Philadelphia General Hospital Research Articles

Reuben Friedman (1892-1956): Dermatologist, historian, and scabies enthusiast.

Reuben Friedman was a prominent physician, scholar, and historian whose work contributed significantly to the development of modern dermatology. He was born into a Russian immigrant family in the Northern Liberties section of Philadelphia, where he established his family and later opened his medical office. He graduated from Temple University School of Medicine, completed his internship at Philadelphia General Hospital, and pursued further training abroad. During the height of his career, Friedman was affiliated with the Philadelphia Skin and Cancer Hospital and served as a faculty member at Temple University School of Medicine. He was recognized internationally for his extensive work on scabies, penning four books, several monographs, and various presentations on its etiology and treatment. His final book, History of Dermatology in Philadelphia, recollects the evolution of dermatology in Philadelphia and numerous biographies of protagonists in the field.

The Evolution and Devolution of Hospital Care

The Evolution and Devolution of Hospital Care

"Spit Spreads Death: The Influenza Pandemic of 1918–19 in Philadelphia"

Reviewed by: "Spit Spreads Death: The Influenza Pandemic of 1918–19 in Philadelphia" Jessica Martucci "Spit Spreads Death: The Influenza Pandemic of 1918–19 in Philadelphia," parade and exhibit. http://muttermuseum.org/exhibitions/going-viral-behindthe-scenes-at-a-medical-museum/ On September 28, 1918, two hundred thousand Philadelphians turned out to watch a parade and buy savings bonds in support of the United States war effort. Gathered in the crowd that day were nurses, industrial workers, military personnel, seamstresses, and homemakers, but an unknown trespasser also lurked among parade-goers—influenza H1N1. Within six weeks, fourteen thousand people in the city had died in the world's deadliest pandemic to date. A special exhibit at the Mütter Museum, which began in the fall of 2019, invites visitors to learn what it was like to live in Philadelphia at the height of the outbreak. Their programming and exhibition endeavor to link visitors to the past through emotional connections forged through art and the clever use of personal narratives. In partnership with Blast Theory, a UK-based artist group known for its large, innovative, interactive public art works, the Mütter Museum kicked off their [End Page 129] influenza programming with a memorial parade 101 years after the original took place (https://www.blasttheory.co.uk/projects/spit-spreads-death/). The registration process for the parade invited participants to choose the name of an influenza victim to honor and remember. When the day of the event arrived, registrants received large white posters printed with their person's name and death certificate. Encouraged to arrive well in advance of the parade's start time, participants milled around, studying their death certificates and chatting with one another about these long-since forgotten flu victims. I marched in memory of Effie D. Baltian, a student nurse at Philadelphia General Hospital. She died where she had worked just a few days prior, taking care of flu patients. She was 23 years old. Click for larger view View full resolution When the memorial parade began, music, composed especially for the event, struck an eerie and somber tone as prerecorded singers solemnly chanted the names of the dead. Participants played the music for the parade on their cell [End Page 130] phones, creating a surround-sound effect throughout the march. At the parade front, a large and illuminated, white rectangular box pushed its way up Broad Street, carving a path through the heart of Center City. Behind it marched the participants, carrying the names of the dead. Every minute or so, a parade organizer would select a participant from the front and ask them to stand still while two additional glowing boxes passed by them on either side. When my turn came, I stood still and watched the lighted tunnel slip past me. I saw the backs of the "living" walking away from me. My peripheral vision obscured by the glowing boxes, I felt a fleeting moment of fear, isolation, and loneliness before slipping into the noisy crowd of my "dead" companions. Suddenly, one could imagine what it must have been like to see your neighbors and family members getting sick, to wonder if you would be next. The parade created a space where the anxiety and fear from the past felt momentarily palpable again. At the end of the route, the past faded again, giving way to stands set up to dispense contemporary information about the museum and healthcare, including flu shots. The museum exhibit begins with a video of the parade that evoked faint echoes of the participatory experience. Next, visitors encounter the first of several large and beautifully designed museum panels. Following these through the exhibit, one learns about everything from manufacturing during WWI to the reliance on vaccination as a tool of modern public health to the creation and purpose of the Spit Spreads Death parade by Blast Theory. The exhibit displays a relatively small number of objects, including (though not limited to) buttons and stickers handed out during the 1918 parade, a medical specimen of a pneumonia-infected lung, some recreations of pinewood coffins, and never-opened Christmas gifts wrapped by a flu victim. This relative sparseness offers a welcome simplicity...

Thomas L Petty

Thomas L Petty

Peter C. Nowell (1928–2016)

The pioneering cancer cytogeneticist, Peter C. Nowell, died on December 26, 2016, from complications of Alzheimer’s disease at the age of 88. His work laid the foundation for the recognition of the genetic basis of cancer that paved the way for modern targeted cancer therapeutics. Nowell’s observations of changes in chromosomal anatomy during progression of malignancies led him to predict that it was the accumulation of genetic abnormalities that underlies cancer progression, predating notions such as genomic instability as a fundamental hallmark of cancer. Portrait of Peter C. Nowell. Image courtesy of the University of Pennsylvania Art Collection. Nowell was born on February 8, 1928, in Philadelphia. He attended Wesleyan University as an undergraduate and medical school at the University of Pennsylvania, graduating in 1952. He then performed a rotating internship at Philadelphia General Hospital and trained in pathology at Philadelphia’s Presbyterian Hospital. Nowell was drafted into the military and spent 2 years studying the health effects of radiation at the Naval Radiological Defense Laboratory in San Francisco, before joining the faculty at the University of Pennsylvania in 1956, where he stayed for the remainder of his career. As a pathologist, Nowell’s primary tool for discovery was the light microscope. He contributed to development of methods for visualizing chromosomes in mitotic cells (karyotyping). In 1960, using his improved karyotyping methods, Nowell and his associate David Hungerford published their discovery of the first nonrandom chromosomal alteration in cancer: an abnormally small chromosome #22 that was present in all blood or marrow samples from patients with chronic myeloid leukemia (CML) (1). In the seminal paper describing this finding, Nowell wrote that … [↵][1]1To whom correspondence should be addressed. Email: drukerb{at}ohsu.edu. [1]: #xref-corresp-1-1

Giants in Chest Medicine: Jay A. Nadel, MD

I thank Richard S. Irwin, MD, Master FCCP, and Editor in Chief,CHEST, for offering me the opportunity to profile Jay A. Nadel, MD, a giant in chest medicine. Born in 1929 in Philadelphia, Pennsylvania, Dr Nadel received his MD degree from Jefferson Medical College in 1953. During his internship and residency in cardiology at Philadelphia General Hospital (1953-1956), Dr Nadel met Julius Comroe, MD, who headed the Graduate School at the University of Pennsylvania. Subsequently, Dr Nadel spent 2 years in the US Air Force (Travis Air Force Base) near San Francisco, California, and Dr Comroe was recruited to head the Cardiovascular Research Institute at the University of California, San Francisco (UCSF). In 1958, Dr Nadel wa s chosen to be Dr Comroe's research fellow.

Explorer, Nobel laureate, astrobiologist: things you never knew about Barry Blumberg.

Baruch S. “Barry” Blumberg, winner of the 1976 Nobel Prize in Physiology or Medicine and founding director of the NASA Astrobiology Institute (NAI), passed away suddenly of a heart attack at age 85 on April 5, 2011, during a conference at Ames Research Center. That Barry spent his last day conceptualizing an International Research Park on the Moon befits the unflagging curiosity that characterized his life in general and his scientific career in particular. In this paper I trace Barry's scientific career, including his early formative years and the unexpected path that led to the Nobel Prize. I also show that Barry's perspective and approach to science in general made astrobiology a natural area to attract his attention after he had retired from medical research. Indeed, his priorities as NAI director reflect directly things that were important to him throughout his career.

Lessons in creating a rewarding career.

Lessons in creating a rewarding career.

Honoring the past: A prologue for the future of neuroscience nursing.

The 1870s marked the first report of neurological nursing. Sir Victor Horsley, a neurosurgeon at the National Hospital in Queens's Square London, invited nurses to observe neurosurgery to better care for these patients postoperatively. The National Hospital in Queens's Square quickly became a recognized center for neurological care and was the first neurological institute in the world. Concurrently, nurses learned from Dr. Charcot at Salpetriere in Paris. In both cases, the education was informal through physicians imparting information, but nurses began to learn principles of neuroscience patient care. Europe became the hub of modern medicine serving as centers for medical education and breakthroughs attracting the best renowned physicians. It was also a time when neurology and psychiatry were closely intertwined as one science, an entanglement that would take many decades to separate into individual specialties. The development of neurosurgery was instrumental in fostering neurological nursing's development. Physicians trained in Europe returned to the United States with new neurological knowledge, and became recognized leaders especially in neurosurgery. As neurosurgery and neurology developed, it became clear that specially trained nurses were needed to care for these patients. Neurological nursing began to emerge as a subspecialty in the United States with informal lectures by physicians gradually emerging into more formalized education. In the early 1900s, Dr. Charles Mills lectured to nurses about the care of patients with neurological disease at the Philadelphia General Hospital. The course content became a book entitled The Nursing and Care of the Nervous and the Insane published in 1889. Dr. Mills wrote, “in no class of cases is it more important for a nurse, caretaker, or companion to have good principles of action and clear notions of practice, than among patients suffering from nervous or mental afflictions.” Technology in the form of invasive blood pressure monitoring, let alone ICP monitoring did not exist. Consequently, nursing care relied on close observation of patients and changes in the level of consciousness (LOC), the most sensitive neurological indicator of change and other subtle changes, to be communicated to the physician. The New York Neurological Institute was founded in 1909; Amy Hilliard became the first superintendent of nurses in 1910. She organized the first postgraduate course in the care of patients with nervous system diseases for nurses taught by physicians. Papers, based on these lectures, were published in the American Journal of Nursing in 1911; other publications followed. In 1910, Dr. Harvey Cushing performed the first transspenoidal approach for pituitary tumors. In 1923, neurosurgeon, Dr. Dandy, opened the first specialized care unit for postoperative neurosurgical care at Johns Hopkins Hospital in Baltimore, Maryland. Neurological nursing took root as the subspecialties of neurology and neurosurgery continued to develop fueled by the needs of soldiers from the World Wars. Both physicians and nurses recognized the need for informed nurses to care for neurological patients. In the 1960s, a few universities began to offer master's degrees in neurological and neurosurgical nursing. Critical care units began to appear in the 1960s first as coronary care units. It was not until the 1970s that neurological intensive care units (NICU) were established. Many landmarks followed for neuroscience nurses: American Association of Neurological Nurses (AANN) founded (1968) and name changed to American Association of Neuroscience Nurses (1984); World Federation of Neuroscience Nurses founded (1969); first issue of Journal of Neurosurgical Nursing (1969); first neurological certification examination (1978); and first stroke certification examination (2012). “What's past is prologue” (Shakespeare, The Tempest). What is sustained for the future is the knowledge, keen observational skills, and critical thinking skill of the neuroscience nurses that established the subspecialty of neuroscience nursing. Invasive monitoring including ICP monitors, imaging diagnostics (computed tomography, magnetic resonance imaging), and NICUs were not part of the landscape until the 1970s. Yet, no substitute has been found to replace the observational skills and caring attitudes of neuroscience nurses who approach patients holistically. The technologies, albeit amazing, are tools, not replacements. Perhaps the greatest addition occurring is the development of high level communication skills by well-educated nurses confident in their knowledge, clinical skills, and roles as equal partners with other health professionals in collaborative interprofessional team practice, which results in safer and better patient outcomes. The evolving roles of neuroscience nurses will continue with a future that includes more, smaller, and less invasive technology/nanotechnology, individualized care based on individual genomic profiles, and pharmacogenomics designed to match patient responsiveness to drug therapies. However, the fundamental core of neuroscience nursing values on competencies of observations, clinical reasoning, intervention, compassion, and caring are enduring now and in the future.

2012 Ends an Era

The 20th-century medical scene was very different from the freewheeling 19th century in which patients were subjected to a mixture of science and charlatanism from medical practitioners with widely varying credentials and training. The various state medical licensure boards began to exert more authority and work together in the Federation of State Medical Boards. The Council on Medical Education and Hospitals of the American Medical Association (AMA) published in 1914 the first list of approved internships in the United States, the American Board of Ophthalmology provided in 1916 the first board certification of a medical specialty, and in 1920 the Council on Medical Education and Hospitals appointed committees in each medical specialty to determine what training was necessary to qualify as an expert in that specialty field. In 1934, the American Psychiatric Association (APA), the American Neurological Association (ANA), and the Section on Nervous and Mental Disease of the American Medical Association joined in forming the American Board of Psychiatry and Neurology (ABPN) with the goal of establishing examinations for certification in psychiatry and neurology. The first examinations by the American Board of Psychiatry and Neurology were held in June 1935 at the Philadelphia General Hospital. Changes over the years included adding in 1959 a certifying examination in the subspecialty of child psychiatry and adding in 1969 certification in ‘‘neurology with special competence in child neurology’’ (terminology changed to ‘‘neurology with special qualification in child neurology’’ in 1985). As the American Board of Psychiatry and Neurology looked toward the 21st century, it determined that the Part II oral examinations should be replaced with the documentation of specific resident competencies during training and a redesigned computerized certification examination. Thus, the Part II oral examinations were phased out except for those individuals still qualified through their training in the older system prior to the new requirements. In September 2012, neurology examiners congregated in Indianapolis, Indiana, to perform the last of these Part II examinations and on the morning of Saturday, September 22, 2012, the examinations were held at Goodman Hall of Indiana University Health. The examiners for the child neurology portion of the examinations are listed in Tables 1 and 2. The team led by Director Patricia Crumrine performed the patient examination sessions and the team led by Director Ann Tilton (Figure 1) performed the vignette case examination sessions. The very last child neurology session, ending at 12:10 PM, was the vignette case examination of one candidate conducted in 20-minute periods in order by John Bodensteiner, Robert Rust, and Roger Brumback (a future trivia game answer to ‘‘Who was the last child neurology Part II examiner?’’). Much has been written about the various changes in the American Board of Psychiatry and Neurology over the nearly 8 decades since its founding. Let us hope that the American

Ask the Experts: The management and treatment of atopic dermatitis

Lawrence Charles Parish is a graduate of the University of Pennsylvania College of Arts and Sciences (PA, USA), and received his MD from Tufts University School of Medicine (MA, USA). Following an internship at the Philadelphia General Hospital (PA, USA), he took his dermatology training at the Hospital of the University of Pennsylvania (PA, USA) under Donald Pillsbury and Walter Shelley. Currently, he is Clinical Professor of Dermatology and Cutaneous Biology at the Jefferson Medical College of Thomas Jefferson University (PA, USA), where he is also Director of the Jefferson Center for International Dermatology. He holds visiting professorships at Tulane University School of Medicine (LA, USA), Yonsei University College of Medicine (Seoul, Korea) and Zagazig University Faculty of Medicine (Zagazig, Egypt). Parish is a member of the American Academy of Dermatology and the American Dermatological Association. He is an honorary or corresponding member of Austrian, British, Bulgarian, French, Israeli, Italia...

The Australia antigen and role of the late Philadelphia general hospital in reducing post-transfusion hepatitis and sequelae

Baruch Blumberg, who received the Nobel Prize for Physiology or Medicine for his discovery of the Australia antigen, died on April 5, 2011. Arguably, that discovery has been the most important advance in the field of Hepatology. It led to the virtual elimination of transfusion related hepatitis B in most parts of the world and was essential to the identification of hepatitis A, C, D and E viruses. Credit for this is due Dr. Blumberg and teams in Philadelphia and Tokyo. In lieu of an Associate Editor commentary, Drs. Senior, London, and Sutnick, who were members of that remarkable team, tell us their inspiring story.

Osler Under 40

Osler Under 40

Recurrent Dislocation of the Shoulder Joint

Recurrent Dislocation of the Shoulder Joint

Anthony Frederick DePalma, MD

My first meeting with Dr. DePalma was in 1957 as an intern in his office on the 6th floor of the Curtis Clinic. He and I spoke for a while about the residency and he looked at me and said, “You know you are going to be 33 years old before you make a plug nickel.” I replied, “Well, I don’t make any money now, so what is the difference?” He laughed and I got the residency. In the next two years, I spent many hours in the operating room with Dr. DePalma and learned quickly how skilled a surgeon he was. He was a master technician: he knew where to put his incision; he was kind to soft tissue; he worked quickly, resulting in minimal blood loss. He performed surgery of the spine, hip, knee, shoulder, foot, ankle, and hand. Well before the advent of sports medicine, he performed surgery on members of the Philadelphia Phillies Baseball team. He was the true general orthopaedist. Although he would point out things to us during surgery, he expected his residents to know what he was doing. Most of the time he was quietly thinking of what his next move would be. There were times when he would be upset with us and he would let us know in no uncertain terms that we were not doing what he expected of us. I remember him quietly saying to me at the end of a certain procedure, “Phil, don’t ever do that again.” Dr. DePalma exemplified what a physician in a school of medicine is about: education, research and clinical care. He was a tireless educator. He taught the third year class lectures, beginning with congenital problems and ending with trauma and musculoskeletal conditions. In the senior year, he would meet with groups of seven students rotating through orthopaedics and have an hour-long session with them. They would present a subject to him which he would critique. Dr. DePalma started his day at eight o’clock in surgery; he would operate Monday, Tuesday, Thursday, and Friday at Jefferson (on Wednesdays he would go to Philadelphia General Hospital where he would be the surgeon for cases picked by the Jefferson residents). He would be finished by one o’clock and go to office hours. He would have dinner at six o’clock, then go to sleep shortly thereafter. He would wake at midnight to write his papers and books until four o’clock in the morning. Then he would go back to sleep for a few short hours before beginning again. He did research, and he wanted all of his residents to do the same. He placed so much emphasis on research that four of his residents received PhDs for their successful work. Dr. DePalma was prescient. In the early sixties, he knew the time would come when there would be orthopaedic subspecialties. To prepare his residents for this time, he sent Jim Hunter to do a fellowship in hand surgery with Dr. Robert Carroll. On his recommendation, I did a rehabilitation fellowship at the Institute for Physical Medicine and Rehabilitation at NYU. This man was an unbelievable person, teacher, clinician and surgeon. I am privileged to have known him.

Founders of Pediatric Pathology: Marie Valdés-Dapena

Marie (‘‘Molly’’) Valdes-Dapena (Fig. 1) (nee Brown) was born on July 14, 1921, in Pottsville, PA. After primary education she attended Immaculata College, near Philadelphia, majoring in Biology and graduating in 1941. She entered Temple University School of Medicine (TUSM) in Philadelphia in 1941 and received her MD in 1944. Molly was a rotating intern and a resident in Pathology (1944–49) in the Philadelphia General Hospital (PGH). She was licensed to practice in 1945 and certified by the American Board of Pathology (ABP) in 1949. She worked the next 2 years as Assistant Pathologist at the FitzgeraldMercy Hospital (‘‘Fitz’’) in Derby, PA. In 1951, she moved to the Women’s Medical College Hospital (WMCH) of Philadelphia (later the Medical College of Pennsylvania) as Pathologist and later as Director of Laboratories. While at WMCH, Molly also held appointments at the University of Pennsylvania School of Medicine and Dentistry as Instructor of Pathology. She rose through the ranks to Associate Professor before beginning her new professional life and ‘‘the apprenticeship’’ in Pediatric Pathology at St Christopher’s Hospital for Children in Philadelphia (‘‘St Chris’’). At ‘‘St Chris and TUSM, Dr Waldo E. Nelson was the Chief of Pediatrics. Other prominent staff were Dr Angelo DiGeorge (Di-

Principles and practice of surgery. By W. Wayne Babcock, M.D., Emeritus Professor of Surgery, Temple University; Acting Consultant, Philadelphia General Hospital. With the collaboration of 37 Members of the Faculty of Temple University. 10¾ × 6½ in. Pp. 1331, with 1141 illustrations. 1946. London: Henry Kirnpton. 60s. net

Principles and practice of surgery. By W. Wayne Babcock, M.D., Emeritus Professor of Surgery, Temple University; Acting Consultant, Philadelphia General Hospital. With the collaboration of 37 Members of the Faculty of Temple University. 10¾ × 6½ in. Pp. 1331, with 1141 illustrations. 1946. London: Henry Kirnpton. 60s. net

George E. Pfahler

As a resident physician at Philadelphia General Hospital in 1899, George E. Pfahler was assigned to start an x-ray service. “I can see no future in this field,” he said. “All of the bones of the body and foreign bodies have been demonstrated. But,” he added, “I am here to do what I am told.” So he learned to operate the newly purchased machine.

An Experiment in Leadership: The Rise of Student Government at Philadelphia General Hospital Training School, 1920-1930

An Experiment in Leadership: The Rise of Student Government at Philadelphia General Hospital Training School, 1920-1930

Randall and his plaque

A lexander Randall, the only son among the four children of known lawyer J . W. Randall, was born in 1883. Alexander graduated from the John Hopkins Medical School in 1907 but was not very interested in surgery at that time. He spent 18 months as an intern in the German Hospital (actually, the Lankenau Hospital) of Philadelphia. While there, he came under the influence of Dr. John B. Deaver, who stimulated his interest in surgery. In 1915, he joined the staff of the Philadelphia General Hospital. Two years later, he entered the Army in the University of Pennsylvania Hospital Group and was abroad from 1918 to 1919. In 1921, he was made an associate in urology at the University of Pennsylvania and became assistant professor in charge of the urology department 2 years later. He was promoted to associate professor in 1926 and to full professor in 1929. When he directed the department in 1923, he initiated the residency training program at the University of Pennsylvania and remained as the chief until about 1949. He is probably also the physician who deserves credit for introducing intravenous urography to the United States. This technique had been developed in Germany by Von Lichtenberg, who accepted an honorary degree at the University of Pennsylvania shortly afterwards. Around 1937, Randall was treated with high doses of sulfathiazole because of an inflammatory process, and he had a total renal shutdown. His kidneys eventually functioned again, but residual hypertension led to a minor stroke in 1941; he then suffered multiple strokes until his passing away on November 18, 1951 (Fig. 1). We know additional details about Randall’s life because of the kindness of his son Peter Randall, now a plastic surgeon at the University of Pennsylvania, and because of a report written by his close friend H.B. Wilmer, published in the 1939 “Scope” of the University of Pennsylvania. Dr. Wil-