SCIF Study 2 - David Ellyard

SCIF Study 2 - David Ellyard

TALK ABOUT: time period, nationality, brief personal details, nature of issue they dealt with, their response and their impact upon medical knowledge or practiceJames Lind (1716-1794) - Scottish - citrus and scurvy

born into family of merchants

began medical studies as apprentice of George Langlands

in 1739, entered Navy as a surgeons mate

1747 - naval doctor of HMS Salisbury in the Channel Fleet, conducted an experiment on scurvy whilst patrolling the English Channel during the War of the Australian Succession

despite good food and sweet water, 80 out of 350 men had scurvy (weakness, depression, livid skin spots, blackened gums) within 10 weeks

access to fresh food known to clear scurvy within weeks, and juices of citrus fruits like oranges, lemons and limes had been long suspected to be an effective remedy

chose 12 sufferers, groups in pairs, and each pair had a different addition to their normal rations of gruel, mutton brother and ships biscuit (cider, vitriol (sulfuric acid), vinegar, seawater, spicy paste and barley water, two oranges and a lemon)

only those drinking cider and eating fruits showed improvement, more pronounced in the citrus eaters as one was fit for duty within six days

shortly after Lind retired from the Navy to practice as a private physician

1753 - A treatise of the scurvy (virtually ignored)

whilst his findings were accepted by the Admiralty, it was 40 years before lemon and lime juices were used by all Royal Navy ships

1762 - wrote an essay recommending watercress (13 the Vitamin C of orange juice) to be grown on ships, taken up in 1775 by British Army in North America

however, Lind believed scurvy was the result of putrefying food in the body, bad water, excessive work and living in a damp atmosphere, and hence he never advocated for citrus juice as a single solution; in addition, he weakened the effect by boiling it which destroyed Vitamin C (but Vitamin Cs existence he did not know of)

regardless, experience within the navy convinced officers and surgeons to use citrus juices

also noted typhus didnt occur where patients were baths and had clean clothes and bedding, and recommended this for British navy, discovered the steam of heated salt water was fresh and provided a new method for obtaining freshwater in the case of scarcity of water that had gone bad (distillation)

furthered understanding and interest in realm of nutritional health

William Withering (1741-1799) - English - active ingredient in foxglove (for dropsy) trained as physician (studied medicine) at University of Edinburgh Medical School (also botanists, geologist, chemist) member of Lunar Society of Birmingham (1765) - the lunatics, met full moon (easier to walk home) to link knowledge and enterprise physician at Birmingham General Hospital treating patient with dropsy (atrial fibrillation) - heart failure due to fluid build-up patient improved after taking traditional herbal remedy from Mother Hutton (old, folk herbalist; contained over 20 ingredients) Withering determined there was an active ingredient in the mixture occurring in foxglove leaves (now known as digitalis) slows and strengthens heartbeat, improving circulation and clearing congestion worked on treatment for 10 years, did 156 documented clinical trials (using various parts of the plant from several seasons, safest means of employing it) and observed side-effects and toxicity, all recorded in his book: 1785 - An Account of the Foxglove and Some of its Medical Uses led to understanding of active ingredients, for example the miraculous bark from South America that cured malaria was found to have the active ingredient quinineEdward Jenner (1749-1823) - English - vaccination of smallpox apprentice for 7 years to surgeon Daniel Ludlow in South Gloucestershire 1770, apprenticed in surgery and anatomy under John Hunter and others at St. Georges Hospital, Dont think; try.

1773 - returned to native countryside at Berkeley

MD at University of St. Andrews

smallpox blinded, maimed, disfigured and killed though who contracted it, particularly amongst indigenous populations in Africa, America and Oceania

since the start of the century, inoculation had been used in Europe to confer immunity and prevent spread, and smallpox sufferers rarely got it twice

pus from a pustule was rubbed into a small incision on the skin to inoculate, however Jenner improved upon this

the procedure of inducing immunity with cowpox was done, but it wasnt until 20 years later that it was widely understood (Jenners work)

he noted that milkmaids were generally immune to smallpox, postulating pus in the blisters milkmaids received from cowpox protected them from smallpox

1796 - tested hypothesis by inoculating 8-year-old son of Jenners gardener using pus from milkmaid, who got a fever and some uneasiness, and then injected him with variolous material (the routine method of immunisation at the time) with no disease following 1798 - An Inquiry into the Causes and Effects of the Variolae Vaccinae led to global eradication of smallpox 200 years later, led to work on immunisation/vaccination (further worked on by Pasteur and Koch), questioned how did the body fight off infectionsRen Laennec (1781-1826) - French - stethoscope mother died of tuberculosis, had tuberculosis himself began medical studies under uncle Guillaime-Franois Laennec, then later in Paris where he was trained to use sound (percussion) as a diagnostic aid by Corvisart 1819 - De l'Auscultation Mdiate (On Mediate Auscultation) invented stethoscope to allow auscultation (listening to internal sounds) without issues of age, sex and degree of fatness of the patient

used the idea that scratching on wood with a pin would amplify the sound if you put your ear next to it

rolled paper into cylinder to listen to their heart, found it amplified the sound action

then made wooden cylinder version, advanced hearing allowed him to classify sounds in terms of rales, rhonchi, crepitance and egophony (terms still used today) to diagnose by sound also developed understanding of peritonitis and cirrhosis

James Simpson (1811-1870) - Scottish - anaesthetics completed education at 18 (obstetrician), had to wait 2 years for medical licence

developed Air Tractor (earliest childbirth-assisting vacuum extractor), improved design of obstetric forceps, fought infection during childbirth, early advocate of midwives, introduced anaesthesia to childbirth at 28, appointed Chair of Medicine and Midwifery at University of Edinburgh

1799 - Simpson first used anaesthetic (nitrous oxide or laughing gas) 1847 - discovered chloroform during experiment with friends (trying new chemicals, they all woke up the following morning)

significant as many had died from the shock/pains of surgery, and now not only could surgery be done with relative ease, it could also be done over a longer period of time allowing more thorough investigations

John Snow (1813-1858) - English

born into poor neighbourhood

at 14, apprenticed as a surgeon to William Hardcastle, when he first encountered cholera

enrolled in Hunterian School of Medicine in 1836

1837 - worked at Westminster Hospital

20 years later, first paper linking illegal food additives in bread and distortion of bones

one of the first to study and calculate dosages of ether and chloroform as surgical anaesthetics, designed apparatus to administer and mask for physician

personally administered chloroform to Queen Victoria for her last two children, leading to wider public acceptance of obstetric anaesthesia

sceptic of miasma theory, marked houses with cholera outbreak in area around him, and after talking to local residents, linked it to a public water pump on Broad Street, which convinced the local council to disable it (even though microscopically he could not identify anything) which ended the outbreak (although Snow believes it was already declining so too hard to say), however officials didnt want to believe his theory as it accepted oral-fecal contact (as the water was infected by sewage-runoff) and reinstalled a pump, however eventually later supporters won over

further supported Germ Theory of disease, showed that disease could be transmitted by water

Ignaz Semmelweis (1818-1865) - Hungarian - washing hands son of prosperous grocer studied medicine (after switching from law) at University of Vienna, specialised in obstetrics assistant in the First Obstetrical Clinic (maternity institution where underprivileged women would have children cared for; they were subjects of doctor and midwifery training) of Vienna General Hospital, Austria well known that more died of puerperal (or childbed) fever here than 2nd Obsterical Clinic (only midwives) and even on the street 1847 - determined it was because doctors had been in contact with cadaverous particles found calcium hypochlorite removed smell of infected autopsy tissue, so instructed doctors to wash hands with this between autopsies and patient examination reduced mortality rate to comparable with others his idea that diseases had set causes (not that each case of disease was unique) and cleanliness was the most important factor was ridiculed and rejected as it did not conform to current paradigms (unexplainable - no understanding of germ theory of disease, they believed in miasma theory and dyscrasia - much like 4 humours) and many doctors were offended that their hands could be unclean as they were gentlmen 1848 - widened washing protocol to all instruments whilst the British argued they had already concluded this and he had to point out the differences, Semmelweis influenced many people that led to the slow uptake of better hygiene not only for obstetricians, but all doctors and midwivesLouis Pasteur (1822-1895) - French - supported Germ Theory, artificial vaccines

three children that died of typhoid, led him to cure infectious diseases (previously had been researching crystallography and molecular asymmetry)

1854 - dean of faculty of sciences at Lille University

1856 - local wine manufacturer (M. Bigot, the father of a student) wanted to avoid souring alcohol after long storage, and the following year he developed his ideas, demonstrating that the yeast produced alcohol and lactic acid (due to bacterial contamination), which soured the wine

following experiments on fermentation, he boiled broths in swan-necked flasks, then exposed one to air where dust particles could pass through, finding only that one fermented

definitively disproved the Theory of Spontaneous Regeneration (as Francesco Redi had suggested, supported his Germ Theory)

he also found when working on chicken cholera, infecting with a spoiled culture failed to induce the disease in some chickens, and upon infecting them with the proper culture they were not diseased; in 1870s applied this immunisation method to anthrax in sheep, comparing 25 pre-inoculated to 25 un-inoculated; he also found anthrax did not infect chickens unless their body temperature was cooled (43o37oC), at which point they could gain the disease; also made vaccine for rabies

unlike Jenner, the vaccine was generated artificially, so a weak strain need to be found

Joseph Lister (1827-1912) - English - antiseptics a prosperous Quaker who attended University College, London, initially for a BA in botany, then a Bachelor of Medicine became professor of surgery at University of Glasgow, Scotland 1867 - promoted carbolic acid (phenol) as an antiseptic as it eased the stench of sewage waste in irrigated fields

prior to this many assumed infections or wounds resulted from chemical damage, and surgeons were not required to wash hands before seeing a patient as it wasnt considered necessary (stains were like a warriors war wounds)

tested by spraying surgical instruments, incisions and dressings, and found it remarkably reduced the incidence of gangrene published his findings in The Lancet over 6 articles (1867)

instructed surgeons to wear clean gloves and wash their hands with 5% carbolic acid before and after operations

father of modern surgery - changed surgery forever, drastically reduced chances of infection, further confirmed Pasteurs theories

Marie Curie (1867-1934) - Polish (naturalised-French) - radiation parents respected teachers, although became poorer after losing Polish national uprisings to restore independence

first studied in Floating University, Warsaw

1891 - moved to France, studied physics, chem and maths University of Paris

explained Becquerels observation of radiation in uranium, related amount of radiation to amount of uranium, discovered the radioactive elements radium and polonium

first used medically in WWI, where she used X-ray equipment to produce mobile radiography units (petites Curies or Little Curies). used hollow needles containing radium emanation (later identified as radon) to sterilise infected tissue

her work has been vital in understanding and utilising PET, X-ray and CT scans

Willem Kolff (1911-2009) - Dutch (Netherlands) - haemodialysis, artificial organs studied medicine at Leiden University in his hometown one of first patients was 22yo man dying of renal failure, prompted him to perform research on artificial renal function replacement, treated his first patient in 1943, and first saved a patient with haemodialysis in 1945 sent machines to London, Amsterdam, Poland and US

1940 - organised first blood bank in Europe

later involved in development of heart-lung machines to maintain heart and pulmonary function for heart surgery, and the development of the artificial heart (first implanted 1982, patients heart functioned until death) father of artificial organs - saved millions through haemodialysis and permanent artificial organs, which are procedures being performed and further investigated today

Christiaan Barnard (1922-2001) - South African - heart transplant father was a minister

one brother (Abraham) died from a heart problem aged 5

studied at University of Cape Town Medical School

trained as cardiothoracic surgeon at University of Minnesota, US, where he became acquainted with Norman Shumway who did much of the research leading to the first successful human heart transplant 1967 - completed second successful kidney transplant in South Africa (one year after the first)

experimented for several years with animal heart transplants (on over 50 dogs)

two months after the kidney transplant, he performed the first successful heart transplant by paralysing the donated heart with potassium, and continued to do so even without as good immunosuppressants that we have today also performed first heterotopic heart transplant, where the original heart is not removed but a double heart is formed

also first surgeon to attempt xenograft (cells from another animal)

his work ploughed through what was believed to be the capabilities of a surgeon, extending it beyond our previous reaches and saving many lives through practice and inspiration