 Dr. Joseph E.
Murray, first kidney transplantation, Peter Bent Brigham Hospital, Boston. 1952 Paul Zoll develops the first cardiac pacemaker.
1952 First hypothermic application on humans by John Lewis and Richard Varco at the University of Minnesota in Minneapolis
using Bigelow's technique at 82 degrees C.
1952 Charles Hufnagel sews an artificial valve into a patient's aorta. 1953 Dr. Frank F. Allbritten develops
the left ventricular vent thus solving intra-cardiac air complications. 1953 Dr. John H. Gibbon, Jr., Jefferson Medical College
Hospital, Philadelphia. First successful application of extracorporeal circulation in a human, an 18 year old female with
an atrial septal defect. 1953 Dr. Michael DeBakey, Baylor University, Houston, implants a seamless, knit Dacron tube for surgical
repairs and/or replacement of occluded vessels or vascular aneurysms. 1953 Lillehei, controlled cross-circulation using live
human donor lungs for oxygenation of patients' blood during infant and pediatric surgery.
1954 IBM develops the Gibbon Model III heart-lung machine,
delivered to Jefferson Medical College in July, 1954. 1954 Nationwide application of Jonas Salk's polio vaccine. 1955
American physician and virologist Jonas Edward Salk introduced a killed-virus vaccine against polimyelitis.
1955 Melrose suggested the deliberate manipulation of the ionic
environment of the myocardium (cardioplegia). 1955 Clowes, large flat multi-layered ethylcellulose membrane oxygenator; used
clinically on several patients. 1955 Mustard, used excised lungs from rhesus monkeys to oxygenate blood during pediatric surgery.
1957 Wild et. al. report the use of ultrasound to visualize the heart non-invasively. 1957 Dr. C. Walton Lillehei and Earl
Bakken, electronic engineer develop the first portable pacemaker. Bakken later forms the Medtronics Corporation. 1957 Dr.
Willem Kolff and Dr. Tetsuzo Akutzus at the Cleveland Clinic implant the first artificial heart in a dogs. The animal survived
for 90 minutes. 1958 Dr.'s Norman Schumway and Richard Lower begin a series of experiments in animal heart transplantation.
1958 Dr. Mason Sones, a cardiologist at the Cleveland Clinic Foundation develops coronary angiography.
1959 Marcello Siniscalco of Memorial Sloan-Kettering Cancer Center
in New York and Arno G. Motulsky of the University of Washington diagnose hemolytic anemia. 1960s The National Aeronautics
and Space Administration (NASA) provide numerous contributions to medicine. Examples not only included the observation and
documentation of metabolic and physiological stress but inventions like telemetry, Teflon, titanium, freeze-drying, microwave,
fiberoptics, advances in computerization etc. 1960s Dr. Richard Dyer pioneers a renewed interest in intraoperative autotransfusion
leading to the development of the first commercial auto-transfusion apparatus.
1960s American physiologist Judith Pool discovered that
slowly thawed frozen plasma yielded deposits high in Factor VIII. The deposits called cryoprecipitates are further refined.
1960s Vaccine against hepatitis.1960s Issac Harary, UCLA laboratory biochemist discovered the "automaticity" of
heart cells leading to investigations at the cellular level. 1960 Medtronic develops the first fully implantable pacemaker.
1960 Dr. Albert Starr, Oregon surgeon develops the Starr- Edwards heart valve. One of the most successful heart valves produced
until the late 1970s.
1961 Dr. R.L. Swank,
University of Oregon Health Sciences Center observed that the microviscosity of stored blood was significantly greater than
that of fresh blood leading to the discovery and filtration theory of microaggregates. 1961 Callaghan, developed an artificial
placenta for extracorporeal support of newborns with RDS. 1962 Moulopoulos et. al. suggested the use of a single chambered
intra-aortic balloon, positioned in the descending thoracic aorta, to accomplish the same hemodynamics as did arterial counterpulsation.
1964 Dotter and Judkins used tapered Teflon dilating catheters during arteriography to dilate occluded peripheral arteries.
1964 Bretschneider introduces cold cardioplegia. 1965 Raskkind, developed a low volume disposable pumpless bubble oxygenator
for use as a substitute lung on children with cystic fibrosis, RDS, and CHD. 1966 Tchobroutsky, long term support of puppies
and fetal lambs in a controlled environment using extracorporeal circulation. 1967 Rene Favaloro, an Argentine surgeon working
in the United States performs the first coronary bypass operation using the patient's native saphenous vein as an autograft.
1967 December 3, South African heart surgeon
Dr. Christian Neethling Barnard performs the first heart transplant at Groote Schur Hospital in Capetown. This was shortly
after touring the United States and observing Dr. Norman Schumway's nine year study with animal heart transplantation
and rejection methods. 1968 Kantrowitz et. al., the first clinical trial in man of intra-aortic balloon pumping. 1968 Kolobow
and Zapol, partial extracorporeal gas-exchange in alert newborn lambs with a membrane artificial lung, perfused via an A-V
shunt for periods up to 96 hours.
1969
Dr. Denton Cooley, Texas Heart Institute, Houston, Texas, implanted a total artificial heart designed by Domingo Liotta. The
device served as a "bridge" for cardiac transplantation until a donor heart was found, 64 hours. The cardiac transplant
functioned for an additional 32 hours until the patient died of pneumonia. 1969 Zapol and Kolobow, "artificial placentation."
Prematurely delivered fetal lambs connected to an extracorporeal membrane oxygenator by umbilical cord, and placed in a tank
of artificial amniotic fluid. 1969 Dorson, long-term partial bypass support of a 1.6 Kg. premature infant with RDS for 20
hours.
1970 Robert Jarvik, Ph.D. designs
the Jarvik series of artificial hearts. 1971 White, ECMO on newborn babies using veno-venous bypass for up to 9 days.
1972 Hill, adult ECMO for shock-lung syndrome; perfusion for 75 hours. Survived. 1972 Kolobow, ECMO on an 11 year old boy
for 10 days. Survived. 1974 Dr. Gerald Buckberg advocates the use of blood/ crystalloid cardioplegia fortified with substrates.
1975 Dr. Willem Kolff, University of Utah, designs a nuclear-powered artificial heart (Westinghouse Corporation). 1975 British
scientists George Kohler and Cesar Milstein of Cambridge's Medical research Council Laboratory of Molecular Biology develop
the monoclonal antibody.
1975 Biomedicus Bio-Pump (Centrifugal) introduced for
clinical application. 1975 Introduction of computerized axial tomography, the "CAT-scanner." 1977 Dr. Andreas Gruntiz,
Switzerland experiment with transluminal coronary angioplasty. Gruntiz later relocates to Emory University, Atlanta. 1980s
Michel Mirowski and a team of scientists at Sinai Hospital in Baltimore, Maryland develop the automatic implantable cardiac
defibrillator (AICD). 1980 Bergman et. al. describe femoral artery percutaneous insertion of an intra-aortic balloon using
a modification of the Seldinger technique.. 1981 January. Cyclosporin-A introduced. An immunosuppressive drug it reopened
the medical interest in organ transplantation. 1981 Dr. Denton Cooley implants another pneumatically- driven artificial heart
designed by Dr. Akutsu. This artificial heart was used for 27 hours as a "bridge" to cardiac transplantation. 1982
Dr. William DeVries implants the Jarvik-7 into Barney Clark, DDS, Dr. Clark lives 112 days. 1983 Cobe Laboratories introduce
the Model CML (Cobe Membrane Lung) a single pumphead membrane. 1984 Loma Linda Medical Center, Baby girl Faye's native
heart is explanted and replaced with a baboon heart. She survived for 3 weeks.
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