Medicine in the 20th Century (1900s) – Flashcards

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Drugs available before Germ Theory
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Opium, Cinchona
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Opium
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Juice of seed pods of white poppy Ancient Egypt and Greece (Calomel was the only other drug used more) Prime ingredient = morphine Morphine discovered in 1806 Only relieved symptoms - no cure 1832 ingredient in morphine known as codeine - cough suppressant Laudanum = main pain medication of 1800s (opium in sherry) Often used in child care (give to crying babies)
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Cinchona
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Bark of Febrifuga tree "Fever tree" Contained quinine used to treat malaria Fever reduction, pain relief, anti-inflammatory "Jesuit's bark" or "the bark" Jesuit's brough cinchona bark from Peru Took powder, mixed in wine, drink teh liquid
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Two major stages of development in drug therapy (1800s)
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1. Purification of old drugs (from advancements in chemistry) 2. Synthesis of new drugs for the purpose of killing germs (1860s-70s) (post-Germ therapy)
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Purification of old drugs
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Early 1800s; purification of active ingredients in natural drug materials 1806 - Morphine from opium 1817 - Emetine from ipecac 1817 - Strychnine from St. Ignatius beans (stimulant, rat poison) 1819 - colchicine from autumn crocus (gout); used into early 20th century - pale yellow powder, unique to UK 1820: Quinine from cinchona - reduce fever, malaria; made into pills to ingest; very bitter 1821 - Caffeine from coffee; no medical application 1832 - Codeine from opium; supress coughing - furthe risolated from morphine
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Hypodermic syringe
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1850s - provides controlled dosages and went directly into blood stream; faster result
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Willow Bark
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NO CINCHONA Ancient Chinese and Egyptian healers used to lower fever, ease inflammation and reduce pain 1828 discovered active ingredient = Salicin
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Salicyclic Acid
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1873 Used against pain and fever Began to break down into carbolic acid in alkaline conditions (blood, pH=7.4) Believed it could provide internal antisepsis; more useful in anti-fever drug (didn't kill any germs) but sure relieved symptoms! Became popular anti-fever drug but had very painful/irritated stomach side effects
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Aspirin
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1899 In 1897, German man suffering from Rheumatism took SA to relieve symptoms Complained about stomach pains to son who was a well-known chemist at Bayer Begins to study salicylic acid and experiments with different structures and eventually makes aspirin (acetylsalicyclic acid) Marked by Bayer under the name "Aspirin" and becomes the first modern drug First drug to be discovered using a line of reasoning that took form in the late 1800s
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Chemical reasoning behind research...
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Start with a drug that has a positive effect but also likely has undesirable effects then: 1. Determine drugs chemical structure 2. Visualize/draw similar chemical structures 3. Synthesize the visualized, theoretical structures in the lab 4. Test synthesized compounds on lab animals for desirable properties, and minimal or no side effects
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Paul Ehrlich
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Early 1900s (German; 1854-1915) Traditional physicians training, MD Career spent mostly working as chemist and pharmacologist Professor at University of Berlin; a lot of research at Koch Institute "Dr. Ehrlich's Magic Bullets" Attempting to make a germ that would only harm bad cells "Magic bullets" - drugs that kill germs without injuring the body Also coined "chemotherapy"
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Magic bullets
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drugs that kill germs without injuring the body
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Ehrlich's approach
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Body makes it own magic bullets in the immune system (white cells and antibodies); could we make something like that? 1. Find a dye/stain that shows affinity for, and toxicity to, a germ 2. Determine its chemical structure 3. Synthesize many similar structures 4. Test each for: toxicity to germ and safety for patient
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Trypan red
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"African Trypanosomiasis" (sleeping sickness) Studied by Ehrlich Transmitted by titsee fly Came up with chemical that cured sleeping sickness - no one had ever come up with a drug/chemical to cure a disease But he was in Germany and this was a fairly exotic disease; so wasn't really appreciated as much as anticipated
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Syphilis germ
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1905 germ was discovered by another german Ehrlich set out to find a cure for syphylis Key ingredient in trypan red was arsenic so he experimented with hundreds of drugs using arsenic for syphilis
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#606 Salvarsan
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1909 first cure to syphilis that isn't harmful to patient Sent samples to labs all over the world (including Peterkin in Seattle) Wasn't a complete magic bullet because of inflammation at injection site, took several repeated injections over a year to cure syphilis Felt job was not done
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#914 Neosalvarsan
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1912 new cure for syphilis three years after initial one This IS the magic bullet Quicker to cure, less side effects and only cure until penicillin in 1940s
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Eli Lilly
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One of the biggest pharmaceutical companies in the world Before Ehlrich, pharma companies were pretty small - just chemists making compounds Once Ehrlich's methodology came out many pharma companies developed greatly All of them need large labs, expensive equipment, expensive labor, long time periods
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Drug manufacturing shift
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From small companies making compounds to big business and big investment into modern pharmaceutical industry
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Prontosil/Sulfanilamide
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German company came out with new product with the name Prontosil Claimed a new cure for several infectious diseases including strep, pneumonia, gonorrhea Sent samples out to other labs and hoped to demand positive results/demand (sales) One lab in Paris discovered the compound it was made of and made it themselves Lab was at Pasteur Institute
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Sulfa drugs
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Both French and Germans started with sulfanilamide and began to synthesize it More than 1000 different structures patented as drugs between 1935-1940 Used on Winston Churchill in 1942 when caught pneumonia in Middle East and hospitalized in Tunisia Treated with sulfapyridine (made in Britain's May and Baker)
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Defining characteristics of 20th century medicine
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Growth of Technology, Rise of Specialization, Emergence of hospital as center for delivery area
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Opthalmoscope
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Herman von Helmholtz; MD; German (1821-1894) Major works as doctor and in physics Professor at University of Berlin Developed it in 1850 Allowed to look into eye Helped understand visual perseption and color vision
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Larynoscope and various endoscopes
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1850s-60s Visualize pathology with new scopes
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Clinical Thermometer
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1860s-70s Karl Wunderlich (MD; German; 1815-1877) Thermometers of the past (back to mid-1700s) were not very reliable Realized in 1800s that signs go along with specific diseases so they needed objective characteristics (i.e. numbers) Wunderlich designed a clinical thermometer to be exact Professor at University of Lichesed in Germany Began to use as tool to collect more signs
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X-rays
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1895 by Wilhem Conrad Rontgen German physicist (NOT MD) discovered by accident Research in 1890s on different types of light rays Nov 1895 noticed ray was different than others - traveled in a straight line and penetrated opaque objects; saw inside wooden box with early x-ray By Dec 1895, published "On a New Kind of Ray" Showed an x-ray of an arm Public found super fascinating and used x-rays for everything Also public fear of immoral use of x-rays (i.e. x-ray specs to see through clothes)
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Improper use of x-rays
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Overexposure to patients to radiation Administration as therapy for infection Overexposure of medical personnel
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Specialization
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Rapid growth of medical knowledge brought about specialization from mid-1800s and on Many societies and orgs created to foster the specializing By early 1900s, at least 12 specializations From 1865 to 1930, percentage of American physicians who specialize increased from 2.5% to 75%
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Hospital modernization - Before late 1800s
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Prior to late 1800s.... They were crowded, dirty, understaffed For poor people (rich would have MD/surgeon come to them at home) Low patient attention, caretakers had very little training Prior to 1700s, hospitals run by religious organizations i.e. Catholic churchs During 1700s hospitals funded by private donations became more common
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Hospital modernization during 1800s
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During 1800s, tax supported hospitals began to open Cities grew so more hospitals became common - but care remained the same Private, religious or public monies E.g. Bellevue Hospital in New York - woman came in and gave birth to baby; by the next morning rats had eaten the baby
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Hospital modernization in later 1800s (improvements)
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1. Increased value attached to cleanlieness due to Sanitary Reform Movements (1840s-60s) and the Germ Theory (1880s-90s) 2. New Technology (x-rays, bacteriology labs) most economically site din hospitals
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Pre-1800 nurses
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Seen as Sairey Gamp, nurse in Dicken's "Martin Chuzzlewit" (1844) Fat, old, dirty, tobacco and alochol Depicted as unskilled labor, laziness, and took low-paying jobs because no other abilities Significantly changed by end of 19th century
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Florence Nightengale
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Helped establish new precedence for nursing in late 1800s English; 1820-1910 Born in Italy but moved with parents to England when young Wealthy, educated family - but wanted to be a nurse Went to Paris and had basic nursing training Came back to England when Crimean War began (1853-56) Heard stories of war and left England on personal mission to go to Crimea to provide nursing care for British Troops Referred to as "Lady with the Lamp" - changing to more regular patient care Returned back to England after war and became leader in the elevating of status of nursing Award from Queen Victoria and wrote many articles on nursing reform
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Nightengale School for Nurses
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1860 in St. Thomas Hospital, London Queen & British Govt gave her $225,000 as a gift/reward for her service so she created a nursing school Graduates signified professionalization Pioneers the R.N. (Registered Nurse) - needed an education to become one Beginnings of professional nursing education However, nurses still played subordinate roles (custodial roles too)
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"Notes on Nursing" (1859)
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Published book by Nightengale with her philosophies 1. Provide cleanliness [Sanitary Reorm Movement] 2. Support nature's efforts to heal [Paris School] 3. Provide nourishment, hydration, warmth, ventilation, comfort, and emotional support
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Medical education in US
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US trained physicians were not good Best ones came from England or Scotland because European Med Ed was more rigorous No medical schools until 1760s - probably no more than 300 MDs Most practitioners with training were surgeons and apothecaries Care also provided by midwives, ministers and folk healers
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Medical Education in second half o f1600s
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Young men trained for medicine through apprenticeship No science or theory 5-7 year apprenticeship; "slave in training" Only given certificate - but didn't necessarily need one to practice
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Early 1700s Medical Ed
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Young men start to go to Europe to study medicine By 1800, over 200 Americans who had trained in Europe for MD returned to US to practice University of Edinburgh was most popular i.e. Benjamin Rush
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Medical Department of the College of Philadelphia
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1765, First medical school in colonies Later becomes University of Pennsylvania in 1770s Founders were two Edinburgh graduates Raised and educated in America John Morgan (Graduated 1762) and William Shippen (Graduated 1761) Used to be good friends But after starting med dept both accused other over trying to rob him of glory of founding America's first medical school But school survived because of third professor, Benjamin Rush (Edinburgh) Craik & Dick went here
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Other pre-1800 medical schools
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1768: King's College (Columbia), New York, NY 1783: Harvard, Cambridge, MA 1798: Dartmouth, Hanover, NH Four medical schools total by 1800
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How Medical Schools Operated
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Quality of Medical Education declined in early 1800s 19th century med schools were proprietary i.e. owned by faculty Schools competed for students/customers because it was paid by student fees; so to make school attractive they eased up on fees and standards No national standards at all Students could practice medicine by showing certificate or diploma from one of the schools Pretty much anyone could get in to medical school in 1800s Most students were 17 or 18 years old
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19th Century medical school academics
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Two terms, each 14-16 weeks Second term identical to first; repeated because most weren't smart enough to get it the first time Thesis required based on library research (no clinical or laboratory aspect) - very poorly written, plagiarism Final Comprehensive examination - oral exam Cost student $5: if failed money back, if passed school kept - so proprietary schools pretty much let everyone pass Exam had around 9 faculty sit in chairs around table and student asked questions
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Medical education and anatomy
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European medical schools believed students needed to do anatomy and dissections Even at good colleges students had to provide their own corpse Too many students and no way of getting bodies legally Hence "resurrectionism"
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Resurrectionism
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Early 1700s (Before US had schools) No legal avenue to gain bodies for medical school use Students would steal bodies from graves, put in bags, and sell to medical school students Worked in groups of three (two to dig and one for getaway wagon) By 1752, Parliament made it legal for med schools to use bodies of executed criminals for dissection purposes Similar thing happened in America
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The Anatomy Riots
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Resurrectionism happened in 1780s-90s in America In NYC 1788, for three days several deaths occurred over near King's college 1785-1855 there were seventeen other riots over stealing bodies of loved ones Families began hiring guards and developing protection for caskets
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Burke and Hare
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In Edinburgh 1827-28 William Burke and William Hare ran a boarding house A boarder died in 1827 but still owed rent Took body to Edinburg and sold to Dr. Knox (for anatomy lab) A few weeks later another tenant had fever and waited for him to die Didn't die so they suffocated the person - became known as "Burking" Began burking other tenants and sold bodies to Dr. Knox By Oct 1828, 16 bodies were delivered to Dr. Knox from Burke and Hare On Halloween, friends came to visit a tenant and found the body. Called authorities and investigations began Hare cooperated but Burke did not Dr. Knox threatened and ostracized Burke went to trial and convicted for murder Hare imprisoned and Burke hanged - one of the larges public executions EVER (20,000) Burke also skinned and dissected "The Body Snatcher" 1884 was a story that came from it
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Warburton Anatomy Act
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1832 the Act passed in England Lord Warburton of English Parliament pushed through act that provided "unclaimed bodies" for medical schools (e.g. the poor, prisoners) Legal source that medical schools could use to get cadavers
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Anatomy Acts in America
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Began in mid 1800s 1831 - Massachusetts 1833 - Connecticut
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Women in Medicine prior to 1850s
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Seen as "too delicate" or "too sensitive" for medicine; particularly dissections Always participated in medicine as midwives Barred from medical profession until 1800s - even though they had critical roles
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Women in Medicine - pressure in 1830s and 40s
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1. Feminist Movement (strong in 1840s) Option for women to attend college, women began their own colleges (Seven Sisters) 2. Desire for female physicians - particularly with Ob/Gyn issues, plus male docs didn't give best attention/privacy issues
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Powerful opposition for Women in Medicine
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1. Medical study an affront to modesty (degrading to women) 2. Potential for romantic encounter with male patient 3. Women intellectually incapable of medical study 4. Women emotionally unstable 5. Women physically incapable of medical practice (i.e. "monthly weakness")
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Elizabeth Blackwell
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English; 1821-1920 Mid 1800s Quaker by religion; Family immigrated to US when teen Social family that lived in Cincinnati and New York In early 20s, became school teacher in Kentucky Friend became ill and wanted female doc but none were found so died Blackwell applied to medical schools beginning in 1846 Applied to Geneva Medical School, NY 1847 Treated as joke by Dean and then by students Asked for a vote to see if she could come; unanimous vote of admitting her Admitted at age 26 as an auditee in medical profession - behavior reported on regularly Graduated 1849 and first in class Couldn't find work in US - traveled to France for further study Wanted to be surgeon but lost an eye from infection 1855 returns to NY to open New York Infirmary for Women and Children 1860: Opened New York Women's Medical College 1869: Teamed with nightengale to open Women's Medical College in London Wrote book titled "Pioneer Work for Women"
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Emily Blackwell
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Admitted to Rush Medical College in Chicago After a few months, faculty expelled her because she was "disruptive"/there
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Women in Medicine shift
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Other women came into medicine very slowly; generally admitted to one of the few women medical schools *1860s on By 1900., 7% of physicians in US were women - but didn't change until 1960s Similar development with race in medicine
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Race in Medicine (1)
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1867: Rachel Coles, first black woman to get MD 1847: David Peck, first black man to get MD (admitted to medical school before Elizabeth Blackwell) (Rush Medical College 1846 admitted; degree in late 1847) 1850s Harvard admitted 5 black students - students protested and admission rescinded
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Race in medicine (2)
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1865: Slavery abolished by 13th Amendement 1868: 14th amendment allowed citizenship for former slaves 1868: First medical school opened for only Black students (Howard University - Medical Department) in DC 1896: Jim Crow segregation ruled constitutional Howard's faculty was white except Alexander Augusta
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Alexander Augusta
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American; 1825-1890 Received MD from small medical school in Canada Came to US at beginning of Civil War - signed on as Union Army Military doctor After war made a hospital director but too much protest So later hired at Howard to teach anatomy
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Meharry Medical School
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Second medical school for Black students founded in 1876 (after Howard)
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Race in Medicine (3)
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By 1900, few black MDs in US Maybe 380 at best estimate Only 7% were graduates of traditional white colleges Other 93% from Howard or Meharry AA had own hospitals and organizations 1895: National Medical Association started by Black Physicians
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Race in Medicine (4) 1900s
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Few black MDs admitted to AMA In 1950, if AA MD listed on AMA members, they were parentheses with "colored"
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Bill-Burton Act
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1946 Permitted use of federal funds to construct segregated hospitals
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Race in Medicine today
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As of 2006, AA US population is 12.3% Total black MDs and students was only about 2.2% of population SEVERE underrepresentation in all aspects of medicine
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American Medical Association (AMA)
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1847 AMA Founded to (1) improve medical education and (2) Decrease competition among physicians and raise their income Many schools refused to change their low standards
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AMA Committee on Education (1860s) recommended:
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1. Higher entrance requirements 2. Lengthening of terms to nine months 3. Increase in number of terms to four 4. Adoption of graded curriculum 5. Reform licensing laws to require final exam separate from school that attended
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Harvard adoption of AMA recommendation
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By 1870 Harvard had adopted all five recommendations. Ended up with the most stringent course of study in all of American and later became the leader in medicine for years.
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Association of American Medical Colleges (AAMC)
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1876: AAMC founded Urged all member schools to adopt the Harvard Plan Journal of American Medical Association (JAMA) started in 1883 [BMJ and Lancet are way older though]
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Academic leaders in medical education
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1600s - Padua 1700s - Edinburgh in Scotland 1800s - University o f Paris Late 1800s -Several German colleges i.e. University of Berlin
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German university model for medical education
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Many American students left for Germany for MD training German model becomes what higher education in America adopts E.g. Seminar system Many PhD degrees required students to learn German
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Johns Hopkins
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Wealthy Baltimore philanthropist Made millions on railroads and impressed with German model of education Took $7 million of own money and created: 1876: Johns Hopkins University in Baltimore 1889: Johns Hopkins University Hospital 1893: Johns Hopkins University Medical School Provided large endowment to start Had the same, if not higher, standards as Harvard Required undergraduate degree for medical school (unlike Harvard) Emphasized pre-med education; science Reading knowledge of French and German for admittance First class had 15 men and 3 women (daughters of trustees)
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Growth of AMA Membership
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1900 - 8400 members (8%) 1910 - 70,000 members (70%) Another committee started on education and grading of medical schools AMA Wanted to close certain schools for poor standards So decided to higher outside of organization
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Carnegie Foundation for the Advancement of Teaching
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Funded and founded by Andrew Carnegie in New York Studied teaching and education AMA made agreement with Carnegie foundation Carnegie looked for an individual to lead research - do an objective study of all medical schools in America and Canada Chose Abraham Flexner
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Abraham Flexner
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American NOT a physician Credentials in education and prominent educator from Lexington, KT Wrote books on American colleges - studied several other areas of education No stake in outcome - impartial observer 1909 Flexner began his travels to evaluate schools Visited 155 medical schools in US and Canada Jan 1909 to Apr 1910 Died in 1959 1950 AAMC created Abraham Flexner Award for Medical Education because he "revolutionized medical schools"
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The Flexner Report
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1910 Report published by Abraham Flexner after being contracted by AMA and Carnegie Institute All but Johns Hopkins were 'attacked'; called "utterly wretched... disgraceful..." Recommendations: 1. 120 should be closed down for being "worse than useless" (2 in PNW: UO & Wilamette) 2. Higher Entrance Requirements (i.e. undergraduate degrees) and adopt a rigorous scientific curriculum "biomedical model" 3. End proprietary system; state funding & philanthropic support 4. Licensing exams stricter Effects: - By 1920, 31 of 155 schools closed (today 134 in US & Canada) - Remaining schools now have 4 year curriculum with each year different - Different financial support via tax dollars and philanthropy - MD salaries increased signficiantly - Training people costs a ton of money $$$ (scientific medicine requires more equipment, labs, PhD to teach) Shut out poor, rural, minorities, and women - All schools for women and AA shut down except Meharry and Howard
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Scientific Medicine
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Began after Flexner (Early 1900s) A lot of change from Germ Theory to Flexner 1920s American Medicine became better as hospital developed Various progress and problems emerged
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Blood Transfusion
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Tried with Harvey Late 1600s between animals, humans & animals Several fatalities Blood types different in early 1900s and realized the matching was necessary
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Vitamins
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1912 1st vitamin discovered, Thiamine, Vitamin B (helps prevent beriberi - damage to nerves, enlarged heart, swelling) (came about after whole grains were a thing) Vitamin deficiencies initially believed to be from germs but once discovered vitamins there were other thoughts Scurvy treated with Vitamin C (ascorbic acid) Vital + amines = Vitamins 1917 Vitamin A fights blindness (rentinol) 1922 Vit D (calcitriol) fights rickets & osteoporosis 1937 Vitamin B3 (niacin) fight pelegra
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Endocrine System
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Before 1921 (insulin discovery) diabetics died often Treat tons with diabetes after 1920s because of understanding of Endocrine system
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Antibiotics
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Drug go against germs as antibiosis (coined by 1899 Pasteur student) Pasteur studies pencillium molds (decaying fruits/veggies) but never got far Doesn't appear until Alexander Fleming
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Sir Alexander Fleming
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Scottish; 1881-1955 Trained MD works at St. Mary's Hospital in London Scientific Research, bacteriologist Observed action of penicillium, 1928 Left for vacation and found some staff colonies died because of something in the air (found musty mold growing on fruits in lab) > Antibacterial substance Became known as "Penicillium mold" or "Mold juice" 1929 WRote for British Journal and believed mold juice could kill germs Couldn't produce enough of it or purify or find source Won Nobel Prize in Medicine
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Purification of Penicillin
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1940 at Oxford University 1941 First human test (also Oxford) Worked well but still couldn't make enough
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US Contribution to Penicillin
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1942 Large scale production of penicillin begins in Peoria, Illinois by USDA (Northern Regional Research Laboratory NRRL) Asked people to send in moldy plants and rotten things
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Mary Stevens
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Degree in bacteriology After hired by USDA, sent to look for moldy fruit/veggies (blue/green things) Brings a canteloupe and finds best strain from it Becomes known as "Moldy Mary" Produce thousands of doses from the single strain but still not enough
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WWII and Penicillin
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1942-44 WWII Penicillin earmarked for military Got donations to build more labs for military
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Penicillin and the Public
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Penicillin released for civilian use in 1945 Better production
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Impact of Penicillin
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on bacterial infection: 1. Quick cure for syphilis and gonorrhea 2. Pneumonia (20% then 5% mortality) 3. Meningitis (100% then 5%) 4. Bacterial endocarditis (100% then 5%)
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Selman Waksman
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American 1888-1973 PhD from Berkley in Biochemistry Worked at Rutgers, NJ lab Research on antibiotics Coins the term "Antibiotic" Discovered streptomyacin > cure for TB and bubonic plague Eventually made by Merck Later discovered 1949 neomycin - product to kill bacterial infection Neosporin derived from this 1952 got Nobel Prize for his work
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Organ Transplants & Artificial Organs
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1950s and 60s brought about some extraordiantry research in artificial organs I.e. first artificial heart
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Medical research rare in America before 20th century
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1893: Johns Hopkins first American med school that required research from faculty 1902: Rockefeller Insitute 1910: Rockefeller Hospital 1930: National Insitute of Health (NIH) 1946: NIH Grant Program 1946: Communicable Disease Center (1970: CDC) 1948: National Insitutes of Health 1953: NIH and clinical research 1988: National Center for Chronic Disease Prevention and Health Promotion
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Rockefeller
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1902: Rockefeller Institute Money came from philanthropy - John D Rockefeller made millions from standard oil company In 1901, grandchild died from infectious disease (scarlet fever) Took millions of personal money and opened the institute; first institution dedicated solely to "biomedical research" (trying to understand the underlying causes of disease) Also gave money to open school of medicine at University of Chicago The best served on the board i.e. Simon Flexner and Dr. William Welch 1910: Rockefeller Hospital Rockefeller institute had an electron microscope in 1940
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National Institute of Health (NIH)
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1930 Began in 1889 as part of US public health serve in Staten Island New York for the immigrants coming to US Became known as the "Hygienic Laboratory" Initially related to public health and later realized they needed to recruit individuals with the expertise in chem, pharmacology, and zoology Began hiring more PhDs than MDs Moved from Staten Island to Bethesda, MA in 1930s and changed name Federal money delegated by progress to support NIH 1948: Changed to National Institutes of Health By 1998, 27 institutes of original NIH
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Communicable Disease Center
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1946 part of US Public Health service Located in Atlanta, GA because malaria was a major issue when CDC formed A lot of it is connected with Emory University By 1950s major issue was STIDs 1960s - TB Now it is known as Centers for Disease Control (CDC)
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National Center for Chronic Disease Prevention and Health Promotion
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1988 CDC new name is now this By 1970s many communicable diseases had been eradicated because of vaccinations Focus shifted to chronic disease like alcohol, tobacco, drugs etc., physical activity and nutrition
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Iatrogenic Illness
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Illness resulting form medical treatment What medicine can do FOR us but also what it can do TO US Dr. Robert H. Moser (MD, San Antonio) FACP Wrote "Diseases of medical progress: A Study of iatrogenic disease" in 1959 (and later 1964 and 1969) Major 'illness' resulted from thalidomide Sleeping tablet in Europe, 1959 OBs gave to pregnant patients for nausea In 60s pediatricians began to notice major birth defects with mothers who used thalidomide Didn't happen as much in US because never licensed by FDA
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Premature Births
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Many babies were born prematurely meaning anything earlier than 37-42 weeks gestation Chances of survival were low back in the day But now its a lot better with NICU incubators However 24th week is about a 50/50 odd
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Adverse Drug Reactions
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Since 1960s, concern for ADRs Medicine causing death
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Medicine becoming more expensive
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Patient resentment over physicians income Patient anxiety over being able to afford needed care After Flexner, more med schools close, less MDs produced and greater patient base Rise of HMOs - manage health care prices
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Impersonal nature of physician-patient realtionship
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More attention to signs and less on symptoms (patient's feelings) Saw patients for short amount of time "The dying man cannot get comfort from the mechanical doctor"
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Wholistic medicine
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1970s backlash to impersonal-ness Treated patient as a whole person, not simply a disease Dropped "w" and wrote as Holistic 1978: American Holistic Medical Association Gentler, more natural therapies 1992: Office of Alternative Medicine
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Drugs available before Germ Theory
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Opium, Cinchona
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Opium
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Juice of seed pods of white poppy Ancient Egypt and Greece (Calomel was the only other drug used more) Prime ingredient = morphine Morphine discovered in 1806 Only relieved symptoms - no cure 1832 ingredient in morphine known as codeine - cough suppressant Laudanum = main pain medication of 1800s (opium in sherry) Often used in child care (give to crying babies)
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Cinchona
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Bark of Febrifuga tree "Fever tree" Contained quinine used to treat malaria Fever reduction, pain relief, anti-inflammatory "Jesuit's bark" or "the bark" Jesuit's brough cinchona bark from Peru Took powder, mixed in wine, drink teh liquid
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Two major stages of development in drug therapy (1800s)
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1. Purification of old drugs (from advancements in chemistry) 2. Synthesis of new drugs for the purpose of killing germs (1860s-70s) (post-Germ therapy)
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Purification of old drugs
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Early 1800s; purification of active ingredients in natural drug materials 1806 - Morphine from opium 1817 - Emetine from ipecac 1817 - Strychnine from St. Ignatius beans (stimulant, rat poison) 1819 - colchicine from autumn crocus (gout); used into early 20th century - pale yellow powder, unique to UK 1820: Quinine from cinchona - reduce fever, malaria; made into pills to ingest; very bitter 1821 - Caffeine from coffee; no medical application 1832 - Codeine from opium; supress coughing - furthe risolated from morphine
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Hypodermic syringe
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1850s - provides controlled dosages and went directly into blood stream; faster result
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Willow Bark
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NO CINCHONA Ancient Chinese and Egyptian healers used to lower fever, ease inflammation and reduce pain 1828 discovered active ingredient = Salicin
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Salicyclic Acid
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1873 Used against pain and fever Began to break down into carbolic acid in alkaline conditions (blood, pH=7.4) Believed it could provide internal antisepsis; more useful in anti-fever drug (didn't kill any germs) but sure relieved symptoms! Became popular anti-fever drug but had very painful/irritated stomach side effects
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Aspirin
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1899 In 1897, German man suffering from Rheumatism took SA to relieve symptoms Complained about stomach pains to son who was a well-known chemist at Bayer Begins to study salicylic acid and experiments with different structures and eventually makes aspirin (acetylsalicyclic acid) Marked by Bayer under the name "Aspirin" and becomes the first modern drug First drug to be discovered using a line of reasoning that took form in the late 1800s
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Chemical reasoning behind research...
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Start with a drug that has a positive effect but also likely has undesirable effects then: 1. Determine drugs chemical structure 2. Visualize/draw similar chemical structures 3. Synthesize the visualized, theoretical structures in the lab 4. Test synthesized compounds on lab animals for desirable properties, and minimal or no side effects
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Paul Ehrlich
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Early 1900s (German; 1854-1915) Traditional physicians training, MD Career spent mostly working as chemist and pharmacologist Professor at University of Berlin; a lot of research at Koch Institute "Dr. Ehrlich's Magic Bullets" Attempting to make a germ that would only harm bad cells "Magic bullets" - drugs that kill germs without injuring the body Also coined "chemotherapy"
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Magic bullets
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drugs that kill germs without injuring the body
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Ehrlich's approach
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Body makes it own magic bullets in the immune system (white cells and antibodies); could we make something like that? 1. Find a dye/stain that shows affinity for, and toxicity to, a germ 2. Determine its chemical structure 3. Synthesize many similar structures 4. Test each for: toxicity to germ and safety for patient
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Trypan red
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"African Trypanosomiasis" (sleeping sickness) Studied by Ehrlich Transmitted by titsee fly Came up with chemical that cured sleeping sickness - no one had ever come up with a drug/chemical to cure a disease But he was in Germany and this was a fairly exotic disease; so wasn't really appreciated as much as anticipated
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Syphilis germ
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1905 germ was discovered by another german Ehrlich set out to find a cure for syphylis Key ingredient in trypan red was arsenic so he experimented with hundreds of drugs using arsenic for syphilis
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#606 Salvarsan
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1909 first cure to syphilis that isn't harmful to patient Sent samples to labs all over the world (including Peterkin in Seattle) Wasn't a complete magic bullet because of inflammation at injection site, took several repeated injections over a year to cure syphilis Felt job was not done
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#914 Neosalvarsan
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1912 new cure for syphilis three years after initial one This IS the magic bullet Quicker to cure, less side effects and only cure until penicillin in 1940s
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Eli Lilly
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One of the biggest pharmaceutical companies in the world Before Ehlrich, pharma companies were pretty small - just chemists making compounds Once Ehrlich's methodology came out many pharma companies developed greatly All of them need large labs, expensive equipment, expensive labor, long time periods
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Drug manufacturing shift
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From small companies making compounds to big business and big investment into modern pharmaceutical industry
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Prontosil/Sulfanilamide
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German company came out with new product with the name Prontosil Claimed a new cure for several infectious diseases including strep, pneumonia, gonorrhea Sent samples out to other labs and hoped to demand positive results/demand (sales) One lab in Paris discovered the compound it was made of and made it themselves Lab was at Pasteur Institute
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Sulfa drugs
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Both French and Germans started with sulfanilamide and began to synthesize it More than 1000 different structures patented as drugs between 1935-1940 Used on Winston Churchill in 1942 when caught pneumonia in Middle East and hospitalized in Tunisia Treated with sulfapyridine (made in Britain's May and Baker)
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Defining characteristics of 20th century medicine
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Growth of Technology, Rise of Specialization, Emergence of hospital as center for delivery area
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Opthalmoscope
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Herman von Helmholtz; MD; German (1821-1894) Major works as doctor and in physics Professor at University of Berlin Developed it in 1850 Allowed to look into eye Helped understand visual perseption and color vision
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Larynoscope and various endoscopes
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1850s-60s Visualize pathology with new scopes
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Clinical Thermometer
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1860s-70s Karl Wunderlich (MD; German; 1815-1877) Thermometers of the past (back to mid-1700s) were not very reliable Realized in 1800s that signs go along with specific diseases so they needed objective characteristics (i.e. numbers) Wunderlich designed a clinical thermometer to be exact Professor at University of Lichesed in Germany Began to use as tool to collect more signs
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X-rays
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1895 by Wilhem Conrad Rontgen German physicist (NOT MD) discovered by accident Research in 1890s on different types of light rays Nov 1895 noticed ray was different than others - traveled in a straight line and penetrated opaque objects; saw inside wooden box with early x-ray By Dec 1895, published "On a New Kind of Ray" Showed an x-ray of an arm Public found super fascinating and used x-rays for everything Also public fear of immoral use of x-rays (i.e. x-ray specs to see through clothes)
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Improper use of x-rays
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Overexposure to patients to radiation Administration as therapy for infection Overexposure of medical personnel
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Specialization
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Rapid growth of medical knowledge brought about specialization from mid-1800s and on Many societies and orgs created to foster the specializing By early 1900s, at least 12 specializations From 1865 to 1930, percentage of American physicians who specialize increased from 2.5% to 75%
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Hospital modernization - Before late 1800s
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Prior to late 1800s.... They were crowded, dirty, understaffed For poor people (rich would have MD/surgeon come to them at home) Low patient attention, caretakers had very little training Prior to 1700s, hospitals run by religious organizations i.e. Catholic churchs During 1700s hospitals funded by private donations became more common
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Hospital modernization during 1800s
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During 1800s, tax supported hospitals began to open Cities grew so more hospitals became common - but care remained the same Private, religious or public monies E.g. Bellevue Hospital in New York - woman came in and gave birth to baby; by the next morning rats had eaten the baby
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Hospital modernization in later 1800s (improvements)
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1. Increased value attached to cleanlieness due to Sanitary Reform Movements (1840s-60s) and the Germ Theory (1880s-90s) 2. New Technology (x-rays, bacteriology labs) most economically site din hospitals
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Pre-1800 nurses
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Seen as Sairey Gamp, nurse in Dicken's "Martin Chuzzlewit" (1844) Fat, old, dirty, tobacco and alochol Depicted as unskilled labor, laziness, and took low-paying jobs because no other abilities Significantly changed by end of 19th century
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Florence Nightengale
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Helped establish new precedence for nursing in late 1800s English; 1820-1910 Born in Italy but moved with parents to England when young Wealthy, educated family - but wanted to be a nurse Went to Paris and had basic nursing training Came back to England when Crimean War began (1853-56) Heard stories of war and left England on personal mission to go to Crimea to provide nursing care for British Troops Referred to as "Lady with the Lamp" - changing to more regular patient care Returned back to England after war and became leader in the elevating of status of nursing Award from Queen Victoria and wrote many articles on nursing reform
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Nightengale School for Nurses
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1860 in St. Thomas Hospital, London Queen & British Govt gave her $225,000 as a gift/reward for her service so she created a nursing school Graduates signified professionalization Pioneers the R.N. (Registered Nurse) - needed an education to become one Beginnings of professional nursing education However, nurses still played subordinate roles (custodial roles too)
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"Notes on Nursing" (1859)
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Published book by Nightengale with her philosophies 1. Provide cleanliness [Sanitary Reorm Movement] 2. Support nature's efforts to heal [Paris School] 3. Provide nourishment, hydration, warmth, ventilation, comfort, and emotional support
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Medical education in US
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US trained physicians were not good Best ones came from England or Scotland because European Med Ed was more rigorous No medical schools until 1760s - probably no more than 300 MDs Most practitioners with training were surgeons and apothecaries Care also provided by midwives, ministers and folk healers
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Medical Education in second half o f1600s
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Young men trained for medicine through apprenticeship No science or theory 5-7 year apprenticeship; "slave in training" Only given certificate - but didn't necessarily need one to practice
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Early 1700s Medical Ed
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Young men start to go to Europe to study medicine By 1800, over 200 Americans who had trained in Europe for MD returned to US to practice University of Edinburgh was most popular i.e. Benjamin Rush
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Medical Department of the College of Philadelphia
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1765, First medical school in colonies Later becomes University of Pennsylvania in 1770s Founders were two Edinburgh graduates Raised and educated in America John Morgan (Graduated 1762) and William Shippen (Graduated 1761) Used to be good friends But after starting med dept both accused other over trying to rob him of glory of founding America's first medical school But school survived because of third professor, Benjamin Rush (Edinburgh) Craik & Dick went here
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Other pre-1800 medical schools
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1768: King's College (Columbia), New York, NY 1783: Harvard, Cambridge, MA 1798: Dartmouth, Hanover, NH Four medical schools total by 1800
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How Medical Schools Operated
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Quality of Medical Education declined in early 1800s 19th century med schools were proprietary i.e. owned by faculty Schools competed for students/customers because it was paid by student fees; so to make school attractive they eased up on fees and standards No national standards at all Students could practice medicine by showing certificate or diploma from one of the schools Pretty much anyone could get in to medical school in 1800s Most students were 17 or 18 years old
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19th Century medical school academics
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Two terms, each 14-16 weeks Second term identical to first; repeated because most weren't smart enough to get it the first time Thesis required based on library research (no clinical or laboratory aspect) - very poorly written, plagiarism Final Comprehensive examination - oral exam Cost student $5: if failed money back, if passed school kept - so proprietary schools pretty much let everyone pass Exam had around 9 faculty sit in chairs around table and student asked questions
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Medical education and anatomy
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European medical schools believed students needed to do anatomy and dissections Even at good colleges students had to provide their own corpse Too many students and no way of getting bodies legally Hence "resurrectionism"
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Resurrectionism
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Early 1700s (Before US had schools) No legal avenue to gain bodies for medical school use Students would steal bodies from graves, put in bags, and sell to medical school students Worked in groups of three (two to dig and one for getaway wagon) By 1752, Parliament made it legal for med schools to use bodies of executed criminals for dissection purposes Similar thing happened in America
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The Anatomy Riots
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Resurrectionism happened in 1780s-90s in America In NYC 1788, for three days several deaths occurred over near King's college 1785-1855 there were seventeen other riots over stealing bodies of loved ones Families began hiring guards and developing protection for caskets
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Burke and Hare
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In Edinburgh 1827-28 William Burke and William Hare ran a boarding house A boarder died in 1827 but still owed rent Took body to Edinburg and sold to Dr. Knox (for anatomy lab) A few weeks later another tenant had fever and waited for him to die Didn't die so they suffocated the person - became known as "Burking" Began burking other tenants and sold bodies to Dr. Knox By Oct 1828, 16 bodies were delivered to Dr. Knox from Burke and Hare On Halloween, friends came to visit a tenant and found the body. Called authorities and investigations began Hare cooperated but Burke did not Dr. Knox threatened and ostracized Burke went to trial and convicted for murder Hare imprisoned and Burke hanged - one of the larges public executions EVER (20,000) Burke also skinned and dissected "The Body Snatcher" 1884 was a story that came from it
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Warburton Anatomy Act
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1832 the Act passed in England Lord Warburton of English Parliament pushed through act that provided "unclaimed bodies" for medical schools (e.g. the poor, prisoners) Legal source that medical schools could use to get cadavers
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Anatomy Acts in America
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Began in mid 1800s 1831 - Massachusetts 1833 - Connecticut
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Women in Medicine prior to 1850s
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Seen as "too delicate" or "too sensitive" for medicine; particularly dissections Always participated in medicine as midwives Barred from medical profession until 1800s - even though they had critical roles
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Women in Medicine - pressure in 1830s and 40s
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1. Feminist Movement (strong in 1840s) Option for women to attend college, women began their own colleges (Seven Sisters) 2. Desire for female physicians - particularly with Ob/Gyn issues, plus male docs didn't give best attention/privacy issues
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Powerful opposition for Women in Medicine
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1. Medical study an affront to modesty (degrading to women) 2. Potential for romantic encounter with male patient 3. Women intellectually incapable of medical study 4. Women emotionally unstable 5. Women physically incapable of medical practice (i.e. "monthly weakness")
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Elizabeth Blackwell
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English; 1821-1920 Mid 1800s Quaker by religion; Family immigrated to US when teen Social family that lived in Cincinnati and New York In early 20s, became school teacher in Kentucky Friend became ill and wanted female doc but none were found so died Blackwell applied to medical schools beginning in 1846 Applied to Geneva Medical School, NY 1847 Treated as joke by Dean and then by students Asked for a vote to see if she could come; unanimous vote of admitting her Admitted at age 26 as an auditee in medical profession - behavior reported on regularly Graduated 1849 and first in class Couldn't find work in US - traveled to France for further study Wanted to be surgeon but lost an eye from infection 1855 returns to NY to open New York Infirmary for Women and Children 1860: Opened New York Women's Medical College 1869: Teamed with nightengale to open Women's Medical College in London Wrote book titled "Pioneer Work for Women"
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Emily Blackwell
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Admitted to Rush Medical College in Chicago After a few months, faculty expelled her because she was "disruptive"/there
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Women in Medicine shift
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Other women came into medicine very slowly; generally admitted to one of the few women medical schools *1860s on By 1900., 7% of physicians in US were women - but didn't change until 1960s Similar development with race in medicine
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Race in Medicine (1)
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1867: Rachel Coles, first black woman to get MD 1847: David Peck, first black man to get MD (admitted to medical school before Elizabeth Blackwell) (Rush Medical College 1846 admitted; degree in late 1847) 1850s Harvard admitted 5 black students - students protested and admission rescinded
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Race in medicine (2)
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1865: Slavery abolished by 13th Amendement 1868: 14th amendment allowed citizenship for former slaves 1868: First medical school opened for only Black students (Howard University - Medical Department) in DC 1896: Jim Crow segregation ruled constitutional Howard's faculty was white except Alexander Augusta
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Alexander Augusta
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American; 1825-1890 Received MD from small medical school in Canada Came to US at beginning of Civil War - signed on as Union Army Military doctor After war made a hospital director but too much protest So later hired at Howard to teach anatomy
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Meharry Medical School
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Second medical school for Black students founded in 1876 (after Howard)
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Race in Medicine (3)
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By 1900, few black MDs in US Maybe 380 at best estimate Only 7% were graduates of traditional white colleges Other 93% from Howard or Meharry AA had own hospitals and organizations 1895: National Medical Association started by Black Physicians
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Race in Medicine (4) 1900s
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Few black MDs admitted to AMA In 1950, if AA MD listed on AMA members, they were parentheses with "colored"
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Bill-Burton Act
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1946 Permitted use of federal funds to construct segregated hospitals
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Race in Medicine today
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As of 2006, AA US population is 12.3% Total black MDs and students was only about 2.2% of population SEVERE underrepresentation in all aspects of medicine
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American Medical Association (AMA)
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1847 AMA Founded to (1) improve medical education and (2) Decrease competition among physicians and raise their income Many schools refused to change their low standards
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AMA Committee on Education (1860s) recommended:
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1. Higher entrance requirements 2. Lengthening of terms to nine months 3. Increase in number of terms to four 4. Adoption of graded curriculum 5. Reform licensing laws to require final exam separate from school that attended
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Harvard adoption of AMA recommendation
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By 1870 Harvard had adopted all five recommendations. Ended up with the most stringent course of study in all of American and later became the leader in medicine for years.
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Association of American Medical Colleges (AAMC)
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1876: AAMC founded Urged all member schools to adopt the Harvard Plan Journal of American Medical Association (JAMA) started in 1883 [BMJ and Lancet are way older though]
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Academic leaders in medical education
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1600s - Padua 1700s - Edinburgh in Scotland 1800s - University o f Paris Late 1800s -Several German colleges i.e. University of Berlin
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German university model for medical education
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Many American students left for Germany for MD training German model becomes what higher education in America adopts E.g. Seminar system Many PhD degrees required students to learn German
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Johns Hopkins
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Wealthy Baltimore philanthropist Made millions on railroads and impressed with German model of education Took $7 million of own money and created: 1876: Johns Hopkins University in Baltimore 1889: Johns Hopkins University Hospital 1893: Johns Hopkins University Medical School Provided large endowment to start Had the same, if not higher, standards as Harvard Required undergraduate degree for medical school (unlike Harvard) Emphasized pre-med education; science Reading knowledge of French and German for admittance First class had 15 men and 3 women (daughters of trustees)
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Growth of AMA Membership
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1900 - 8400 members (8%) 1910 - 70,000 members (70%) Another committee started on education and grading of medical schools AMA Wanted to close certain schools for poor standards So decided to higher outside of organization
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Carnegie Foundation for the Advancement of Teaching
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Funded and founded by Andrew Carnegie in New York Studied teaching and education AMA made agreement with Carnegie foundation Carnegie looked for an individual to lead research - do an objective study of all medical schools in America and Canada Chose Abraham Flexner
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Abraham Flexner
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American NOT a physician Credentials in education and prominent educator from Lexington, KT Wrote books on American colleges - studied several other areas of education No stake in outcome - impartial observer 1909 Flexner began his travels to evaluate schools Visited 155 medical schools in US and Canada Jan 1909 to Apr 1910 Died in 1959 1950 AAMC created Abraham Flexner Award for Medical Education because he "revolutionized medical schools"
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The Flexner Report
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1910 Report published by Abraham Flexner after being contracted by AMA and Carnegie Institute All but Johns Hopkins were 'attacked'; called "utterly wretched... disgraceful..." Recommendations: 1. 120 should be closed down for being "worse than useless" (2 in PNW: UO & Wilamette) 2. Higher Entrance Requirements (i.e. undergraduate degrees) and adopt a rigorous scientific curriculum "biomedical model" 3. End proprietary system; state funding & philanthropic support 4. Licensing exams stricter Effects: - By 1920, 31 of 155 schools closed (today 134 in US & Canada) - Remaining schools now have 4 year curriculum with each year different - Different financial support via tax dollars and philanthropy - MD salaries increased signficiantly - Training people costs a ton of money $$$ (scientific medicine requires more equipment, labs, PhD to teach) Shut out poor, rural, minorities, and women - All schools for women and AA shut down except Meharry and Howard
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Scientific Medicine
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Began after Flexner (Early 1900s) A lot of change from Germ Theory to Flexner 1920s American Medicine became better as hospital developed Various progress and problems emerged
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Blood Transfusion
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Tried with Harvey Late 1600s between animals, humans & animals Several fatalities Blood types different in early 1900s and realized the matching was necessary
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Vitamins
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1912 1st vitamin discovered, Thiamine, Vitamin B (helps prevent beriberi - damage to nerves, enlarged heart, swelling) (came about after whole grains were a thing) Vitamin deficiencies initially believed to be from germs but once discovered vitamins there were other thoughts Scurvy treated with Vitamin C (ascorbic acid) Vital + amines = Vitamins 1917 Vitamin A fights blindness (rentinol) 1922 Vit D (calcitriol) fights rickets & osteoporosis 1937 Vitamin B3 (niacin) fight pelegra
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Endocrine System
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Before 1921 (insulin discovery) diabetics died often Treat tons with diabetes after 1920s because of understanding of Endocrine system
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Antibiotics
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Drug go against germs as antibiosis (coined by 1899 Pasteur student) Pasteur studies pencillium molds (decaying fruits/veggies) but never got far Doesn't appear until Alexander Fleming
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Sir Alexander Fleming
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Scottish; 1881-1955 Trained MD works at St. Mary's Hospital in London Scientific Research, bacteriologist Observed action of penicillium, 1928 Left for vacation and found some staff colonies died because of something in the air (found musty mold growing on fruits in lab) > Antibacterial substance Became known as "Penicillium mold" or "Mold juice" 1929 WRote for British Journal and believed mold juice could kill germs Couldn't produce enough of it or purify or find source Won Nobel Prize in Medicine
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Purification of Penicillin
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1940 at Oxford University 1941 First human test (also Oxford) Worked well but still couldn't make enough
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US Contribution to Penicillin
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1942 Large scale production of penicillin begins in Peoria, Illinois by USDA (Northern Regional Research Laboratory NRRL) Asked people to send in moldy plants and rotten things
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Mary Stevens
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Degree in bacteriology After hired by USDA, sent to look for moldy fruit/veggies (blue/green things) Brings a canteloupe and finds best strain from it Becomes known as "Moldy Mary" Produce thousands of doses from the single strain but still not enough
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WWII and Penicillin
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1942-44 WWII Penicillin earmarked for military Got donations to build more labs for military
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Penicillin and the Public
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Penicillin released for civilian use in 1945 Better production
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Impact of Penicillin
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on bacterial infection: 1. Quick cure for syphilis and gonorrhea 2. Pneumonia (20% then 5% mortality) 3. Meningitis (100% then 5%) 4. Bacterial endocarditis (100% then 5%)
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Selman Waksman
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American 1888-1973 PhD from Berkley in Biochemistry Worked at Rutgers, NJ lab Research on antibiotics Coins the term "Antibiotic" Discovered streptomyacin > cure for TB and bubonic plague Eventually made by Merck Later discovered 1949 neomycin - product to kill bacterial infection Neosporin derived from this 1952 got Nobel Prize for his work
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Organ Transplants & Artificial Organs
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1950s and 60s brought about some extraordiantry research in artificial organs I.e. first artificial heart
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Medical research rare in America before 20th century
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1893: Johns Hopkins first American med school that required research from faculty 1902: Rockefeller Insitute 1910: Rockefeller Hospital 1930: National Insitute of Health (NIH) 1946: NIH Grant Program 1946: Communicable Disease Center (1970: CDC) 1948: National Insitutes of Health 1953: NIH and clinical research 1988: National Center for Chronic Disease Prevention and Health Promotion
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Rockefeller
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1902: Rockefeller Institute Money came from philanthropy - John D Rockefeller made millions from standard oil company In 1901, grandchild died from infectious disease (scarlet fever) Took millions of personal money and opened the institute; first institution dedicated solely to "biomedical research" (trying to understand the underlying causes of disease) Also gave money to open school of medicine at University of Chicago The best served on the board i.e. Simon Flexner and Dr. William Welch 1910: Rockefeller Hospital Rockefeller institute had an electron microscope in 1940
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National Institute of Health (NIH)
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1930 Began in 1889 as part of US public health serve in Staten Island New York for the immigrants coming to US Became known as the "Hygienic Laboratory" Initially related to public health and later realized they needed to recruit individuals with the expertise in chem, pharmacology, and zoology Began hiring more PhDs than MDs Moved from Staten Island to Bethesda, MA in 1930s and changed name Federal money delegated by progress to support NIH 1948: Changed to National Institutes of Health By 1998, 27 institutes of original NIH
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Communicable Disease Center
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1946 part of US Public Health service Located in Atlanta, GA because malaria was a major issue when CDC formed A lot of it is connected with Emory University By 1950s major issue was STIDs 1960s - TB Now it is known as Centers for Disease Control (CDC)
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National Center for Chronic Disease Prevention and Health Promotion
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1988 CDC new name is now this By 1970s many communicable diseases had been eradicated because of vaccinations Focus shifted to chronic disease like alcohol, tobacco, drugs etc., physical activity and nutrition
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Iatrogenic Illness
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Illness resulting form medical treatment What medicine can do FOR us but also what it can do TO US Dr. Robert H. Moser (MD, San Antonio) FACP Wrote "Diseases of medical progress: A Study of iatrogenic disease" in 1959 (and later 1964 and 1969) Major 'illness' resulted from thalidomide Sleeping tablet in Europe, 1959 OBs gave to pregnant patients for nausea In 60s pediatricians began to notice major birth defects with mothers who used thalidomide Didn't happen as much in US because never licensed by FDA
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Premature Births
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Many babies were born prematurely meaning anything earlier than 37-42 weeks gestation Chances of survival were low back in the day But now its a lot better with NICU incubators However 24th week is about a 50/50 odd
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Adverse Drug Reactions
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Since 1960s, concern for ADRs Medicine causing death
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Medicine becoming more expensive
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Patient resentment over physicians income Patient anxiety over being able to afford needed care After Flexner, more med schools close, less MDs produced and greater patient base Rise of HMOs - manage health care prices
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Impersonal nature of physician-patient realtionship
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More attention to signs and less on symptoms (patient's feelings) Saw patients for short amount of time "The dying man cannot get comfort from the mechanical doctor"
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Wholistic medicine
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1970s backlash to impersonal-ness Treated patient as a whole person, not simply a disease Dropped "w" and wrote as Holistic 1978: American Holistic Medical Association Gentler, more natural therapies 1992: Office of Alternative Medicine