Renowned Physicians Research Articles

Classic clinical descriptions of disease: curing medical education with a dose of the past

The importance of clinical skills, including obtaining patient history and performing physical examination, has been de-emphasized in the modern medical school curriculum. With advancements in diagnostic technologies, the clinical presentation of diseases in medical textbooks has been simplified, diminished, and largely replaced with detailed pathophysiology and laboratory findings. The implementation of the United States Medical Licensing Exam (USMLE) Step 1 has also contributed in pushing medical education toward classroom-based learning rather than emphasizing clinical experience. Clinical skills competency is crucial to accurately diagnose patients and simultaneously lowers health care costs by not relying on unneeded diagnostic tests. To address this gap in medical knowledge, a group of students at Texas Tech University Health Sciences Center, Lubbock, Texas, have created a website documenting classic clinical disease descriptions written by some of the renowned physicians from the 19th and 20th centuries, including Osler, Flint, Gowers, etc. This website will continue to grow and will be a useful tool for professors, physicians, and medical students.

Albucasis: A Pioneer Plastic Surgeon.

The middle ages in the Arab world etched medical advancements that laid the foundations of modern medical practice. Among the several renowned physicians of historical importance, Abu Alkasem al-Zahrawi (Albucasis) left his mark in the fields of medicine and surgery. He is notably famous for his 30-volume compendium Kitab-al Tasreef, which served as his magnum opus. The last volume of this work was reserved for surgery. During his lifetime, Albucasis made contributions of unparalleled luminosity to the field of surgery. He described surgical techniques for a range of procedures encompassing several subspecialties that comprise modern plastic surgery. Beyond just a physician and surgeon, Albucasis was a remarkable teacher who taught medical students with fervor and emphasized the importance of affording treatment to patients of all social classes and the value of physician-patient relationships. The focus of this review is to explore the contributions of Albucasis to the field of plastic surgery.

Ab Manr ῌasan Qamarī: Promoter of the Medical School of Rāzī (Rhazes).

The medical history of Iran and Islam is marked by the presence of renowned physicians, some of whom are not well known outside Iran. Ab Man⋅r ῌasan ibn Nḥ Qamarī Bukhārā 'ī was an Iranian physician living in the fourth century AH (10th century CE). The scientific works of this sage indicate his skill and expertise in medical science. He was a man of such scientific stature that the renowned Iranian philosopher and physician, Avicenna, use may have been one of his disciples. Qamarī may be credited as one of the promoters of the medical school of Muḥammad Ibn Zakarīyyā Rāzī. Some of his works, including Al-Tanwīr Fī 'Isṭilāḥāt Al-Ṭibbīyyah and Al-Ghinā and Al-Munā are still extant. In this paper, his scientific life and works, based on primary sources, have been studied in order to shed light on his role in formation of the Muslim Medical School.

The Person Behind the Inventor of the Heart-Lung Machine: John H. Gibbon Jr, MD (1903-1973).

The Person Behind the Inventor of the Heart-Lung Machine: John H. Gibbon Jr, MD (1903-1973).

A Fine doctor.

I met Jonathan Fine for the first time in 2011. He was to travel back to Boston through Mumbai after a stint in Chattisgarh, where he had volunteered with Jan Swasthya Sahayog, the well-known rural hospital near Bilaspur. A friend suggested that since he was a doctor who had done pioneering work by setting up the renowned organisation Physicians for Human Rights, we should arrange a talk by him for medical students. A lecture was thus organised at my alma mater, the GS Medical College and KEM Hospital, where Jonathan spoke on "Why should doctors engage with human rights?" In his characteristic blunt style, rather than talk about his past, he exhorted the audience to visit Chattisgarh and see the severe inequities he had witnessed.

Dr Edward Jenner (1749–1823): Eighteenth-Century Cardiology Pioneer

The critical observations made by the polymath Dr Edward Jenner MD FRS within the realms of medicine and natural science are legendary, yet his hypothesis expressed in 1786 as to the cause of angina pectoris is not so widely documented. Not found in the published literature of its time, Jenner's work on the subject only came to light following the examination of his correspondence with friend and mentor John Hunter, and the minutes of an obscure provincial medical society revitalised in 1896, the centenary of Jenner's discovery of vaccination. The first to grasp the role of the coronary arteries in heart disease, Edward Jenner deserves the belated recognition of his place among the list of renowned physicians to have made significant contributions to the latter eighteenth-century British enquiries into the causes of heart disease.

Don't Focus on Statistics.

Don't Focus on Statistics Mary Fauvre March 12, 1982 was the worst day of my life. Our son was 19 months old and he was diagnosed with acute lymphoblastic leukemia (ALL); our family's lives changed forever. In a space of 24 hours we were told our baby might die, and that if he lived, he probably would be sterile—two predictions of unequal weight but of horrifying impact. I have a Ph.D. in Educational Psychology/Child Development and my husband has four older children from a previous marriage, so we had thought we had some idea about child rearing. But with this terrifying diagnosis, neither of us had any idea how the future would unfold for our beautiful, bright, verbal, jolly little boy. In hindsight, we know we were lucky, but 34 years ago we were devastated. It all started on a Friday morning when I took him to the doctor to check on his unusual pallor and fatigue. Based on stat blood tests, which showed his hemoglobin at 3.4, our pediatrician sent us directly to the closest tertiary care university teaching hospital. We were admitted and he was treated with packed red cells, which improved his energy and color immediately. He felt great: "Shoes on, shoes on. … Go home!" was his mantra, which I will never forget. They did not send us home, but the next day the chief pediatric hematologist/oncologist met with us, and tried to answer our anxious questions. He told us not to pay attention to statistics, but when we pestered him, he reported that based on age and presenting symptoms the "odds of survival" showed our son's case in the 50–50 category. We were even more upset, and we agreed to try not to focus on statistics. While ALL has become one of the more treatable cancers, in the early '80's there were still lots of unanswered questions, and several experimental protocols were under study. We were basically in a state of shock as the doctors explained everything that lay ahead. We knew that information from others who preceded us in this nightmare had already contributed significantly, so we agreed to participate in the current research study. Our son was randomly assigned to a treatment protocol that involved the most intense sequence of drugs: cranial radiation followed by two or three years of monthly IV vincristine and cyclophosphamide on consecutive days, in addition to the standard L–Asparaginase, 6–mercaptopurine, prednisone, and intrathecal methotrexate. We understood that the "experimental" aspect of the protocol was the cyclophosphamide. The most urgent decision related to this regimen was whether to insert a Broviac catheter in order to facilitate the administration of the vincristine and cyclophosphamide. For reasons that escape memory at this point, the decision was made not to do the Broviac. I confess that I was relieved not to have the additional responsibility of cleaning it and maintaining a sterile environment on a busy two year–old boy, but he did get a few vincristine burns over the years. The medical team at the hospital and clinic was an outstanding group of highly trained professionals, including a wonderful nurse practitioner and a psychologist, in addition to the renowned physicians and residents in training. They were patient with us and tried to answer our endless questions, even as they kept emphasizing the importance of "informed consent." Both my husband and I address problems and challenges through education and research, and we immersed ourselves in textbooks that defined all the different types of blood cells and blood diseases and cancers. If the medical team wanted us to be informed but not to focus on statistical outcomes, we thought the least we could do would be to try to understand the biology and chemistry of acute lymphoblastic leukemia. Within a matter of just a few weeks, the doctors told us the disease was in remission, and we all heaved a big sigh of relief. We began to consider how to lead our lives with this "new normal" as something that would be with us forever. The medical team told us there was a strong probability that our son would develop a learning...

Bedside teaching: an underutilized tool in medical education.

Bedside teaching (BST) is a fundamental component of clinical training and an essential tool in the creation of a competent physician.1-15 Sir William Osler (1849-1919), one of Canada’s most renowned physicians, was the first to introduce BST to medical education in 1892. He described modern medical education as something that needed to be taught at the bedside: “Medicine is learned by the bedside and not in the classroom.”9 BST allows the physician and patient to interact at the bedside; through this physician-patient interaction process, medical students and residents are simultaneously afforded the opportunity to learn clinical skills, clinical reasoning, physician-patient communication, empathy, and professionalism.6,12,15 In real practice, comprehensive history taking can help the physician diagnose up to 56% of patient problems, which may rise to 73% if a physical examination is added.8 Much information can be gained and a proper diagnosis reached by obtaining a good medical history and performing an efficient clinical examination.8 Clinical teaching in which the patient is involved is enriched by these visual, auditory, and tactile experiences. Senior medical students and medical residents believe that BST is a valuable but underutilized tool.15 Time spent on BST has been on the decline since 1978, as highlighted by Ahmed, who reported that the proportion of teaching time taken up by BST had declined from 75% 30 years ago to only 16% today.8 The learning triad The BST learning triad comprises patients, students, and tutors.6 All three must be present for BST to occur and it must occur within a clinical environment. Each individual member brings his or her own value to the learning triad. For example, the student brings medical knowledge and the eagerness to learn; the tutor brings depth of knowledge, mentorship, and willingness to help the student learn and make connections; and finally, the patient brings relevant clinical issues to the forefront that allow the student to learn. An effective learning environment requires all three groups to work together in the learning triad.6 The obstacles that may reduce the effectiveness of BST can be categorized by each group in the learning triad.

Paralysis with muscle atrophy

The mid-1800s were fruitful for French neurologists, especially at the Hôpital de la Charité in Paris. At this hospital, Pierre Eloy Fouquier, the protégée of renowned physicians Corvisart and Laënnec, worked as the private physician of Charles X and Louis Philippe, kings of France. It was here that Fouquier met François-Amilcar Aran who, in 1850, described a new disease that he referred to as “progressive muscular atrophy”.1Aran FA Recherches sur une maladie non encore décrite du système musculaire (atrophie musculaire progressive).Archives Générales de Médecine. 1850; 4 (172–214 (in French).): 5-35Google Scholar Later, commenting on a presentation at the Royal Medical and Chirurgical Society in 1851, Edward Meryon went on to officially describe fatty degeneration of skeletal muscles. He discussed several cases of young boys who had experienced increasing weakness of the limbs that could not be halted “in spite of all remedial measures”, and in particular noted the condition's predilection for male patients and its familial nature.2Meryon E On fatty degeneration of the voluntary muscles (report of the Royal Medical and Chirurgical Society).Lancet. 1851; 2: 588-589Google Scholar In 1853, Jean Cruveilhier described progressive atrophic muscle paralysis (“paralysie musculaire progressive atrophique”),3Cruveilhier J Sur la paralysie musculaire progressive atrophique.Archives Générales de Médecine. 1853; 5 (in French): 561-603Google Scholar the characteristics of which match those of amyotrophic lateral sclerosis, later known as Charcot disease. At the time, the topic generated controversy, with Cruveilhier defending the disease as a primitative nerve lesion, whereas Duchenne de Boulogne argued for initial muscle involvement. Duchenne is indeed renowned for his later contribution to the specialty of muscular diseases: the eponym Duchenne muscular dystrophy is applied to the most common and most severe dystrophy in childhood.4Duchenne (de Boulogne) G De la paralysie musculaire pseudo-hypertrophique ou paralysie myo-sclérotique.Archives Générales de Médecine. 1868; 6 (179–209, 305–21, 421–43, 552–88 (in French).): 5-25Google Scholar Interestingly, although Aran and Meryon were believed to be the first to describe this motor neuron disease, we had the opportunity to obtain a handwritten unpublished medical course by Fouquier (“Cours complet de médecine”), dated 1817. In this text, there is a chapter dedicated to paralysis that includes descriptions of “paralysis with muscle fatty degeneration and atrophy”. Thus, it seems that Fouquier, rather than Meryon or Aran, was in fact the first to describe this disorder. The mid-1800s were fruitful for French neurologists, especially at the Hôpital de la Charité in Paris. At this hospital, Pierre Eloy Fouquier, the protégée of renowned physicians Corvisart and Laënnec, worked as the private physician of Charles X and Louis Philippe, kings of France. It was here that Fouquier met François-Amilcar Aran who, in 1850, described a new disease that he referred to as “progressive muscular atrophy”.1Aran FA Recherches sur une maladie non encore décrite du système musculaire (atrophie musculaire progressive).Archives Générales de Médecine. 1850; 4 (172–214 (in French).): 5-35Google Scholar Later, commenting on a presentation at the Royal Medical and Chirurgical Society in 1851, Edward Meryon went on to officially describe fatty degeneration of skeletal muscles. He discussed several cases of young boys who had experienced increasing weakness of the limbs that could not be halted “in spite of all remedial measures”, and in particular noted the condition's predilection for male patients and its familial nature.2Meryon E On fatty degeneration of the voluntary muscles (report of the Royal Medical and Chirurgical Society).Lancet. 1851; 2: 588-589Google Scholar In 1853, Jean Cruveilhier described progressive atrophic muscle paralysis (“paralysie musculaire progressive atrophique”),3Cruveilhier J Sur la paralysie musculaire progressive atrophique.Archives Générales de Médecine. 1853; 5 (in French): 561-603Google Scholar the characteristics of which match those of amyotrophic lateral sclerosis, later known as Charcot disease. At the time, the topic generated controversy, with Cruveilhier defending the disease as a primitative nerve lesion, whereas Duchenne de Boulogne argued for initial muscle involvement. Duchenne is indeed renowned for his later contribution to the specialty of muscular diseases: the eponym Duchenne muscular dystrophy is applied to the most common and most severe dystrophy in childhood.4Duchenne (de Boulogne) G De la paralysie musculaire pseudo-hypertrophique ou paralysie myo-sclérotique.Archives Générales de Médecine. 1868; 6 (179–209, 305–21, 421–43, 552–88 (in French).): 5-25Google Scholar Interestingly, although Aran and Meryon were believed to be the first to describe this motor neuron disease, we had the opportunity to obtain a handwritten unpublished medical course by Fouquier (“Cours complet de médecine”), dated 1817. In this text, there is a chapter dedicated to paralysis that includes descriptions of “paralysis with muscle fatty degeneration and atrophy”. Thus, it seems that Fouquier, rather than Meryon or Aran, was in fact the first to describe this disorder.

Bloodletting from the Ankle Vein to Treat Sciatic Pain

The most renowned physicians through the Middle Ages and the Renaissance up to the Modern practiced bloodletting from the “sciatic vein” (saphena minor or small saphenous vein, which runs behind or under the external ankle) as a cure for sciatic pain. Here we review historic descriptions of this procedure carefully selected from medical literature in Latin language from the Middle Ages and the Renaissance and hazard a guess as to why phlebotomy of the sciatic or saphenous veins was conceived of as a possible remedy. In the early Middle Ages, Mesue (Ibn Masawaih, 777–857) (Assyrian Christian physician) was the first to report bloodletting from the “sciatic vein” (saphena minor or small saphenous vein) for: “ De dolore anche et sciatico ”: “pain in the hip and sciatic” [1]. He wrote: “ Galienus comendavit et ex venis quae flobotomantur est vena inter minimum, et secundum pedis, si materia in inferioribus iam existit flobotomia, enim huius vene est maius iuvamentum quam sciatice et saphene in hoc casu …”: “Galen recommended phlebotomy, and among the veins that may be bled, there is a vein between the little toe and the second toe of the foot, for matters in the lower parts. In fact, in this case, the benefit of this vein is greater than that of the sciatic and saphenous veins.” Isaac Judaeus (Ishaq ibn Sulaiman, c 850–ca. 932) (Egyptian Jewish physician) introduced wrapping the leg, when he wrote: “ Sciatica que sub talo est exterior: cum phlebotomanda fuerit: totam coxam et tibiam usque ad spacium quattuor digitorum a talo fortiter ligari convenit … phlebotomo vena aperiatur …”: “The vein sciatica, which is external and inferior to the ankle, when it has to be bled, it is appropriate that the whole thigh and tibia are strongly wrapped at four fingers above the …

Facetten der japanischen Akupunktur im frühen euro-japanischen Kulturaustausch – Teil 2

The overwhelming cultural charisma of China all too easily prevents recognition of neighbouring countries’ autonomy and achievements. Even though until the 19th century Western papers on acupuncture and moxibustion were predominantly based on Japanese information, distinctions from Traditional Chinese Medicine were hardly recognized for a long time. The first part of this article (DZA 2/2015) traced some traits of Japanese acupuncture during the 17th century. This period is marked by Europeans venturing for the first time to glimpse into this strange therapy from a remote part of the world, while Japanese physicians embarked on the development of novel concepts and therapeutic methods. The second part of the article will describe Engelbert Kaempfer’s treatise on the therapy of ”colic” and the invention of the guiding tube by Sugiyama Wa’ichi. Furthermore, the pioneering Kaempfer and ten Rhijne’s attempt at interpreting the Sino-Japanese concepts as well as the reaction of renowned physicians of the 18th century will be presented.

Humphry Davy

Humphry Davy

Briefpatienten - Die Geschichte der Konsiliarkorrespondenz - Einst weit verbreitete Praxis, erlebt sie heute eine gewisse Renaissance

Nowadays, a medical treatment without the personal meeting of the patient and the physician for the initial anamnesis and physical examination is regarded as offending the rules of good clinical practice. For the longest time, however, the epistolary consultation was a wide-spread and well-established practice. The patients' letters preserved in the correspondences of renowned physicians represent one of the main sources for medical historians who try to investigate in the feelings, thoughts and behaviour of patients of the early modern period. The paper discusses the rise and decline of the phenomena of consulting correspondence, analyses the advantages this praxis had both for the patients as for the physicians involved, and presents one example from the correspondence of the physician and surgeon Lorenz Heister (1683-1758).

The mysterious death of America’s richest woman in 1917, Mary Lil’ (RIP)

Suspicious circumstances surrounding the death of wealthy socialite Mary Lily "Lil'" Kenan Flagler Bingham in 1917 prompted a secret autopsy conducted by renowned physicians at the request of her relatives. Mrs Bingham, who was formerly married to railroad magnate, Henry Flagler, was among America's richest people at the time of her death. Mary Lil's untimely death occurred approximately six months after her marriage to Judge Robert "Bob" Worth Bingham, a college boyfriend whom she married three years after Flagler's death. In order to establish Mary Lil's medical condition prior to her death, a book about Mary Lil's life written by Pulitzer Prize author, David Chandler and articles from the New York Times; The Louisville Courier Journal, a Kentucky newspaper; and Mary Lil's hometown newspaper, The Morning Star, in Wilmington, North Carolina were examined. Although a team of medical experts performed a secret autopsy following her death and released their findings to her family, the examination and tests results remain undisclosed to the public.

Historical Vignettes in Heart Failure

“…Heart failure is simply inability of the heart muscle to maintain the circulation, and t…his failure of the heart muscle is due to the disturbance of the normal adjustment of the various factors concerned in the circulation…. The more I study the symptoms of heart failure, and the more I reflect on the part played by the heart muscle, the more convinced am I that the explanation of heart failure can be summed up in the general statement that heart failure is due to the exhaustion of the reserve force of the heart muscle as a whole, or of one or more of its functions. This statement may seem so self-evident as scarcely to need amplification, but as a matter of fact, this, the essential principle of which diagnosis, prognosis and treatment should be based, is often practically ignored…”1 James Mackenzie, one of the most renowned physicians of his time, published the first edition of his book Diseases of the Heart in 1908. This treatise contains an insightful description of the importance of myocardial abnormalities in the development of heart failure, which became known mechanistically as “forward heart failure.” In addition, Mackenzie indicates the importance of a decrease in myocardial contractility (exhaustion of the reserve force) as the principal mechanism by which heart failure develops. He stated, “The more I study the symptoms of heart failure, and the more I reflect on the part played by the heart muscle, the more convinced am I that the explanation of heart failure can be summed up in the general statement that heart failure is due to the exhaustion of the reserve force of the heart muscle as a whole, or of one or more of its functions. This statement may seem so self-evident as scarcely to need amplification, but as a matter of fact, this, the essential principle of which diagnosis, prognosis and treatment should be based, is often practically ignored.…” The focus on myocardial abnormalities ended with Mackenzie and instead shifted to cardiac hemodynamics as the principal mechanism for the development of heart failure. This clinical view, pioneered by Ernest Starling in England and Carl Wiggers in the United States, dominated the study of heart failure for more than 70 years.

Nikolaj Serikoff, Arabic medical manuscripts of the Wellcome Library: a descriptive catalogue of the Haddād collection (WMS Arabic 401–487), Sir Henry Wellcome Asian Series, vol. 6, Leiden and Boston, Brill, 2005, pp. xiii, 553, and CD, €175.00, $236.00 (hardback 90-04-14798-5).

This is a catalogue of the Haddād Collection, which forms part of the Arabic manuscript collection in the Wellcome Library (London). Purchased in 1986 through Sotheby's, the manuscripts once belonged to the library of Dr Sami Ibrahim Haddād (1890–1957), a well-known Lebanese physician and historian of medicine. The eighty-seven codices described contain more than a hundred texts on various aspects of medicine and related subjects, ranging from the thirteenth to the twentieth century, all written in the Arabic language and script. The texts are works of the most renowned physicians of the medieval Islamic period including translated works of Galen and Hippocrates and numerous texts by less famous authors, some of whom are anonymous, which are important by virtue of their content. The book is also a revised version of a less complete on-line edition of the same work, published on the Wellcome Library's website (http://library.wellcome.ac.uk). While the latter offers rather limited searchability, the printed publication, enlarged by fourteen appendices, provides a well-structured analysis of the collection. The addenda consist of numerous indices, lists, tables and concordances. Some of the descriptive bibliographical information, incipits and basmallahs for example, are entirely listed in Arabic, while indices of personal names and titles are found in both transliteration and the original script. In the last appendix the reader is presented with a thumbnail index of selected images from each manuscript, which can then be viewed in digital format from the CD enclosed in the book. In a chapter on format, the author enlarges on the codicological descriptions used in the catalogue. Amongst terms such as mistara (the trace of a type of stencil used by the scribe as a tool to imprint lines onto the paper) and catchwords (the first word of a page written at the bottom of the previous one) the understanding of which the author takes for granted, the reader will discover the pace. This is a concept developed by the author and introduced as “a sequence of repeated patterns which facilitate the description and identification of the hand and the layout of a whole page”. Angles and ratios of repetitive features characteristic of a given Arabic script sample are measured with respect to the density of the text, which is calculated from the number of lines on the page and the number of links in a line. In one of the numerous appendices to this catalogue, brief instructions on how to calculate the pace can be found, followed by various pace tables for all eighty-seven manuscripts. No evaluation of this measure has however been produced, which is not surprising considering the limited number of texts and the diversity of their origin and history. Nevertheless, the reader is given the opportunity to experiment with the method, which is clearly based on much painstaking and lengthy work. As for the description of the manuscripts' contents, this work is more than just a catalogue. It deserves to be called a research tool. The very detailed accounts of single chapters of the texts, comprehensive summaries of contents, distinctions between a genuine beginning of a work and the start of the manuscript, together with reproductions of textual fragments (without corrections), provide a solid foundation for investigating the manuscripts in the collection. In short, the catalogue is a major resource for medical historians, library professionals, and other scholars interested in the subject.

Decisionmaking Issues in the Rehabilitation Process

Family members are widely believed to be the best decisionmakers for those with brain injuries, but the rehabilitation process does not in fact give them that authority. I have been teaching health care ethics at St. John's University in Jamaica, New York, since 1984. Although I have researched and written a great deal in the field of health care ethics, I had done no work in the area of traumatic brain injury, nor do I remember ever attending a professional conference where that topic was examined. I had never thought about traumatic brain injury as a distinct topic of medical ethics and certainly had not studied the topic in depth. All of that changed, however, as a of a phone call that my husband and I received on the Sunday evening of 22 February 1998. The caller was the trauma room doctor from Cook County Hospital in Chicago. He was calling to inform us that our twenty-one-year-old daughter, Michelle, a senior at the University of Chicago, had been hit by a car. She had suffered severe brain trauma and was on a ventilator. The staff was preparing for immediate brain surgery, and we were advised to go to Chicago as quickly as possible. We found out later that Michelle had arrived at the hospital as a three on the Glasgow Coma Scale and that there had been some discussion as to whether they should operate at all. Michelle survived the surgery and several surgeries after that. Because she had hydrocephalus, she needed to have a shunt implanted, but before that could be accomplished she had to recover from numerous external shunt infections. After eight weeks, she was released from the hospital, although still unconscious, and went to the Rehabilitation Institute of Chicago (RIC) to begin a rehabilitation program that included coma stimulation. During that time, she had two admissions to Northwestern University Hospital, one for pneumonia and another for a urinary tract infection. During both admissions, she also underwent surgery to correct problems with her shunt. On 10 June 1998, Michelle and I flew to Newark Airport and from there went to Edison, New Jersey, where Michelle entered the rehabilitation and coma stimulation program at JFK Johnson Hospital. She was still unconscious. In July of 1998, we were informed that she was no longer a candidate for their program. We were able to have her transferred to the extended-care program at JFK, where she continued to receive therapy. Around the beginning of October, a little over seven months after the initial injury, Michelle began to emerge from the vegetative state and therapy began in earnest, but after several months, it was determined that she had plateaued and that any more progress was unlikely. In June of 1999, we moved Michelle to a brain injury unit on Long Island, but again Michelle was discharged because she was not making sufficient progress. In November of 1999, we brought Michelle home to live with us, where she receives twenty-four hour nursing care and daily therapy. Our only other option would have been to place her in a nursing home. For nearly two years, I have been by my daughter's bedside at some of the best rehabilitation centers in the country. During this time, I have met many other families of people with head injuries as well as some of the most renowned physicians in the field of head injury. This experience, and my professional background, put me in a unique position to describe the issues that families must address in the decisionmaking process of rehabilitation. And although every case is different, my own family's story suggests that there are severe problems with the process. It is widely accepted that family members should have decisionmaking authority for their brain-injured loved ones, but the rehabilitation process of brain-injured individuals does not in fact give them that authority. Two caveats before I begin: First, although much of my analysis is critical of the rehabilitation process, I wish to stress that I am extremely grateful to the many health care professionals who have worked with my daughter and my family. …

Always the Whole and Its Parts

We all agree that medicine is a biological science. When our elders understood this fact, they were faced with the difficulties of integrating within the complete organism the functions of its various organs. The relationships between the whole and its parts were therefore open issues at the beginning of modern medicine. They continue to be relevant today. In 1827, Cuvier, the naturalist, prefaced his eulogy of three renowned physicians, Corvisart, the inventor of cardiology, Pinel, one of the founders of psychiatry, and Halle ´, who advocated a scientific approach to clinical medicine, with this remark: “Which art is closest to divination?. . . All (the parts) play endless interactions, acting and reacting continuously with one another and with the whole. The sting of a pin can bring about tetanus; an imperceptible miasm a...c anspread death in a vast region in but a few days” (1). These words reveal the bewilderment of the founder of paleontology in front of medicine. Since 1950, a reductive analysis has focused on the study of isolated factors, while no comparable attempts were made at establishing links to other normal or pathologic functions. Then, in the laboratory, test tubes had replaced live animals. But everything changed with transgenic mice and rats, leading to a different experimental pathology in which the whole is modified by a specific chemical anomaly of one part, thus revealing unexpected interferences. For those who are smart enough to understand my broken English, I end with this quote from Claude Bernard, who, irritated by the continuous questioning on physiologic regulations by the mathematician Joseph Bertrand, responded, “There is someone who knows much more than you do about integrals. It is the dog now in experimentation” (2).

Charcot and Duchenne: of mentors, pupils, and colleagues.

In the history of medicine, there have been notable mentors, famous pupils, and celebrated colleagues. Seldom, however, have two renowned physicians simultaneously been mentors, pupils, and colleagues to each other, as was the case with Jean-Martin Charcot (Fig. 1) and Guillaume Benjamin Amand Duchenne (Fig. 2). Notwithstanding a 19-year difference in age and the fact that each was a well-published neurological scientist in his own right, these investigators developed a multifaceted relationship which served to reciprocally foster their separate vocations, enhance their mutual endeavors, and enrich the field of neurology. This study examines the teaching, learning, and scientific sharing that uniquely marked the careers of Charcot and Duchenne.

Cardiac massage: a method rescued from oblivion.

Cardiac massage: a method rescued from oblivion.