Great Doctor Research Articles

Surgical Limits: The Life of Gordon Murray (review)

Reviewed by: Surgical Limits: The Life of Gordon Murray Christopher J. Rutty Surgical Limits: The Life of Gordon Murray. Shelley McKellar. Toronto: University of Toronto Press, 2003. Pp. x, 270, illus. $45.00 Concise, though richly detailed, Shelly McKellar's reluctant biography of Dr Gordon Murray (1894-1976) carefully captures the brilliant, though often restless, lonely, and ultimately tragic life of a Canadian surgical pioneer, forever testing his own surgical limits and those of the Toronto medical establishment. It is a reluctant biography because McKellar was not particularly interested in writing about medical lives, much less about 'great doctors, and shivered at the thought of doing "dead white guy history"' (vii). Her biography of Murray grew out of an interest in the history of medical technology, innovation and change, medical knowledge [End Page 860] diffusion, and the concept of cure. Specifically, her interest in Murray developed from his building of the first North American artificial kidney machine in Toronto in the 1940s. In the process of analysing this new piece of homemade medical technology, McKellar soon found herself 'drawn into this surgeon's extraordinary and controversial career' (vii). Fortunately, McKellar's reluctant approach to tackling a biography of a 'great doctor' like Murray turned out to be quite successful, well written, illuminating, and effective. Surgical Limits began as a PhD thesis McKellar wrote at the University of Toronto under the supervision of Michael Bliss, a Canadian historian well experienced in the art of biography writing, including biographies of such great Canadian doctors as Frederick Banting and William Osler. Interestingly, in her preface that outlines her apprehensions about writing a medical biography, McKellar does not mention Bliss's Banting or Osler biographies, but pointed to Judith Leavitt's Typhoid Mary: Captive to the Public's Health and Jacalyn Duffin's Langstaff: A Nineteenth-Century Medical Life. While both biographies are noteworthy, it would seem that Bliss's Banting: A Biography, in particular, would be a more relevant model for a study of Murray's life as a Canadian surgeon and a celebrated, though tragic, medical hero. There are many similarities between Murray and Banting beyond their shared surgical passions, high public profile, and frustrations at Toronto General Hospital. They were contemporaries - Banting born in 1891 and Murray in 1894 - and both spent most of their lives in Toronto, often the focus of newspapers looking for their next great life-saving discovery. If Banting had not died in a plane crash in 1941, the remainder of his life may well have played out along lines similar to Murray's: working in isolation, driven to repeat and surpass past triumphs, and pushing surgical limits beyond the breaking point, despite the risks to patients and professional reputation. McKellar's life of Gordon Murray follows this path. She takes the reader from the celebrated triumphs of Murray's pioneering clinical use of heparin (a blood anticoagulant prepared and purified by Connaught Laboratories) in the late 1930s under the leadership of insulin co-discoverer Charles H. Best, followed by his 'blue baby' surgical successes, and the building, and clinical use, of his artificial kidney on patients in the 1940s. The tone of the story, however, shifts sharply in the 1950s after Murray abruptly left Toronto General Hospital and the University of Toronto to set up his own private research laboratory, the W.P. Caven Memorial Research Foundation (later the Gardiner Medical Research Foundation), in a small house in Toronto to independently pursue surgical and other medical problems that interested him. Murray's first such [End Page 861] research problem was not surgical, but rather the surprising development, production, application, and public championing of a dubious anti-cancer serum. This was followed by a questionable and sensational method of mending severed spinal cords and curing paraplegia in the 1960s that forced a controversial end to his surgical career. McKellar's Gordon Murray was a brilliant surgeon, though ultimately a flawed character. He was driven by the dichotomy of looking forward, pushing his surgical limits to solve the next great medical problems, while remaining locked in a fiercely individualistic approach to surgery and research that had served him well in the 1930s and early 1940s, but left him...

Dr Thomas Chaplin, Scientist and Scholar in Nineteenth-Century Palestine

For a quarter of a century Dr Thomas J. Chaplin (1830–1904) held the position of director of the British Hospital for the Jews in Jerusalem. During these years he acted to improve the medical situation in the city and engaged in scientific researches in a variety of fields. The article critically reviews his activities in the Holy Land and shows that the impact of his works and the contribution of his achievements are diverse. However, by virtue of these achievements and his gracious personality, the Jewish people in Jerusalem named Chaplin as 'The Great English Doctor'.

The Prodigious Pustule

The Prodigious Pustule

How to find a great doctor for asthma: One who meets your specific needs

How to find a great doctor for asthma: One who meets your specific needs

How much water an Airbus can buy

Oscar Wilde reputedly lay on his death bed sipping vintage champagne. When asked why, he replied, “Isn't it obvious? I'm dying beyond my means.” Sixty years before, Wilde's father was training at Moorfields Eye Hospital in London, just around the corner from John Snow. Snow beat Hippocrates to the title of greatest doctor ever in Hospital Doctor 's 2003 survey. Snow famously removed the …

Factors associated with a delay in the diagnosis of narcolepsy

Background: There can be a long interval from the onset of symptoms before a diagnosis of narcolepsy is made. There are no multivariate analyses reported in the literature of factors that may contribute to this delay. The aims of this study were to describe the delay in diagnosis of people with narcolepsy living in the UK and to identify associated factors.Methods: The study comprised a postal survey of 500 members of the Narcolepsy Association UK, which included questions regarding age of onset of symptoms, year of diagnosis and subject demographics. Cox's proportional hazards regression was performed.Results: A total of 313 questionnaires were returned of which 219 had been completed sufficiently for analysis. The interval between symptom onset and diagnosis ranged from within 1 to 61 years with a median of 10.5 years. Multivariate analysis showed that the presence of cataplexy as one of the initial symptoms and a more recent year of symptom onset were the only factors associated with time to diagnosis.Conclusions: We have confirmed that the diagnosis of narcolepsy can be delayed for many years particularly when cataplexy is absent initially. The delay in diagnosis in the UK appears to be decreasing, probably through greater doctor and patient awareness of the clinical manifestations of narcolepsy.

Doctors and Discoveries: Lives That Created Today's Medicine (review)

In the postface to his 1931 classic, The Great Doctors, Henry Sigerist said of the ongoing march of medical progress that "[t]he tempo of evolution has slackened a little as compared with that of a few decades back."1 Within some fifteen years, penicillin was ready for widespread clinical use, and the "tempo of evolution" had once more picked up. The real accelerando began in the years soon after Sigerist's death in 1957, and seems not yet to have reached its peak. As a result, numerous names have been added to the catalog of greatness. It is time to catch up, which was very likely foremost in the mind of John Galbraith Simmons when he conceived of his eminently useful Doctors and Discoveries.

The Model of a Great Doctor

The Model of a Great Doctor

Henry E. Sigerist: medical historian and social visionary.

FOR CLOSE TO 3 DECADES in the first half of the 20th century, Henry E. Sigerist was widely admired as the world’s leading historian of medicine.1 Born in Paris of Swiss parents, young Henry grew up in Paris and Zurich; he then studied philology at the University of Zurich and oriental languages at University College and Kings College, London. He returned to Zurich to complete a medical degree and served as a medical officer in the Swiss army. Having decided that he wished to study the history of medicine, and having the financial means to live as an independent scholar, Sigerist went to Leipzig, Germany, to study under Karl Sudhoff, director of the University of Leipzig’s pioneering Institute of the History of Medicine. Sigerist taught the history of medicine at the University of Zurich until 1925, when, at the precocious age of 34, he succeeded Sudhoff as director of the Leipzig Institute. In 1932, Sigerist moved to the United States to succeed William Henry Welch as director of the Johns Hopkins University Institute of the History of Medicine, which had recently been created on the Leipzig model. Sigerist brought to Johns Hopkins the high standards of German scholarship and transformed the institute into a national center for the history of medicine in the United States. He reorganized the American Association for the History of Medicine and began publishing a major scholarly journal, the Bulletin of the History of Medicine. He also played an important public role. An urbane and eloquent lecturer, he enjoyed celebrity status at medical society meetings, before civic organizations and women’s clubs, in colleges and universities, and at intellectual forums and student conventions. Sigerist was a prolific writer. His first books published in English, The Great Doctors and his admiring account of American Medicine, were received with general enthusiasm.2,3 But Sigerist’s political views were being honed by his observations of the American capitalist system in the throes of economic crisis, his anguished awareness of the rise of German fascism, and his optimistic belief in the future of socialism. His 1937 book, Socialized Medicine in the Soviet Union, created a sensation.4 Sigerist portrayed the radically transformed health care system of the Soviet Union as a model for public health and medical care worldwide, the final stage in a long historical evolution of health care organization. The book was widely read, being both criticized and admired. Sigerist now emerged as a major spokesman for “compulsory health insurance” and was much sought after as a lecturer, popular author, and radio commentator. He published articles in mass circulation magazines and left-leaning journals. When Time magazine published his portrait on its cover in January 1939, it described him as both the world’s greatest medical historian and the nation’s most widely respected authority on compulsory health insurance and health policy.5 But in the 1940s, Sigerist’s welcome in America began to turn sour. He was attacked by the American Medical Association, criticized by Hopkins medical alumni, and declared unfit for government service. Tired and under severe strain, he struggled to continue writing his long-promised and recently begun multivolume History of Medicine.6,7 In 1947, with continuing financial support from the Rockefeller Foundation, he left the United States and retired to Switzerland, where he died in 1957. As Sigerist was preparing to leave the United States, Alan Gregg of the Rockefeller Foundation eloquently described his contribution at a dinner held in his honor: Beyond and above anyone else Henry Sigerist made us aware of the fact that medicine is the study and application of biology in a matrix that is at once historical, social, political, economic, and cultural. . . . Sir Oliver Lodge once remarked that the last thing in the world that a deep sea fish could discover would be salt water. Henry Sigerist removed us, with a historian’s landing net, from a circumambient present into the atmosphere of the past and thus discovered to us the milieu in which we were swimming, floating, and betimes stagnating.8

Alfonso M. de Liguori e la civilta letteraria del Settecento: Atti del Convegno internazionale per il tricentenario della nascita del santo (1696-1996): Napoli, 20-23 ottobre 1997 (review)

Alfonso M. de Liguori e la civilta letteraria del Settecento. Atti del Convegno internazionale per il tricentenario della nascita del Santo (1696-1996), Napoli, 20-23 ottobre 1997. Edited by Pompeo Giannantonio. [Biblioteca dell' Archivum Romanicum, Vol. 286.] (Florence: Leo S. Olschki Editore. 1999. Pp. xix, 474. Paperback.) Scholarship and hagiography go hand in hand in this new volume, edited by Pompeo Giannantonio, of papers presented at the conference celebrating the tricentenary of the birth of St. Alphonsus of Liguori. Perhaps an inevitable consequence of the contrasting interests served here, several contributions appeal more or less exclusively to modern spiritual needs. Otherwise, the predominant theme is to situate the multifaceted personality and career of St. Alphonsus within the cultural context of eighteenth-century Italy, best known to us through the past twenty years of scholarship by Franco Venturi, Mario Rosa, Giuseppe Galasso, and others. Now we can appreciate better than ever Alphonsus' affiliation with the major cultural movements that also involved Catholic leaders such as Ludovico Antonio Muratori and Francesco Antonio Zaccaria. With them, he shared a commitment to wide-ranging publishing activity for the propagation of faith and the encouragement of piety at all social and cultural levels. His works of general instruction were perhaps even more voluminous than the works of profound erudition that earned him the title of the Great Doctor of Prayer. Presented here by Anco Marzio Mutterle, his correspondence with the Remondini firm in Bassano and Venice illuminates his strategies, in the various parts of Italy, for getting his message across-often at the expense of his publishers' interests in monopoly editions. With members of the Arcadian Academy's literary movement Alphonsus shared a concern for simplifying language and removing the pompous ornamentation sometimes associated with the so-called Baroque. At the same time, he was engaged in the recovery of popular literary traditions ignored by the quintessential Arcadian, Pietro Metastasio, to whom his higher flights of poetic fancy have most frequently been compared. In his appeal to a wider audience, Edoardo Villa notes, he went beyond Muratori and Zaccaria, directing his poetic expression to the least sophisticated believers. To this end his advocacy of linguistic correctness, analyzed by Paolo Mario Sipala and Milena Montanile, did not preclude a judicious use of Neapolitan dialect-as Patrizia Bertini Malgarini and Ugo Vignuzzi show. …

Learning from Sir William Osler about the Teaching of Palliative Care

The publication by Michael Bliss of his authoritative and illuminating text William Osler: a Life in Medicine (1) provides a wonderful opportunity to reflect on the life of a great man who had a major influence on medical undergraduate teaching and medical practice. His approach to the care of both patients and colleagues was warm and encouraging. He demonstrated a humanistic approach to medicine that was reflected in his clinical practice, his teaching, and his writings, and that remains influential today. He had the ability to blend wide knowledge with high ideals and common sense to influence the ways in which the doctor-patient relationship developed. Drawing on passages from the biography of William Osler, and linking his practice with the work of Donald Schön and the development of reflective practice, this paper identifies elements of our roles as clinicians and teachers that could be enhanced by further examination of the life of a man who has been described as the "greatest doctor in the world" (1, p. 480); a physician "whose work lies on the confines of the shadowland" (1, p. 291).

Do extraordinary experiences make great doctors?

Do extraordinary experiences make great doctors?

Changing Perspectives: From Transplant Surgery to Diabetes Primary Care

Editor’s note: In the “Practice Profiles” department of Clinical Diabetes , we spotlight clinicians who have chosen to dedicate a significant portion of their time to the care of patients with diabetes. Suggestions for clinicians to interview in the future are welcome and can be e-mailed to levetan@juno.com. From as early an age as I can remember, I wanted to go into medicine. In fact, I can’t tell you just what started it, but by the time I moved literally into the shadow of the Mayo Clinic in Rochester, Minn., at the age of 10, I was already certain that medicine had an appeal that I couldn’t find in any other profession. I was born in the rural town of Harmony, Minn., population less than 500, in the upstairs of an old house. My father, a Methodist minister, then moved us to an underserved area of North Minneapolis for about 6 years and then to Rochester, where I attended high school. I earned my bachelor of arts degree at Carleton College in Northfield, Minn., and then attended the then-very-new Mayo Medical School. Several of Mayo’s great doctors had been role models for me at a younger age, and I had a great deal of respect for many of the physicians who worked there. It fulfilled a real ambition of mine to be able to return to Rochester to learn from them. When I was in medical school at Mayo, I met Alison, an English premedical student doing a research clerkship there. We fell in love and got engaged as I completed my Halsted (surgery) residency at Johns Hopkins Hospital in Baltimore, Md. We got married a year later and moved to Sheffield, England, so Alison could finish medical school. I initially got a job doing transplant research in the …

William Osler: A Life in Medicine

Preface: On Doing an Osler Autopsy 1. English Gentlemen with American Energy 2. Learning to See: Student Years 3. The Baby Professor 4. The Best Men: Philadelphia 5. Starting at Johns Hopkins 6. We All Worship Him 7. The Great American Doctor 8. Leaving America 9. A Delightful Life and Place 10. Sir William 11. All the Youth and Glory of the Country 12. Never Use a Crutch 13. Osler's Afterlife

Augustine through the Ages. An Encyclopedia (review)

The great African Doctor of the Church is doing well by the encyclopediasts. Alongside the stately progress of the Augustinus-Lexikon (over 1900 columns to reach 'Donatists,' in German, French, or English), Augustine through the Ages presents in some 500 articles by 150 scholars Augustine's life, work, thought, and influence for a readership ranging from the academic researcher to the merely curious. Users with nothing but English will find a few bibliographies beyond them, and have to negotiate around some untranslated Latin, but for the most part this volume will prove accessible to serious monoglott students. It is not Augustine for the masses.

Communication in health care

Introduction approach which has exercised considerable influence Although communication in health care is as old as came from the communication sciences. Dividing comHippocrates, it has only recently received attention in its munication into senders, receivers, media, and messages, own right. That is not to say that great doctors such as this discipline formulated the requirements to be put on Hippocrates, Maimonides, Boerhaave or Virchow did not the message in particular. The influence of this approach mention the doctor-patient relationship. On the contrary, was especially felt in the field of patient instruction, 9 they stressed that it was of the utmost importance. In health promotion, and patient education. Watzlawick’s fact, in the days before bacteriological and virological thorough analysis of interaction between people made knowledge, trust, confidence and the power of persuasion clear that messages are not simply messages, but can were a doctors most effective tools. But it is only in the carry different layers of sometimes contradictory meanlast half century that doctor-patient communication has ing. In addition, senders and receivers do not have fixed become an object of attention in its own right. The roles, but constantly take different points of view.A final conference on Communication in Health Care, with the group of theoretical approaches to be mentioned here abstracts presented in this volume, represents the state of came from information theory and has had its influence 10 the art in this subject in 1998. In this editorial we give a on medical decision making .These theoretical apretrospective account of the preceding issues in this proaches, formulated between 1940 and 1970, provide ongoing story. the foundations for the purposes of communication in 11 health care as distinguished by Ong and colleagues : Theoretical foundations creating a good personal relationship, exchanging inSeveral theoretical perspectives fostered the early studies formation, and making treatment decisions. of doctor-patient communication. From a sociological perspective, the concept of ‘power’ was a central issue. 1 The ‘medical model‘ elaborated by Parsons and Vocational and postgraduate training 2 Freidson defines a hierarchical relationship between Training and research into patient-provider interactions doctor and patient. This relationship was criticized by seem to have developed more or less independently of 3 4 many, including Thomas Szasz , Ivan Illich and followeach other. For centuries, communication skills were ers of the Frankfurter Schule, to name just a few of the taught In medical education implicitly. The clinical 5 most well-known. In a special way, ethnomethodology method as taught at universities, mostly in a classical 6 and conversation analysis elaborated sociological remaster-disciple relationship with its roots in the middle search on communication at a micro-level through paying ages, paid little explicit attention to communicative skills. attention to linguistic aspects. ‘Power,’ however, remains Students learned to take a good anamnesis, following a a significant theme within this tradition.Psychoanalysis hypothetico-deductive route to come to a proper diagand psychotherapy offered a different point of view. nosis. ‘Good bed-side manners’ were considered to be Concepts like therapeutic transference and counter-transimportant, but more of an art than a skill. In fact, 7 ference inspired Balint in his work with small groups of communication was learned by imitation of the master, general practitioners. His aim was to make doctors aware not as a discipline of its own. In 1924 the first textbook 12 of the complex interaction between them and their on medical interviewing was published . It must have patients, often built up over a life-time partnership. Carl taken another forty years to put the medical interview on 8 Rogers and his ideas of a therapeutic relationship based the curriculum, at least in the Netherlands. The content of on unconditional positive regard required attention for the curriculum was derived from clinical expertise and such concepts as empathy and interest and focused on the focused on good case history taking skills and models for importance of non-verbal behaviour.Another theoretical special kinds of interactions, like ‘breaking bad news’.

Health and Healing in Eighteenth-Century Germany

Medical history has shifted focus the accomplishments of great doctors and nurses to a closer examination of the cultural context in which all health-related activities necessarily take place. The view from below prominently involves patients and their families as well as less formal healing networks populated by individuals often branded as opportunistic quacks or magicians. This form of cultural history is difficult to research and write. It requires extensive archival research and an open mind, ready to jettison some of the most cherished preconceptions held by contemporary practitioners of the craft. Lindemann's study centers on the north German duchy of Braunschweig-Wolfenbuttel during the 18th century, but her conclusions address broader issues in European and medical history. Her multiple sources are mostly individual narratives of illness and healing, collected for bureaucratic reasons parish records, case histories, and investigations of quacks. In a reflection of corporate mentality derived the

The Primacy of Persons: Edith Stein and Pope John Paul II

Laura Garcia The Primacy of Persons: Edith Stein and Pope John Paul II Anyone familiar with Pope John Paul II's encyclical on The Dignity and Vocation of Woman or his more recent Letter to Women will hear echoes of Editii Stein's pioneering work on die nature and role ofwomen. Most ofStein's essays on this topic stem from the decade of her professional life between her conversion from Judaism to die Catiiolic faith and her entrance into the Carmelite community at Cologne, roughly 1923 to 1933. Their importance cannot be overestimated , both in terms ofdieir originality and level ofinsight,but also in terms oftheir influence on the diought ofotiiers. On a recent visit to the United States, Cardinal Lustiger ofParis, himselfa Jewish convert to Cadiolicism, referred to Stein as one of die greatest philosophers ofour time. "Her best pupil,"he said, "is the Holy Father." Edith Stein's first academic position was at a convent school devoted primarily to teacher training. Partofdiemotivation forher inquiries into die nature and vocation ofwoman was die need to educate women in a way that would be perfective ofdiem, notjustgenerically as human beings, but precisely as women. In organizing the curriculum ofa high Logos 1:2 1997 The Primacy of Persons school or university, she argued for a reexamination of the prevailing assumption that an educational system set up originally to meet the needs ofmen will be equally suitable for die formation ofwomen. One can already see in tiiis way offraming the question diat Stein rejected die claim that diere are no important differences between men and women. She saw tiiis claim as a kind of strategy for convincing a male-dominated world to admit women to university education and die professions and to give them die vote. By die late 1920s and early 30s, the impact of the firstWorld War had forced women into virtually every profession and accelerated women's emancipation as conceived by die founders of die movement. Stein felt diat it was now possible to return to a calmer discussion of the obvious differences between men and women, with a view to discovering woman's unique gifts and calling and to tailoring woman's education to prepare her to take her place in the world. As a philosopher, she naturally begins with an effort to analyze the true nature offeminine humanity, or with what might be called an ontology of woman. She saw her work as barely more dian a beginning, as pointing a direction which others might be able to develop more fully. Edidi Stein was herself one of the first women to benefit from the opening of the German universities to women, and her talents were quickly recognized by the founder of phenomenology , Edmund Husserl. She became one of Husserl's star pupils and was chosen to serve as his assistant while in graduate school. After her conversion to Catholicism in 1922, Stein turned to an intense study ofthe great Catholic philosopher and Doctor of the Church, St. Thomas Aquinas. Stein was fascinated by St.Thomas' view of the human person, adopted from Aristotle, according to which the soul is the form of the body. Unlike the radical dualism of Descartes, which represents soul and body as so radically distinct as to be two different entities, Thomas insists upon the unity of the person, since each natural substance is a composite ofform and matter. Further, since 91 92 Logos matter is what distinguishes one human being from another, the body is essential to the person, not simply a machine or a ship that can be discarded widiout serious loss to the "real" self. Along witii St.Thomas andAristotle, Stein acknowledges tiiat there are traits unique to die human soul, abilities (or at least dispositional traits) that are shared by every member ofthe species. Rationality, and along with it the ability of free choice, belong to every human being and hence to every woman as a human person. But if die soul is die form of die body, and die form ofhumanity is individuated by being united widi tiiis body or mat one, Stein reasons diat die woman's soul will have a spiritual quality distinct from die...

Mineral water and spas in Portugal

M ineral waters and spas have been known on the Iberian penisula for centuries. During Roman times large buildings were erected, and their remains can be seen in Conimbriga, Troia, and Ossonaba-Milreus in the Algarve.’ In Lisbon the socalled Cassian Spas were built in 49 B.C.E. by the order of Quint0 Cassio and Lucia Cassio who represented Julius Caesar. They are an important part of the Roman ruins that lie underneath the old part of modern Lisbon.’ In Vizela, in the north of Portugal, ruins of the Roman Baths can still be visited. They were erected in 81 C.E. during the reign of Titus Flavius.’ During the Arab occupation, interest in thermal baths persisted, probably under the influence of the great medical doctor Avicena.’ Many Portuguese kings used spas, and the founder of the country, D. Afonso Henriques (11431, wounded in the battle of Badajoz

THE COLLEAGUE WHO CHANGED MY LIFE

A great doctor died last December. Few, I believe, would disagree with the adjective, except the man himself. Yet Alan Jacobs was not widely known, worked at a measured pace, and, I guess—being merely his awed senior house officer in 1961—probably shunned office. He carried out one major piece of research—on arterial embolism—based characteristically on painstaking clinical observation. It took him 16 years. His secretary joked she lost as many from her life, endlessly retyping what became, when he was 53, his DM thesis. Livingstone published it as a monograph, a notable honour. A dignified career then, not an electrifying one, yet Jacobs made an impression on me which still …