Timeline

In 1872 skulls discovered in Neolithic gravesite in central France with 40 of 120 showing roundish holes 2-3 inches wide. The skull holes, studied by Paul Broca in Paris, were of both genders and all ages, and virtually none were accidental, pathological, traumatic, thus providing evidence of Neolithic practice of trephining skull down to layer of tissue encasing brain and spinal cord (dura mater). Among this and other samples, the usual estimates for survival of different samples of trephined skulls range from 50 percent to 90 percent with most estimates on the higher side (Gross, ch 1). In early modern Europe, surgeons used the operation primarily in cases of skull fracture (Evans & Read, 37).

First identification of gout (podagra, i.e., acute gout occurring in first metatarsophalangeal joint) by Egyptians. In fifth century B.C., Hippocrates referred to it as the “unwalkable disease” and linked it to an intemperate lifestyle (Nuki & Simkin). Dominican monk Randolphus of Bocking, domestic chaplain to the Bishop of Chichester (loc 1197–1258), was first to use the word “gout” to describe podagra. It derived from Latin word gutta (drop), which referred to the belief that an excess of one of the four humors had dropped or flowed into a joint (Coperman).

Creation of Code of Hammurabi, a Babylonian (Iraq) legal text that stipulates re surgery, surgeon is paid only if treatment is successful. If something goes wrong, surgeon called to account. If a bone is broken during surgery, then one of his own bones should be broken (article 197). If a patient is a nobleman (awelum) who dies at the hands of a surgeon, the surgeon’s own hands are to be cut off (article 218) (Van de Laar, ch 7).

Edwin Smith Papyrus, ancient Egyptian scroll on practical management of traumatic wounds. Document acquired by American Egyptologist Edwin Smith in 1862, but only published in translation by historian J. Ames Breasted in 1930 and reissued in a new translation, with commentaries, in 2012 (W. Moore; Vargas; Sanchez I & Meltzer). In the Papyrus, the swnw (physician) at bedside placed his hand right into the patient’s open wound, “conveying in this ritualized act control, reassurance, and healing” (Stepansky II, 196).

Ebers Papyrus, which contains over 700 drug formulas and folk remedies.

Ancient Egyptian papyrus in texts in the Papyrus Carlsberg Collection at University of Copenhagen documents earliest known pregnancy test: woman urinates into bags of barley and wheat. If seeds grow in either bag, woman is pregnant. If barley seeds grow more, infant will be male; if wheat, female. NIH study in 1963 showed that test was 70% accurate for determining pregnancy, though not gender (P. Ghalioungui, et al.)

oldest version of the myth of the physician man-god Asklepios related by Homer and set down in writing by Hesiod a century later. It speaks of “the blameless physician, a “gentile craftsman” and “soother of cruel pains,” who “ministers to the common people, criminals and outcasts among them, regardless of the consequences” (Bailey).

Eruption of Athenian plague during second year of Peloponnesian War, when Athens was under siege by Sparta, and Athenians seeking protection from Spartan invaders crowded inside the city walls. From Thucydides’ description of the epidemic in his history of the war, we understand it as “a virgin soil epidemic with a high attack rate and an unvarying course in persons of different ages, sexes, and nationalities” (R. J. Littman). But the plethora of symptoms recorded by Thucydides – sudden onset of headache and inflammation of eyes and throat, followed by sneezing, hoarseness, and violent coughing; then vomiting, fever, restlessness, sleeplessness, and emergence of genderized blistering rash; and final stage of diarrhea, sometimes accompanied by blindness and necrosis – do not map onto a single modern diagnosis. The weight of evidence, however, tends toward a diagnosis of epidemic typhus or smallpox, with smallpox the more likely possibility (Bock). If not malignant, confluent smallpox, the cause of the epidemic may well have been “an organism now extinct, or at least one that has evolved over two millennia in ways that make it no longer deadly” (Hanson, 72).

Leprosy (Elephant’s Disease; Elephantiasis) reaches Egypt by the time of the Ptolemaic Kings (after 305BCE), and Greek physicians in Alexandria began seeing cases of it in early decades of 3rd century. Then, four skeletons discovered in Dakhleh Oasis (of Egypt’s western desert) showed effects of leprosy: “These skeletons belonged to Europeans, either Greeks or Macedonians, not to native Egyptians, and they were dated to the second century BC. The results of this bioarchaeological research prove that Mycobacterium leprae arrived in the Mediterranean basin sometime after Alexander’s Eastern conquest” (Miller & Nesbitt,10-11).

Greek philosopher and physician Diocles, possibly a student of Aristotle, writes first (lost) book about anatomy, based on animal dissection. He was the first to write medical treatises in Attic rather than Ionic Greek (Banerjee).

Greek physician and anatomist Herophilus and his student Erasistratus, living and working in Alexandria, perform first dissections of human cadavers over a 30-40- year period, after which human cadaver dissections were not legally performed for 1600 years (Bay & Bay; Wiltse & Pait).

Birth of Aulus Cornelius Celsus in Galia Narbonensis, a Roman province in southern France. First of encyclopedists and first major author writing in Latin. De Medicina is oldest recognized medical treatise after the Corpus Hippocraticum. Argued that surgery was an integral part of medicine, listing all known surgical conditions and operative techniques specific to each body region (Rutkow, ch 3).

Greek physician Dioscorides writes his five-volume pharmacopeia, De Materia Medica, that will be translated into Latin and Arabic over the next 15 centuries. It is “the prime historical source of information about the medicines used by the Greeks, Romans, and other cultures of antiquity. . . . It formed the core of the European pharmacopeia through the 19th century” (Upson-Saia, loc 968ff.; NYU Dentistry Rare Books).

Birth of Soranus of Ephesus (Asia Minor). His Greek Gynecology “represents ancient gynecological and obstetrical practice at its height. Through the work of translators, abbreviators, and compilers, much of Soranus’ views and practices survived through the middle ages into the sixteenth century” (Temkin,xxv). The work comprises four books, the first on midwives, menstruation, conception, abortives, and contraceptives; the second on parturition and care of newborns; the third on various gynecological afflictions and their treatment; and the fourth Materia Medica and an index of names and subjects. His work on the skills of midwives is especially noteworthy and gained expression in medieval midwifery through the work and writings (possibility via an amanuensis) of Trotta of Salerno (Dunn; Karamanou, et al.) The most influential of the Latin translations of Gynecology was that of Muscio, who abbreviated and simplified Soranus text to make it even more accessible to midwives (Karamanou, et al.; M. H. Green, loc 592ff.) As a member of the methodist sect (i.e., school of medicine), Soranus replaced Galenic humors with categories of flux (status laxus) calling for a styptic treatment; constriction/tension/tightness (status strictus) calling for a relaxing therapy; and a mix of the two. These categories gained expression in the symptoms of different classes of diseases. E.g., hysterical suffocation with convulsions exemplified status strictus calling for relaxing treatment. “It is largely from the treatment of diseases as recommended by Soranus that the underlying nosologic notion becomes evident” (Temkin, xxxi). The connection between pathology and treatment gains expression in Soranus’ attention to the whole course of a disease, and its differentiation into stages (xxxiv).

Birth of Galen in Pergamum. His “skills with fractures and dislocation, head injuries, lacerations, and draining blood and other fluids from wounds of the chest and abdomen served him well; he was shortly appointed surgeon to the city’s stable of gladiators.” But he insisted on applying animal findings to humans and, contra Celsus, held the ancient Greek belief that surgery was separate from, and a lesser mode of treatment than, medicine. In early 160ADs he moved to Rome, where he became a favorite of the elite. His works form almost half of all extant ancient Greco-Roman medical writings and, excepting the Corpus Hipplcraticum and De Medicina, almost 85% (Rutkow, ch 3 ). Galen’s understanding of gout represented his sole departure from his theory of humoral balance as cause of disease. With gout, it was a matter of unnatural accumulation of humors (usually phlegm) in the affected part (e.g., the big toe) (Coperman, loc 553). Areteus departed from Galen in suggesting the cause of gout might be not an excess of a regular humor at the site of inflammation, but a specific “pecant” [toxic] humor in the blood. Only in the mid-19th century did Garrod discover that the pecant substance was uric acid (loc 574-577).

Roman emperor Hadrian (117CE-138CE) issues decree banning circumcision, to that point entailing only cutting off the part of foreskin that could be pulled past the glans (i.e., mashuk method). Partly in response to Hadrian’s decree, Simon bar Kochba led third Jewish rebellion against Roman occupiers, and by way of provocation, adopted the periah method, fully exposing the glans, which entailed removing the rest of the foreskin by cutting around the base of the glans (= origin of word circumcise, meaning “to cut around”) (Van der Laar, ch. 3).

Antonine Plague, brought to the Roman Empire by Emperor Lucius Verrus’ army returning from the Eastern border, where soldiers contracted it during the siege of Mesopotamian city of Seleucia in the winter of 165-166. The plague of smallpox and possibly measles decimated the Empire, killing between 7-10% of the Empire’s 75 million people; in the army and densely populated cities, death rate may have reached 13-15%. The plague is also known as “Galen’s Plague,” as Galen, who was present in Rome when the plague arrived and also during an outbreak among troops stationed at Aquilea in the winter of 168/9, described it briefly in the treatise Methodus Medendi ("Method of Treatment") and elsewhere. It is Galen’s description of signs and symptoms that makes the case for smallpox very strong, with a high incidence of hemorrhagic smallpox during the outbreak (Yeomans; R.J. Littman & M.L. Littman; Hayes, ch 3).

Second epidemic wave of smallpox in Roman Empire, with up to 2,000 deaths a day in Rome alone (Yeomans).

Razi, author of comprehensive 22-volume book of medicine (Liber Continens), provides, inter alia, first accurate description of smallpox and suggests using control groups for more precise clinical assessment, e.g., of bloodletting (Azizi; Al-Razi).

Justinianic [Bubonic] Plague: “First Plague Pandemic” reported in Constantinople, with death rate of 60-80%; Justinian himself contracted it but survived. It would reappear in waves for 200 years, reaching as far north as Germany and Britain.

In seventh-century Alexandria, Paul of Aegina strongly supported the view that leprosy was among the most contagious diseases. “After Paul, however, no subsequent Byzantine physician described leprosy as contagious. . . This may have been because “Byzantine physicians had come to see such a view concerning the propagation of leprosy and perhaps other diseases as immoral and unethical” (T. Miller & Nesbitt, 56-7).

Birth of Avicenna near Bukhara in what is now northern Afghanistan. After reading Plato, Aristotle, and Ptolemy, he took up medicine at age 13, began treating patients at 16, and was summoned to help treat emir of Bukhara, whom he cured after his own physicians had given up hope of recovery (Abu-Asab, et al., Intro).

Muslim-Persian physician Avicenna complete Canon Medicinae (The Canon of Medicine) in five volumes. It was translated into Latin in Toledo in 12th entury and was standard text for teaching medicine in European universities through the 18th century (Siraisi, 19-40). Although Galen is cited respectfully and appreciatively ca. 300 times in the Canon, he challenges Galen’s philsophy of medicine and rejects his view regarding the physiology of pain and of the pulse, the same nature of tendons and nerves, and the separation of mind and body. Avicenna, through critical thinking, observation, and testing, revised and systematized medical thinking, which is why Europeans considered him as the most prominent physician of the Islamic Golden Age (Sadeghi, et al.).

Demise of monastic-based medicine at Council of Clermont: Monks no longer permitted to practice general medicine or civil law. At Council of Tours in 1133: Ecclesia abhorret a sanguine (“the Church abhors the shedding of blood”) Then in 1215, Pope Innocent III proclaims: “No cleric is to be put in command of cavalry, archers, or others of the same kind who shed blood, nor are subdeacons, deacons, or priests to exercise that part of surgery involving catheterization and incision” (Rutkow, ch 3).

Revival of Greco-Roman medicine begins in Salerno, when Roger II of Sicily decrees that all practitioners of medicine and surgery in his realm must pass battery of tests administered by secular physicians. Then, decades later, Frederick II of Hohenstaufen grants Salerno’s faculty sole authority to approve all physicians and surgeons in the kingdom. Publication of Practica Chirurgie by Rogerius (Roggerio dei Frugal, aka Roger of Salerno) ca. 1180 “was the era’s preeminent manuscript and earliest original surgical work in the West” (Rutkow, 43). Frederick-type ordinances for lay control spread to Spain in 1283 and then to Germany. By beginning of 14th century, Paris replaced Salerno as gathering place for surgical talent, though the surgical practice was divided between rivalrous groups of illiterate barber-surgeons and small faction of educated surgeons.

The Trotula, “the three most important specialized texts on women’s medicine in medieval western Europe” (M. Green, 14): Publication as a single volume of three separate works on gynecology, obstetrcis, and cosmetics. The volume, titled The Trotula, the book comprise: 1. On the Conditions of Women; 2. On Treatments for Women; and 3. On Women’s Cosmetics. Each work had at least one author, and only book 2 incorporated the contributions of Trotula (i.e., Trotta, a female practitioner in Salerno, an empiric who may not have been literate, who treated the women of Salerna. It is clear that, whether or not she wrote the text, it embodied the manner in which women practitioners – who, unlike males, could touch the female genitalia – treated women in the 12th c. Salerno. Book 3 On Cosmetics may have been authored by a man who observed the appearance of Muslim women, probably in Sicily. During the 17th century, the three texts were edited for publication as a single highly condensed volume. The Renaissance edition was the basis for modern translations, which passed on “the historical distortions of the Renaissance edition, a work which is in fundamental respects a humanist fabrication” (M. Green, Intro).

Birth of Italian Mondlino dei Luzzi, who reintroduced dissection into medical education at Univ. of Bologna and composed the Anathomia, one of first texts in Western medicine focused on anatomy (B. Moran, 21).

Responding to rivalrous discord between uneducated barber and educated surgeons, Phillip IV decrees that only those who undertake examination from a royally authorized source can practice surgery in Paris. In 1372, the barber surgeons counter with their own charter from Charles V, who grants recognition to the Guild of Barber-Surgeons (Rutkow, 47).

Leper Massacre in southern France, spurred by specious claim of leper plot to poison the wells throughout France (T. Miller & Nesbitt, 96-97, 106ff.). The massacre followed from the greater fear of leprosy in Western Europe than in the Byzantine East. Whereas Byzantine physicians “repressed any suggestions that leprosy was contagious,” this was not true in some regions of Western Europe, where “social attitudes, reflected in legal codes [rooted in Germany customary law, not Roman law] and customary practices, played perhaps the central role in placing victims of Elephant Disease ‘outside the camp’.” Byzantine law “did not allow for any expulsion or quarantine of lepers by the state” (117).

Mineral springs discovered in Spa, a village in Belgium.

the Black Death, likely a combination of bubonic and hemorrhagic plague. It arrived in Messina, Italy in October 1347 via a docking vessel that probably originated off the Crimean Peninsula. The ship was laden with infected rats, themselves laden with infected fleas.

Guy de Chauliac authors first textbook that labels leprosy “contagious and infectious” and includes [corrupt] air and contact, jointly, among its primary causes. It is striking, given the Black Death (1347-1350) that Guy was silent on the need for sequestration of lepers, “while officials who recorded medical interventions,” along with authors of vernacular medicine, “began to link this need with contagiousness before 1347. This linkage apparently emerged in the closing decades of the thirteenth century” (Demaitre, loc 992-94). Official procedures and some vernacular treatises convey “overall impression that they firmly linked infection and sequestration decades before academic authors propounded the connection” (loc 1003-4). From around 1400, the tightening of social structures (via temporal lords) emphasizing “conveyance by air rather than touch” (loc 967-96 8). Sixteenth-century authors “moved farther away from the teachings of Avicenna and Galen . . . by integrating communicability ever more fully into the essence of leprosy” (loc 974). For Paré, “the sweat and vapors that issue from their [lepers’] bodies are poisonous. And so is their breath, and drinking from the cups and other vessels from which they have drunk” (loc 979).

Birth of physician and alchemist Paracelsus in Swiss village of Einsiedeln, who launched a one-man campaign against Galen and ancient Greek view of human anatomy based on Galen’s dissections of animals; refused to lecture in Latin, only in colloquial German (Rutkow, 55-56). One of the treatises he planned to publish near end of his life, Septem defensiones (Seven Defenses), his defense of his ideas against his detractors, was published only in 1955 when Carinthia published the books as Die Karntner Schriften (The Carthusian Writings). In it he argued that ancient Greek medicine was fine for ancient ailments, but not those of the present (B. Moran, 13, 28).

Possibly first written account of cesarean section in which both mother and infant survived. It was performed in Switzerland by Jacob Nufer, a sow gelder, on his wife, who after several days of labor and the assistance of 13 midwives, could not deliver vaginally. The mother subsequently gave birth normally to five children, including twins, whereas the cesarean baby lived to 77. The account is open to question since it was only recorded 82 years later (Sewell).

Founding of Royal College of Physicians of London in the reign of Henry VIII, as petitioned throughout the 1510s by Thomas Linacre (Chauvois, 95) – the first significant professional organization of physicians (Brint, 27). In 1523 it extended its power from London to all of England (Skuse, 66-67).

First recorded small pox epidemic in Hispaniola, spreading to Mexico in 1520 and aiding Cortez in conquering Mexico from the Aztecs.

Outbreak of Dancing Plague in Strasburg in July; by August it led to over 400 deaths. Possible causes: mass stress-related hysteria, ingestion of ergot. Doctors of the time attributed it to hot blood.

After a two-term stint at Univ. Basel (1527-28) , where Paracelsus was ostracized by faculty and denied a lecture hall, he went to Nuremberg, a German publishing center, but publishers wouldn’t touch his Seven Defenses or other works: “Rather than defining disease as a general imbalance of humours, it described each illness as a distinct entity, related to a specific part of the body” . . . this new medicine required knowing how the body worked not just on the basis of anatomy, but on another foundation – namely, chemistry.” Paracelsus sought to replace traditional medicine with the “light of nature” that resulted from close examination of natural things (28-29).

First appearance of term “syphilis,” often confused with leprosy. Both were viewed as a weaving together of sin and contagion (B. Moran, 36).

After a battle, Paré ran out of oil [for cauterizing wounds,] “and so concocted instead an ointment from egg yolk, oil of roses, and turpentine, which he administered cold. The following day, the patients who had received this soothing balm were in far better shape than those cauterized with oil.” Paré also used ligatures to improve patients’ chances of surviving amputation (Ball, 73; cf. Rutkow, who clarifies that the cauterizing was done “with red-hot irons, then flood the area with a gummous-like mixture of boiling oil and herbs. . . cauldrons of scalding-hot oil of elders mixed with treacle, a molasses-like liquid, were always at the ready” [69]).

Publication of Vesalius’s six anatomical teaching illustrations based on dissections via grave-robbing, visits to charnel houses, etc.

Britain’s Henry VIII grants the livery for a Company of Barber Surgeons, under the rules of which no barber could perform surgery and no surgeon could shave or cut hair, though both groups could still pull teeth (Skuse, 111).

Publication of Vesalius’s De Humani Corporis Fabrica Libri Septem (On the Fabric of the Human Body), which “helped overthrow the stifling dogma of Galenism by promoting the accurate study of the human body. First time accurate anatomical drawings integrated with written text (Rutkow, 57, 61). The folio was printed in Basel by Johannes Oporinus in Latin, Greek, and Hebrew, and included fold-out pages for large illustrations. The novelty and impact of the book “were due mainly to Vesalius’s recognition that proper instruction in anatomy demanded good diagrams. . . those in Vesalius’s [presumably by members of Titian’s school] book reflected the spirit of the Renaissance artist with their dramatic realism. . . . It was one thing to say Galen was (sometimes) wrong, but illustrations of that fact as finely observed as those in De Fabrica seemed to present an unanswerable case” (Ball, 67-69). Fabrica “was the definitive break from old models of anatomy by Galen, and the gold standard for a new kind of anatomical study based on observing the body as it really was, not as ancient scholars supposed it to be”(Skuse, 22). Copernicus’ De revolutionibus orbitum celestum libri VI also published in 1543.

Publication of Paré’s first major book, The Method of Treating Wounds Made by Arquebuses and Other Firearms, used to bolster his standing with French aristocracy; 2nd ed. to Henry II (Rutkow, 71).

Skin grafts for missing or diseased noses, rediscovery in 16th c. Renaissance Italy: “We have records of two families practicing their own special techniques in Renaissance Italy. The Branca family were from Calania in Sicily and are remembered as the surgeons who ‘rediscovered’ the skin graft operation and later improved it by taking skin from the forearm rather than the forehead.” The second family, the Vianeo family from Tropea also developed a technique for taking the skin from a person’s forearm and transplant it onto their face (Craddock, 14). Skin grafts were introduced to Italian universities beginning in 1560s, when Leonardo Fioravanti, posing as a surgeon, had observed the Vaneo brothers perform rhinoplasty, introduced the brothers’ secret method to Bolognese professor of surgery Giulio Cesare Aranzio (d.1589), who began sculpting noses in Bologna. Aranzio, in turn, passed the technique on to Gaspare Tagliacozzi, who codified it in 1597 in De Curtorum Chirugia per Insitionem (On the Surgical Restoration of Defects [or: Mutilation] by Grafting) (Craddock, 40-41).

Following Greeks’ and Romans’ use of ligature to tie off smaller blood vessels, Paré, during Italian Wars, used forceps-like instrument of his own design (bec de corbin [crow’s beak]), grasped, separated, and ligated large blood vessels from stump of amputated limb (Rutkow, 72-73).

Servetus propounds new thesis of unperforated cardiac septum and transpulmonary passage of blood, which is contrary to Galen’s notion that the blood rises to the lungs only to ‘nourish’ them and that it lies there stagnant, becomes exhausted, and does not pass right through the lungs (Chauvois, 74).

Publication of Oxford physician Thomas Willis’ second ground-breaking book on the brain, Pathological Cerebri, where he rejected supernatural explanation of epilepsy which, he claimed, following Hippocrates, simply resulted from difficulty understanding the disease s (Evans & Read, 41).

Italian anatomist Realdo Columbo (of Padua) adopts Servetus’s hypothesis in his De Re Anatomica, a text that made a great impression on young William Harvey (Chauvois, 73).

Paré, travelling in northern France, has brush with death when his horse kicked him hard enough to shatter both bones of his lower left leg. Following recovery, he became more preoccupied with gangrene, amputation, disability, and prostheses, of which he produced detailed illustrations of prosthetic arms, legs, and hands (Skuse, 124-126).

Geronimo Mercuriale formulated concept of syncope and demonstrates its connection with slow pulse rate (Aquilina).

Publication of Phillip Barrough’s Method of Physick, among the first “medical textbooks as marketing strategy” aimed at lay folks without means to be attended by a physician in person, but still seeking to benefit from medical expertise. It was also among first medical texts written in English, not Latin (Skuse, 76).

Gaspare Tagliacozzi (Bologna) publishes De Curtorum Chirugia per Insitionem [On the Surgical Restoration of Defects by Grafting], first book on reconstructive surgery, including description of use of pedicle grafts to repair amputated noses, along with repair of mutilated lips and ears. Like Fioravanti, he compared surgery, especially skin grafts, to the cultivation of trees (Graddock, 40-41). But rhinoplasty faded after his death in 1599 (Grogono,186); Harold Gillies was not familiar with his work. In anticipation of criticism that surgical grafting involved playing God, Tagliacozzi spent first 10 chapters of the book extolling the dignity of the face, and the importance of the lips, ears, and nose in the composition of the face. Skin grafting thereby became a restorative operation. Helping people reclaim their natural proportions (Craddock, 46-47).

William Harvey restarted an arrested pigeon's heart by a simple flick of the finger (Aquilina).  He arrives at University of Padua, from which he receives his doctorate in 1602 and returns to Cambridge, where he receives his license and becomes a candidate at the College of Physicians in 1602 and a Fellow in 1607 (Chauvois, 92ff.). He receives appointment as physician to St. Bartholomew’s Hospital in 1609 (96).

William Harvey receives medical degree from University of Padua and returns to London.

Santorio Santorio attempts first measurement of human temperature with a thermoscope with a calibrated tube. “At the end of the sealed tube, he had a bulb blown of the optimal size to be inserted in the mouth. The open end was submersed in fluid. As the air expanded due to the oral temperature, fluid was expelled from the tube. After a fixed period of time, the bulb was removed, the air cooled, causing the fluid to rise in the calibrated tube” (Grodzinsky & Sund Levander).

Harvey appointed Lumleian Lecturer of London College of Physicians (Chauvois, 96, 98), a position established in 1581 and held for life (100-102). His notes for the visceral lectures of April 1616 record his discovery of blood circulation (106). Cf. Craddock : “He [Harvey] lectured about and demonstrated, the circulation of the blood from about 1615, and in 1624 published his discovery in Latin. Then in 1628 it came out in English. When Harvey likened the heart and circulatory system to a pump and the vena cava to ‘the cellar and cistern of the blood,’ he dragged the body out of an agricultural frame and into a mechanical one (Craddock, 53).

Death of Shakespeare; Harvey appointed Physician Extraordinary to King James I (Chauvois, 113, 115-16). Charles I appointed him Physician Ordinary by 1632 (Craddock, 58).

Army surgeon Gaspare Aselli, then in Milan, while dissecting a dog recently fed and killed, discovered lacteals, i.e., abdominal vessels covering the mesentery and intestines and which, on puncture, containing a milky white substance. Repeated animal experiments showed the vessels only appeared after recent feeding, and Aselli concluded “that the vessels were indeed lacteals, vessels that carry digested food (chyle) from the intestines.” His discovery was set forth in De lactibus, published posthumously in 1627. In 1628, Fabrice de Peiresc confirmed observation of lacteals on dissection of a criminal fed two hours before his execution. It fell to French physician Jean Pecquet in 1651 to “accurately describe the cisterna chili (also called the receptacle of Pecquet) and the thoracic duct along with its valves, where the lymphatic system terminates into the left subclavian vein.” Aselli’s discovery was opposed by William Harvey, who maintained on the basis of erroneous Galenic assumptions that mesenteric veins transport chyle to the liver.  (Park &I Riva; Suy et al., I, 165-66; Suy et al., II, 325-27; Natale, et al., 421-22). Indeed, “The anatomy and the physiology of the digestive system according to Galen were indeed supposed to be the only real truth in the first half of the seventeenth century (Suy et al., II, 330)

Publication in Frankfurt of Harvey’s Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (typically, De Motu Cordis), the first accurate description of the human circulatory system as a “circle” (Chauvois, 111; Rutkow, 83-85). Only 72pp. long, it made bloodletting “even more popular” (Rutkow, 86).

English Civil War, with King Charles I settled in Christ Church College in Oxford, accompanied by the Royal Physician William Harvey, in November 1642. The war interrupted the medical training of Thomas Willis at Oxford. A royalist, he began medical training in 1646, and was rewarded for his loyalty with his bachelor of medicine after only six months of study, thereupon beginning his practice in the villages and marketplaces of Oxfordshire (Arráez-Aybar).

First recorded outbreak of yellow fever in Western Hemisphere in the Yucatan of Mexico. First confirmed outbreak in North America was in Boston in 1693 (Byerly I, Introduction).

Execution of Charles I, who had been handed over to Cromwell by the Scots in 1647 (Chauvois, 148). At Oxford, William Harvey befriended the royalist Charles Scarburgh. On moving to London, top royalist intellectuals gathered at his dinner table, forming the nucleus of what would become the Royal Society (granted a royal charter by King Charles II in 1662). Around Scarburgh’s table, they came to grips with the circulatory system as a mechanism they might be able to use for medical purposes: “It was here that the seeds of the first sustained research programme into blood transfusion were sown.” The young Christopher Wren “would become instrumental in early blood transfusion” (Craddock, 64-65).

In his Experimenta Nova Anatomica, Jean-Pierre Pecquet reported discovery of thoracic chyle duct (thoracic duct) during dissection of a dog (Suy et al., III, 390-92). In 1652, the Dutch researcher Johannes van Horne, dissecting various animals in Leiden, made the same discovery. Ditto the Swede Olof Rudbeck, dissecting a calf carcass in 1651 and published his dissertation in 1652. He endorsed his predecessors’ belief that blood was not formed in the liver. Also in 1652, Thomas Bartholini, working in Copenhagen, published his observations, which included two human dissections, on the chyle vessels and the thoracic duct. Bartolini differentiated the milky chyle originating in the small intestine mesenteric vessels from the clear fluid circulating into systemic vessels; he named the latter for the first time ‘lymphatics’, confirming the correct lymph circulation. The new term appeared in the title of a second book, published in 1653 (Natale, 422). Bartholini too became convinced that all chyle and superfluous serous liquid were evacuated to the heart. “The discovery of the thoracic duct for drainage of chyle and lymph to the subclavian vein(s) and thence to the heart was, next to Harvey’s theory on blood circulation (De Motu Cordis, 1628), the most important milestone by far that would turn established medical thinking on its head” (396). But none of the four proposed an alternative function for the liver. From 1653 on, priority dispute between Bartholini and Rudbeck over discovery of the serous lymph vessels = “lymphomania at its worst” (395).

Petrus Borellus writes the first publication on the use of the microscope in medicine. Among his 100 observations and applications was how to remove ingrowing eyelashes invisible to the naked eye (Hajdu).

Dutch surgeon Job van Meeke documents first successful bone graft by a Russian surgeon who repaired soldier’s cranium with piece of dog bone. The Church deemed the procedure “unchristian” and excommunicated the soldier (Fitzharris II, 50).

Using a 32-power microscope, in his Scrutinium Pestis, the Jesuit priest Athanasius Kircher described microscopic “worms” in plague victims, which he suspected caused the disease. Most likely, he was viewing pus cells, or perhaps red blood cells. Twelve years earlier, in 1646, he had written that “a number of things might be discovered in the blood of fever patients”  (Hajdu).

King Charles II founds Royal Society of London; Thomas Willis elected a Fellow in 1663.

Publication of Thomas Willis’ Cerebri anatome (The Anatomy of the Brain), while Willis was Professor of Natural Philosophy at Oxford, where he used brain anatomy as a means of investigating the soul. More specifically, brain anatomy held the key to understanding the rational soul, which acted on the brain. It would reveal structural similarity between man and animals while showing a difference in high function, thus proving that man had an immortal soul in addition to the soul held in common with animals (O’Connor, 140). In the book, Willis coined the term “neurologia,” elsewhere the “doctrine of the nerves.” He gave the term in Greek and included in it the cranial, spinal, peripheral and autonomic nerves, as distinct from the brain and spinal cord (Arraez-Aybar, et al.). It was also in Cerebri anatome that Willis identified the “circle of Willis,” the arterial circular mass at the base of the brain. In this, his opus, “Willis did not work alone but in collaboration with a multidisciplinary team composed of Thomas Millington, Christopher Wren and Richard Lowers” (O’Connor, 141). “Willis deployed this neologism to indicate his intent to perform a comprehensive and detailed analysis of the brain and nerves in order to substantiate a new pathology and a new physiology. . . His next two works “suggest the progress of his research from anatomy to pathology, and eventually to physiology. . . . He dedicated each of his neurological works to Gilbert Sheldon, Archbishop of Canterbury from 1663 – 1679, and he [Willis] intended his neurology to serve the ideological and political ends of Sheldon’s church,” i.e., the Church of England (Caron, 529).

Richard Lower performs first successful animal blood transfusion (dog to dog), using hollow reeds and tin pipes in place of Wren’s porcupine quills and Potter’s windpipe. After a year of experimentation, he realized he had to connect arteries to veins to use the pumping action of the heart. When he did so, “the blood flowed more freely, the arterial flow actively propelling the liquid through the connecting mechanism.” In February 1665, Lowe performed his transfusion experiment before an audience at a meeting of the Royal Society attended by Robert Boyle, who, at meeting of January 1666 read a list of 16 transfusion questions he wanted answered in subsequent experiments (Craddock, 72-73, 76).

Following military service in the Parliamentary Calvary during the English Civil War, Thomas Sydenham returned to Oxford for three years, of which the high point was his friendship with Robert Boyle. In 1665 he married Mary Gee and bought a house in Westminster, where he began his medical practice shortly thereafter (Dewhurst, ch. 1). John Locke, widely read in medicine but unlicensed, served as his clinical assistant, while supporting Sydenham’s researches (60).

In Paris, Jean-Baptiste Denis, assisted by Paul Emmerez, perform first animal-to-human blood transfer using the “pure” blood of a lamb (the “lambs of God”), believing, per Galen, that “If you could fill up a patient with pure – or, better still, specially designed – animal blood, you could cut down the level of corrupt blood . . . Transfusion would in this way add a new level to the humoral machine, making a mechanical system of something that was never anything of the kind” (Craddock, 90). Their first two patients survived their transfusions, but the third one, using calf’s blood died. Their final transfusion, calf to (mad)man (Mauroy) “to improve his character” (110)  his death after a third transfusion, not owing to the transfusions, but to arsenic poisoning, administered by his wife, after a cabal of transfusion detractors secretly persuaded her to bear false witness against him. Despite his innocence, Denis’ reputation was ruined, and transfusion was “effectively abandoned” in both France and England(113-114). As to their previous transfusion successes, “Denis and Emmerez couldn’t have known that platelets would naturally stick to the side of their silver tube if they took too long to make the transfusion. This was happening all along. Obstructing the flow of blood would have meant their patients got little or no blood inside them after all. Some would have made it through [as] a human body can deal with a small amount of animal blood with only relatively mild symptoms” (95).

French Parliament reaffirms verdict of Chatelet court that blood transfusion can only be performed with express approval of Paris Faculty of Medicine (which is to say, never): “The very idea of transfusion flowed from theories and practices that, in Catholic France, were simply untenable. . . . infusion and transfusion experiments relied as well on Cartesian theory . . . such arguments of a body-soul divide flew in the face of the most important traditional teaching of all the Bible. To imagine transfusion meant to dismiss biblical dictates such as in Deuteronomy 12:23, ‘Eat not the blood, for the blood is the life.’ . . . Denis’s attempts to build a reputation on the new science of transfusion were clearly doomed from the beginning (Tucker, ch. 15).

Thomas Willis (Oxford) describes symptoms of myasthenia gravis in De Anima Brutorum (Keynes, 314-315)

Hugh Chamberlen, in his translation of Mauriceau’s Traité des maladies des femmes grosses, announced, without revealing, the family secret that permitted the delivery of a living child when delivery was obstructed by the head. It proved to be the use of three instruments: the midwifery forceps, the vectis, and the fillet. He was ignored (A. Wilson, 54-57). Yet various forms of these instruments were being used by others in the Dutch Republic, France, and England by early 1730s (66). In England, Hugh Chamberlen II sold forceps to Tories like him, so that “the forceps was specifically a Tory instrument in London until about 1740” (74).

Publication of Thomas Sydenham’s main work, Observationes Medicae, in which he recast his previous book on fevers and extended his study of London epidemics from 1161 to 1675 (Dewhurst, 65). He also received his doctorate in medicine during trip to Cambridge, and the year his reputation began to take off following publication of Charles Goodall’s The College of Physicians Vindicated. There Sydenham was included in a group of eminent licentiates of the London College of Physicians (Anstey). John Locke was Sydenham’s greatest promoter, beginning with an adulatory poem commending the 2nd. Ed. of Sydenham’s, Memodus of 1668, followed by his dedicatory epistle to the Observationes Medicae. Beginning in the 1690s, however, Locke’s praise of Sydenham involved not diagnostics or therapeutics, but Sydenham’s practice of Experimental Philosophy as a physician (Anstey).

Thomas Sydenham simplifies Paracelsus’s recipe for laudanum to opium in alcohol (tincture of opium).

Thomas Sydenham published his treatise on hysteria (Epistolary Dissertation to Dr. Cole) in which he recognized the widespread nature of psychological illness and independently confirmed Carolus Piso’s observation that males were as susceptible to hysterical symptoms as females. He attributed the symptoms to an imbalance of the “animal spirits” led to disorders of the most vulnerable organs; these organs were susceptible to the accumulation of putrid humors that rendered the organs unable to purify blood. Sydenham included patients with symptoms of hypochondria (males) and depression in surveying the protean symptomatology of hysteria, and his treatise was “the most important seventeenth-century treatise on psychological medicine” (Dewhurst, 75).

Thomas Sydenham publishes Tractus de pedagra et hydrope (Treatise on gout and dropsy). “Sydenham’s was the first influential voice since Greek times to preach unfashionable moderation; and subsequently both Boerhave’s and Cullen’s practice followed closely that of their great predecessor” (Coperman, loc 301ff.) He opposed the normal practice of bleeding for gout (loc 307) and harbored a “personal antagonism” to purging under any circumstances (loc 323-325). The treatise on gout is “a classic” in which “the concentration required in writing it frequently caused attacks of gout in Sydenham himself. The treatise on dropsy was “much less satisfactory,” as Sydenham was “Completely ignorant of the physiological and pathological mechanism causing oedema” (Dewhurst, 76).

First description of chorea (movement disorders, esp. facial tics) by Thomas Sydenham (Sydenham’s chorea) which, in late 18th and early 19th centuries was widely linked to a prior attack of rheumatic fever (Kushner, 32-33), though Charcot, unconvincingly, later denied the connection (36).

Parisian barber-surgeon Charles François Félix de Tassy, surgeon to the court, successfully operates on Louis XIV for large perianal fistula, using two instruments he made for the operation: an enormous anal retractor and an ingenious, sickle-shaped knife – a scalpel with a semicircular probe on its end. He practiced the operation for two months on 75 impoverished citizen volunteers in a Parisian hospital (Van de Laar, ch 27; Fry)  “a shift in how the public viewed the craft of surgery. 1686 declared L’année de la Fistula  Royal approval for surgical amphitheater completed in 1695  new laws in 1699 that “gave rise to an important change in the composition of the Paris surgical community; surgeons with a university background and understanding of science began to divorce themselves from less educated . . barber-surgeons and illiterate tradesman . . .” (quotes from Rutkow, 94-95).

Publication of first monograph on menstruation by English physician John Freind’s Emmenologia.

John Floyer publishes his two volumes on the pulse and the pulse-watch. By counting the number of pulses within one minute, he created a demand for watches capable of registering seconds (Davis II, 122-24).

Fahrenheit’s thermometer becomes available, and Herman Boerhaave and his pupils Gerard van Swieten and Anton de Haen noted its value. van Swieten recommended that it, rather than the hand, be used to measure fever, whereas de Haen pointed out that a physician’s touch was inadequate, especially when a shivering patient complained of extreme coolness while registering a temperature that was three or more degrees above normal (Grodzinsky & Levander).

Alexander Monro (primus) elected Professor of Anatomy at Edinburgh University (Wright St.-Clair [WSC], 32), which chair was removed from connection with the Incorporation of Surgeons and became part of the University proper in 1725 (36-37).

Spaniard Gaspar Casal studies mal de la rosa (pellagra) and found it useful to provide milk, cheese, eggs, and meat but stopped short of attributing it to deficiency of food. In 1771, Italian Francis Frapolii, studying poor around Milan, named the condition pelegra, later pellagra from Italian pelle (skin) and agra (rough), concluding it could be cured by a robust diet; then in 1776, Italian Joseph Odoarali blamed it on excessive use of corn, and in 1783, Italian Francesco Fanzago confirmed that pellagra victims subsisted on potenta (made of ground cornmeal). In 1810, Italian Giovanni Marzari proposed pellagra might be a deficiency disease, as corn lacked something essential to health (Bryan, 81-83).

Smallpox outbreak in Boston. Despite Cotton Mather’s advocacy of inoculation, only a single Boston physician, Zabdiel Boylston, took up the practice. It was condemned both by the public and the clergy, the latter led by William Douglas, who dismissed African accounts of its efficacy as an affront to the will of God (Wehrman, 15-17). It next broke out in Phila. in 1736, then Charleston, SC in 1738, where James Kirkpatrick’s An Analysis of Inoculation (1754) helped make him, esp. in the South, “a founding father of American inoculation.” (24) In Phila., Dr. Adam Thomson and NY’s Dr. George Muirson both claimed to have invented “the American method of inoculation, i.e., heavy use of mercury prior and during stages of inoculation (28). Next major epidemic in Charleston in 1760, during French and Indian War, when the city went mad for inoculation. After another wave in 1763, most white residents of Charleston had been inoculated and were nearly fully immune to smallpox – not so blacks and Native Americans (Wehrman, 33, 128).

Publication of Alexander Monro’s great text of osteology, The Anatomy of Human Bones (WSC, 42).

Publication of Pierre Fauchard’s two-volume L Chirugien-dentiste, ou Traité des Dents (The Dental Surgeon, or, Treatise on the Teeth), the first scientific approach to dental care. Its view of tooth transplants was in contradistinction to the traditional tooth drawers for whom tooth decay resulted from tooth worms. In addition, Fauchard “invented the ideas and tools for filling teeth, filing them and applying braces to straighten them. . . . This new kind of specialist surgeon he called a dentiste stuck . . . making its way into English as ‘dentist’ twenty years or so later” (Chaddock, 119-121, quoted at 119). In the 1760s, after extensive experiments transplanting cockerels’ spurs to their heads, a cockerel testicle to a hen’s belly, and a human tooth to a cockerel’s comb, John Hunter began transplanting teeth “donated” by poor children to wealthy recipients. He believed the transplants worked “because of a vital principle’ establishing a connection with the new part, bringing it back to life. Like the Boerhaavian vitalists who came before him, he believed life was a physical thing, an invisible particle that couldn’t be seen or even detected by scientific instruments” (Craddock, 153-155). During the mid-18th century, the desire for clean teeth, a nice smelling mouth, and a nice smile was fueled by “a widening class system and consumer revolution in a culture that increasingly defined people by what they looked like and what they owned. This was the shift that dentistry in general, and the tooth transplant in particular, needed in order to become popular” (147). In England, popularity of tooth transplants peaked in 1770s and 80s, and thereupon declined, as dentists realized they didn’t work most of the time, with recipients contracting syphilis and occasionally dying. The naked elitism of the procedure, especially the cruelty to poor children selling their healthy teeth to the wealthy (especially the new money) for a small payment, became increasingly offensive (Chaddock, 161). Even “Hunter himself, who had clearly since been shaken by the savagery he’d helped unleash,” urged his former pupil William Rae to “talk about the immorality of the operation.” In 1803, Joseph Fox, another Hunter pupil, wrote that the operation involved “’a defect of the moral principle as one person is injured and disfigured in order to contribute to the luxury and convenience of another’” (164-165).

Publication of George Cheyne’s The English Malady, which consigned nervous disorders solely to the upper classes, holding that one-third of all upper-class disorders were nervous. Nervousness grew out of “the new ‘nervous’ vitalism [which] bound the soul to the body . . . and made it into a material thing that pulsed through it. This could be a Christian soul, as it was for Boerhaave, but it didn’t need be. It could be a mere particle. As medical belief in souls and humours declined even further, more and more doctors became convinced that the body was a material thing” (Chaddock, 141-143).

Following extinction of the Chamberlen family, use of forceps was published by Edmund Chapman; between 1733 and 1735, forceps entered the public domain (A. Wilson, 109-110).

Posthumous publication of William Giffard’s (London) Cases in Midwifery, 225 dated cases between 1725 and 1731, characterized by his use of midwifery forceps (his “Extractor”) for obstructed births by the head from 1728 to 1731, including use of single blade of the forceps as a vectis (A. Wilson, 91-96). Even in his early (1728) cases with forceps, most (around 75%) were delivered alive and the median delay before Giffard was called was only 48 hours as opposed to the 3-4 days characteristic of traditional obstetric surgery. Between 1728 and 1731, the median delay fell to 36 hours and the proportion of stillbirths dropped from 1-in-4 to 1-in-10 (97-98).

Claudius Amyand, surgeon at St. George’s Hospital and Sergeant-Surgeon to King George II, performs first English appendectomy (Trombley, 57).

William Smellie returns to London and begins teaching midwifery (to over 900 male and unknown numbers of female pupils over the next 10 years), inducing poor mothers to be used as teaching material via a fund for their maintenance during lying-in (A. Wilson, 123-24).

Stephen Hales presents first paper to Royal Society on his invention of ventilators for use on ships, without specifying that many of the ships in question carried enslaved Africans. In second paper of 1755, he more explicitly referred to slave ships as key evidence of value of ventilators on ships (Down, ch 1).

French anatomist J.B. Winslow warns that regular use of the corset deforms the ribs (Schiebinger, 198).

Smellie’s reluctant readoption of the forceps (A. Wilson, 127). In 1745 he discovered forceps could be used to rotate the head and this converted him to the forceps (128).

British “educated” surgeons petition Parliament for legal separation from the barbers  dissolving of London Company of Barber-Surgeons (which included educated surgeons) and establishment of independent Company of surgeons, which in 1800 became the Royal College of Surgeons, and in 1843 the Royal College of Surgeons of England (Rutkow, 101; J.O.Robinson).

Publication of Bernhard Albinus’s (Leyden anatomist) Tabulae sceleti et musculorum corporis hominis [Tables of the Skelton and Muscles of the Human Body], which exemplifies anatomical atlases “of the idealized sort,” in which, as per pre-late-19th-century naturalism, the atlas provides “pictures of an ideal skeleton, which may or may not be realized in nature, and of which this particular skeleton is at best an approximation” (Daston & Galison, 90). “Albinus and other idealizing atlas makers did not hesitate to offer pictures of objects they had never laid eyes upon, but in the interest of truth to nature rather than in violation of it” (91). By contrast, “atlases of characteristic images” presented individual cases as exemplary and illustrative of broader classes and causal processes, e.g., Morel’s Traité des dégénérescences physiques, intellectuelles, et morales de l’espece humaine (1857). In such atlases “Individual depiction by no means precluded essentialist typologies, even in pathology” e.g., in Gottlieb Gluge’s Atlas of Pathological Histology (1853), the individuals “nonetheless pointed beyond variability to an underlying type of which they were characteristic, setting strict limits to deviations” (95).

Founding of the Royal Academy of Surgery in France; it was preceded by “The Academy Society of Surgery,” founded in 1731 (Lacheretz).

In England “. . . there emerged a man-midwifery of a very different kind: booked onset calls (and among the very wealthy advance calls) in lieu of a midwife. . . . During the next two decades it became clear that this was a permanent and irreversible shift: the midwife’s hegemony had been decisively fractured” (A. Wilson, 164). This new man-midwifery arose from the choices of women . . . whereas the lying-in hospitals were created by men” (165). This led to critiques of the social role of the man-midwife, beginning with campaign of Frank Nicholls in 1751-52, according to whom the male midwife violated “modesty” and transposed methods appropriate for difficult births to the realm of normal deliveries (166-167).

Publication of Smellie’s Treatise on the Theory and Practice of Midwifery (A. Wilson, 124).

In Britain, dissection is mandated as an option to postmortem gibbering for murderers. To gibbet is to dip a corpse in tar, suspend it in a flat iron cage (i.e., the gibbet), and crows peck it apart (Roach, 41).

Opening of Pennsylvania Hospital, of which Benjamin Franklin, approached by Philadelphia physician Thomas Bond, played pivotal role as fundraiser. The first public, voluntary hospital in the Colonies, it was financed by combination of government funds from the colonial legislature and private contributors. In 1751, Franklin’s fundraising campaign introduce the innovative concept of matching funds for the project (Corner, 4; Abrams, 80-81, 86-88 ); in 1755; John Morgan became hospital apothecary (Bell2, 25-27).

Leopold Auenbrugger, working at Vienna’s Spanish Military Hospital, discovers significance of thoracic percussion in diagnosing pleural effusions (esp. in TB). He compared the physical signs with post-mortem findings, in which he also injected fluid into pleural cavity and showed it was possible by percussion to tell exactly the limits of fluid present. His findings, largely ignored in his own lifetime, were published seven years later in Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi (a book of 95 pages), where he initially described the sonic qualities of the thorax in terms of drums and their variable timbral possibilities (17). He used precise musical terminology to describe various thoracic sounds. After noting that ‘the healthy human thorax sounds, if it is struck,’ he added that ‘the sound the thorax gives is observed to be such as in drums [tympanis] when they are covered by a cloth or by another fabric made of thick wool’. His description “showed close knowledge of contemporary drum technique, including the use of muting cloths called coperti, used to muffle the sound of the timpani” (18). “Going far beyond pulse observations or scrutiny of such manifest signs as stool, urine, or the visual appearance of the skin, percussion treated the body as a musical instrument capable of producing deeply revealing sounds, for the first time allowing the prediction of disease in the absence of any other symptoms” (20).

Alexander Monro (primus) and Wm. Cullen given licenses to practice as physicians by Edinburgh Royal College and admitted as Fellows (WSC, 48).

Alexander Monro (secundus, 3rd son of primus) takes over anatomy lectures from his father, which he would continue for 50 years, counting among his students, inter alios, Charles Bell, John Cheyne (Dublin), and William Shippen, John Morgan, & Benjamin Rush (from US) (WSC, 73-81).

First lateral arteriorrhaphy (repair of lacerated artery) by Richard Lambert (Friedman, 16-17).

John Morgan goes to London, where he learns to make anatomical preparations under the Hunters (Bell2, 48-50).

Swiss naturalist and philosopher Charles Bonnet documents visual hallucination in his 87-year-old grandfather, Charles Lullin, who was nearly blind from cataracts. The condition, Charles Bonnet Syndrome (CBS) was formally named after its founder by George de Morsier in 1937. It occurs in individuals with significant vision loss (e.g., heavy cataracts, age-related macular degeneration) who remain cognizant they are hallucinating and take no action. CBS is believed to result from sensory deprivation and cortical processing imbalances; it is not associated with mental illness (Weatherby, et al.; Christoph, et al.).

Morgagni’s publication, at age 79, of De Sedibus et Causis Morborum per Anatomen Indagatis (On the Seats and Causes of Disease, Investigated by Anatomy), establishing the field of pathological anatomy (Nuland, 63ff.). “Morgagni’s anatomic orientation shifted medical thinking away from a concept of illness as a disruption of humoral equilibrium (a view of illness as a system-wide event) to a concept of illness as a structural disruption in a specific anatomic portion of the body (a view of illness as a localized event” (Reiser II, 904).

John Hill finds clear link between long-term use of snuff and cancer of the nasal cavity (Van de Laar, ch 19)

Wm. Shippen, with support of John Fothergill, returns to Phila. and opens a private school of anatomy in Phila. (Corner, 11-12). Yellow Fever epidemic in Phila.

In the face of another smallpox epidemic, Boston “in the spring of 1764, attempted the largest general inoculation in either Great Britain or its colonies.” By June 30, of 699 cases of natural smallpox, there were 124 deaths. A total of 4,977 people were inoculated, with only 40 deaths: “the scale of the general inoculation, and the universality of Boston’s general inoculation by race and class exploded the demand for the procedure” (Wehrman, 61-2). “The anger toward Parliament’s revenue acts [Sugar and Stamp Acts] in 1764 and 1765 was, at least in part, rooted in their costly effort to inoculate the city against smallpox. . . . Parliament deserved none of the credit for Boston’s triumph over smallpox (67).

Establishment at College of Philadelphia of first regular medical school in British North America, by John Morgan and William Shippen, Jr. (Bell, 28). Morgan preempted Shippen in arguing for a university-affiliated school of medicine, esp. in his “Discourse upon the Institution of Medical Schools in America, delivered at the 1765 commencement of the College of Phila. (Corner, 19-22). Medical classes begin in fall of 1766 (Bell2, 140); medical degrees (bachelor’s and doctor’s) authorized in May, 1767 (Bell2, 147); first medical degrees (M.B.) awarded at commencement of 1768 (Bell2, 149; Corner, 27-28).

William Hunter opens Grand Windmill Street School in London, a forerunner of the general medical school (Kobler, 146-149); John Hunter gives himself syphilis, to chart the progress of the disease (154-55), is admitted to Royal Society, made member of Corporation of Surgeons, and finally appointed to surgical staff of St. George’s Hospital (163-64). Rules and regulations of medical school of College of Phila. Institute, leading to the degree of Bachelor of Medicine (Corner, 25-26; Rutkow, 110-111).

Norfolk Anti-Inoculation Riots, fueled by anger not at inoculation per se, but at physicians who administered inoculation without approval of local government in their homes and private inoculation hospitals, serving wealthy residents who could afford their fees. “For the rioters, the real threats were those who would risk the lives of the community as a whole to protect themselves” (69, 75). Thomas Jefferson defended the inoculators in court “in part to justify his own strong support for inoculation. Given his own recent inoculation in Philadelphia in 1760, he likely viewed the litigation as an opportunity to bring inoculation into the colony so that wealthy Virginians need not travel to other colonies to receive it” (83). For most Norfolk residents, “liberty was of interdependence not independence” (91).

Edward Jenner arrives in London and becomes one of John Hunter’s first house pupils (Kobler, 174ff.). Jenner stays with Hunter two years before returning to Berkeley to begin general medical and surgical practice.

Joseph Priestley discovers nitrous oxide (Simpson, 112).

William Cullen assumes Chair of the Practice of Physic at University of Edinburgh: “His clinical skills, fair judgment, and a certain lack of therapeutic aggressiveness endeared him to most of the patients seeking his advice” ( The consultative practice of his last 20 years, later years, conducted by mail, has left ca. 3,000 letters and his replies (Risse (II), 339-340).

After British Parliament announces tax on cheap India tea that would flood the colonial market, colonies’ printed protests linked the “pestilential teas” with sickness, i.e., plague and smallpox. “. . . colonists actually burned more tea than they pitched into the ocean. East India Company tea, Americans had been persuaded to believe, was a noxious pollutant, and so ordinary citizens in towns across America organized bonfires to cleanse their communities of its contagion” (Wehrman, 110-111). Salem supported Boston, though its outrage was fueled by the brief, disastrous appt. of James Latham, a disciple of Britain’s Robert Sutton and his “secret” method of inoculating – which relied on the American use of mercury at the time of inoculation , as inoculator at Salem Hospital. Latham had been the darling of Salem’s Loyalists until child deaths followed by outbreak of natural smallpox (155) led Salem to repudiate him. “Latham’s disturbing reign over Salem Hospital proved to them that the British were determined to profit from American ingenuity [re use of mercury] even at the expense of American lives (158). In summer and fall, another wave of smallpox overtakes Boston, including British troops garrisoned there. Americans blamed British for the outbreaks, holding “infected” tea responsible for its spread (164). Boston’s last town meeting before Battle of Lexington “had nothing to do with taxation, representation, tea, or gunpowder. It was about smallpox.” But Bostonians voted against a general inoculation as they had in 1764 (165), feeding the persistent rumor that the British “were trying to infect Americans with inoculation” (165). After disastrous Canadian campaign, when American troops were devastated by smallpox outside Quebec, Mass. General Court voted on July 3, 1776 to allow inoculation: “Even though Boston was teeming with the sick, the prospect that the city could conquer smallpox made it ‘a scene delightful indeed’” (184).

In France, Louis XV dies of smallpox on 10 May, after which Louis XVI and his brothers promptly have themselves inoculated (G. Miller).

Publication of William Buchan’s Domestic Medicine; or, A treatise on the prevention and cure of diseases by regimen and simple medicines ; With an appendix containing a dispensatory. For the use of private practitioners (London: Printed for W. Strahan, T. Cadell, J. Balfour, and W. Creech). Buchan linked appalling childhood mortality directly to parental ignorance or carelessness, including maternal dependence on wet nurses, while also holding physicians responsible, as they had “long neglected childhood ailments because they were ‘generally considered as the sole province of old women.’” On parents, especially mothers, fell the burden of preventive living, and he discussed bad influence at length, including: diseased parents, improper clothing, air, food and exercise, precocious schooling and employment; uncleanliness and hired nurses (Murphy, 41-42).

Morgan succeeds Benjamin Church as Director-General of Continental Army in October (Bell2, 179). 1777: Morgan dismissed by Congress on 9 January (Bell2, 205).

In February, reversing his firm policy against inoculation, Washington orders inoculation of Continental Army asap, seeking to complete the process before British resumed their campaign in the spring. His order “came only after soldiers, officers, and doctors demanded that the life-preserving procedure be implemented (Wehrman, 193). His wife Martha’s easy inoculation in Philadelphia “proved an education that her husband could not ignore” (198). He was also influenced by the doctors in his Hospital Department, esp. Wm. Shippen, his chief medical officer, and John Cochran, a successful inoculator who, like Washington, served with the British during the French and Indian War (204-205, 218 ). By the fall of 1778, “smallpox was gone from the military in New England, and the epidemic that had begun there in 1773 was finally ending” (235). Inoculations “effectively saved the American army from collapsing from disease, as the Northern army had during the Canadian campaign” (236).

Founding of Société royale de médecine in Paris, its purview was everything pertaining to public healthcare (Hannaway; Goubert).

German anatomist Samuel Thomas Sömmering, an accomplished artist who studied medicine at the University of University of Göttingen, names in his doctoral thesis the 12 pairs of cerebral nerves upon which the modern cranial nerve nomenclature is based. He matched textual descriptions with clear, persuasive illustrations (C. E. Storey).

John Hunter acquires most sought-after specimen for his menagerie of human and animal oddities: skeleton of Charles Byrne, 39-foot giant suffering from childhood acromegaly (giantism) (Rutkow, 112-114).

Thomas Trotter, Edinburgh physician aboard British slave ship Brookes, observes scurvy among ca. 300 of 500 enslaved Africans in struggling to breathe in bottom of ship, reaffirms James Lind’s observations of 1740s on ability of citrus fruit (here, the sucking of limes and ripe guavas) to cure and prevent scurvy  new ideas about scurvy in his Observations on Scurvy (1786). He argued that scurvy resulted from poor nutrition, not racial identity, focusing on the slave trade itself not individual characteristics, aligning his theory with 18th c. pneumatic chemistry (e.g., how crowded environments changed air quality), arguing that acidic fruits cured scurvy because they contained “vital air” (i.e., oxygen). Trotter’s analysis of both scurvy and effects of lack of air “provides an important case study in the development of an epidemiological approach to disease” (Downs, ch 1).

Emperor Joseph II realizes his mother’s (Empress Maria Theresa’s) vision by establishing Vienna’s Allgemeine Krankenhaus.

John Hunter’s most famous operation for a popliteal aneurysm; he ligated the artery in the thigh and patient did fine owing to collateral circulation (Friedman, 40-42). William Withering (Edinburgh, London) publishes treatise on Foxglove and its extract digitalis, introducing it as a diuretic for treatment of dropsy, ascites, anasarca, etc. (Mair, 197-99). In 1799, John Ferrier concluded that its essential action was on the heart (199).

John Redman elected first president of College of Physicians of Philadelphia (Bell, 37).

Five thousand rioters (including Blacks) storm NY Hospital in 2-day Doctors’ Riot, pillaging Columbia Med School and assaulting physicians after med students extended grave robbing into white graveyards at Trinity Church and Brick Presbyterian Church (Washington, 177).

Scottish physician David Pitcairn makes connection between heart disease and rheumatic fever, noting that patients with latter had symptoms of heart disease; the theory came to wider attention in 1912 with publication of William Charles Wells (Morris, loc 2144).

Death of William Cullen, great Edinburgh medical educator whose system greatly influenced the medicine taught in Philadelphia (Caton, 36).

Merger of College of Philadelphia and University of the State of Pennsylvania (each with its own medical school) into the University of Pennsylvania with a single faculty (Shippen, anatomy & surgery; Kuhn, theory & practice of medicine; Rush, institutes of medicine, etc.) (Bell, 110; Corner, 41-43).

Beheading of Louis XVI in January; arrival of 2,100 French refugees from Santo Domingo, fleeing slave revolt, in Phila.  yellow fever epidemic in Phila. In Aug, with multiple sudden deaths esp. on Water St., Fellows of College of Physicians, convening at request of mayor, debated whether the fever was caused by foul air, esp. from cargo of rotting coffee deposited at Joseph Ball’s wharf (Rush) or was a contagious disease imported from Santo Domingo brought to Phila. by the Santo Domingo refugees (Currie, following Cullen’s nosology) (Powell, chap 2). Rush treats via “Rush’s System,” i.e. “The Great Purge”: bleeding and purging with extremely high doses of calomel (mercury) and jalap “so drastically that it shocked most of his colleagues” (Corner, 46; Powell, chap 3, sec II). Rush based his purge on that of Dr. Thomas Young’s “’Ten-and Ten’ in the Revolutionary army – ten grams of calomel (mercury) and ten of jalap. This Rush resolved to do,” increasing the jalap initially to 15 grams (Powell, chap 3, loc 1484ff.). Rush was opposed by many, esp. William Currie, whose pamphlet, expanded to a handbook, argued that the only way to contract Yellow Fever was through contact with someone who was infected or his clothing or “porous substances,” that it was not carried by the air, etc. The only way to neutralize the contagion was “the pure vital air of the atmosphere,” and a benign, healthful regime. He rejected bleeding and mercury, advocating instead mild purgatives to reduce arterial tension slowly and safely, without contributing to debility (Powell, chap 3, sec III)

John Hunter makes first attempt at aneurysm surgery on a human, viz, on a 45-year-old coachman with long-standing popliteal aneurysm: he attached four cotton ligatures around the artery a distance above the aneurysmal sac, thinking that if blood supply to aneurysm were cut off it would no longer increase in size, the contents of the sac would clot, and in time would be reabsorbed by body. Patient survived as did Hunter’s next three: “The Hunterian operation for aneurysm quickly became the standard procedure for the continent” (Morris, loc 1128). From 1863 through 1940s, Hunter’s approach was supplanted by that of Charles Moore: inserting objects (e.g., wire that formed coils) into the aneurysm to induce clotting. In the first case in 1864 he threaded 26 yards of fine steel wire into the patient’s aneurysm, but he lived only four more days Beginning in 1870s some surgeons ran electric current through the coils to heat them and speed up clotting (loc 1160-66).

Jenner’s crucial experiment demonstrating that cowpox vaccinated against smallpox (Kobler, 182-183).

Term “plastic surgery” introduced by French surgeon Pierre-Joseph Desault, signifying an object that could be shaped or molded.

President John Adams signs into law the United States Marine Hospital Service “to provide for the relief and maintenance of disabled seamen.” It led to a network of hospitals at sea and river ports, with sailors paying a monthly twenty-cent tax out of their wages as insurance for hospital care. Over the next century, it would evolve into the APHS (Abrams, 2).

Yellow fever epidemic in Louisiana territory, followed by epidemics in 1805, 1807, 1809, and 1811: “By the time Louisiana applied for statehood in 1812, yellow fever . . . had become nearly synonymous with New Orleans,” with mass deaths that “caused cascading structural problems for American government in Louisiana. It delegitimized American rule and embarrassed the United States’ authority at the precise moment it sought to project confidence to the local Creole population . . . The virus killed so many newly transplanted government officials that it slowed the wheels of the administration, disrupted commerce, and massively delayed land and legal reform.” Further, it “cast new Americans as unwelcome and unworthy invaders, unable to survive – let alone succeed – in subtropical New Orleans (Olivarius, 33). Racialized thinking led to belief that Africans had racial immunity to yellow fever (39-40).

University of Pennsylvania creates separate professorship of surgery, given to Philip Syng Physick (Corner, 51-53), who stood at head of American surgery for over a third of a century “and won an international reputation, esp. for his skill in lithotomy and for inventiveness in devising methods for the treatment of major fractures” (53). Succeeded by John Syng Dorsey in 1818 and William Gibson in 1819 (68-70).

Sertűrner isolates from opium a “principle” that, in animal experiments had marked narcotic properties, and which he named principium somniferum. He described it as having an “almost alkaline-like character,” but did not positively state that it was an alkali, reserving the problem for further investigation (Lesch II, 312-13) . . . Only Sertűrner . . was willing to suggest that the ‘almost alkali-like character’ of his principle was intrinsic. In retrospect this appears a breakthrough, and it is sometimes labelled the discovery of morphine. Yet Sertűrner’s results were largely ignored between 1805 and 1817 . . . there were good chemical reasons for suspecting or rejecting Sertűrner’s conclusion” (Lesch, 315-16). Whereas Sertűrner emphasized the alkaline nature of morphine in his paper of 1817, the French chemists Gay-Lussac and Robiquet, reacting to his paper, stressed that morphine was an organic base with a family resemblance to other physiologically active organic substances. Then, in 1818, the French pharmacists Pettetier and Caventou announced the isolation of the active principle of the strychnos family of plant poisons, a principle they could show to be a salifiable organic base. They placed strychnine with morphine as members of a new class of salifiable organic bases (321-23). Cf. Parascandola (80-81)’s simplified account: Field of alkaloid chemistry opens up when German pharmacist Friedrich Sertűrner isolates morphine and recognizes it as an alkaloid, though it was later that French chemist Joseph Gay-Lussac and pharmacist Pierre Robiquet appreciated that morphine was just the first of a whole new class of organic bases (morphine, strychnine, quinine) to which generic term “alkaloid” was introduced in 1818, though not generally used until much later (Parascandola, 80-81).

Corvisart, in Essay on the Organic Diseases and Lesions of the Heart and Great Vessels, associated failure of mitral valve to open completely (stenosis) with a palpable “thrill,” a vibration, felt by doctor’s fingertips on patient’s chest (the mitral thrill), but his main concern was with prediction of cardiac enlargement (“aneurysm”). Like Sénac, he believed heart diseases came from “the passions,” such as a fit of anger or the distress owing to the “horrible times” of the French Revolution (Duffin, 178).

Astley Cooper performs first successful carotid artery ligation (Friedman, 49-51).

Italian surgeon Guiseppe Baronio performs first autogenous skin graft, lifting skin from one side of a ram’s body and transplanting it on to the other (Chaddock, 166).

German pharmacist Wilhelm Sertürner isolates morphine and codeine from opium (Caton, 75).

Ephraim McDowell performs first ovariotomy (in Danville, KY) on Jane Todd Crawford, removing a tumor that was partly cystic (15 lbs) and partly solid (7.5 lbs) in about 25 minutes (Schachner, 61ff.). “To recognize McDowell (as first surgeon to perform an ovariotomy) sent a message to Europeans that Americans were in fact the original gynecologists” (McGregor, 160).

Napoleon’s surgeon Baron Dominique Jean Larrey performs first operation on a case of suppurative pericarditis (Richardson, 39-40).

Italian Giovanni Marzari proposed pellagra might be a deficiency disease, as corn lacked something essential to health (Bryan, 81-83).

Use of screened examinations (oral examinations = “the green box”) at University of Pennsylvania (Corner, 61-62).

New England Journal of Medicine begins publication

Death of Benjamin Rush (Corner, 64).

Laennec discovers mediate auscultation with a paper horn; begins stethoscopic research early in 1817, with “pectoriloquy” [literally, “the chest speaks”] his first breakthrough (exaggerated intensity of voice through chest wall associated with cavity in underlying lung and hence with pulmonary phthisis [Duffin, 134-138]); received medical and popular attention in mid-1817 in consultation for dying Mme de Staël; presented to Académie des Sciences in Feb, 1818 (Duffin, 124-127).1819: “egophony” [from Greek, aïgon, after the bleating voice of a goat] = distinctive nasal quality of voice heard through chest wall overlying fluid in thoracic space (assoc. with pleural effusion) (145-147). 1824: “Bronchophony” = “imperfect” pectoriloquy; louder than usual sound of patient’s voice through chest but only the airways (bronchi), not the whole chest, that “spoke” (assoc. with bronchiectasis and pneumonia) (163-66). “ . . . even a trained musical ear would struggle to discern stethoscopic crackles and fizzes that . . . sound more like twentieth-century musique concrète or artificially synthesized sounds than anything remotely considered ‘music’ during the nineteenth century. . . . Laennec’s Treatise is a fascinating exercise in awakening and expressing whole new realms of sonic awareness and timbre. Though he developed a new vocabulary to describe ‘unmusical’ sounds with greater precision, at many points the shaping force of previous musical and sonic experiences seemed to guide his choices” (Pesic, 23). Laennec drew on sounds from his Parisian milieu to characterize chest sounds: a râle had as most common meaning the death-rattle from the hospital ward; microacoustic death-rattles: as dying breaths rattled through fluid-filled lungs, those in earlier stages of pulmonary disease might emit micro-rattles from their fluid-compromised lungs (Pesic, 24). His hospital practice consisted of lower-class craftsmen and workers (esp. metal-workers), so he described a characteristic “metallic tinkling through the stethoscope by evoking an eerily diminutive craft-scene, hearing ‘a noise perfectly like a blow struck on metal, glass, or porcelain, which one strikes lightly with a nail or on which one drops a grain of sand’” (25). Austin Flint in 1850-52 made auscultation understandable to Americans by, inter alia, suggesting variations in pitch made it easier for students to distinguish various sounds  “Flint’s Law” on the correlation of pitch, resonance and consolidation of the lungs (= part of lung filling with liquid and swelling/hardening) (D. Smith, 139)

British surgeon Joseph Carpue publishes An Account of Two Successful Operations for Restoring a Lost Nose, in which he resurrected Sushruta’s “Indian method”, which leads to revival of rhinoplasty.

German pharmacist Friedrich Wilhelm Sertűrner isolates morphine from opium and identifies it as a salifiable (capable of reacting with an acid to form a salt) organic base; it was recognized by Gay-Lussac and Robiquet, in response to Sertűrner’s paper, as signifying a new class of compounds: the plant alkalis. The category of plant bases in general or plant alkalis in particular did not exist prior to 1817; all known bases and alkalis pre-1817 mineral substances (potash, soda, ammoniac) (Lesch II,308-310). In 1805-06, Sertűrner had isolated from opium a “principle” that, in animal experiments had marked narcotic properties, and which he named principium somniferum. He described it as having an “almost alkaline-like character,” but did not state that it was an alkali, reserving the problem for further investigation (313).

Astley Cooper performs first (unsuccessful) abdominal aortic ligation; in 1923, Rudolph Matas performed first successful one (Friedman, 51).

McDowell publishes report (Schachner, 86-88) on his first three cases of ovariotomy in The Eclectic Repertory and Analytical Review, under sponsorship of editor Dr. Thomas C. James, professor of midwifery at U. of Pa (106-108). In 1816, via his nephew William McDowell, he had sent copies of his report to his Edinburgh teacher John Bell (which fell into the hands of John Lizars, who absorbed and reprinted McDowell’s work into his own paper of 1824 in Edinburgh Medical & Surgical Journal) and to Philip Syng Physick of Phila., who said nothing and did nothing. Lizars paper of 1824 (93-101) “had but a failure to report, as no tumor was found, the very title, Observations on Extirpation of the Ovaria, with Cases, by John Lizars, etc., becomes questionable” (103, 187-190; Shepherd[2], 38-41).

James Parkinson offers clinical description of Parkinson’s disease (resting tremor, rigidity, and postural reflex embarrassment) in An Essay on the Shaking Palsy.

In Mass., Charleston Asylum (renamed McLean in 1926) opens its doors, several years before MGH (Beam, 19-20). It was the first insane asylum in the U.S. Also in 1817, Phila. opens its first insane asylum in Frankfort, and Connecticut followed with the Hartford Retreat in 1822 (Hansen & King, 65).

Harriet Hunt first female applicant to Harvard Medical School; her application is rejected.

Michael Faraday discovers sulphuric ether (Simpson, 112).

McDowell publishes second report on ovariotomy, also in Eclectic Repertory, adding two cases to the original three (Schachner, 109-115).

Laennec publishes his Treatise on Mediate Auscultation: “The stethoscope made it possible to reveal physical changes before the patient died. Disease no longer had to be defined by subjective symptoms felt and described by the patient; it could now be defined and classified as a physical change detected objectively by the doctor, sometimes even without the patient’s knowledge. As a result, concepts of disease could be reformulated to incorporate anatomical observations. The stethoscope had finally ruptured the epistemological barrier that had prevented the seemingly useful pathological anatomy from finding applications in the clinical setting” (Duffin, 152). “Finally, it was possible for physicians to prove that a person was physically sick without feeling sick. With the stethoscope, the doctor could detect a lesion before the patient had suffered any symptoms. Even people who felt completely well could no longer be certain that they were. Reiser compared Laennec’s invention to Gutenberg’s as the instrument that turned the focus of medicine from sick people to disease. Physicians became the custodians of knowledge that had previously belonged only to their patients. Laennec is their hero” (Duffin, 302-03;also 298-99; Reiser, 25-29). “The elevation of the auscultatory sound to a level of concrete reality occurred only because of the close demonstrable correspondence between the sound and the visible lesion disclosed at autopsy. Successful auscultation required the physician to transform the sound he heard into a picture he could visualize. One metaphor that recurred regularly in the medical literature between 1820 and 1850 was ‘seeing’ disease by listening through the stethoscope. . . . Auscultatory sounds could be demonstrated in the laboratory ‘with all the precision attainable in some of the higher branches of physics.’ . . . The existence of physical principles, which explained the mechanisms of the sounds produced by the body’s organs, bore witness to the superiority claimed for auscultatory signs. Physicians venerated such evidence. It brought them close to a dream of that period: to be able to base medical practice on scientific law” (Reiser, 30, 31).

Robert Gooch, one of London’s leading obstetric practitioners, coins term “puerperal insanity,” which was adopted by physicians, alienists, and asylum practice, where it was divided into categories of melancholia and mania. In many institutions, the diagnosis accounted for ca. 10% of female admissions by mid-century. Both upper-class women, “cushioned by wealth and luxury” and attended in childbirth by newly emergent male specialists, and poor women “debilitated by want and hardship” were deemed vulnerable to puerperal insanity (Marland, 79-80).

First publication of Pharmacopoeia of the United States of America (USP), followed by publication of the United States Dispensatory (commentary on USP) in 1833 (Higby, 81-83). After 1865, “pharmacists turned more and more to wholesalers for their prescription ingredients and less to their own laboratories. . . .”Antagonism between the small-scale practitioners who wrote the standards and the large-scale manufacturers who made most drug preparations reduced the effectiveness of the Pharmacopoeia during the 1860s and 1870s (95).

Rise of medical sectarianism (Thomsonians, etc.) heightened medical “regulars” awareness of group identity and its rooting in allegiance to a shared tradition. “Growing awareness of orthodox identity after the 1820s was expressed most visibly by the proliferation of explicitly orthodox medical institutions” (Warner III, 241).

Founding of Philadelphia College of Pharmacy immediately after University of Pennsylvania created degree of Master of Pharmacy. It began its journal in 1825, which was renamed the American Journal of Pharmacy in 1835 (Corner, 72-73; Liebenau, 22). Opening of MGH as small, private, voluntary hospital for the worthy poor.

Laennec begins his two-year course of lectures on clinical medicine at the College de France: “he would tout the benefits of auscultation and flaunt his extensive knowledge of pathological anatomy, but, in his opinion, the topic of disease exceeded the bounds of a method based only on anatomical correlations” (Duffin, 259). He held the human body was composed of solid, liquid, and vital principles; the vital principle “was a real but invisible force like gravity, whose existence could be known by observation of its effects in the laboratory or in the clinic” (263). Each principle had a corresponding class of disease identified by the location of its lesion; “Changes associated with stress and sadness were the vital lesions” (266). Asthma and mental diseases were lesions of the vital force localized in the lung or brain, respectively (269). For Laennec, “all sounds are absent in the cadaver; abnormal sounds, which were produced in life but not connected with a physical alteration after death, must represent manifest alterations in the vital principle” (273).

Publication of successful case of ovariotomy by Prof. of Surgery Nathan Smith of Yale, the second ovariotomist in U.S., in Edinburgh Med. & Surg. J., which likely came to attention of John Lizars, who then presumably took McDowell’s report of 1817 seriously, and reprinted it in his own paper of 1824 (Schachner, 188-89).

David Barry’s (British surgeon) experiments on cardiovascular physiology of animals that contradicted Laennec on two key points: (a) audible sounds not due to contraction, but to dilatation and passive filling of heart chambers; (b) first sound made by expansion of atrium and second by expansion of ventricle (Duffin, 186-87).

first course of lectures at Jefferson Medical College, founded after the surgeon George McClellan (graduate of Penn Medical, 1819) and associates in 1824 proposed to Jefferson College at Canonsburg a medical faculty connected with the college (da Costa, 326-333; Corner, 77-79; Aptowicz, 51-53). McClellan’s ambition had outgrown his flourishing private anatomy school. “There was, from the beginning, personal as well as institutional bad blood between the two schools. McClellan and Gibson had been adversaries . . . For many years Phila. physicians were divided by their respective loyalties to the two schools” (Corner, 78-79; Aptowicz, 59-60). Thomas Wakley founds the Lancet to expose evils of British medical education (Truax, 26).

Formal opening of University of Virginia, of which Thomas Jefferson was principal founder and designer. The university included a chair of medicine held by English-born Robley Dunglison, who shared Jefferson’s affinity for rational scientific inquiry and antipathy for heroic medicine. Dunglison, who became Jefferson’s personal physician for the final year of his life, held the chair of “anatomy, surgery, the history of the progress and theories of medicine, physiology, material medica, and pharmacy” ( Abrams, 222-223).

Itard’s original report of the Marquise de Dampierre, appropriated by Gilles de la Tourette 60 years later as first example of “maladie des tics” (renamed Tourette’s Syndrome by his mentor, Charcot) (Kushner, 10-11).

Pierre Bretonneau groups cases of angina maligna and cases from 1818, 1825, and 1826 epidemics of “malignant sore throat” as diphthérite, identified by characteristic pseudomembrane in pharynx, larynx, or both; croup (usually combined with malignant sore throat in early 19th century) and diphtheria held to be one and the same (Hammonds, 19). He called it diphthérite, from the Greek word for “leather” or “hide,” which described the pseudomembrane in the throat.

Richard Bright published Reports of Medical Cases, linking “dropsy” (accumulation of fluid in the tissues = Bright’s Disease) with shriveling of kidney and albumin in the urine: “His work built an alliance between bedside observation, anatomical dissection, and chemistry.” Albumin test “the harbinger of further application of chemistry to medical diagnosis” (Reiser, 127-28).

William Burke and William Hare murdered between 16 & 23 Scots and sell their bodies to anatomy professor Robert Knox  burking = murder, usu. By suffocation, to effect sale to anatomists (Washington, 182).

word “tuberculosis,” derived from the name of the anatomical lesion that typifies the disease, coined by Johann Lukas Schönlein: “It arose as part of the reformulation of disease naming – from symptom-based to lesion-based terminology – that had been unleashed by Laennec’s discovery (Duffin, 155).

Rostan coins the word organicism (Duffin, 272). His “confident optimism that organic lesions would eventually be found for all diseases ended discussion of diseases still awaiting their anatomic correlative: functional illness was not (yet) disease” (299). Laennec’s “apparent vitalism” “represents a repudiation, or at least a mistrust, of the reductionist language that auscultation had generated” (301). He “refused to endorse the narrow extrapolation of organicism, which reduced the unknown essence and cause of disease to the physical change. Organicism was refuted by the stories of his patients and by the psychic or unknown causes of their illnesses, which were being neglected in the overenthusiastic application of his own anatomical method” (302).

George Stromeyer (Hanover) refines and then popularizes tenotomy to treat clubfoot (use of tenotome to divide tendons & fascia without traumatizing other structures of ankle and foot) (Linker, 41).

Passage of Britain’s Anatomy Act, legalizing medical dissection and making pauper bodies available for medical research should no one claim them (Truax, 25).

In “On Some Morbid Appearances of the Absorbent Glands and Spleen,”  presented to Medical and Chirurgical Society in London, physician and pathologist Thomas Hodgkins presented findings from seven cases of enlarged lymph nodes and spleen – three patients of Richard Bright and Thomas Addison and one of Robert Carswell – but without inflammation or other significant pathology. He noted that the disease spread to contiguous lymph node groups, with spleen involvement a later development  Hodgkin’s disease, the term first used by Samuel Wilks in his 1865 article, “Cases of Lardaceous Diseases and some Allied Affections with Remarks” (M. Stone; Lakhtakia & Burrney; A.M. Kass & E. Kass , 207ff.).

First interpretation of heart sounds as products of valve closure in thesis of Joseph Rouanet (Duffin, 200; D. Smith, 143), though his theory was not accepted immediately.

Justus von Liebig publishes paper on synthesis of chloral hydrate, though its sleep-inducing effect was only pointed out in 1862 by German physician Johann Liebreich.

Marshall Hall publishes paper describing reflex function, i.e., the reflex arc (Schiller, 79-80).

Louis, father of the numerical method, publishes his Recherches sur les effets de la saignée dans quelques maladies inflammatoires, which analyzed effects of bloodletting at different stages of pleuropneumonia, erysipelas of the face, and angina tonsillaris and raised questions about its indiscriminate use. James Jackson translated the work and added his own observations of his use of bleeding in 34 cases of pleuropneumonia in Boston (Cassedy, 74). Pliny Earle followed with study of bloodletting in American asylums, and from his own cases at NY’s Bloomingdale Asylum, “that the decreased use of bleeding had been accompanied by an increase in the number of cures” (75).

By 1835 Becquerel and Breschet had established  the mean temperature of a healthy adult as 37 °C  (98.6 °F).  By the 1860s, the use of the thermometer had become more common, and the physiological significance of body temperature was becoming clearer (Grodzinsky & Levander).

Thomas Watson (London) discovers situs inversus in post mortem of John Reid, reported to London College of Physicians in May, 1836 (McManus, 1-4).  First use of bromine (bromide=bromine and salts) by French as sedative.

William Jeaffreson, a provincial surgeon from Framlingham, performs first successful ovariotomy in England (Schachner, 194; Shepherd[2], 41-42).  First successful ovariotomy in London not until 1842 (by Frederick Walne), and first in London hospital not until 1846 (by Caesar Hawkins) (Schachner, 197; Shepherd[2], 47, 49).  Prior to 1840s and even after ovariotomies were performed, physicians frequently tapped ovarian tumors through abdominal wall using a trocar. They then drained fluid from the tumor out through the peritoneal cavity (McGregor, 161).

James Simpson, following training in pathology at Edinburgh Univ. with John Thomson, switches to midwifery and publishes paper on hermaphroditism, with a formidable bibliography “including Latin, Greek, French, Persian, Sanskrit, and American sources” (Simpson, 74).

Publication of Wm. Stokes’s Diagnosis and Treatment of Diseases of the Chest, which built on Laennec, included an exhaustive discussion of bronchitis as a key to thoracic pathology, and propounded use of stethoscope as an aid to detecting foreign bodies in the air passages (Stokes, 64-72).

James Paget bides time as medical writer for Medical Gazette and Quarterly Review (Paget, 72-77).

Josef Skoda (Vienna) published authoritative book on percussion/auscultation that subjected Laennec’s teaching to criticism:  “Using experiments, he traced many of the sounds heard in auscultation and percussion in their physical origins, and demonstrated that each sound was characteristic of a specific physical alteration that could have been produced by any one of several causes, but was not necessarily distinctive of a specific disorder.  Accordingly, he disagreed with many of the specific signs of disease and the causal explanations Laennec had advanced for them.” His research was ignored in Britain and US until 1850s (Reiser, 39).

Charles Goodyear perfects process of vulcanization, patented in 1844. It ushered in the era of false teeth for the masses beginning in the 1850s, as dentists used Vulcanite to make denture bases.  Patent on Vulcanite dentures expired in 1881 (Wynbrandt, 166-170).

Publication of Samuel Morton’s Crania Americana, which argued that Caucasians had the largest skulls and hence possessed the greatest intellectual capability, where Blacks were the “lowest grade of humanity.”  It “advanced scientific racism and served as a justification for slavery.”  His theories were taken up by Ira Russel and other USSC physicians and used to understand differences in Black and white mortality during the Civil War:  “They applied a polemical theory to help understand a medical crisis.  They upended the growing medical trend to focus on external factors as the cause of disease spread . . .    Unlike their British counterparts, they turned to craniology as part of their so-called sanitary method, infusing a well-established racial tradition into the work of the federal government’s effort to protect the health of soldiers” (Downs, 131).

Simpson, at 28 and relying on his publications and the international commentary they elicited, elected to Professorship of Midwifery at Edinburgh by one vote (Simpson, 80-85).

Establishment of first professional scientific society in U.S., Association of American Geologists, which became the American Association for the Advancement of Science in 1847, led by Louis Agassiz and Benjamin Peirce.  National Academy of Science followed in 1851: “Simply by providing an occasion for meeting and talking together, the two organizations helped crystallize a pecking order among the nation’s scientific men. . . . Furthermore, the existence of these two overarching professional structures facilitated the formation of collegial networks of men working on closely related, specialized problems” (Haskell, 68-74, quoted at 73).

Jacob Henle, Koch’s teacher, publishes “ “Of miasmas and contagions and of miasmic-contagious diseases,” which propounded an idea of contagion far ahead of its time.  “Henle believed that disease was caused by seeds or germs, which were living animate beings.  These entered the system through mucous membranes, the alimentary canal, and broken skin.  Inside the body they increased rapidly, a fact verified by the period of incubation after exposure to the disease.  Henle thought the germs were probably plant parasites or fungi, of which different varieties produce different disease” (Allen, 501-02; P. Kazanjian, Intro). In late 1840s, textbooks by George B. Wood and Alfred Stillé, both of University of Pennsylvania, contained the animalcular hypothesis of disease, presenting it to readers as a possible explanation of disease (Allen, 509-10).  John K. Mitchell (also of Phila) propounded an influential animalcular theory that diseases were caused by fungi in 1849 (Cryptogamous Origins of Fevers) (511-12).

Jacques-Joseph Moreau published his first article on Cannabis indica; his monograph, Du hachisch et de l’alienation mentale followed in 1845 and launched “the systematic study of the psychological action of psychotropic drugs, which became a model for later research in experimental psychopharmacology and psychopathology. . . . Moreau defined an essential underlying assumption of psychoactive drug research, later described as the ‘psychotomimetic’ view of the effects of psychoactive drugs: namely, the identity of the psychological nature of the delirium in both insanity and drug intoxication” (Snelders, Kaplan & Pieters, 100).

James Simpson’s series of articles in Edinburgh Med. & Surg. Journal, argues that the leprosy of the ancient and medieval periods was identical to that of the present, and that “the elephantiasis of the Greeks, the Arabic juzam, the lepra of the Latin translators, the simple leprosy of the Middle Ages and the tubercular leprosy of modern European medicine once more become one and the same disease” (Edmond, 40).

Crawford Long first operative use of ether via inhalation to remove two neck tumors from James Venable; James Braid discovers hypnotism (“nervous sleep”) in Manchester and employs it during confinements (Fulop-Miller, 99-105; 360-62). Charles Clay of Manchester performs his first successful ovariotomy via the long incision and long ligature and is criticized by Liston and others (Shepherd[2], 42-45).

Gabriel Andral publishes Pathological Hematology, charting abnormal variations of blood’s constituents during disease via chemical reactions and microscopic analysis.  He determined proportions of blood’s elements to each other and constructed a numerical portrait of blood’s appearance.  Alfred Becquerel’s did the same for urine in 1841, estimating the quantity of water, urea, uric acid, lactic acid, albumin, and inorganic salts (Reiser, 129-32).

Oliver Wendell Holmes reads his paper on “The Contagiousness of Puerperal Fever” to the Boston Society for Medical Improvement, attacking the authorities of his day, esp. Charles Meigs of Jefferson Medical College (Nuland, 51056). Establishment of “Collegiate System” at St. Bartholomew’s with Paget as first “Warden” (Paget, 122-130).

Joseph Lister arrives at University College London to begin Arts degree, after which, in 1846, he begins medical studies; observes Robert Liston’s first operation with ether on 21 December 1846. Began hospital training at University College Hospital and soon contracted mild case of smallpox that unnerved him and led to serious depression. Lister withdrew from UCL in March, 1848, treated himself via Naturopathy with retreat to rural Ireland, then returned to UCL in 1849 restored and recommitted to surgery.  Assigned dresser to senior surgeon John Eric Erichsen.  Received bachelor of medicine with honors in 1852, when he becomes Fellow of Royal College of Surgeons and house surgeon at UC H.  In 1852, he passes exams at Royal College of Surgeons; 1853, not sure of surgery (again), so becomes physician assistant to Walshe; Sept 1853 off for his European tour, but gets waylaid at Edinburgh Royal Infirmary under James Syme, becomes Syme’s House Surgeon in 1854.  Accepts Regius Professorship of Clinical Surgery at Glascow University in 1859, though only granted privileges at Glascow Royal Infirmary in 1861, where he remained preoccupied with how poisonous matter got from wounds into the veins.   Then in 1869, following Syme’s stroke, he is offered and accepts Syme’s professorship at Edinburgh.

Karl von Rokitansky appointed director of pathological anatomy at University of Vienna (Nuland, 70-72).  Founding of Association of Medical Superintendents of American Institute for the Insane (AMSAII) and their American Journal of Insanity.

James Simpson suggests to Charles Clay of Manchester (a pupil of Lizars) that the generic term “gastrotomy” be replaced with “ovariotomy” (Schachner, 198).  Lister enters University College of London (Truax, 24). Charles Jackson introduces Thomas Morton to chloric ether (distillation of chloric acid and alcohol), used by Boston medical students in “ether frolics,” which Simpson used in summer of 1844 to desensitize tooth of a dental patient (Simpson, 114-115).  14 October 1844: Morton anesthetizes John Warrens patient for removal of vascular tumor from neck (117-18).

Simpson reportedly coins term “ovariotomy” (Simpson, 225)

Yellow fever  epidemic on Boa Vista, one of the  Verde islands off coast of W. Africa, then governed by Portuguese.   James McWilliam’s report of 1846 blamed epidemic on British ship Éclair for bringing the “remittent fever” to the island, which worsened (e.g., the “black vomit”) among British sailors and island residents after ship’s arrival. Military physician James McWilliam’s report of 1846, based on over 100 carefully and neutrally conducted interviews among all island residents –  washerwomen, military guards, townspeople of all races, free and  enslaved – “reveals how slavery and imperialism advance epidemiological practices” and “helped to solidify the interview as a fundamental method in epidemiological analysis” (J. Downs, 53, 62-63, 67, 74).  The report also incorporated observations on the geography, geology, climate, and anthropology of the locations visited along with statistic on the men who became ill and died”  (54).  Re racial difference, “he was more concerned with the influence of climate and environment, not physiology, of the African people” (55). McWilliam was wrong about the transmission of yellow fever (viz, by fleas not person to person), but his interview methodology became “a fundamental practice in both public health and epidemiology” (65).

AMA establishes its code of ethics, which includes its “consultation clause.”  During the Civil War, the Army Military Board prohibited homeopaths from serving as army surgeons (M. Kaufman, 104).  In 1903, AMA revised its Code of Ethics, allowing members greater freedom in consultation admitting to membership eclectics and homeopaths, providing they ceased using those titles (Haller II, 272-275).  104

Semmelweis eliminates puerperal fever in obstetric wards of Vienna’s Allgemeines Krankenhaus; flees Vienna in 1850; died in asylum in 1865 from puerperal-fever infection in right hand (Walker, 70-73; Simpson, 211-214).

Marion Sims conducts surgical experiments on as many as 11 (slave) patients residing at his clinic in Montgomery, AL in search for surgical cure of vesico-vaginal fistula. (Obstetric fistulas resulted from obstructed labor, misshapen pelvis resulting from poor nutrition or rickets; use of pessaries, etc. [Schwartz, 234-236]).  Sims’ innovations included development of duckbilled speculum, the sigmoid catheter (to drain off urine while the surgical wound healed), and silver suture (McGregor, 47-54; Schwartz, 237-240).  The ultimate benefit of using infection-resistant silver sutures was counterbalanced by the “savage medical abuse” to which he subjected his original 11 slave subjects, with the first, Anarcha, receiving 30 surgeries over the 4-year period.  The fact that the surgical benefits of his discovery were unfairly distributed was a violation of distributive justice: “One danger of violating distribute justice is that this tends to perpetuate social inequality , and this is exactly what has happened with vesicovaginal fistula” (Washington, 100). “He never felt the need to anesthetize his black patients in Montgomery.  White women with vesico-vaginal fistulas who came to Sims in 1849, to have what finally had become viable surgical therapy, were unable to withstand the same operation without anesthesia.  Through his medical career Sims maintained a class-bound [actually a racist] prescription for the use of anesthesia with an unspoken premise that those women in the wealthy tier were by far the most vulnerable to pain” (51; cf. Schwartz, 231; Washington, 94  -96, ).  “Imprisonment” was Sims’ metaphor for control of his enslaved  experimental subjects.  He addicted them to morphine, but refused to administer it during his surgeries, giving it only after the surgery to ease recovery (Washington, 95-96). Sims avoided writing about his reliance on slave subjects; in his big article on vesico-vaginal fistula of 1852 he described the slave women “in typically ambiguous and indirect language” (59). . . . Even in his extensive use of woodcuts for illustration, Sims evaded the issues of slavery and race by portraying his patients as white even when they were African America” (60).  . . . in retrospect, Sims attributed his four-year preoccupation with perfecting a treatment for vesico-vaginal fistula as a reflection of his concern to find relief for women.  He had forgotten his original distaste for treating female disorders and now chose to practice only among the white women of the upper and middle classes” (61).  Sims’ former student, Nathan Bozemen, who operated with Sims, improved his  technique via his button suture (vs. Sims’ clamp suture) (Schwartz, 240-242).  He claimed that fewer than half of Sims’ slave subjects gained relief from the four-years of experimental surgeries (Washington, 97).

Eliz. Blackwell begins attending first of two four-months series of lectures at Geneva Medical College, after unanimous vote of student body to admit her (they thought it was a joke).  She spends six months between terms at Phila’s Bleckley Almshouse (later, PGH), where her room was right off women’s syphilitic ward.  Graduated 1st in class in 1848 with thesis, subsequently published, on (epidemic) typhus (ship fever).  Then back to Phila where she attended lectures at Jefferson, then off to Paris in 1849, where she resumed student status to study midwifery/obstetrics at La Maternité, France’s largest public maternity hospital, where she contracted purulent ophthalmia from an infant delivered from a gonorrheal parturient, with left eye surgically removed in 1850.   Then to St. Bartholomew’s Hospital in London, where she was mentored by James Paget and befriended by Lady Byron and Florence Nightingale.  Returns to NYC in 1853 and begins practice (with few patients) and opened New York Dispensary for Poor Women and Children in 1854, the same year her sister Emily Blackwell graduated from Cleveland Medical College. After graduation, Emily set sail for Edinburgh to attend James Young Simpson and learn ob/gyn.  Simpson’s surgical treatment of her cousin Marie’s cervical prolapse practically killed her.

James Paget, age 33, elected Assistant Surgeon of St. Bartholomew’s Hospital and Professor of Anatomy and Surgery to Royal College of Surgeons (Paget, 135-138), though he had yet to do a single operation in private practice (155).  Semmelweis begins his two-year appointment as assistant in obstetrics at Vienna’s Allgemeine Krankenhaus (Nuland, 83ff.).

Founding of American Medical Assn. at convention at Phila. Academy of Natural sciences, with Nathaniel Chapman, University of Pennsylvania’s senior medical professor, unanimously elected president (Corner, 97-98).

Edward H. Barton first military surgeon to use general anesthesia (ether) in combat in Mexican-American War (Connor; Aldrete, et al.).

Second cholera epidemic moves from India to Russia to Britain, reaching London in September (Hempel, 111ff.).   In Jamaica, anticontagionists Gavin Milroy, sent by British Colonial Office to investigate, blamed the epidemic on poor sanitation, overcrowding, poor ventilation, viz, “’an impure or contaminated state of the atmosphere,’ arising from decomposing material and human respiration. . . . The function, format, and genre of colonial recordkeeping was in dialogue with sanitary reform efforts in the metropole,” e.g., Milroy’s correspondence with Edwin Chadwick  (Downs, 80-82, quoted at 82).

First meeting of American Assn. for Advancement of Science in Phila, which grew out of the Association of American Geologists and Naturalists (founded 1840) (Fye, 170, 178).  Elisha Bartlett publishes Enquiry into the Degree of Certainty in Medicine, “the best-known assessment of the certitude vouchsafed by a thoroughgoing program of empiricism. . . . Bartlett’s treatise was an assertion that French medical empiricism was more than merely an elite bludgeon for system bashing; it would lead to positive medical knowledge, to enduring truth” (Harley, 248).

In U.S., beginning of “modern spiritualism” with unexplained rappings of the Fox sisters in Hydesville, NY, criticized (as to somnambulism and trance) by William Hammond and George Beard in the 1870s (Brown II).

English physician Alfred Garrod discovers gout caused by excess uric acid; hence gout is a type of arthritis (Storey).

Louisiana’s Samuel Cartwright, one of the south’s great exponents of “Negro medicine,”” publishes The Diseases and Physical Peculiarities of the Negro Race, a compendium of racist “science” arguing, inter alia: Cranium of blacks 10% smaller than whites; blacks have different breathing apparatus and skeletal structure than whites; listing of imaginary “black diseases,” “whose principle symptoms seemed to be a lack of enthusiasm for slavery” (Washington, loc 606-675).

Marion Sims’ first successful operation for vesico-vaginal fistula (published in 1852) via use of vaginal speculum he invented and silver wire sutures (Marr, 10-11; M-S2, 93-94).

Worthington Hooker publishes the only 19th c. monography by an American on medical ethics.  He discussed the natural influence of the mind on disease, esp. the role of hope in treatment:  “The care of the body therefore should always be accompanied should be neither a groundless optimism nor, as it had been in the past, a manipulative effort to deceive the patient.  Precisely in this way, the hope ministered by the physician differed from that exerted by the quack” (Lavi, 52-53).

Establishment of Epidemiological Society of London, which signaled official recognition of epidemiology.

Publication of Lemuel Shattuck’s Report of a General Plan for the Prevention of Public and Personal Health, “the most famous document of the American public health movement,” proposing establishment of general board of health and local boards of health to supervise implementation of comprehensive sanitary measures” (Ellis, ch 1).  1856-60:  Four successive national conventions on sanitary reform and quarantine regulations following outbreak of yellow fever in south in 1850s led to formation of United States Sanitary Commission in 1861 to assist union army medical dept and provide medical services for Union soldiers (Ellis, ch 1).

Founding of Epidemiological Society of London.

Establishment of Women’s (originally Female) Medical College of Pennsylvania, whose graduates were only recognized by the state medical society in 1871 (M-S, 49, 76-8; Peitzman, 9-13).  Royal Medico-Chirurgical Society of London debates and totally denounces ovariotomy via Robert Lee’s paper analyzing 162 operations for ovarian tumors in Great Britain (Shepherd[2], 50-51); Shepherd, 37).  John Snow administers chloroform to Queen Victoria during labor with her eighth child (Hempel, 103-104). Semmelweis, denied reappointment as assistant in obstetrics at Allgemeine Krankenhaus in 1849 and denied access to cadavers for teaching as a Docent in midwifery, flees Vienna to Buda-Pest (Nuland, 125ff.).

Opening of Univ. Michigan Medical School which, however, had no hospital for 27 years, making due with Wed. & Sat. afternoon consultations conducted by surgeon Moses Gunn (Vaughan, 190-91, 95-97).  In 1877, wooden pavilion hospital opened” “When built it was understood that this hospital would become so badly infected within ten years that it would be necessary to burn it” (203).

Paul Broca, then a 25-year-old anatomy professor, wins Académie de Médicin’s Prix Portal on the question of cancer with his monograph (pub. In 1853) on cancer, viz, a detailed description of malignant neoplasm spreading by venous channels, but which held, mistakenly, to Johannes Müller’s 1838 blastema theory of cancer cell origin (i.e., that cancer cells arise from budding elements, a noncellular soup (blastema) between normal tissue, not from other, normal cells, per Virchow, whose famous aphorism -- “omnis cellula e cellula” -- was given in 1858) (Schiller, 62ff).

Germans von Bärensprung and Traube begin to use temperature signs as basic data to diagnose diseases, predict their course, and determine treatment (Reiser, 115).

European nations establish International Sanitary Commission in Paris  (absent U.S.) to observe and monitor cholera and other infectious diseases beyond national borders, esp. at eastern borders of Europe.   “Chief among their concerns was to identify the beginnings of an epidemic and enact the necessary quarantine measure to prevent it from entering Europe,” though there was controversy over usefulness of quarantine, e.g., by Britain.  Quarantines were ultimately endorsed for plague, cholera, and yellow fever (Downs, 173-74).

Helmholtz invents ophthalmoscope (Stevens, 100).  Arthur Leared designs the binaural stethoscope essentially in use today (Reiser, 41,43).George Camman of New York invents the binaural stethoscope and sends one to Austin Flint (D. Smith,141).

Sims’ paper on vesico-vaginal fistula repair published in JAMA; “it made his national reputation” (Washington, 96).

Establishment in NYC of The Jews’ Hospital, renamed in 1866 the Mount Sinai Hospital.  Bernard Sachs appointed consulting neurologist in 1893 and Attending Neurologist and head of Neurological Service in 1900 (Stein).

Lister receives B.M. and made FRCS of England; off to study with James Syme in Edinburgh; marries Syme’s daughter, Agnes Syme, in 1856 (Truax, 39, 42ff.).

Britain replaces Madhouse Act of 1774 with the Lunatic Asylum Act, “to detain and house a bewilderingly diverse range of people. . . . children and adults, violent criminals, epileptics, people with tuberculosis and other diseases, alcoholics and women with menstrual problems.  All the conditions would eventually be the target of eugenic purification in Germany, America and elsewhere” (Rutherford,   55).

New Orleans’ worst yellow fever epidemic, with ca. 12,000 deaths, followed by at least 3,000 the  following year, 2,600 in 1855, and 5,000 in 1858 (Olivarius, 86).

First two successful hysterectomies for fibroid tumor performed by Walter Burnham of Worcester Medical School and Gilman Kimball of Lowell, MA. (Barr, 113); Queen Victoria’s use of chloroform, administered by John Snow, during labor with her 8th child, Prince Leopold, breaks opposition to chloroform during confinement (Caton, 26-28, 63; Fulop-Miller, 341-42; Simpson, 155-57; Newson, 869), though this general claim is belied by lack of attention in lay press and failure to alter entrenched opposition to anesthesia in childbirth (Connor & Connor, 1996). Cholera epidemic in Edinburgh (Simpson, 199). Passage of Britain’s Vaccination Act, instituting compulsory vaccination against smallpox (all infants to be vaccinated within first three months of life, in default of which parents liable to fine or imprisonment), the compulsory aspects of which were extended under the Vaccination Act of 1867 (Porter & Porter)

Alexander Wood (Edinburgh) invents hollow needle for subcutaneous injection; Charles Gabriel Pravaz invented hypodermic syringe, with which to administer Sertürner’s morphine (Fulop-Miller, 353-55; Caton, 75). Simpson, in presidential lecture to Edinburgh Medico Chirurgical Society, pronounces silken thread surgery’s greatest advance of the past 50 years (Simpson, 208).  Karl Vierordt introduces the sphygmograph (Evans, 787).

Crimean War, Russian medical advances during: Professor N.I Pirogov, a volunteer field surgeon, introduced plaster cast for setting fractures, devised an osteoplastic method for amputation; his “Pirogov Amputation”, a relatively conservative approach, significantly increased survival rates, as did his innovation of the plaster cast, first used successfully in the Sevastopol campaign (Chan Kai Der & Nubari). Pirogov also introduced ether and chloroform anesthesia into field surgery, having introduced both ether and chloroform anesthesia in Russia in 1847, following investigation of the clinical course of ether anesthesia on himself and his assistants (Hendricks, et al.). Contrary to observations of British and French physicians, Pirogov did not believe that anesthesia increased likelihood of mortality (e.g., acute cardiac death), surmising that the deaths they reported resulted from too rapid and too excessive administration of chloroform.

Sir Alfred Baring Garrod described first clinical chemical test, his famous “thread test,” a semiquantitative method for measuring uric acid in blood or urine. That is, the thread test demonstrated that most of his gouty patients were hyperuricemic. The test revealed small quantities of uric acid around the thread in normal persons and patients with gout. Garrod went on to demonstrate the presence of urate deposits in the articular cartilage of patients with gout. It was these deposited urate crystals that cause gout inflammation (Nuki & Simkin; Iglesias; Hickman).

Eliz. Blackwell establishes New York Dispensary, though, with few patients, she ends up giving lectures on girls’ development and doing social work; in 1868, she and her sister Emily found Women’s Medical College of the New York Infirmary, meeting highest standards of medical education (M-S, 72-76).

On 4 November, Florence Nightingale arrives at Barrack Hospital in Scutari, which housed over 2,300 men, comparing her reformist efforts to the work of Christ (Downs, 92).  Her nursing work with wounded soldiers  “overshadow[s] her work in public health and epidemiology . . . she was an epidemiologist, based on her efforts in disease prevention, sanitation, theories of disease transmission, and the development of civil engineering practices, particularly her efforts to develop blueprints for hospitals. . . While doctors like Gavin Milroy and James McWilliam emerged as leading epidemiologists in the first part of the nineteenth century, Nightingale became a key theorist in the study of disease in the second half of the century” (93).

Manuel Garcia, Spanish singing teacher living in London, invents laryngoscopy (Stevenson [2], 30-31).

Karl Vierordt introduces the sphygmograph, which produced pulse training by connecting pen and revolving drum device to an artery noninvasively, via a spring pressed on the artery; it was refined and rendered usable in 1860 by Etienne-Jules Marey, which greatly simplified Vierordt’s design via a level with one end resting on a pulsating artery and the other connected to a pen that left tracings on a rotating drum (Reiser, 101-102).

Sims’ Woman’s Hospital opens in NYC as a charity hospital (Marr, 22), albeit staffed entirely by men (Nimura, 195). Following a state appropriation of $10K the following year, it became the Woman’s Hospital of the State of New York (McGregor, 69). Impetus came from philanthropic women reformer, led by Sarah Doremus, for whom the hospital was part of a moral, Protestant mission allied with sanitary reform (McGregor, 69-72). Thirty women formed the original Board of Managers; male Board of Governors for the new facility completed in 1868; “Serving women of the middle classes as well as poor women was a given at the institution (79). . . . Some have asserted that medicine had gained a stronger authority even before scientific practice – that is, laboratory science – was integral to the practice of medicine.  The Woman’s Hospital is one such example.  It used relatively modern medical practices, including clinical treatment and specialization, even before the implementation of scientific medicine.  Neither anesthesia nor antisepsis were yet in use when the Woman’s Hospital opened. . . . Still the hospital in its early years used many surgical therapies and admitted a high percentage of patients from the middle classes” (82). Sims understood his treatment of vesico-vaginal fistula and the creation of the hospital as “a kind of religious mission” (95).  He argued that “it was the hand of God that propelled him to success.  Hence, he came to see his work in gynecological surgery as having a divine origin” (97). Sims’ assistant surgeon, Thomas Addis Emmet, a southerner from Virginia, was a strong proponent of Irish rights who graduated from Jefferson Medical College in 1850 (100-101). Elizabeth Blackwell countered with her lecture/pamphlet, “On the Medical Education of Women,” foundational to her NY Infirmary for Indigent Women and Children, which opened in 1857 with support of Florence Nightingale, Henry Beecher, and Horace Greeley (Nimura, 196-203). Marie Zakrezewska was the attending physician and sister Emily performed the surgery.  Elizabeth back to England in fall of 1858 for lecture tour to raise funds, declines to administer Nightingale’s fund, and was tempted to stay on and open Women’s Hospital there.

William Gibson retires Univ. of Pennsylvania chair of surgery.  George B. Wood opposed Samuel D. Gross as Gibson’s successor; Gross thereupon refused Penn nomination and received and accepted appointment to Jefferson Medical College, “where for 28 years he ranked as the leading American surgeon” (Corner, 105-106).

Edict by dean of faculty of Paris Ecole de Médicine suppressed all teaching by internes of private clinical courses. This made singularity of Paris for postgraduate study by Americans less self-evident at same time as American society was paying increased attention to German culture: “By 1855, then, there was growing awareness that if anything threatened to impede access to private clinical instruction in Paris, there might be equally attractive opportunities on the other side of the Rhine” (Warner, 300-301). As Americans shifted to Vienna in the 1860s, they absorbed common German practice of referring to living patients, not just cadavers, as “material.” “And some, a miniscule minority upon whom the lion’s share of historical attention has been lavished – set off to Germany for scientific study in the experimental laboratory.  But what most American physicians wanted from Germany was the same kind of ready access to bodies and practical clinical instruction (for which they expected to pay) that for so long had drawn them to Paris” (305).

By end of year, ovariotomy had been performed 97 times with 54 successes in U.S.; 123 times with 71 recoveries in England; 47 times with 13 recoveries in Germany; but still “unmercifully condemned in the first city of France” (Schachner, 177), where it was first advocated by a French surgeon, Nelaton, in 1861 (179).

Publication of Paul Broca’s On Aneurysms and Their Treatment (931 pages in length), “one of the last books in the classical manner as well as one of the first modern monographs on a relatively limited subject.”  Broca added novel concept: Broca’s “active [i.e., good, hard fibrous, organized thrombus] and passive [i.e., soft product of mere clotting] clot.”  He hailed Bellingham’s “indirect compression” – bearing down on the feeding artery through the intact tissues to produce an “active clot” through decreased blood flow to the lesion (Schiller, 106-110; quotes at 107).

Ann Preston becomes Dean of Women’s Medical College: “she devised a strategy for women physicians to assert a professional credibility while maintaining their conventiona1 gender identification” (Wells, 62); her “crossed-dressed rhetoric consistently refunctioned the tools of the domestic sphere as the proper apparatus of professional medicine (66) -- a sphere in which “the doctor is the manager of daily life, the teacher of good habits (67).

Abraham Jacobi and colleagues establish the German Dispensary of the City of New York in the Kleindeutschland district on Manhattan’s lower east side.  There Jacobi implemented his Virchowian ideology (= all children enter world as physiological equals) and developed pediatric medicine (Bittel, 159-61).  Elizabeth Blackwell, aided by sister Emily and Marie Zakrezewska, open New York Infirmary for Indigent Women and Children, staffed solely by women and supported by Florence Nightingale, Henry Ward Beecher, and Horace Greeley (Nimura, 196-203).  Zakrezewska was resident physician and ran the place, with Emily performing the surgery.

Charles Locock introduces bromides and reports results in treatment of women with catamenial or hysteriform epileptic seizures; in 1897, Neil Macleod carried out first “sleep cure” (“the bromide sleep”) with bromides (López-Munoz, et al., 330).

Spencer Wells (London) performs his first ovariotomy (using his  exteriorization method to cut down risk of peritoneal infection), leading to a revival of the operation (Shepherd, 37; McGregor, 160). Reported on first five cases to RMCS in 1858 and argued that the pedicle should be exteriorized; by end of 1862, he had reported 50 cases with 33 recoveries and had overcome the critics (Shepherd[2], 37, 55-59).  Johann Czermak (Budapest) develops first practical laryngoscope (Stevenson [2], 32-33).

Passage of Medical Act in Britain, which established General Medical Council, which compiled a nation-wide medical register and a National Pharmacopoeia (Simpson, 224; Stokes, 169).

Publication of Nightingale’s Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army: “Her primary concerns, sanitation and the development of preventive methods, are the major tenets of modern public health .”  An adherent of miasma theory, she held that the few small openings in the Barrack Hospital provided “no way for the ‘hot and foul’ air to escape,” adding that during first seven months of the Crimean campaign, “mortality exceeded that of the plague of 1665 as well as that of recent cholera epidemic” (Downs, 96-97).

Virchow’s Cellular Pathology “put an end to the last vestiges of humoralism.  In doing so, however, Virchow undermined the foundations of constitutional pathology by arguing that, for the future, pathology must abandon all prior theories founded upon diathesis and dyscrasis and, instead, rely on histology” (Haller, 13).

Debate on “spontaneous generation” between Pouchet and Pasteur; Pasteur wins with Academy lecture and is elected to Academy in 1862 (Olmstead, 122-23).

Publication of both Darwin’s Origin of Species and Claude Bernard’s Lectures on the Liquids of the Organism. According to the latter, blood as “internal environment” mediating between life of organism and its external environment (Olmstead, 107-08).

Publication of Alfred Garrod’s The Nature and Treatment of Gout and Rheumatic Gout, in which he differentiated patients with gout from patients with arthritis rheumatoid. Here he introduced the term “arthritis rheumatoid,” i.e., rheumatoid arthritis, rejecting terms like “chronic rheumatism” (Herberden) and “rheumatic gout” (Fuller), in order to differentiate the disease from gout and rheumatism. Rheumatoid arthritis was characterized by its difficult control and disabling clinical course (Iglesias, et al.; Hickman).

Austin Flint in New Orleans first hears the loud presystolic murmur at apex of heart known as the Austin Flint Murmur.  Flint called it the mitral direct murmur (D. Smith, 145).

Publication of U.S. edition of Nightingale’s Notes on Nursing, in which she argued that nursing knowledge was gendered and distinct from medical knowledge: it was “everyday sanitary knowledge” of fresh air, warmth, proper ventilation, nutritious diets, exemplary hygiene, and calm environments that all women were responsible for (D’Antonio, 6-7).

Lister off to Glasgow as Regius Professor (Truax, 57ff.), where he adopted James Symes’ method of wound treatment: pads of folded lint along sides of wound and a piece of lint over wound to absorb discharges (Walker, 78).  Claude Bernard’s physical breakdown (Olmstead, 114).

French Empress Eugénie travels to Edinburgh to see Simpson for vesico-vaginal fistula following stillbirth two years earlier when she was 19. Marion Sims, then visiting Europe, performed successful surgery in Paris, though the Empress nearly died from chloroform overdose (Simpson, 237, 242-244).

Paul Broca presents case (and brain) of Leborgne (aphasic for 21 years prior to death at 51) to Paris Société d’Anthropologie and determines, via autopsy and clinical inference that “this primary clinical symptom coincided with that primary anatomical lesion in the frontal lobe” [Schiller, 186] , and that the “third frontal” convolution (inferior frontal gyrus) was the seat of aphemia [aphasia] (Schiller, 177-186).  In his second case presentation of Lelong, also of 1861, his belief in localization by convolution was strengthened, “for this time the lesion “ was clearly confined to the second and third frontal convolutions, with the latter more affected than the former, and in a portion of their posterior third’” (188). Semmelweis finally publishes long overdue exposition of his Lehre, Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers (Nuland, 153).

On June 13, Lincoln creates U.S. Sanitary Commission, of which Frederick Olmsted becomes Executive  Secretary (Rutkow, 66-81; Humphreys, 103-151). Initial meeting was called by Elizabeth Blackwell in NYC to create interface between women’s charity groups and Union Army sick (Humphreys, 103); through USSC, women supplied bedding, clothing, and food (fruit & vegetables).  USSC had its own system of medical supply depots with its own transportation (Humphreys, 120-126). Other USSC activities includes distribution of educational pamphlets; medical inspection of regimental camps; soldier aid stations (boarding houses) for soldiers on furlough; and hostels and hospital directory for travelers, especially to Washington, in search of loved ones (126-129). Through its paid agents, USSC aided in naming the dead (Faust, 110-111).  In fall, 1864, USSC published Narrative of Privations and Sufferings of United States Officers and Soldiers While Prisoners of War in the Hands of the Rebel Authorities following limited prisoner exchange of spring, 1864.  But report covered up conditions in northern prison camps (248, 256-2). One explanation:  it was a campaign document intended to support Lincoln’s reelection by showing southern leadership as too evil for a negotiated peace, as advocated by Democrats and their candidate, McClellan (264). USSC became an instrument of antebellum racism by regarding race as a factor in the spread of disease; this “undermined the sanitary practices that Nightingale had promoted. . . . USSR doctors changed the direction of the early development of epidemiology as a field by resurrecting an outdated theory about racial identity as an explanation for the cause of disease.”  This began with a massive effort to catalogue the height, weight, and other characteristics of both Black and white soldiers . . . (Downs, 122-123).   The comparison of native white, foreign-born, and Black soldiers to explain varying rates of mortality and susceptibility to disease “fed into a larger discourse that used racial differences as a way to justify slavery and other forms of oppression” (123).  It “morphed into an organization that collected data aiming to reify racial difference” (124).

Establishment of Women’s Hospital of Philadelphia, to which location WMC moved in 1862 (Peitzman, 24-26).  Founding of the Philadelphia Drug Exchange  in January to provide a central location for the sale of drugs, which soon became a trade association controlling competition among Philadelphia merchants (Liebenau, 23).

Following placing all medical charities in NYC under the medical board of Bellevue Hospital, Bellevue Hospital opened  Bellevue Medical College.  In NYC, “Bellevue Hospital was of central importance in providing subjects for clinical study and lectures in surgical amphitheaters,” and Austin Flint exerted his greatest impact there (McGregor, 130; D. Smith, 146-147). In 1873, Bellevue was one of only nine American hospitals, out of 178 in the country, that offered organized clinical instruction on a regular basis (147).

Explosion of prosthetic industry, with 133 patents issued for, e.g., the Anglesey or “America” leg, constructed of brass and leather and the Benjamin Franklin Palmer leg (B. Miller).  But only a small fraction of empty sleeves wore artificial limbs, which were painful, ill-fitting, and unpleasant (Jordan, 108-109).

Lincoln signs into law medical reform bill that reorganizes Army Medical Department, accepting some recommendations of Sanitary Commission (appointment of medical inspectors and surgeon general on basis on merit rather than seniority) but not others (enlarged ambulance system controlled by Medical Department, not Quartermaster) (Rutkow, 112).

Construction and opening of Satterlee Hospital (the Union’s General Hospital) in West Philadelphia which, at its peak, had 4,500-bed capacity, with nearly 3,400 patients in May, 1864. Hospital closed 3 August 1865.  Nursing provided by 91 Sisters of Charity.  Most common chronic diseases were wasting diseases (diarrhea, dysentery) and typhoid fever, with outbreaks of small pox and gangrene in 1864 (Humphreys, 164-167).  Tonic treatment for wasting diseases included nourishing food, alcohol, iron compounds, and tonics such as quinine (158).

William Hammond becomes Chief of Medical Bureau of U.S. Army (surgeon general of Union Army).  His early reforms included evaluation of all army surgeons (voluntary and lifers) to strict medical examination boards staffed by elite physicians guided by science and, via Circular 2 of May 21, 1862, establishment of Army Medical Museum.  Museum was widely advertised and open to public, since (1) it was funded by federal government and was to be a “memorial of shared sacrifice” and (2) it attested to the scientific authority and social prominence of the orthodox physician; “in opening up the museum’s collection the war physicians could demonstrate their deeper knowledge of the body and new avenues of medical research that developed through the war” (Devine, 182-183). This meant that the medical department of the Army claimed “ownership” of all military bodies, and used this claim to justify dissections (189, 192-19 3). The diseases that ravaged soldiers’ bodies shaped the projects and directed the specific aspects of scientific medicine; but often the individual soldier had to relinquish ownership and control of his body for this knowledge to be developed” (212-213).

Opening in August of Turner’s Lane Hospital in Philadelphia, where S. Weir Mitchell mentored Morehouse and Keen in study of nerve injuries.

Opening in August of Turner’s Lane Hospital in Philadelphia, where S. Weir Mitchell mentored Morehouse and Keen in study of nerve injuries. “Classifying, diagnosing, and treating these disorders were of equal importance in these first investigations”  Circular No. 6 on reflex paralysis (cases of sudden palsy as a result of wounds in remote regions of the body” (Devine, 140, 145). In addition to gunshot wounds, “They also studied “epilepsy, palsies, reflex paralysis, singular choreas, and stump disorders. Thus within the new specialty hospital very specific divisions or categories were created to study Civil War nervous conditions” (142). Most disorders at Turner’s Lane were functional or psychological, which led to research of functional disturbance that involved cases “that exhibited functional disturbances, such as headache, trance, hysteria, delirium, chorea, reflex spasms, and tetanus, which is where the initial focus lay” (142). Mitchell used electricity to exercise muscles in persons at rest (143), and bore out the discovery of medical benefits of induced faradic current of Guillaume Duchenne (144). “But Mitchell was perplexed about the relationship between loss of motion and loss of sensation, which did not equally damage motor and sensory fibers. This apparent contradiction directed his research . . .” (146-7). Mitchell’s interest in pain as symptom of nerve disorder, with classification of pain as: neuralgic, aching, or burning (148). “The physicians at Turner’s Lane were trying to establish a pattern of symptoms or behaviors that could be linked to specific nervous disorders. They took thousands of pages of notes and compiled statistics using the symptoms of the patients to direct their focus. They were thus able to determine “. . . for example, that both cutaneous and muscular hyperesthesia . . . was not uncommon in wounds of nerve trunks or spinal injuries” (151). After War, Mitchell et al. stayed in touch with their patients, enabling them to do follow-up studies on effect of weather patterns on nervous injuries/stumps, how patients did in life after losing a limb (154-158). He published a monograph with his son John Mitchell in 1897 that recovered present histories of 40 Civil War amputees and discussed ongoing physical and social challenges of living without a limb (157)  development neurology as specialty with a clinical approach pioneered by Mitchell et al. at Turner’s Lane Hospital (157-58). Jacob Da Costa given a ward to study exhausted hearts (“irritable [i.e., rapidly beating] heart” or “soldier’s heart”); he analyzed at least 300 cases of heart disease at the Hospital during the war, and his wartime research  articles on passage of functional valvular disorders to organic valvular disease (irritable hearts could  cardiac hypertrophy); meaning of murmurs; nature of “irritable heart” (result of stress, anxiety, cardiac exhaustion, and debilitation); and effectiveness of various drugs (incl belladonna) to lower pulse (Devine, 158-160).

Battle of Fredericksburg (December) “represented a turning point in the medical treatment of combat casualties. For the first time in a great battle, three cardinal components of military medicine (evacuation measures, supply concerns, and hospitalization needs) were planned and facilitated in advance. Thus the Battle of Fredericksburg is of singular significance to the history of military medicine” (Rutkow, 206). But Letterman’s major misstep was insisting on keeping all wounded on-site for as long as possible, forestalling their evacuation to hospitals in Washington (220). Union troops sustained almost 6,000 wounds of upper and lower extremities, but fewer than 1,200 gunshots to the abdomen, chest, and head (217).

Passage of congressional bill to establishment army ambulance department of men drilled specifically to take care of Civil War wounded (Rutkow, 260); passage of Union’s Enrollment Act (draft) to refill Union army ranks with 300K men following disastrous Union losses at Fredericksburg, etc.  NYC draft riots of July, 1863 (260-264).

Amputation (“empty sleeve”) as badge of honor in Confederacy. Stonewall Jackson’s loses his left arm during Battle of Chancellorsville in May and terms his missing limb a blessing. This set tone for society’s coming to see an empty sleeve as a symbol of worthy sacrifice for the Confederacy, not a mark of shattered masculinity; “no amputation in the Confederacy did more to commend amputees to the public” (B. Miller, 63-64).

Founding of Friedrich Bayer Company; Bayer developed acetanilide, a derivative of coal-tar, as first synthetic antipyretic (fever-reducing) drug (Antifebrin) and then in 1887, Bayer began to manufacture phenacetin, which eventually became more successful as an analgesic-antipyretic agent than acetanilide (A. Jones, 341).

Publication of British undertaker William Banting’s A Letter on Corpulence, first modern diet program written by a layperson and focused on weight reduction as a goal in itself; wildly popular in England and U.S. With sales of 60-70,000 by 1878, it marked beginning of a diet discourse in U.S. that was gendered: “Banting explicitly addressed men. His repeated recommendations for rowing, smoking, and ample use of alcohol put his advice out of the reach of most women of the time. Banting suggested a high-protein diet that promoted lean meat, which then as now was associated with masculinity and virility” (Vester, 42). It was also aimed at the striving middle-class, not the rich; in U.S., dieting “now often referred to as ‘banting,’ was generally interpreted as a positive sign of healthy ambition. . . . Banting and other early diets offered the middle-class male body a specific niche: visibly affluent and physically comfortable, it was a canvas for the display of restraint through dieting” (43). In women’s magazines “There were no suggestions made that the female body itself can be altered, which stands in stark contrast to the body management expected from men. . . . Medical experts commonly stated instead that plumpness was beneficial for pregnancy and childbirth. . . . If doctors urged women to watch their weight in the second half of the 19th century, it was to put on more pounds, not to shed them” (48). . . . Not fashion and not medical experts, but early women’s rights activists were the original voices urging women to use a healthy diet and physical exercise to grow strong” (49). . . . This ‘natural’ [uncorseted] body remained a marginalized beauty ideal through the 70s and early 80s, explicitly associated with strength, health, and the drive for female independence, an ideal that gained more adherents as the suffrage movement gathered momentum in the 1890s, when middle-class women started to make fashionable dress reform and the slender female body” (50). . . . In the 1890s slenderness and mental activity were firmly associated. Overweight was increasingly thought to be a sign of laziness, passivity, and slow wits, all of which were frowned upon by women’s rights activists and increasingly by society in general” (51). . . . [By early 20th century] Female slenderness started to be induced with more conservative messages, such as that women who wish to slim down should do more domestic work (instead of sports or work outside the home). . . . middle-class women were encouraged to seek fulfillment and slenderness in homemaking as an appropriate activity for the new woman. In this context overweight was interpreted as a sign that women were lazy and ‘bad’ homemakers” (55).. . . [By the 1920s] dieting became a widely popular practice among the while middle class. By this time most of the tropes that are connected today with dieting were firmly in place and dieting a widely accepted practice for women” (56).

Morell Mackenzie founded his clinic, “Metropolitan Free Dispensary for Diseases of the Throat and Loss of Voice” in London. James Paget told him “he might as well found a Hospital for Diseases of the Great Toe.” During early years, many cases of chronic laryngeal disease were tuberculous; over 10% (probably underestimated) were syphilis of the throat (Stevenson [2], 35-37).

Glasgow Professor of Chemistry Thomas Anderson introduces Lister to Pasteur’s article, “Researches on Putrefaction” of 1863: putrefaction caused by living ferments (Truax, 85; Walker, 82-84). Spencer Wells mentions Pasteur’s work and its bearing on “purulent infection” at Cambridge meeting of BMA. (Shepherd[2], 76-77).

Pasteur’s lecture at the Sorbonne capping his debate with Felix-Archimede Pouchet over spontaneous generation. He emphasized role of contaminated mercury as source of error in Pouchet’s experiments allegedly demonstrating spontaneous generation (Geison, 119) and rehearsed his famous experiments in which yeast-water was prevented from alteration by denying the access of any atmospheric dusts (120), Ironically, in early 1850s, Pasteur himself attempted to discover experimentally the “cosmic asymmetric force” that was ultimately responsible for life (138-42).

Adolf von Baeyer synthesizes barbiturates (closed-chain ureic compounds), though the synthetic process was developed and perfected by French chemist Edouard Grimaux in 1879 (López-Munoz, 331).

Publication of S. W. Mitchell’s Gunshot Wounds and Other Injuries of Nerves, growing out of Mitchell’s and Keen’s work at U.S. Army Hospital for Diseases of the Nervous System in N. Phila during Civil War. It provided first detailed study of traumatic neuroses and introduced concept of causalgia (burning sensation caused by inflamed nerves) (Rutkow, 254).

Pub of Jacob Da Costa’s Medical Diagnosis, which included a section related to his wartime work on cardiology and went through nine editions (Devine, 158-9). After War, Da Costa’s publications explained value and meaning of murmurs as signs of organic valvular disease; and explored “irritable heart” (stress, anxiety, cardiac exhaustion); and recorded his experiments with remedies (e.g., tincture of gelsemium [yellow jasmine plant], veratrum viride [American hellebore, another plant], belladonna, or tincture of digitalis) to reduce the pulse. Also, “Through his research with his Civil War patients, Da Costa was able to demonstrate that irritable heart could develop into cardiac enlargement and functional heart disease could be transformed into organic heart disease” (159-163).

Opening of New York State Inebriate Asylum, first private inebriate asylum in U.S. advanced by physicians as a medical institution (Tracy III, 107-111); followed by Pennsylvania Sanitarium in 1867. For the private asylums, medical treatment “was more ancillary than primary. . . . in practice, their institutions combined medical and moral reform, harking back to the heroic struggle for manhood, and [they] prioritized an atmosphere of routine domesticity” (112, 113).

Founding of International Red Cross (initially called Committee of Relief for Wounded Soldiers) growing out of Geneva Conference of 1864. U.S. declined to form American Branch in 1866 and did so only in 1883 (Humphreys, 267-270).

Founding of American Social Science Association, with first meeting under sponsorship of Mass. State Board of Charities (Haskell, 91-121). Its prime object was to understand society and to improve it, with implicit assumption “that the social order is fundamentally rational and will reveal itself to the patient inquirer. Beneath the confused surface of events there is a harmonious order, a realm of ‘Truth,’ in which the interests of all members of society blend without friction” (101). Both ASSA and the Board of Charities “were institutional devices designed to invigorate and systematize the collection, dissemination, and evaluation of factual information” (103). “Merely to gather the most elementary statistical data about society,” it was believed in the 1860s, “would, in itself, lead almost automatically to vast social improvement” (102).

Lister, influenced by Pasteur’s papers on fermentation and putrefaction, begins search for effective antiseptic, seeking one that worked prophylactically; lands on tries carbolic acid (from coal-tar; in raw form, creosote, a wood strengthener); he limited his trial to compound fractures after two preliminary failures; achieved success with 8 of 9 cases; then applied “antiseptic system” to abscesses (especially psoas abscesses), then to lacerated and contused wounds  publication in Lancet in 1867 his five-part article, On a New Method of Treating Compound Fracture, Abscess, etc., with Observations on the Conditions of Suppuration (Fitzharris, 162-170).

Semmelweis dies of blood poisoning (pyemia) in Viennese asylum (Truax, 95; Walker, 73; Simpson, 214; Fitzharris, 159ff.); Claude Bernard publishes Introduction to the Study of Experimental Medicine (Olmsted, 131). Mackenzie publishes The Use of the Laryngoscope in Diseases of the Throat (Stevenson[2], 11, 40).

Broca, in debates at Paris Académie de Médicin, following on Bouillaud’s remarks on hand-brain-dominance, argued that specific localization was consistent with the two hemispheres supplementing each other in some measure, thereby “put[ting] forth ideas we associate with a much later stage of aphasiology, ideas about Gestalt, plasticity of the child’s brain, and speech therapy for the aphasic” (Schiller, 198). Debate followed report on posthumous Dax memoir, on whether aphemia (aphasia) on left-sided lesions of third frontal convolution only, per Broca (Schiller, 197ff.). Armand Trousseau, in the discussions, substituted “aphasia” for Broca’s “aphemia,” though what endured was the bastard term “Broca’s aphasia” (200).

Mollie Fancher, dragged by a horse car for a block, conveyed to her house at 160 Gates Avenue, Brooklyn that she would never leave again (Stacey 5ff.) Classic symptoms of hysteria included alternating spasms and trances (44-46), fainting spells, progressive loss of all her senses (49f.), inability to take food or drink (the spasms closed her throat) -- a “mind-numbing progression of seesawing symptoms through the days and nights of the spring of 1866” (50), then a nine-year trance from 1866 to 1875 (63-64) followed by five alternating personalities (DID) (65-68). Her alleged clairvoyance and 12-year fast erupted into public consciousness in the papers of Buffalo, Brooklyn, and NYC in 1878; the breakthrough story, “Dead and Yet Alive!”, appeared in the Sunday New York Sun on 24 November 1878 (90-96); it brought her to the attention of the NY neurologist William Hammond (surgeon general under Lincoln for two years, whose personal conflict with Secretary of War Stanton led to his dishonorable discharge), who became her “chief adversary” (96, 116ff.), who issued two public challenges to her to prove her clairvoyance and her fasting. Stanton was joined by George M. Beard, for whom Fancher was a case of “hysteria of a traumatic origin, with contractures and attacks of ecstasy” (149) or, if not a hysteric, then an intentional deceiver (149-50). Her condition is tantamount to “Victorian anorexia” but not to modern anorexia nervosa, as she lacked an obsession with thinness (184-85).

Following Stephen Smith’s appearance before joint session of NY State Legislature in 1865, NYC Metropolitan Health Bill, largely drafted by Smith, becomes law in 1866; the bill “marked a pivotal point in the history of public health in New York City and the United States as a whole” (Rutkow, 271). The Metropolitan Board of Health responded to the outbreak of cholera in NYC with isolation of cholera patients and disinfection of their excretions (277). This approach to cholera did not change when bacterial etiology gained hold in 1880s: the cholera vibrio replaced the cholera poison; the yellow fever poison became the yellow fever germs. Both “were still to be controlled by isolation of patients and disinfection of the environment surrounding them” (280). The Metropolitan Health Bill was also a response to the NY Draft Riots of 1863, a four-day orgy of violence against blacks and destruction of property which awoke city residents to the extent of poverty, filth, and misery in tenement dwellers. Then, in 1871, Members of NY Citizens Assn. met to plan organization of the American Public Health Assn. (Ellis, ch 1).

University of Pennsylvania, under leadership of trustee George Bacon Wood (former professor of Materia Medica), established an auxiliary faculty of five professors on fixed salary to reintroduce natural sciences into the curriculum, including study of hygiene. It lasted until 1898 (Corner, 125-128).

Austin Flint’s Treatise on the Principles and Practice of Medicine, which went through six editions in his lifetime, sold over 40,000 copies and was the most popular medical work in 19th-century America (D. Smith, 148)

Mary Putnam Jacobi in Paris, where she wrote (anonymously) some 170 pages of medical journalism, including weekly letters (1867-69) on French medicine for the Medical Record, 300 pages of essays and commentary, and an undetermined amount of popular journalism, and gained admittance to the École de Médecine (Wells, 152-53, 158ff.; Bittel, 50ff.).

Royal College of Physicians’ Report on how to control leprosy in Britain’s West Indian colonies, essentially the work of Gavin Milroy, a critic of the quarantine system. The report, preceded by several interim reports, declared leprosy non-contagious, “essentially a constitutional disorder . . . best tackled by improving the health, diet and living conditions of native populations.” This reflects the fact that, in 1850s and 60s, “anti-contagionists had the upper hand in the long-running debates with contagionists over public policy. The failure of quarantine measure to halt the spread of cholera in 1848-9 had resulted in a number of diseases being refashioned as non-contagious and therefore best prevented by environmental and sanitary reform” (Edmond, 53-54). As such, the Report of 1867 reaffirmed the findings of the Norwegian Official Report on Leprosy of 1847 (58). And it provided reassurance to Britian’s colonial administrators and settlers that “Europeans were virtually immune to the disease. . . The 1867 Report officially encouraged the idea that leprosy was a native disease, transmitted indigenously, and unlikely to jump the barriers of race or geography” (57). In 1889, Morrell Mackenzie dismissed the 1867 Report as a “vast edifice of errors” (92). The Report’s findings were cast aside by the Berlin International Leprosy Conference of 1897, and also by the Royal College’s new Leprosy Committee in 1898; the new Committee acknowledged that the 1867 Report’s findings were “ill-advised” and that the communicability of leprosy by direct or indirect means was “an established fact” (108).

Allbutt clinical thermometer, the first small practical thermometer, hit the market via firm of Harvey & Reynolds and then by Thackeray of London. The thermometer could record a temperature in five minutes. Its inventor, British physician Thomas Clifford Allbutt, went on to invent the ophthalmoscope and became president of the British Medical Association in 1920 (Grodzinsky & Levander).

Pennsylvania first state to pass anatomy act making unclaimed bodies available to med schools for teaching and research; by 1913, every state but NC, Alabama, and Louisiana had such acts.

Lister publishes “On a new method of treating compound fractures, abscesses, etc.” in five installments in Lancet (Truax, 117; Fitzharris, 169-70) and is promptly opposed by Lawson Tait and his mentor, James Young Simpson, for whom “Lister’s discovery [was] little more than the advocacy of carbolic acid as an antiseptic in the management of wounds” (Shepherd, 17-20; Truax, 118ff). In June, Lister operates on his sister Isabella for breast cancer – in his home dining-room table (Truax, 136).

Joseph Jones’ Researches upon “Spurious Vaccination”; or the Abnormal Phenomena Accompanying and Following Vaccination in the Confederate Army, during the Recent American Civil War, 1861-1865, identifying scurvy, malnutrition, and syphilis as main factors “that prevented vaccinations from working effectively and that often led to other medical problems and even death” (Downs, 166).

Nadezhda Suslova gets medical degree from University of Zurich: “It was the first medical degree awarded to a modern woman in a recognized university of high academic standards” (Bonner, 37). She was followed by Frances Elizabeth Morgan (British) and the American Susan Dimock.

Publication of Carl Reinhold Wunderlich’s major work, Temperature in Diseases, translated into English in 1871. “Wunderlich showed that when the temperatures were plotted on charts, the disease could be shown to follow certain laws, which could be characterized by the trend in temperature. Overall, he studied some 25,000 specific cases. This was clearly a significant contribution to the subject and places Wunderlich at the forefront of discovery in this aspect of clinical observation.” He recommended the axilla and mouth as preferred sites for taking temperature, warning, however, of the effects of ingestion of food and drink, and oral breathing when suffering from nasal congestion (Grodzinsky & Levander).

New York Medico-Legal Society receives charter (the same year a similar organization was established in Paris) though it had little positive impact on relationship of law and medicine. Clark Bell (a lawyer) became president in 1872 and dominated the organization (via his obsession with the medical jurisprudence of insanity) until his death in 1918, when the society ceased to function (Mohr, 219-222). Of similar, less formal organizations in other cities, “none of them amounted to much” (272). AMA formally recommended that schools to train nurses be attached to hospitals (Schultz, 389).

In November, opening of Elizabeth and Emily Blackwell’s Woman’s Medical College of the New York Infirmary, with unprecedented three years of study and course of lectures that progressed (instead of repeating) year by year. Eight months later, Elizabeth returned to England for good, where her career flattened, as Elizabeth Garrett and Sophia Jex-Blake made it clear they would not have her as mentor. Unlike them, she sought women physicians “formed in her own image, devoted to health education rather than clinical practice, and inspired by right living rather than scientific advancement” (Nimura, 243ff., quoted at 251).

Wunderlich establishes that temperature of a healthy person is constant whereas variation of temperature occurs in disease.

Ernest Haeckel first suggests killing impaired infants, a proposal amplified by his disciple Adolf Jost and pioneer race hygienist Alfred Ploetz. Proposals to kill the unfit grew in frequency from 1890 on (Pernick, 22-23).

Laboratory synthesis of alizarin (the red dye of the madder root) in a Berlin technical college, the Gewerbe-Akademie, which “soon led to extensive cooperation between academe and industry . . . that enabled growth in both sectors and brought much prestige to the former. In this way, the original vocational pursuit of dye manufacture spawned the modern science of organic chemistry; and training in organic chemistry in the latter half of the nineteenth century was also training for the synthetic dyestuffs industry.” It was made possible by the benzene ring theory (Kekulé’s six-carbon benzene ring of 1865) (Travis II, 388, 390).

Publication of Thomas Emmet’s Vesico-Vaginal Fistula, dedicated to Sims (Marr, 84-85). First “modern” formulation of autointoxication by Senator, whereby putrefactive decomposition of proteins produced toxins harmful to the host (Dally, 69).

Mary Putnam, joined by three others, first woman to be admitted by Paris Medical Faculty (Bonner, 49). Putnam’s permission was granted directly by Victor Duruy, the Minister of Public Instruction, who granted her permission to take her exams and exemption from the 16 inscriptions (courses) and three exams required of other applications (Bittel, 66-67).

Pub. of Carl Wunderlich’s On the Temperature in Diseases which declares thermometry as superior to all other diagnostic techniques. It rapidly became a classic, and “elevated thermometry to a highly regarded diagnostic technique in the 1870s” (Reiser, 116-121),

Broca’s final views on aphasia, which he subdivided into four categories: alogia (failure to speak because no ideas to express); verbal amnesia (absence of link between ideas and words); aphemia (failure to speak but ability to understand what is said); and alalia (breakdown of mechanical agents of articulation, e.g., hemiplegia of the tongue) (Schiller, 202).

William Withey Gull first mentions anorexia nervosa under the name “hysteric apepsia.” In 1873, Charles-Ernest Lasegue published article “On Hysterical Anorexia,” which was “much more prescient of 20th-century ideas of neurosis and of anorexia nervosa itself (Stacey, 176-83).

Publication of Francis Galton’s Heredity and Genius, with its claim that “eminence” runs in families. It “lays out an empirical theory of the greatness of British men.” Absent a concept of genes or any mechanism for biological heredity, Galton believed the success of genius men “showcases an innate and heritable condition, passed from father to son” (Rutherford, 40).

Clara Barton, seeking to locate missing Civil War soldiers, journeyed to Switzerland to see if signatories of first (1864) Geneva Convention (= International Red Cross) could help.

Claude Bernard administers hypodermic injection of morphine as basal narcotic prior to administration of ether or chloroform by inhalation (Fulop-Miller, 355). Lister accepts professorship of surgery at Edinburgh (Truax, 141ff.). WMC students jeered and harassed (“blackguarded”) on first attendance at clinical lectures at Pennsylvania Hospital; jeering became a riot when, during the surgery lecture of the second hour, a male patient was briefly exposed (Peitzman, 33-38; Wells, 193-200). “The jeering incident is also, I would argue, a demonstration of the place of women in the visual economy of medicine and of the disruption of that economy that women physicians effected” (Wells, 199). Charles W. Eliot becomes president of Harvard (which post he held for 50 years), with reorganization and ample endowment of the medical school the first of his nine points(Fye, 98ff; Aub & Hapgood, 140-144).

“The introduction of chloral hydrate [chloroform + formic acid] in 1869 as the first synthetic compound used in mental health care marks the start of modern psychopharmacology” (Snelders et al., 98). The chemical was synthesized by Justus von Liebig as early as 1832 and research on its therapeutic use began in the 1860s (107). It was first tested on psychiatric patients, as was cannabis: “Chloral became famous because of the experiments of Oscar Liebreich on the inmates of the Charité asylum in Berlin, and on the patients of the medical faculty ward of his teacher Rudolf Virchow” (108). It was hailed as a wonder drug, first in Germany and then in Britain, France, and the Netherlands (110). I t still exists today (Noctec) in some countries (A. Jones, 339).

Battle in Edinburgh over medical education of women. Group of five, led by Sophia Jex-Blake, gained admission, with provision to be taught in separate classes. In 1873, Jex-Blake’s accusation of Professor Christison’s assistant in the “Riot” at Surgeons’ Hall, the Court of Sessions ruled that the decision to admit the women had been illegal and the experiment ended (Bonner, 125-29).

At annual mtg in Washington, DC, AMA refuses to seat black members of Washington’s newly established National Medical Society (Baker, 307-309; Ward, 192-93).

University of Michigan first public med school to admit women, albeit in separate classes until 1883 (More, 100-101).

Fritsch and Hitzig publish their monumental paper on discovery of cortical motor area in dogs (Finger, 159-162).

Following death of father-in-law James Syme, Lister accepts Syme’s post at University of Edinburgh, and introduces self-dissolving antiseptic catgut ligatures and, by 1871, carbolic spray (e.g., a large copper atomizer on a 3-foot-high tripod) at the Edinburgh Royal Infirmary (Fitzharris, 199-201, 208).

Organization of Chicago’s Woman’s Hospital Medical College (M-S, 79-80). Lawson Tait moves to Birmingham and in 1871 becomes “junior surgeon” to newly established Birmingham and Midlands Hospital for Women (Shepherd, 30ff.). Gustav Simon performs first successful nephrectomy (removal of whole kidney) (Shepherd, 71).

Lewis Sayre (Bellevue surgeon) examines a 5-year-old boy with difficulty walking owing to “a penis so tightly wound in its foreskin as to literally cripple the child.” He performs first circumcision at Bellevue and went on to popularize circumcision owing to the dangers of the “constricted penis.” By 1900, it had become “a routine medical procedure for millions of American boys” (Oshinsky 126-127).

“Ether Revolution,” especially in London & Boston. By end of 1875, majority of London hospitals used ether or combination of nitrous oxide and ether as anesthetics of choice; chloroform remained dominant in Scotland and on the continent (Stratmann, 151ff.). By 1882, the year of Joseph Clover’s death, “the ‘ether frenzy’ was over. Deaths had occurred both under ether and nitrous oxide, and there was a renewal of interest in chloroform” (164).

Growth of state boards of health, following examples of NY City Metropolitan Board (1866) and Mass. State Board (1869) and founding of NY Public Health Assn in NY in 1872. By 1879, 17 state boards in existence, 9 in south, where cholera and especially yellow fever epidemics “provided the main energies for their formation.” They remained ineffectual and unfinanced paper organizations until the yellow fever epidemic of 1878 led state legislatures to empower them, especially to impose and enforce quarantines. Sanitation of secondary importance, with southern legislatures content to relegate it to private charities (Humphreys, 55-57). No women or blacks served on southern state health boarded through 1905 (59). In “Yellow Fever bill” of 1879, southern Congressman argued that only a national quarantine administered by a national board of health could control yellow fever, since locally imposed quarantines would never be maintained to the extent they compromised commerce. Northern congressmen, under thumb of their states’ own quarantine boards, opposed the bill as violation of states’ rights insensitive to local conditions, as understood by local authorities. A much weaker bill creating the National Board of Heath did pass in 1879 (62-64).

Antivaccination movement, in Britain: “The tightening of compulsory vaccination legislation in 1871 had produced an anti-vaccination movement with a journal and a national association. This remained strong throughout the 1880s and 90s and persisted until compulsory vaccination was ended in 1909, by which time smallpox had virtually disappeared. The movement had often been represented as a defense of local liberties against metropolitan interference and state power. . . It was widely believed that vaccination spread eczema and there were fears that it could infect children with syphilis. The scars left by vaccination were commonly referred to as ‘the mark of the beast’, a term often applied to leprosy as well” (Edmond, 89).

Creation of first real bureau of standards, the Physikalische-Technische Reichsanstalt in Berlin, with Helmholtz as founding director (T. Porter, 27).

Lister successfully performs surgery at Balmoral Castle on Queen Victoria’s orange-size underarm abscess, using carbolic spray liberally. This hastened acceptance of antiseptic method throughout the continent, but less so in London and virtually not at all in U.S. (Fitzharris, 207ff.).

Tait first (?) to remove a small diseased ovary diagnosed as source of severe pain (removal of ovary for condition other than cyst) (Shepherd, 50). Wm. Hammond publishes A Treatise on Diseases of the Nervous System, the first American neurologic text.

Jacob M. Da Costa’s published “On Irritable Heart: A Clinical Study of a Form of Functional Cardiac Disorder and its Consequences” in Am. J. Med. Sciences. Da Costa’s syndrome = irritable heart = neurocirculatory asthenia = soldier’s heart = effort syndrome = cardiac neurosis (Paul). It was investigated in WWI, especially in Britain by group under Thomas Lewis and James Mackenzie. Heart disease first attracted serious attention following British retreat from Mons in August 1914, when soldiers were sent back to England with chest pain. It eventually became third leading cause of discharge from British Army during WWI (Howell, 37). Lewis, in his MRC report on soldier’s heart, advocated the term “effort syndrome” for most cases, since the symptoms merely “exaggerated manifestations of healthy responses to effort” (Howell, 41; Lawrence, 31). Lewis summarized his experience in a monograph of 1919, The Soldier’s Heart and the Effort Syndrome. Among the symptoms, breathlessness and fatigue were universal; palpitation very frequent, and about half of patients had vague left chest distress with or after effort. Lewis believed the dominant etiological factor was “infection of one kind or another” (Paul, quoted at 310), which compromised the global functioning of the heart construed as a failure of cardiac reserve – this was in accord with the physiological perspective of the “new cardiology” of which Mackenzie was architect (Howell, 41-43; Lawrence, 31). Alfred Cohn of Rockefeller University first proposed that the symptom complex was neurotic, a viewpoint more fully elaborated in the work of Paul Wood beginning in 1941. Wood, after wartime experience with the condition, “came down squarely on the side of viewing Da Costa’s syndrome as a manifestation of emotion, more in keeping with the view of Cohn than that of Mackenzie or Lewis, and unlike that of White and Cohen, who considered that the issue was decidedly more complex” (Paul, 312). In 70s and 80s, there was some attempt to place Da Costa’s syndrome and mitral valve prolapse within a single rubric, but it “seems best to keep neurocirculatory asthenia and mitral valve prolapse as separate categories for the time being because they do not have sufficient similarities to justify a single label” (313). Treatment wise, “A program of reassurance, exercise, and physical fitness has been of value” (313).

Mary Putnam Jacobi receives her medical degree from the École de Médicin in Paris and returns to U.S., where she accepts chair of materia medica at Woman’s Medical College of the NY Infirmary and is elected to NY County Medical Society (five months after Emily Blackwell) (Warner, 326-27; Wells, 166-67). Henry Bowditch returns from Carl Ludwig’s Physiological Institute in Leipzig and initiates Harvard’s program in experimental (laboratory) physiology as an aspect of the reform of medical education instituted by Charles Eliot (Fye, 110ff.; Aub & Hapgood, 142, 148; Borell, 296-297). Wm. James was Bowditch’s paid assistant from 1871 to 1874 (Fye, 115). At Harvard, medical training lengthened to three years with academic year of nine months, with a fully graded curriculum and tougher examinations (Corner, 142). Through efforts of Wm. Stokes, University of Dublin established the Diploma in State Medicine (i.e., preventive medicine) (Stokes, 169-73).

Stephen Smith organizes American Public Health Association (Rutkow, 266).

William Welch begins training at College of Physicians & Surgeons in NY, giving up his hope of becoming a Greek tutor at his alma mater, Yale, and is so greatly influenced by Edward Seguin that he wants to specialize in nervous diseases and becomes prosector to the anatomy professors (Flexner, 63-65). Welch graduates in 1875, winning thesis prize with essay on goiter, and is awarded internship at Bellevue Hospital (68).

Robert Battey of Georgia introduced “Battey’s operation” – removal of ovaries for insanity, epilepsy (“menstrual epileptic mania”), severe menstrual pain (oöphorectomy); Lawson Tait “cautiously” performs operation for such indications (MS2, 94-95, 100; Shepherd, 51-53). Tait begins to advocate exploratory abdominal section for obscure clinical conditions (Shepherd, 51-53).

Cancer and various tumor cases “became an integral part of the first significant disagreement between the women and the medical staff” of Woman’s Hospital in NYC: “they [the Lady Supervisors] saw breast cancer as separate and not fitting under the rubric of female disorders that originally defined the hospital. . . . The smell was terrible, the women argued, and damaging to the well-being of the other patients” (McGregor, 190). “Many people identified ‘miasma,’ or qualities of the atmosphere, as the source of a disease – hence the preoccupation with proper ventilation, the fetor [foul smell] of cancer, and the fear of sickness gone this far” (189).

First operation on an injured heart by London surgeon George Callender, who removed a needle stuck in the heart (Richardson, 25).

Golgi’s chance discovery, published in 1873, of “Golgi Method,” i.e., staining by silver nitrate to reveal details of neuronal anatomy, including axonal branching: “. . . when mature nervous tissue was fixed in potassium dichromate for a prolonged time and then soaked in a weak solution of silver nitrate, a chemical reaction produced traces of silver chromate salts loosely deposited throughout the cytoplasm of some of the cells. . . the black silver chromate salts accumulated in only about 5 percent of the neurons . . .” (Rapport, 83-84).

Huntington’s presentation of the hereditary, adult-onset, neurodegenerative chorea that bears his name (Lanska II, 81-85).

Herman Kolbe’s discovery of therapeutic use of salicylic acid “aroused much interest in the medicinal value of derivatives of dyestuff intermediates” within the German chemical industry (Travis II, 392).

Norwegian scientist Gerhard Ammauer Hansen identifies Mycobacterium leprae as bacterium that causes leprosy. In Britain, “Medical debate about leprosy continued into the 1880s and 90s. The question of whether it was heredity or contagious remained, but the discovery of Mycobacterium leprae had opened up further problem with contagionists unable to explain how the disease was transmitted and contracted . . . Hansen’s discovery of the bacillus at the same time as the germ theory of disease was being elaborated reinvigorated the traditional idea that leprosy was contagious and carried debate about the disease into a wider public sphere” (Edmond, 79-80). “Reported cases from the Cape and from the Australian colonies undermined the idea of the white settler colony as a healthy offspring of the metropolitan parent (81).

David Ferrier conducts stimulation and ablation experiments of motor cortex in dogs and monkeys at Yorkshire’s West Riding Lunatic Asylum, continuing, and refining the findings of Fritsch and Hitzig (e.g., that animals higher on phylogenetic scale are more impaired by motor-cortex lesions than lower cousins). Ferrier extended their research to isolation of sensory cortical areas, where Ferrier was accurate for hearing and smell but not for sight and skin senses. Publication of Ferrier’s The Functions of the Brain in 1876 and Localization of Cerebral Disease in 1878 (Finger, 162-167).

Lancet turns against Lister (Truax, 190). Publication of Edward H. Clarke’s Sex in Education, or A Fair Chance for Girls, a best-seller claiming that higher education was sapping reproductive development of talented girls (M-S2, 121). Hungarian Arpad Gerster sails to New York and begins practice in Brooklyn (Gerster, 147ff.).

First publications identifying anorexia nervosa as a coherent disease entity in London (William Gull) and France (Charles Lasegue’s L’anorexie hystérique). Whereas Gull concentrated on strictly medical aspects of the differential diagnosis, Lasegue understood the condition as a hysteria of the gastric center and was first to describe the family environment in which the condition arose. He described the “manipulative politics of anorexia nervosa” in three stages tied to a broad set of frustrations linked to adolescent girls’ transition to adulthood and their ability to disrupt their families by not eating (Bromberg, 110-125 [Gull]; 126-140 [Lasegue]). For Lasegue, anorexia was a middle-class psychopathology that signified “a striking dysfunction in the bourgeois family system (134). “The efficacy of food refusal as an emotional tactic within the family depended on food’s being plentiful, pleasing, and connected to love. Anorexia nervosa required a certain standard of family provisioning and a regularity of fare for the girl’s rejection of food to have any meaning” (139).

In July, first announcement of S. Weir Mitchell’s Rest Cure in article in Amer. J. Med. Sci. (Earnest, 81).

Opening of first Nightingale-inspired nurse training schools (2-3 years) in NY, Boston, and New Haven. One group established by NY socialite Louisa Lee Schuyler and made up of women who had nursed for the Union, set in motion plans for the Bellevue Hospital Training School (Schultz, 389). “As both service and mill work became the domain of the immigrant, nursing was one of the few occupations that could promise white native-born parents that their daughters would receive both a moral and an occupational apprenticeship (Reverby, 48). “. . . love of humanity in a dignified and controlled manner was to transform drudge work into almost consecrated labor [49]. . . . In practice, however, loyalty and deference to the physician, rather than independence were stressed. . . . Drill and discipline, as well as character, became the hallmarks of training [51[. . . . Alongside the analogy between nursing and army life lay the insistence that the nursing student in the hospital was joining a family” [52]. . . . the crucial lessons of training focused on behavior. . . it was precisely behavior as an index of the student’s character that so concerned nursing and hospital authorities. . . . In general, behavior that suggested the student nurses had qualities associated with the untrained nurse was seen as a serious transgression. These were defined variously as crudeness in manner, displays of sexual interest or activity, and any real show of comradeship with the ‘help’” [55]. . . . Nursing thus became, for some women, a less elite equivalent of an education in womanly virtue and female solidarity afforded their richer sisters in the women’s colleges. But for many, as nursing historian Dorothy Sheahan noted, the training school ‘was a place where . . . women learned to be girls.’ Training narrowed, not widened, the range of permissible behaviors for respectable women. And unlike students in the women’s colleges, nurses were strongly discouraged from developing either independent thinking or autonomy” [58].

Comstock Act prohibits mailing of contraceptive information (Borell V, 64).

Following campaign led by Wm. Pepper, Jr. (Corner, 135-137), opening of Hospital of the University of Pennsylvania, with medical staff comprising three faculty members and four non-faculty Clinical Professors of the Hospital of the University of Pennsylvania (Corner, 138).

Sims resigns from Woman’s Hospital of NY State over rulings of Board of Lady Supervisors excluding cancer patients and limiting number of witnesses at operations to 15 (Marr, 41-47). Paul Zweifel’s first publication establishing placental transfer of chloroform, even during labor (Caton, 73-74, 83-84). Lawson Tait reports first successful removal of fibroid tumor of the uterus by abdominal approach (Shepherd, 35, 60). Wernicke publishes Der Aphasische Symptomen-Komplex, positing a sensory complement to Broca’s motor aphasia (“Wernicke’s aphasia”) (Schiller, 207). Forel, as an assistant to Gudden in Munich, claims to make first thin microscopic section of the human brain using “Gudden’s microtome” (Forel, 93).

Karl Kahlbaum (Silesia) publishes monograph Catatonia, or Tension Insanity, which reformulated concept of hysterical insanity from preceding generation, which was ignored until Kraepelin integrated it into his new classification 20 years later (Micale II, 511-12).

London pharmacist Alder Wright made heroin by boiling morphine with acetic anhydride. He was seeking a nonaddictive form of morphine. Bayer marketed Glyco-Heroin in 1898 as a cough suppressant (Schiff, 191).

More than 150 women register for medical study in universities of Switzerland and France. This number swelled in the 1880s and 90s (Bonner, 54-56). Founding of London Medical College for Women, led by Jex-Blake (131-34). Halsted enrolls at College of Physicians and Surgeons, and begins internship at Bellevue Hospital in 1876 (Imber, 21ff.), and heads to Europe (Paris briefly, then Vienna) in 1878, then back to NY in Sept 1880 (31-35), then to Butler Hospital (RI) in 1886 for treatment of his cocaine addiction. There his “paranoia and agitation inspired his alienists to pull out a syringe filled with morphine and inject its soothing balm into his arm” (Markel II, 142). He goes with Welch to Hopkins at end of 1886 but returns to Butler Hospital for nine months in 1887 owing to cocaine relapse.

Lawson Tait first proposes exploratory laparotomy as diagnostic aid (Shepherd, 74-75). Morantz-Sanchez gives year as 1879 (MS2, 99-100).

Gabriel Lippmann invests the capillary electrometer, which could be used to record electrical activity of the heart: “He was engaged on a study of the relationships between capillarity and electrical effects at the boundary between mercury and a solution of potassium bichromate in dilute sulphuric acid. The measuring instrument was the accidental result of a purely physical investigation” (Burnett, 60-61); It was first used in 1887 by Augustus Waller, London physiologist, in conjunction with a mirror galvanometer, to record electrical activity of a man’s heart ( Burnett, 60-61; Fye II, 861).

Daniel Coit Gilman visits Thomas Huxley in London, who recommends appointment of Irish physiologist H. Newell Martin to Hopkins biology (physiology) chair (Fye, 139-143).

Establishment of American Neurological Association by 18 physicians in NYC, with Journal of Nervous and Mental Diseases designated their official organ the following year (Brown, 2; Blustein II, 111). Wilhelm Erb publishes on the concept of tendon reflexes (muscle stretch reflexes), with first account of the use of the reflex hammer applied to the patellar tendon to elicit the patellar or knee-jerk reflex; publication was in Westphal’s Archiv für Psychiatrie und Nervenkrankheiten. Westphal reported the same observations in the same volume, but rejected the view that the knee jerk was a reflex (Schiller, II, 75, 78, 80; Lanska, 1543). “Erb and Westphal had hit upon the unique spot in the body where scientific purity and simplicity reign because only two neurons are involved in the reflex. They had struck a source of untapped knowledge – knowledge that previous generations of physiologists would have found useless” (Schiller II, 82).

Founding of American Gynecological Society by Sims, Emmet, Thomas, Peaslee – all from NYC’s Woman’s Hospital (McGregor, 204,207). Early meetings and debates concerned cervical surgery. In 1877, nasty falling out and pamphlet war of Emmet, Thomas and Peaslee (on one side) and Sims (207ff.). German emigre Emil Noeggerath angered members by insisting 90% of sterile women suffered from gonorrhea contracted from husbands who had been treated for the disease and pronounced cured by their physicians (Stage, 83). He was vindicated in 1879 when Albert Neisser identified gonococcus under the microscope; it retained its infective power long after acute symptoms had passed (Stage, 83-84).

Max Nitze’s development of cystoscope, initially lit by heating a platinum loop with galvanic current, improved via use of 4-sided prism by Young (Young, 86-91). Gotthard Bülau of Hamburg introduces subaqueous drainage of chest (pleural cavity) (Richardson, 26-27). Italian Eduardo Porro introduces “Porro’s operation” (Caesarean section followed by hysterectomy) in response to surgeons’ dissatisfaction with mortality attendant to Caesarean sections (Shepherd 168-69). Opening of Johns Hopkins University in fall, with inaugural addressed given by Thomas Huxley (Fye, 138ff.)

Jules-Emile Pean performs first genuinely successful splenectomy in Paris. Patient was a 20-year-old woman and spleen weighed over a kilogram (Van de Laar, ch 13).

Lancet publishes John Maclagan’s findings on effectiveness of salicin (less refined salicylic acid) in relieving symptoms of rheumatic fever (fever, inflammation, pain) of patients at Dundee Royal Infirmary in Scotland. Almost contemporaneously, Solomon Stricker in Germany declared his tests showed effectiveness of salicylic acid in treatment rheumatism (Jeffreys, 49-55).

Gurdon Buck, who developed techniques for repairing congenital deformities like harelip and alveolar clefts in Civil War hospitals, publishes first reconstructive surgery textbook in U.S., Contributions to Reparative Surgery (Devine, 165-167).

French venereologist Alfred Fournier proposes syphilitic origins of tabes (Micale II, 507).

Robert Koch, 32, working alone in village of Wollstein without any academic credentials, publishes The Etiology of Anthrax, based on the life history of Bacillus anthracis. Via microscopic examination of Bacillus anthracis (rod-shaped bacteria containing refractile spheres [spores]) and animal experimentation with field mice, Koch proved that Bacillus anthracis is source (“the contagion”) of anthrax (Brock, 27-37). Publication followed successful demonstrations to Ferdinand Cohn, Director of Institute of Plant Physiology at University of Breslau and Julius Cohnheim, Director of Institute of Pathology (44ff.). W. H. Welch a visitor in Cohnheim’s lab at time of Koch’s visit (47).

American surgeons begin performing ovariotomies (oophorectomy) on gynecologically healthy women demanding something be done for their depression/malaise (= George Beard’s neurasthenia [nervous exhaustion]). Robert Kitto of Racine, WI, wrote in 1891: “She said, ‘Dr. Kitto, have you succeeded in removing the offending appendages?’ Being answered in the affirmative, she smiled and said, ‘I am so happy, and I feel so different that I know I shall now remain well’” (Kitto).

Mary Putnam Jacobi’s The Question of Rest for Women during Menstruation (her anonymous entry in Boylston Prize competition) used survey data with 268 participants as “a performance that inscribes the relentlessly lay voices of women within the discourses of medicine” (Wells, 175), and “destabilized medicine’s understanding of the male body as normal and the female body as fragile” (176). It was “both a systematic argument against Clarke’s Sex in Education and a performance of her expertise . . . an essay designed to satisfy an audience of Harvard physicians who valued science above sentiment (Bittel, 126, 127). Jacobi found that “Although 35% of her participants had never suffered any pain, the remaining women reported having some type of discomfort during menstruation. But, of those who suffered, two-thirds had inherited ‘physical defects’ that caused forms of uterine disease or weakened their constitutions; others had serious ‘organic defects’ that rest could not cure. Based on her numbers, Jacobi believed that immunity from menstrual suffering did not depend on rest but, instead, on a healthy childhood, a sound family history, marriage at a ‘suitable’ time, a steady occupation, exercise during school life, and ‘the thoroughness and extension of the mental education’ . . . [she held that] menstruation was a time of increased vitality by explaining that women had a ‘reserve of nourishment’ in their bodies that was used for reproductive functions” (129). An extended version of Jacobi’s essay was published in 1877 by G. P. Putnam’s Sons.

AMA seats first female state delegate (from Illinois), Sarah Hackett Stevenson, at its national convention, though acceptance of women only formalized in 1915 (Morantz-Sanchez, 179, 232-233).

Passage of Cruelty to Animals Act in Britain (French, chs 5-7 ), the administration of which “interfered significantly with research in experimental medicine in Britain between 1876 and 1882” (191). Establishment of the Physiological Society in England to coordinate scientific/medical response to antivivisection movement (Fye, 171; French, 196-98).

Welch journeys to Strasbourg to study pathological anatomy via laboratory courses with the microscope (Flexner, 78-79), then on to Leipzig, where he studied pathology with Ernst Wagner and physiology with Carl Ludwig (Flexner, 82-88), who gave him an Arbeit microscopic investigation of nerves and ganglion cells of the heart (85); then to Breslau, where he studies experimental pathology with Julius Cohnheim. Cohnheim’s Arbeit for Welch was edema of the lungs (which problem Welch solved. To wit, when left ventricle was paralyzed and right ventricle continued to pump blood to the lungs, edema resulted) (Flexner, 94-99).

August Charles Bernays returns to St. Louis after studies at Heidelberg (1872-1876; under Gustav Simon), Berlin (1876, under Langenbeck), and Vienna (1876, under Billroth (Bernays, 100), and London (1877), where he passed exams for his M.R.C.S. (Bernays, 102-103). Franklin Martin enrolls in Chicago Medical School (Davis, 9). Lister moves to London (King’s College) (Truax, 193ff.). Publication of Koch’s second paper, containing first published photomicrographs of bacteria (Brock, 62-65).

Listerism “wholeheartedly adopted” by surgical staff of NY Woman’s Hospital (Marr, 135-137). August Bernays, returning to St. Louis, “one of the most insistent and effective pioneers of asepsis” (Bernays, 106). Under leadership of Wm. Pepper, Jr., reforms take effect at University of Pennsylvania: 3 terms of five months each; graded curriculum; expenses of medical school borne by University Board of Trustees; professors placed on fixed salaries (Corner, 146-53). U.S. Army makes antiseptic surgery part of its official military medical practice (Gabriel, 139).

Dr. Robert M. Fuller of Philadelphia [b. Schenectady NY; 1865 graduate of Albany Medical College] publishes his first paper on the tablet triturate (molded tablet as opposed to earlier compressed tablet). His method “consisted first in thoroughly triturating the substances together, and second, in molding this trituration into divisions to which he had already given the name ‘Tablet Triturates’”; Wyeth first drug company to sell the product in 1880s (Rosales, 59n). First manufacturer was Fraser Tablet Triturate Manufacturing Company

Paul Ehrlich enters Berlin’s Charité as assistant and, guided by his work with dyestuffs, begins research on the morphology of cells, especially white blood corpuscles. He discovers in protoplasm a group of connective tissue cells a form of granulation that showed up when stained with basic dyes (“mast cells”): “This was the first case of selective staining and the first occasion that a dye was used as a microchemical reagent” (22). Between 1879 and 1882, “The various types of granules in the white blood corpuscles and the differences in their dye receptivity continued to be Ehrlich’s main guides into the physiology and pathology of the leucocytes” (25).

Publication of Koch’s monograph on bacteriology of sepsis (wound infection), Aetiology of Traumatic Infective Diseases, incorporating three advances: staining of bacteria in diseased tissues with aniline dyes; introduction of Abbe condenser; and first use of Zeiss oil-immersion lens (Brock, 75-81). Worst epidemic in U.S. history set off in New Orleans (Cohn, 99ff.). Establishment of first Institute of Hygiene by Max von Pettenkofer at University of Munich (Brock, 183). Billings delivers 20 lectures on medical education, espousing the research ethic, in Baltimore (Fye, 148-150).

National Yellow Fever Commission (three Southern physicians and an architect; chaired by Dr. Bemis) report to special meeting of APHA in Richmond in November  “a firestorm of controversy” (loc 1405). The report, siding with contagionists and advocates of germ theory, determined that only rigorous quarantine “to the extent of total nonintercourse” had proven effective (1433). Debate at APHA meeting carried over to Congress, with Southern senators and allies calling for national sanitation and quarantine regulations through Bureau of Public Health (and abolition of U.S. Marine Hospital Service), with strong Director General, pitted against AMA, APHA, and congressional allies supporting states’ rights/local control, etc. Bill establishing the Bureau (albeit with four-year term) passed Senate in Feb 1879, but not House, which passed only APHA-sponsored bill that formalized Commission with only advisory role. However, a separate quarantine law was passed and signed into law by Hayes.

First report of effectiveness of arsenic in treatment of a patient with leukemia (“leucocythemia”) out of Boston City Hospital. A2O3 subsequently used as primary antileukemic agent until advent of radiation therapy. It had a resurgence in 1930s when its efficacy was repeated in patients with chronic myelogenous leukemia (CML). Until supplanted by modern chemotherapy, arsenic trioxide after radiation was considered “the most effective treatment for C<ML and other types of leukemia.” In 2000, arsenic trioxide (Trisenox) was approved by FDA for treatment of relapsed or refractory APL (Antman).

Halsted studies in Europe; several months in Vienna with Billroth and his assistants, Mikulicz and von Eiselsberg (Crowe, 20). “The germ theory of disease was in the acute controversial stage, but fast gaining favor among the intellectuals of our profession (Martin, 68).

Bitter conflict between American neurologists and psychiatrists (i.e., asylum superintendents) over management of American asylums. Neurologists sought to establish ideal of science as norm of good psychiatric care (Brown, 4-5; Blustein). The conflict began with Edward Spitzka’s paper on The Study of Insanity Considered as a Branch of Neurology, and the Relations of the General Medical Body to this Branch to the NY Neurological Society in March, 1878. He held the study of insanity should be a subdivision of neurology and expressed outrage at the “sins against science” committed by asylum superintendents. Spitzka’s paper led to a crusade for asylum reform spearheaded by the NY Neurological Society, which sought the support of the NY Medico-Legal Society. Spitzka was joined by Hammond, who argued for the non-asylum treatment of the insane (Blustein). The neurologists, led by Beard and Seguin, joined with lay charity works in the National Association for the Protection of the Insane and the Prevention of Insanity (NAPIPI) in 1880 (Blustein, 257). In 1882, the superintendents and neurologists locked horns in the trial of Guiteau, President Garfield’s assassin. In 1883, NY legislature created a State Lunacy Commission, that defused the issue. Increasingly, neurologists and psychiatrists could agree that professional experts alone should care for the insane: “Unity against lay interference in their work brought the two groups closer together, more firmly committed than ever to a ‘medical model’ of insanity but still far from the goal of explicating such a model in a scientifically rigorous way” (Blustein, 262).

Creation of National Board of Health, staffed by prominent sanitarian members of American Public Health Association (Billings, Bowditch, et al.) to aid southern states and localities in controlling yellow fever via standardized quarantine regulations (a condition for financial assistance), inspectors, etc. Congress funded it for only 4 years, failed to maintain public and Congressional support, competed with Marine Hospital Service for money, and was allowed to expire in 1883. The sanitarian members were more committed hygienists, seeking to sanitize the urban environment, than in yellow fever control per se. Their belief in the universality of hygienic law “clash[ed] sharply with the localistic, protectionist policies of southern boards of health.” Be that as it may, they devoted their energies to modernizing the archaic southern system of quarantine (via inspection of crew, disinfection of cargo, etc.) via simply holding ships in port for a set period of time or denying them entry altogether (Humphreys, 64-67, quoted at 67; Humphreys, 210-11). National Board inspectors, largely limited to lower Mississippi, gathered information on which localities were already infected and which were encouraging propagation of the yellow fever germ (68).

Francis Galton introduces the Word Association Experiment, which is subsequently introduced into Germany and popularized by Wilhelm Wundt, who used the Hipp chronoscope to measure reaction-time in his Leipzig laboratory (Akavia, 74-75). Kraepelin, who worked in Wundt’s laboratory in early 1880s, was first to use the WAE clinically (76); he believed that reaction times, as measured by the Hipp chronoscope, would reveal underlying psychological processes. His student Gustav Aschaffenburg began experiments with WAE that showed that psychopathological states, especially mania, were characterized by peculiar associative patterns, i.e., fatigued and manic subjects displayed prolonged reaction-times vis-à-vis normal subjects (81-82).

Formation of New Orleans Auxiliary Sanitary Association (businessmen and physicians) to raise funds to implement NO Med & Surg Assn’s three recommendations to prevent future yellow fever epidemics: (1) proper drainage of city, including underground sewer system and abolition of privy; (2) paving and cleaning of city streets, with efficient disposal of garbage in Miss. River; (3) safe municipal water supply. ASA failed in all respects owing to lack of funding/support from state legislature and municipal government, and became ineffectual in 1884, when it no longer received fees from quarantine stations. In 1886, many of its members were absorbed into the NO Draining and Paving Association, led by new Louisiana Board of health president Joseph Holt, which was equally unsuccessful (Ellis, ch 5).

Joseph Lawrence invents Listerine, which was 27% alcohol. Sells rights to it to Jordan Lambert in 1881; Lambert began marketing it as an antiseptic with multiple uses (e.g., dandruff remover, floor cleaner, cure for gonorrhea). In 1895, Lambert promoted it to dental profession as an oral antiseptic, the use for which it achieved immortality (Fitzharris, 229-230).

Rudolph Matas accompanies his professor, Sanford E. Chaillé, on yellow fewer mission to Havana, which failed to identify microorganisms in blood of victims (Cohn, 115-17).

First successful removal of a brain tumor by Macewen at Glasgow Royal Infirmary; then Rickman Godlee in London (1884); Horsley’s first brain operation (1886); J. W. Eliot removal of brain tumor in Boston (1895); Cushing’s first case (1902) (Stevenson, 151). Tait successfully removes gall stones via abdominal section, the first such operation in England (Shepherd, 64-65).

Using a cadaver at the Dresden-Friedrichstadt Institute, Maximilian Nitze and Leiter invent first working cystoscope, a small visual probe inserted directly into the bladder through urethra, making it much easier to pulverize and remove bladder stones (Van der Laar, ch 1; Reuter). Nitze’s legacy of discovery, which included taking the first endoscopic photographs and publishing first textbook of urology, “established the specialty of urology and a legitimate claim as the father of urology” (Herr).

Publication of William Hammond’s Fasting Girls: Their Physiology and Pathology, his response to claim that Brooklyn’s Mollie Fancher had lived from 1866 to 1878 without food (Stacey, 126).

Paul Niehaus of Berne first surgeon to attempt (internal) cardiac massage on a human patient; 1901: Kristian Igelsrud of Norway performs first successful cardiac massage, then in 1902 W. Arbuthnot Lane in Eng. had another success (Richardson, 54-56). Lawson Tait diagnoses acute appendicitis and successfully removes inflamed appendix. Tait did another successful case in 1886 but discarded idea of removing appendix in paper of 1889 (Shepherd, 68-70).

Johhan von Mikulicz performs first gastroscopy. Since patient would have to swallow the long tube entirely, the first subject was a circus sword-swallower. He and his student Georg Kelling went on to examine hundreds of stomachs with the gastroscope (Van de Laar, ch 17).

“Bitter controversy” over germ theory “was at its height” (Martin, 87). “In 1880, at least ninety percent of operative wounds became infected; and practically seventy-five percent of abdominal operations performed by the average surgeon proved fatal” (90). Koch moves to Berlin to head new lab for bacteriological research of the Imperial Health Office (Kaiserliche Gesundheitsamt) (Brock, 84-93).

Morell Mackenzie publishes first volume of Diseases of the Throat and Nose; second volume followed in 1884. First volume immediately recognized as “a classical treatise, the standard textbook of laryngology” (Stevenson[2], 44-46). Abraham Jacobi publishes Treatise on Diphtheria, which argued that the disease was highly contagious but not caused solely by a bacterium. He was uncertain about the agent of transmission, but blamed filth and irresponsible disease carriers (i.e., people with mild cases who felt well enough to work and travel) (Bittel, 184-189).

“In the early eighties, probably fifty percent of every gynecologist’s patients suffered from displacement of the uterus” (Martin, 161). “Furor operandi of 1880s, especially regarding gynecological surgery (MS2, 105-110).

Founding of American Red Cross, based on a Swiss model, by Clara Barton; it was reorganized in 1905 under a charge from Congress that gave it special responsibility to help servicemen (Leiby, 159).

Grimaux prepares codeine by methylation of morphine: “Codeine possesses the same pharmacological actions as morphine, but is less potent. . . about 10 percent of administered codeine undergoes O-demethylation to morphine, and the resulting analgesic effect is primarily due to this conversion.” Codeine first isolated from opium by Robiquet in 1833 (Schiff, 192).

Koch publishes paper introducing his “plate technique” (pure culture technique using solid or semi-solid media) and its use in studying pathogenic organisms), the “Bible of Bacteriology.” He used nutrient gelatin to make solid the liquids (e.g., nutrient broths and bouillons) that supported the growth of pathogens. In 1882, gelatin replaced by agar, via his student Walther Hesse (Brock, 94-104). Koch begins experiments leading to discovery of tubercle bacillus in 1882, which involved (a) discovery of technique for staining tubercle bacillus; (b) demonstration that bacillus is invariably present when TB is present; and (c) demonstration that pure cultures of tubercle bacillus are virulent and invariably cause TB when experimental animals (guinea pigs) were incubated with it (Brock, 117ff.; Daniel, 78-82; Caldwell, 159-162)

Scottish surgeon Alexander Ogston discovers staphylococcus as specific bacterium that can cause disease and linked to hospital sepsis (Altman, 180-181; Brock, 80). In 1883, Swiss surgeon Carl Garré, via self-experiments, shows that the same staphylococcus can cause simple skin abscesses and fatal osteomyelitis (Altman, 188-190). In mid-1950s, epidemics of postsurgical wound infections caused by penicillin-resistant strains of staphylococci; Dr. Stephen Elek's self-experiments established relationship between staphylococci and wound infections via surgical sutures, which drastically reduced minimum dose of staphylococci needed to produce infection (Altman, 191-195).  In 1980, first report of toxic shock syndrome (shown to be another name for staphylococcal [not streptococcal] scarlet fever from Rely Tampons, owing to a toxin produced by staphylococci (Atman, 195-199).

Billroth performs historic distal gastrectomy, a turning point in surgery because his patient survived the joining, with at least 50 stitches, of the stomach (6cm. diameter) and the duodenum (3cm. diameter) (intestinal anastomosis) for 10 days, at which point healthy tissue growth makes the sutures unnecessary, proving a successful intestinal reconnection was possible: “This was an achievement that literally pushed back the frontier of surgery.” The patient, Frau Thérèse Heller, died from metastasis three months after the operation, as Billroth’s small incision did not expose the spread of cancer around the tumor he removed (Van de Laar, ch 26).

Detailed description of a successful ovariotomy performed by Edward Jenks, newly arrived at Chicago’s Mercy Hospital, employing “state of the art” Listerism (Martin, 96-102). First gastroenterostomy (bypass operation between stomach and upper small intestine) (Shepherd, 72).

International Medical Congress in Britain where negative impact of the Cruelty to Animals Act of 1876 on experimental medicine was a theme taken up by all the keynote speakers (French, 198-199). Epic confrontation between brain localization and equipotentiality took place between their leading champions, David Ferrier and Friedrich Goltz at Congress (French, 199, 311; Finger, 155-158). In aftermath of Congress, antivivisectionist “Victoria Street Society” prosecuted Ferrier under the 1876 Act for operatively induced cerebral lesions on monkeys. Prosecution failed (the surgery turned out to have been performed by G. F. Yeo, who was appropriately licensed and certificated by the Home Office), but it succeeded in mobilizing the British medical community on behalf of experimental medicine. This led to the founding, in 1881, of the Association for the Advancement of Medicine by Research (A.A.M.R.), which represented experimental medicine with the Home Secretary (out of the public eye), and led to a dramatic increase in granting of vivisection licenses, from 42 in 1892 to 639 in 1913 (French, 200ff.; Finger, 158-159, 169-172).

Carlos Finlay gives first presentation on mosquito vector in Yellow Fever transmission at International Sanitary Conference, and the reaction was silence. In 1882, he identified the genus of the mosquito (Byerly I, 98).

McLean Asylum opens its Training School for Nurses (including a few men in its first class) = first training school in a mental hospital (Paplau, 1989, 18). It closed in 1968.

Langenbach performs first cholecystostomy (removal of whole gallbladder for stones) (Shepherd, 65). Robert Dudgeon invents Dudgeon (wrist) Sphygmograph, which provided pulse readings via radial artery. Emil Behring (assistant of Koch, along with Paul Ehrlich, discoverer of antitoxins and serum therapy [Bäumler,51]), publishes his first scientific paper, On Iodoform and Iodoform Effect, in the Deutsche Medizinische Wochenschrift (Bäumler, 32). Behring joined Koch’s institute in 1889 won first Nobel Prize in medicine in 1901 (Daniel, 84-85).

Max Sanger incorporates use of multiple silver sutures to close uterine wound during cesarean sections, preventing both hemorrhage and infection in abdominal cavity. A new debate, especially among Catholics, on defensibility of craniotomy ensues, with Holy See now prohibiting teaching of craniotomy in Catholic med schools. German surgeons surpass English as arbiters of obstetric surgical expertise (J. Ryan, 480). “It is likely that the success of European operators highlighted the deficiencies of obstetric training at American medical schools (481).

Another virulent yellow fever epidemic beginning in New Orleans and spreading along the Rio Grande; Matas sent to Brownsville-Matamoros by Dr. Chaillé to assist. In Brownsville, he met and cared for Dr. William Crawford Gorgas, destined to be the “conqueror of yellow fever” in Cuba and Panama by mastering sanitation via mosquito eradication (Cohn, 146-150). Founding of Woman’s Medical College of Baltimore (MS, 80-81).

German Chancellor Otto Bismarck proposes, and Reichstag passes, the world’s first social health insurance system, the Krankenversicherungsgesetz (Health Insurance Act). This was Bismarck’s way of defusing growing unrest among laborers and growing power of the Labor movement in German politics. The act introduced compulsory health insurance for all employees, with costs borne jointly by employees and employers.  The act of 1883 was followed by accident coverage in 1884 and old-age and disability pensions in 1889.

Founding of JAMA by Nathan Smith Davis of Chicago Medical College (Davis, 4). Lister (Truax, 235) and Spencer Wells (Dally, 39) knighted by Queen Victoria. Metchnikoff publishes paper identifying phagocytes (Truax, 235).

Cholera epidemic from India to Egypt sends French (under Pasteur) and German (under Koch) expeditions to Egypt to discover the bacteria. German team proceeds to Calcutta, India, where Koch isolates cholera vibrio (the “comma bacillus”) in January1884 (Brock, 140-168; Down, 107). Ernst Jacobi, seven-year-old son of Abraham Jacobi and Mary Putnam Jacobi, dies of diphtheria in NYC (Hammonds, 29-30).

Theodor Kocher presents his evidence on specific cause of cretinism to congress of the German Surgical Association: He discovered that some time after thyroidectomy his patients lost their physical strength and intelligence, showing symptoms like swollen hands and feet, puffy face, and anemia. These changes were even more marked in children, who reminded Kocher of cretins. Kocher claimed removal of thyroid induced these side-effects, and proposed a close relationship between cretinism and thyroid gland. His organ concept of cretinism provided a new focus for research, i.e., the internal secretion of the thyroid gland, and illustrates “the close affinity of surgery and experimental physiology. . . . The ability to provoke and reverse cretinous symptoms independent of place was also the crucial argument against the still-prevailing view that cretinism was endemically caused”(Schlich I, 433-435). . . . In his article of 1892, Kocher held that “The crucial criterion for the attribution of cases to cretinism was now the resemblance of their clinical picture with the effects Kocher had observed after total thyroidectomy, his ‘cachexia strumpiva.’ All those cretins who did not look like Kocher’s artificial cretins were no longer cretins, for example, some deaf-mutes (436). . . What Kocher presented here was the cause of a new cretinism, a cretinism that was defined according to the effects of surgery” (437).

Cambridge physiologist Walter Gaskell , in series of experiments with tortoise hearts, demonstrates that heart contractions are both myogenic (muscular) and automatic (Jeffrey, 24).

Lawson Tait operates successfully for rupture of a tubal pregnancy; by 1884 he had operated five times for such acute hemorrhage with only one death (Shepherd, 59). Nephrectomy for “moveable” or “floating” kidney increasingly replaced by surgery to raise and “hitch up” the kidney (nephrorrhaphy) (Dally, 39-44). Opening of new biological laboratory under H. Newall Martin at Johns Hopkins (Fye, 161-62).

Metchnikoff, in first formulation of active host defense, publishes Research on the Intracellular Digestion of Invertebrates, in which absorption of microbes was merely part of multiple activities of mesodermic wandering cells. In 1884, he published three more papers that lay down the cardinal pillars of his phagocytosis theory: 1) mesodermal amoeboid cells had a diverse purpose analogous to original intracellular digestive function, namely, to engulf and devour atrophied host tissue or invading microorganisms; 2) tissue and blood leukocytes were functionally equivalent; 3) host defense was based on successful containment of pathogen by phagocytes; 4) the inflammatory reaction revolved around this phagocyte-pathogen struggle (Tauber & Chernyak, 137-141). The theory was opposed by Koenigsberg microbiologist/pathologist Paul Baumgarten, for whom only the organism acting as a whole, not the activity of individual cells (intracellular digestion by leukocytes) could assume responsibility for an organism’s integrity (143) and who ignored Metchnikoff’s emphasis on the differentiation of mesodermal cells and how they assumed new functions in evolution: “Baumgarten totally ignored that issue and therefore failed to discern differences in the general properties of phagocytes from the specific phagocytic activity of freely mobile white cells” (144).

Heidelberg research chemist August Bernthsen synthesizes phenothiazine as a synthetic dye, which was discovered to act as an antihistamine (Valenstein, 21).

Manufacture of Joseph Mortimer Granville’s battery-powered vibrator; Granville was “father of the modern electromechanical vibrator” (Maines, 91, 94).

Galton first uses term eugenics (Trent, 136).

Hoechst Dye Company, formerly a coal-tar (aniline) dye manufacturer outside Frankfurt, uses a grad student’s research to produce its first aniline-based pharmaceuticals as end product, among them antipyrine (now phenazone), used as an antipyretic and analgesic, which was a great success and established the outstanding reputation of Hoechst pharmaceuticals worldwide. “Although the tonic’s deeply unpleasant gastric side effects soon forced its withdrawal from the market, antipyrine enjoyed a brief commercial success and inspired a number of imitators” (Jeffreys II, loc 460-464).

Opening of New York Cancer Hospital with support of J. Marion Simms. By 1899, the name changed to General Memorial Hospital for the Treatment of Cancer and Allied Diseases.

Joseph Holt, new president of Louisiana Board of Health, organizes regional conference among southern Board of Health officials to strengthen regional quarantine measures via his “Holt system” of disinfectants for ships arriving from yellow fever infected ports. Cooperation among attendees matched by univocal opposition to federal quarantine measures and the Marine Hospital Service (Humphreys, 115-117).

Chevalier Jackson enters Jefferson Medical College, where Samuel Gross did his best to teach the new methods of antiseptic surgery (Jackson, 57-61). Welch accepts Billings’ offers of Professorship of Pathology at Johns Hopkins (Crowe, 11; Flexner, 128ff.) and heads back to Germany for an additional year of study, culminating in Koch’s first public course in pathology in Berlin in July 1885 (Flexner, 147). Osler appointed Professor of Clinical Medicine at University of Pennsylvania (Corner, 167-73). Halsted experiments with cocaine nerve blocks (regional anesthesia) (Crowe, 25-29). The term “bacteriology” first came into general use (Finney, 327). Koch’s first publication of “Koch’s postulates” in the form used today. He was anticipated by his collaborator Loeffler, who published the postulates in relation to diphtheria in 1883 (Brock, 179-182). Metchnikoff publishes first paper applying phagocytic theory to human disease (anthrax) (Silverstein, 47).

Mikulicz urges that inflamed appendix be removed during acute stage, which was first performed in February 1884 by  Krönlein  (Trombley, 60-61). Establishment of British Gynecological Society, with Lawson Tait as a VP and as second president in 1887 (Shepherd, 153-54). German Arthur Nicolaier isolates pathogens responsible for tetanus, with the “etiological chain of proof” (Koch) provided by Kitasato in 1887 (Bäumler, 75). Friedrich Loeffler, Koch’s assistant, publishes paper that isolates bacilli (identified by Edwin Klebs) and demonstrates their etiological role re diphtheria, though his finding is questioned by Americans, including Abraham Jacobi and T. Mitchell Prudden of NYC (Hammonds, 49-52). Jacobi publishes Diphtheria Spread by Adults, arguing that diphtheria had one predisposing element, a sore mucous membrane, and one cause, direct contagion. His radical proposals were that diphtheria could not be defined solely by a well-formed pseudomembrane and that adults with mild cases could transmit it to others (Hammonds, 30-36).

Battle in Paris over eligibility of women to compete for coveted internships (Blanchist and Anti-Blanchist factions) results in admission of Augusta Klumpke and Blanche Edwards in 1885 (Bonner, 72-73). Roman Catholic “Holy Office” issues prohibition of teaching of craniotomy in Catholic medical schools (J. Ryan, 480). August Forel appointed first deputy director then director (Forel, 137-8) of Burghölzli, replacing Hitzig, who was engaged in prosecuting the previous steward, Schnurrenberger, “the evil spirit of the asylum” (Forel, 124ff.).

Pasteur published technique of increasing virulence of ordinary canine rabies by serial passages through guinea pigs or rabbits, and then discovery of an organism in which serial passages produced the opposite effect, decreasing the virulence of rabies: “Successive passages of the saliva microbe through the guinea pig, for example, made the microbes less virulent for rabbits . . . the virus could be attenuated for dogs by passing it from dog to monkey and then successively from monkey to monkey. . . At some point in its serial passage through monkeys, the rabies virus lost its virulence for dogs and began instead to protect them from the effects of somewhat more virulent strains of the virus, which in their turn acted as vaccines against still more virulent strains until eventually dogs could be rendered immune to even the most lethal virus” (Geison, 191).

John Berry Haycraft discovers the leech saliva chemical in that became known as hirudin, vastly more efficient as an anticoagulant than man-made heparin, the next best blood thinner” (George, ch. 2).

U.S. Congress passes legislation authorizing Army medical officers to provide care to families of service members, army retirees, and people in the community if it did not interfere with regular duties (Byerly I, 56).

Pasteur’s first successful inoculation for rabies of nine-year-old Josef Meister and shortly thereafter, 15-year-old Jean-Baptiste Jupille (Ritvo, 193-94; Bäumler, 48-9; Geison, 206-218) via his new method of attenuation: “Instead of passing the virus through monkeys, they now attenuated it by extracting spinal cords from rabbits dead of the ‘fixed’ rabies virus, cutting them into strips several centimeters long, and then suspending these spinal strips from a thread inside a flask with two cotton-stoppered holes at the top and near the bottom. . . . Infected rabbit spinal strips that were suspended in this filtered, desiccated air gradually lost their virulence vis-à-vis dogs, becoming harmless after a period of time . . .” [It was a matter of drying out the infected spinal marrow; the drier the less potent the virus]. Vaccination of Meister and then Jupille by series of injections of sterilized broth containing a small piece of one of the drying marrows ground up. He began with a marrow old enough to make sure it was not at all virulent then, progressively, injections with ground-up fresher marrows, until final inoculation with a very virulent marrow that had been drying only a day or two (Geison, 212-215). On December 2 in Newark, a rabid dog bit six children, who, via a public campaign, arrived in Paris on December 21 for treatment by Pasteur, with attendant national publicity spearheaded by NY Herald, NY Sun, NY World and NY Times. The Newark boys’ trip to Paris “prompted so much sustained attention by the press and the public as to change popular expectations about medicine more generally. . . . As a result, Pasteur’s rabies treatment . . . stimulated a series of events and expectations that set a pattern through which later discoveries would be experienced. . . . an entirely new idea became embedded in popular consciousness: that medical research could provide widespread benefits” (Hansen, 374, 375). “In a novel fashion, the hydrophobia drama – because it captured the popular imagination – disseminated effectively, if not intentionally, a new image of the value of experimental research in medicine, helping to create a new expectation of continuing medical advances and implicitly encouraging public commitment to such research”(402).

Establishment of Institute of Hygiene at University of Berlin, with Koch first Professor or Hygiene (Brock, 183). T. Mitchell Prudden and Wm. Welch become first Americans to take Koch’s laboratory course in general bacteriology at Gesundheitamt in Berlin (Hammonds, 53). Hugo von Ziemssen established one of first clinical laboratories in Munich, followed by George Dock’s laboratory at Ann Arbor (1893) and Wm. Pepper’s laboratory of clinical medicine in Philadelphia (1895) (Reiser, 139). Publication of first journal of bacteriological research, Baumgarten’s Jahresbericht über die Fortschnitte in der Lehre von den Pathogenen Mikrooganismen umfassend Bacterien, Pilze und Protozoen, followed by Zeitschrift für Hygiene published by Koch’s Institute für Infektionkrankheiten in 1886 (Liebenau, 38).

Joseph O’Dwyer of NYC develops technique of intubation to bypass obstruction of larynx in diphtheria patients (Dowling, 40).

Publication of Gilles de la Tourette’s Étude sur une Affection Nerveuse, arguing that the “maladie des tics” was a progressive illness culminating in involuntary cursing (coprolalia). Of his description of nine patients, “only the Marquise de Dampierre unambiguously qualif ies as suffering from Gilles de la Tourette’s disease as originally described and Tourette syndrome as it is now represented in the DSM-IV” (Kushner, 24). Gilles de la Tourette and Charcot differentiated maladie des tics from florid hysteria by ascribing inherited psychological and physiological causes, a progressive course, and resistance to cure (via hypnosis) to the former (Kushner, 29-32).

American Association of Physicians (AAP) founded by seven physicians, including Osler: It “defined its goals as the advancement of scientific and practical medicine, the development of a Society where like-minded physicians could discuss their work, and the creation of an association for colleagues who have made substantial contributions to the body of medical knowledge” (Snyderman, 1169).

Reginald Heber Fitz’s article, Perforating Inflammation of the Vermiform Appendix, delivered at first meeting of American Association of Physicians, described and named appendicitis (Trombley, 62, 67); T. G. Morton (Phila) & Hall first surgeons to perform appendectomy in U.S. (Trombley, 57, 61-63); private home appendectomy was performed in 1888 (Finney, 81-83; Fulton, 129n; DaCosta, 335). Crile commented on “raging controversy” over use of surgery in treatment of appendicitis – whether at time of diagnosis or only after onset of peritonitis and abscess (Crile, I, 81-82). Halsted enrolls in first (pathology, experimental medicine) courses at Hopkins offered by Welch et al. (Crowe, 13).

Matas publishes two-part serial in New Orleans Med & Surg Journal defining caecum and appendix as intraperitoneal organs (crediting Frederick Treves of London as first with this viewpoint) and urging surgery prior to rupture (Cohn, 168-69); continues support, against the New Orleans establishment, of Carlos Finlay’s doctrine of yellow-fever transmission via mosquito (185-86).

Halsted to Butler Hospital (RI) for treatment of his cocaine addiction; he received daily shots of morphine to combat withdrawal symptoms (Markel II, 133-143). He returned to Butler for nine months in 1887 after a relapse (152).

“Imlach Affair” over whether Francis Imlach (of Woman’s Hospital in Liverpool) performed unnecessary ovariotomies rocked gynecologists in England (M-S2, 127-28; Shepherd, 162-166). Committee of Enquiry followed his removal of both ovaries of young, unmarried woman in 1885 who had a renal stone and infected kidney and a litigation in 1886 followed removal of ovary and tube of Mrs. Casey; Imlach was cleared by jury. Imlach supported by Tait.

August Forel spends five days in Nancy with Bernheim, who “initiated us in the most amiable fashion into all the phenomena of hypnotism or suggestion” and returns to Zurich “almost the complete hypnotist” (Forel, 167).

Lister gives up carbolic spray, following Koch’s discovery of inhibitory action of weak antiseptic solutions; von Bergmann develops aseptic method, which Lister opposed (Truax, 239-242). Ninth International Medical Congress held in Washington, DC, first Congress held in U.S. (Martin, 184-186).

Hungarian chemist Lazar Edeleanu synthesizes amphetamine from the pure alkaloid ephedrine, which had been isolated from the Chinese (and Indian) ephedra plant by K. K. Chen in 1885. The medical properties of amphetamine as decongestant were explored only in the 1920s, and the drug was sold by SK&F in 1932 as Benzedrine. In China, the ephedra silica, in the form of the herb Ma Huang, had long been used as a remedy for asthma.

Morell Mackenzie called in as consultant to evaluate larynx tumor of Crown Prince Frederick of Germany (married to Queen Victoria’s eldest daughter), deemed cancerous by German physicians who were ready to perform laryngotomy (splitting of larynx from the front of throat to gain access to its interior). Mackenzie took two biopsies, which Virchow found negative. Frederick returned with Mackenzie to London where, on June 28, he removed with laryngeal forceps what appeared to be the rest of the growth, which Virchow again found negative (Stevenson[2], 65-89). New subglottic swellings and tumors below each vocal cord confirmed diagnosis of cancer in early November, though Frederick declined a laryngectomy (91-96). Following increased swelling in January, tracheotomy was performed (104-105). Death of Emperor William I on 8 March 1888; death of Emperor Frederick III on 15 June 1888 following a laryngeal fistula and terminal broncho-pneumonia (130-132); he was succeeded by his younger brother, William II. Publication of Mackenzie’s The Fatal Illness of Frederick the Noble in October, 1888, with its vicious condemnation of von Bergmann (“whose roughness was never forgotten by the Emperor” [150]) and the rest of the German consultants (146ff.). Mackenzie relied greatly on Virchow’s negative pathological findings, though Virchow “never accepted his share in this responsibility” (167). “One of the most unfortunate effects of the notoriety of the case upon medical opinion was that the value of the removal of a specimen of living tissue for microscopic examination (biopsy) was discredited for several decades” (168).

Founding of American Physiological Society via Weir Mitchell, Henry Bowditch, and Newall Martin (Fye, 168ff.), partly to coordinate medical response to antivivisectionist attacks (175-176) and also to enable physiologists to be represented at Congress of American Physicians and Surgeons (1888) (180-181).

Founding of American Orthopedic Association by physicians who largely specialized in chronic pediatric conditions (rickets, Pott’s disease [TB of spine], polio deformities, clubfoot, dislocated hips) (Linker, 36). Founding by James Knight of NY Hospital for the Ruptured and Crippled in 1870 and other hospitals for crippled children in decade after Civil War (38-43). Late-19th c. orthopedists shared vision of Progressive reformers engaged in “child saving” and welfare reform: “Disability could be cured, orthopedic surgeons believed, only when the patient became employable” (37).

Establishment of Marine Hospital on Staten Island, a hygienic laboratory set up and directed by Joseph James Kinyoun, that evolved into National Institutes of Health. It was reorganized via 1902 congressional act under director Milton Rosenau as “Public Health and Marine Hospital Service,” with Walter Wyman designated “Surgeon General” rather than Supervising Surgeon. 1902 act added Division of Chemistry, Pharmacology, and Zoology to existing Hygienic Laboratory, renamed the Division of Pathology and Bacteriology (Harden, 9ff.). The latter focused on infectious diseases, with successes re typhoid fever, identification of tularemia, and undulant fever (22). Act of 1912 shortened name to Public Health Service and authorized research on noncontagious diseases (e.g., pellagra) and water pollution (38). During WWI, Hygienic Laboratory isolated organisms from epidemic meningitis, developed tetanus antitoxin and antityphoid vaccine, and “identified shaving brushes used by troops as the source of some cases of tetanus and anthrax” (41). In 1918, congressional act created Division of Venereal Diseases that permitted PHS funding for outside work on venereal diseases and for social science research leading to better educational measures re VD = first federal grants since National Board of Health funded investigation of yellow fever in 1880s (41-42).

Cajal disputes reticular (network) theory of neural transmission of Golgi and Gerlach in claiming that all axons end in gray matter and that these endings are arranged closely around other cells (Rapport, 103). In 1888, he begins to refute reticularists with data as to synaptic boutons (slight swelling in termination of axons where they conform to the dendrites of the neighboring neuron (122-123). Evidence of the synaptic space from the dendritic side came from microscopic studies of receptor cells (rods and cones) of the mammalian retina, with axons of rods and cones conforming to the shape of the dendrites of the underlying cells (124-126). At 1889 meeting of the German Anatomical Society in Berlin, Cajal’s work (viz, his slides) won support of Albert von Kölliker, dean of European histology, who in turn rallied the support of Retzius, His, Waldeyer, and other leading histologists at the conference (137-139). In 1891, Waldeyer, integrating the work of Cajal, His, Forel, and others coined the term “neuron” in two review articles (142).

Official inauguration of the Institut Pasteur (Geison, 261, 263-264, 271).

From waste chemical paranitrophenol lying around back of Bayer’s plant, graduate fellow Oskar Hinsberg produced acetophenetidine, patented as Phenacetin. It was Bayer’s “ground-breaking product, the first really big hit of the nascent pharmaceutical business” (Jeffreys, 64ff.) Several months later, flu epidemic swept Europe and North America  great demand for fever-reducing meds. “Phenacetin was one of the few effective therapies available, and Bayer cashed in.” Phenacetin transformed a small, struggling dye company into a major pharmaceutical firm. Bayer followed the same year with the sedative Sulfonal, and then a refined version, Trional.

Chicago Times exposé of the private practice of abortion in Chicago, under the headline “Infanticide.” The investigation “made it obvious that physicians were an important source of abortions and that abortion was part of regular medical practice” (Reagan, 46-61, quoted at 54).

American George Nuttral confirmed Metchnikoff’s finding of phygocytosis in anthrax-infected frogs, but found that under frog skin, anthrax bacilli were destroyed in great numbers. This led to belief in blood’s bactericidal capacity, which in turn led to finding that opsonins participate in the complex killing process. This led other critics of Metchnikoff to the view that phygocytosis occurred only after bacteria had been fatally wounded, as a post facto scavenger process. This initiated the humoral theory or mechanism of immunity, which was advanced by the 1890 studies of Behring and Kitasato which showed that cell-free serum neutralized the toxins of tetanus and diphtheria and could be transferred to another animal. “Metchnikoff presented the cellularist localist position, arguing for a sovereign activity of a certain cellular group; his humoralist opponents presented a holist position, defending the sovereignty of the organism over its constituents” (Tauber & Chernyak, 149-150, 154-159; quote at 159; Silverstein, 47).

New antiseptic method of surgery “just coming into vogue” at Mass General. Younger surgeons more interested in it than senior surgeons (Finney, 70); the “transition period between the old surgery and the new” (74-75). First attempts at sterilization utilized the hospital bakery oven (75-76); limited types of operations undertaken at the time: “With rare exceptions no operations were done on the gall bladder, the liver, the spleen or the kidney” (79). However, Listerism was “wholeheartedly adopted” by surgical staff at NY’s Woman’s Hospital in 1877 (Marr, 135-137).

In Marseilles Etienne-Louis, Arthur Fallot publishes paper based on post-mortems of three cyanotic young men in whom he found the four characteristic heart deformities of tetralogy of Fallot: pulmonary stenosis, a ventricular septal defect; right ventricular hypertrophy; and overriding aorta (i.e., aorta does not emerge from left ventricle alone, but communicates with both left and right ventricles). He followed this with documentation of all examples of cyanotic disease he could find, calling it la maladie bleue (Morris, loc 757).

Rudolph Matas works out surgical treatment of aneurysm (i.e., suture inside the sac), but only published the method in 1902. It was case of aneurysm of brachial artery where, after preliminary attempts at ligature, he sewed up the lips of the orifices, intima to intima (Cohn, 199-215). Matas published his “epochal modification of revived Antyllian procedure” in Medical News of Philadelphia, but only mustered the courage to repeat the operation 12 years later (280-284), owing, Cohn speculates, to deference to his arch conservative teachers, Edmond Souchon and Stanford Chaillé (213-214). Matas finally reported five successful cases of “intrasacular suture” (“endoaneurismal sutures” [285]) at 1902 convention of American Surgical Assn. in Albany (284-285). Debate between Matas and Ballance on Matas’s endoaneurismorrhaphy versus Hunterian ligature at 1913 International Medical Congress in London (Cohn, 343,345).

Matas’ surgical breakthroughs: actual physical extirpation of aneurysm sac (as opposed to internal suture of sac, “a real Antyllian operation”), with use of “iodoform gauze” (223, see entry above); extirpation of thyroid tumor (thyroidectomy); use of intravenous infusions of saline solution for acute anemia (Cohn, 222-230). Mary Dixon Jones performs first total hysterectomy for fibroid tumors in U.S. (MS2, 101). ADVANCES IN SUTURING SEVERED INTESTINES: Nicholas Senn’s use of decalcified bone plates to support stitches (1887); Robert Abbe and Matas independently replace Senn plates with catgut rings (1889); John B. Murphy demonstrates first “Murphy button” (1902) (Cohn, 192, 224, 232-233).

In Dent v. West Virginia, U.S. Supreme Court upholds constitutionality of West Virginia’s Board of Health Act (1882), with its provision for mandatory state licensing. The WV law “implemented a state-sanctioned licensing process that put the future of medical care into the hands of those physicians most fully committed to educational uplift and scientific advance” (Mohr II, 160). The Court argued that the state’s statutory police powers in the realm of public health trumped an individual’s property rights (viz, an occupation (e.g., medical) practice = a form of property (i.e., an estate) in the eyes of the law [141]) without due process of law (Mohr II, 147-152). The decision represented a “policy wager” that improved standards of health care in the future would follow from a mastery of the academic sciences (159-160). The defenders of the WV license law – the elite regulars from the north (Wheeling) – could not “justify mandatory science-based licenses as a way to guarantee that all physicians would be able to understand and apply the new therapeutic advances then emerging from scientific laboratories, because the license law was passed before any significant therapeutic advances were made” (159).

Following opening of Johns Hopkins Hospital, Halsted breaks with tradition and lengthens surgical residency, in order to give resident surgeons opportunity to develop true expertise and operate on difficult cases. He thereby founded a school of surgery characterized by gentle handling of tissues (Crowe, 47; see 53-54 and Imber [202-204] on Halsted’s guiding surgical principles and procedures). Johns Hopkins Hospital established modern residency with residencies in medicine, surgery, and gynecology, based on the system of “house assistants” in German university medical clinics (Ludmerer, 83). Halsted performed his radical mastectomy, which he began to work out in 1882 (Harvey, 70-71). Finney interviews Halsted about coming to Johns Hopkins and is appointed to the surgical staff (Finney, 85-86). Cushing recounts that “Both Finney and I must have profited much from the Boston school of operating surgeons . . .” (Fulton, 125). Flexner arrives in Baltimore to work in Welch’s lab (Flexner, 160ff.). Howard Kelly appointed gynecologist and obstetrician to the hospital (Davis, 67ff.), holding that all gynecologists should first become abdominal surgeons (73).

Lister introduces double cyanide gauze: “final perfection”; rival schools of aseptic and antiseptic surgeons (Truax, 242-43). Kitasato, working in Koch’s institute, isolates causal agent of tetanus, the toxin Clostridium tetani (Brock, 223-225). Sven Hedin describes “hematokrit” (centrifuge with two whirling test tubes) that forced red blood cells to bottoms of tubes where, as a compact mass, their volume could be measured and the number of cells calculated = accurate index of anemia (Dad used one of these.) This eliminated the flaws in the red blood cell counting technique of William Gowers’ via his “haemacytometer” (Reiser, 132-33).

Mary Dixon Jones and her son Charles indicted for second-degree murder in death of Sarah Bates and manslaughter in case of Ida Hunt (M-S[II], 157-164), and acquitted on manslaughter charges in 1890; murder charges then dropped.

Brown-Séquard’s published report on the rejuvenating effects of injections of extracts of the testes (Borell I & II, Kahn). B-S pursued a “’replacement strategy’ in which an aqueous extract of dog and guinea pig testes, testicular blood, and seminal fluid was prepared, filtered, and then, in the first experiment, injected subcutaneously into his own arm” (Kahn, 143). “It was widely held that loss of semen resulted in the loss of strength, and that debility was the end result of sexual abuse. If weakness was the result of seminal loss, could not strength be gained by seminal retention? Brown-Séquard reasoned that something must be reabsorbed from the semen by the blood, and that these reabsorbed seminal principles must have a dynamogenic power, resulting in increased strength and vigor for those who abstained from ejaculation” (Borell I, 312). Thus, Brown-Séquard “advocated the use of testicular extract for the treatment of debilitating and nervous diseases because of the deductions he had made from generally accepted ideas of human sexuality. He had generalized this mode of replacement therapy in 1891 because of the strong analogies he perceived between the glandular organs and because of his conviction that all living cells probably secrete useful products. He saw this mode of therapy – injection of extracts of animal tissues – as being potentially useful in diseases whose etiology was unknown, but whose pathology was correlated with a particular tissue or organ” (Borell III, 266). The New York Pasteur Institute (founded by Paul Gibier to treat hydrophobia in 1889) supplied organ extracts to American physicians, at least during 1893-1898 (Borell I, 315-319). In 1890, Victor Horsley advocated the grafting of thyroid tissue into myxedematous patient, an idea that his former student George Murray transformed and exploited in 1891 by successfully treating a myxedematous patient with subcutaneous injections of thyroid juice (Borell III, 245). “Murray’s treatment of a myxoedematous patient by the subcutaneous injection of thyroid juice in 1891 was the first generally acknowledged success of the new organotherapy (III, 248). Then, in 1894, the clinician George Oliver and the physiologist Edward Schäfer of University College, London reported On the Physiological Action of Extract of the Suprarenal Capsules [thick connective tissue capsules surrounding the adrenal gland], which, with water, alcohol or glycerin, exerted a powerful action on the blood vessels and heart, causing an “extreme contraction of the arteries, so that the blood pressure is enormously raised” (III, 255-260, quoted at 259). They discovered that “the physiological effects of adrenal extract [could be] measured by standard experimental techniques” (255). Schäfer’s influence  interest in specific druglike effects of adrenal extract among British physiologists (260). Thus, “By 1895, ‘internal secretions’ seem to have acquired a new status in physiological theory because of the direct applicability of the notion of internal secretion to the interpretation of recently accumulated data on the physiology not only of the liver, pancreas, and kidney – all glands with ducts – but also of the thyroid gland, the pituitary body, and the suprarenal bodies – all ductless glands. These data derived principally from the extirpation and transplantation experiments performed by surgeons from the 1880s on. Extracts of organs came to be advocated as a rational substitute for transplanted organs” (Borell III, 266).

American surgeon Charles McBurney describes principles for operating on appendicitis, viz, (1) the sooner the surgery, the greater the likelihood of full recovery, and (2) it suffices to remove the inflamed appendix only as long as peritonitis has not developed. “McBurney’s point” = spot on abdomen of greatest pain (Van de Laar, ch 9).

German researchers Oskar Minkowski and Joseph von Mering, found that removal of pancreas from dogs led to symptoms of diabetes followed by death (Editorial, JAMA).

Frederick Novy begins teaching full-semester lecture-laboratory course in bacteriology for first-year med students at University of Michigan – the first such lecture-lab course in America. Daily one-hour lectures were followed by four-hour lab sessions five days a week for all first-year med students. Novy took the same equipment and methods that he used in his research and made them essential to medical instruction, introducing students to microscopes, solid culture plates, agar preparation, pipettes, incubators, sterilizers, and the handling of animals. Students were taught to identify microbes and then determine whether or not they caused disease according to Koch’s postulates. He wanted med students to learn how to prove or disprove experimentally what they were taught in books and in lectures. To accommodate Novy’s course, Victor Vaughan, his chief, recommended lengthening med school at Michigan from three to four years, which was approved by the Board of Regents in 1891. Two decades later, the Flexner Report attested to the value of laboratory work in med education, crediting Michigan “as a medical school that had already been succeeding in this initiative and as a ‘model of medical education’ in America” (P. Kazanjian, ch 3, quote at loc 1991).

Koch announces in August discovery of tuberculin (extract of virulent tubercle bacilli) at 10th International Congress of Medicine (Berlin), uncritically accepted by Lister. Koch appoints Paul Ehrlich to run the tuberculosis department of Moabit Hospital, where Berlin city authorities had placed 150 beds at Koch’s disposal to test “tuberculin” (Bäumler, 50-51). In fall, construction begins on Koch’s “Institute of Infectious Diseases,” near Charité Hospital that is occupied by July, 1891. By early 1891, tuberculin believed to be of dubious therapeutic but inestimable diagnostic value (Brock, 198ff.).

Emil Behring & Shibasaburo Kitasato, both working with Koch, introduce “antitoxin” concept in The Establishment of Diphtheria Immunity and Tetanus Immunity in Animals in the Deutsche Medizinische Wochenschrift: “The immunity of rabbits and mice that are immunized against tetanus is based on the ability of the cell-free blood liquid to render harmless the toxic substances produced by the tetanus bacilli” (Bäumler, 52-53; Silverstein, 49; Liebenau, 50-51). This is considered the founding of serum therapy (163). The basic finding was that the blood serum of rabbits immune to tetanus could be transferred to other animals, rendering them immune to tetanus (viz, imparting to their blood the ability to destroy tetanus toxin). Hence: “outstanding therapeutic effects are obtainable by blood or serum transfusion” (52). “The discovery of antibody in 1890 reinforced the trend toward humoral theories of immunity, and interest in cellular immunity declined, not to be seriously revived for almost 60 years. After the work of Emil von Behring and his collaborators, the central theoretical questions in immunology involved how antibodies are formed and how they acquire and exercise their specificity” (Silverstein, 94-95).

Jackson develops an esophagoscope “worthy of the name” and begins seeing children with stricture of esophagus from swallowing lye (Jackson, 105-110). Franklin Martin, adopting Georges Apostoli’s use of electricity in treatment of fibroid tumors of the uterus, publishes Electricity in Gynecology (Martin, 145). T. Mitchell Prudden publishes Dust and Its Dangers (Ott, 124-125).

Compulsory fourth year of medical school at Michigan followed by Harvard (1892) and Penn (1893) (Corner, 193).

Opening of NY Midwifery Dispensary on Broome Street (called the Outdoor Department of the Lying-In Hospital), which provided OB care to nearly 50,000 women (a majority of them Russian Jews) on the Lower East Side (Dye, 549, 552) and provided students & MDs with experience in home delivery. . . . the Broome Street doctors consciously worked to systematize obstetrics and to integrate scientific knowledge with everyday practice. . . . This new relationship was predicated upon patients’ acceptance of doctors’ authority. . . . Doctors’ refusal to give midwives a role in the management of birth helped establish a relationship in which only the physician could be regarded as a source of support and expertise (558) . . . the dispensary cases, incontrovertibly document women’s enthusiasm for medical care. Most early dispensary patients do not seem to have had difficulties accepting the terms of the new doctor-patient relationship. . . . By late nineteenth-century standards, the Midwifery Dispensary physicians did provide care that was superior to that ordinarily available to women of any social class” (559).

Henry Dalton of St. Louis successfully sutures a two-inch wound of the pericardium (Richardson, 29). Théodore Tuffier’s successful resection of a lung apex for tuberculosis (Richardson, 33). Women account for 25% of medical enrollment at Bern, which surpassed Zurich in its appeal to foreign women (Bonner, 65).

Opening of Provident Hospital (Chicago), first black-controlled hospital in U.S., founded by surgeon Daniel Hale Williams (S. Smith, 21).

Koch publishes paper on tuberculin; Behring & Kitasato publish paper on tetanus toxin/antitoxin (launching science of serology); Behring publishes paper on diphtheria antitoxin (Brock, 223-227). Ehrlich and associate report first successful application of his “staining” principle (viz, that a chemical, in combining with a microorganism, would destroy it) in treatment of malaria with methylene blue (Dowling, 93). Diphtheria antitoxin, commercially available in 1894 following Emile Roux’s production of antitoxin in horses at Pasteur Institute, marks inauguration of era of specific immunotherapy (Morantz-Sanchez, 235-236; Liebenau, 50-51) and deals a decisive blow to antivivisectionist movement (Ritvo, 162). Metchnikoff publishes Lectures on the Comparative Pathology of Inflammation to refute critics’ charges of teleology and vitalism, that phagocytosis theory imputed psychical activity to the leukocyte. Metchnikoff embraced the latter charge as an evolutionary process, seeing host defense as a byproduct of the digestive process of unicellular organisms (Tauber & Chernyak, 158; Silverstein, 47). Paul Ehrlich closed his private laboratory in order to work with Koch at the Institute for Infectious Diseases; Koch appointed him director of the Moabit Hospital’s tuberculosis department, where Koch’s “tuberculin” was being tested (Bäumler, 47-50).

NY Surgeon William Coley intentionally infects a patient with a sarcoma of the neck with erysipelas, the first instance of “nonspecific immunotherapy” that initiated “the American era of cancer immunotherapy” (Hall, 51ff.). Between 1891 and 1893, he attempted to infect 12 patients, two of whom died from the infections. In 1893, abandoning the use of live bacteria, he treated hopeless sarcomas with a “mixed toxin” of Streptococcus pyogenes (erysipelas) and Bacillus prodigiosus (believed to increase the virulence of the erysipelas germ) filtered through microscopic pores of porcelain that strained out the microbes; he believed the resulting fluid contained the active principle, “Coley’s toxins,” that shrunk and lysed sarcomas (61-67). His first case – a 16-year-old boy with inoperable abdominal tumor – resulted in permanent cure (66-67). Coley’s approach to treating bone sarcomas was abandoned following discovery of x-ray and advent of radiation therapy, endorsed by his colleague and subsequent chief, pathologist James Ewing, who turned against Coley by 1912 (83) and became president of Memorial’s Medical Board in 1913 when it became affiliated with Cornell Medical College (85). Ewing undermined Coley’s reputation at Memorial and “never passed up a public opportunity to express reservations about the bacterial vaccines and . . . came to articulate the major criticism of Coley’s toxins: that all of Coley’s cures were in fact misdiagnosed cases of diseases other than sarcoma. It took considerable gumption for Ewing to press this brief, for a number of those original diagnoses had been microscopically confirmed by Ewing himself when he served as chief pathologist at the Loomis Laboratory” (86).

Wilhelm von Waldeyer-Hartz (Berlin), drawing on the research of Cajal, His, Forel, and others, posits neurone theory, coining the term "neuron(e)" to describe the cellular function unit of the nervous system (Rapport, 142). First patient treated with Behring and Kitasato’s diphtheria antitoxin (Dowling, 36; Liebenau, 50). Heinrich Quincke popularizes lumbar puncture (Dowling, 51).

St. Louis surgeon Henry Dalton successfully repairs two-inch wound in pericardium of young man stabbed in fight (Morris, 354ff.).

First recorded cosmetic surgery, performed by John Roe (Rochester, NY), who described correction of angular deformities of nose via subcutaneous (endonasal) operation; then in 1892, Weir described reshaping a (sunken) nose (= “pollybeak” deformity) in a number of stages that = “summation of the steps used in the modern procedure for nasal reshaping” (Bennett, 155). Finally, in 1898, Jacques Joseph (Berlin) introduces modern rhinoplasty with publication of Surgical Correction of the Nose. Despite Roe’s priority (many endonasal procedures prior to Joseph’s first external procedure), “Joseph may well deserve the designation “father of rhinoplasty’. . . . The rhinoplasty surgical armamentarium today includes many instruments originally designed by Joseph” (Crumley, 12)

Publication of William Osler’s textbook, The Principles and Practice of Medicine.

Opening of Grady Memorial Hospital in Atlanta; it had “carefully constructed and physically separate sections for white and African American patients” (D’Antonio, 109). Its training school for (white) Nurses opened in 1898; by 1914 a separate program to train black nurses began under Ludie Andrews: “But it came only after careful negotiations ensured that Grady’s African American graduates would never be confused with its white ones. African American-trained students and graduate nurses would wear different uniforms, caps, and pins signifying their association, not with Grady Hospital per se, but with the newly chartered and separately titled ‘Municipal Training School for Colored Nurses’” (114). . . . White nurses were advantaged in that they held the privilege of race. They constructed meanings around racialized nursing identities by looking inward to the norms of their own local communities. African American nurses, by contrast, had to look outward to the experiences of other professional friends in Georgia and more national networks outside the state . . . Their struggle against the privileges of white supremacy lasted longer than those in any other state. The Georgia State Nurses Association was the last state association to officially desegregate. It did so in 1961 only after the American Nurses Association threatened to expel Georgia from the national organization if it failed to do so” (130).

First clinical polygraph made for James Mackenzie in London (Mair, 91ff.). In his case of Mrs. Ashworth, Mackenzie likely makes the clinical inference of ventricular extra-systoles, (premature heart beat when chambers beat out of order leading to momentary arrhythmia) as cause of cardiac irregularity (Mair, 132; Wilson, 85-87 gives dates as 1890).

Halsted successfully removes arterial aneurysm of left subclavian artery (first branch of the aorta): “the field of vascular surgery was off and running” (Imber, 272).

S.S. Massilia docks at New York Harbor on January 30, with brief inspection of over 800 Russian Jews at quarantine station off Staten Island; immigrants had been forced to spend three months in typhus-infested districts of Constantinople  typhus fever epidemic in NY’s lower east side, with draconian quarantining in “typhus houses” and then Riverside Hospital on North Brother Island, the city lazaretto (Markel, chaps 1 & 2).

cholera epidemic in Hamburg (Brock, 229) brought 100 cases to NY, leading to first municipal bacteriological laboratory in NY via initiatives of Welch et al. (Flexner, 343). Hamburg epidemic proves cholera was waterborne; Koch demonstrates water filtration key to its control (and, more importantly, to control of typhoid fever) (Brock, 230, 255). Threat of cholera leads NYC Board of Health to establish Division of Pathology, Bacteriology and Disinfection, headed by Hermann Biggs and including a bacteriological laboratory (Hammonds, 67-73). Immigrant Russian Jews deemed the “vector” of the cholera epidemic, as with the typhus fever epidemic the preceding February. Osler, Kelly, and Hurd of Hopkins among those in favor of “shutting the gates” to immigrants; President Harrison mandates national 20-day quarantine on immigrant ships (Markel, 89, 97). First program of this new Division was bacteriological diagnosis of diphtheria, with Wm. Park appointed inspector and bacteriological diagnostician of diphtheria. Parke produced first diphtheria antitoxin outside Europe in NYC lab in 1894 (Hammonds, 73-74; Liebenau, 51-52).

August Laubenheimer of Farbwerke Hoechst signs agreement with Koch for manufacture of tuberculin and with Behring for manufacture of diphtheria serum (Bäumler, 54-55). In 1894, Ehrlich signed his own contract with Hoechst regarding manufacture of diphtheria antitoxin (58-59).

Crile performs first total laryngectomy and then first successful one in 1894 (Crile, I, 52-53,131)

Opening of Johns Hopkins medical school, following $350k from Mary Garrett, daughter of president of Baltimore & Ohio RR, on condition of admission of women. This brought the total raised by the Women’s Fund Committee to $500,000, which is what the university required to fund the medical school (Imber, 184-186). First class of 18 included 3 women. Per Garrett’s stipulations, first U.S. school to require a bachelor’s degree for admission and to require working knowledge of French and German and college biology, chemistry, and physics (M-S, 85-87; Imber, 186-88); and to use the term “resident” for sustained specialty training (Stevens, 121). Lewellys Barker and Tom Cullen, following internships at Toronto General, begin Hopkins internships under Osler and Kelly (Robinson, 72ff.). Beginning of battles, esp. in NYC, between ophthalmologists (“medical oculists”) and optometrists (“refracting opticians”) (Stevens, 103ff.).

Group of nurses, meeting at nursing section of International Congress of Charities, Correction & Philanthropy held in Chicago as part of Columbian Exposition, organized by Isabel Hampton and Lavinia Dock of Hopkins, forms American Society of Superintendents of Training Schools in the U.S. & Canada. This was followed in 1896 by establishment of Nurses’ Associated Alumnae of the U.S. & Canada at a small meeting of the superintendents and representatives of training-school alumnae in NY and then, in 1898, by establishing year-long course in “hospital economics” for graduate nurses – the first formal training program for nursing superintendents (James, 228-235). Also in 1893, Lillian Wald & Mary Brewster found settlement house in NYC lower east side, which moved to Henry Street in 1895 (Estabrooks, 283).

National Quarantine Act, following cholera epidemic, creates national system of quarantine regulations, specific procedures for medical inspection of immigrants and cargos, etc. to be administered by U.S. Marine Hospital Service, but with cooperation and consent of state and local health authorities. In deference to immigration restrictionists, it also gave U.S. President power in case of emergency to suspend all immigration on a temporary basis (a power that has never been invoked) (Markel, 173-182).

NY state passes law requiring all public schools in state to exclude from enrollment any pupil who could not present proof of vaccination. The Jones-Tallett amendment of 1915 modified the law so that it applied only to the 10 cities in NY with population over 50,000, while extending compulsory vaccination to private and parochial schools, which had previously been exempt Colgrove, 185-187).

Rudolf Krehl first to thoroughly articulate concept of pathological physiology in Grundriss der allgemeinen klinischen Pathologie. Krehl taught or influenced American physicians and clinical scientists who transferred the concept to U.S. at turn of century (Fye II , 15-16).

Wilhelm Hiss, Jr., working at Carl Ludwig’s lab in Leipzig, discovers the bundle of cardiac muscle connecting the septal walls in atria and ventricles in mice, dogs, and humans. The “bundle of Hiss” (i.e., AV bundle), conducted cardiac impulses from the atria to ventricles (Jeffreey, loc 136).

Paris surgeon Jules-Emile Péan opens his Hôpital International, and implanted shoulder prosthesis for a 37-year-old baker dying from tuberculosis of the right shoulder. The artificial joint was invented by the dentist J. Porter Michaelis of Paris , and consisted of a rubber ball and platinum tube. Two years after the implant, the patient returned with his persistent elbow fistula, and Péan removed the prosthesis: “ . . . an ossified mantle had formed around the prosthesis. The scar tissue of the original cold abscess had festered and had been transformed into bone tissue. It was a complete mess. . . . The story of the baker and the history of joint prostheses indeed shows that the acceptance of foreign materials by the body depends on the absence of infection. If bacteria attach to something foreign . . . they are apparently beyond reach of the immune system. Prosthetic material will therefore only be accepted if it is fitted under absolutely sterile conditions” (Van de Larr, ch 24; Zilber). “This was probably the first metal articular prosthesis ever implanted, as Themistocles Glück, the pioneer of joint replacement, was still using ivory and cadaveric bone for his prostheses” (Zilber).

Finney travels to German surgical clinics of von Mikulicz, Kocher, Billroth (who had just died): “The name of Billroth is one to conjure with in surgery. He was one of the greatest surgical teachers and contributors to surgical thought of all time” (Finney, 127; cf. Cushing’s remark in Fulton, 120).

Alice Magaw appointed to Mayo-run St. Mary’s Hospital, where she perfects method of open-drop anesthesia, then popular in Germany, publishing results of her method in 1899 (Stepansky III, 44-45).

One of first patients Cushing anesthetizes (etherizes) at MGH dies; Cushing so affected that he and classmate Amory Codman devise improvement in administration of ether – ether charts (Fulton, 69, 93-97). By May 1893, Cushing suicidally depressed (Fulton, 75). NYC founds first publicly supported laboratory devoted to diphtheria diagnosis (Reiser, 142), with diphtheria antitoxin produced in NYC lab under Wm. Park in 1894 (Liebenau, 52).

Franklin Mall, who studied with Ludwig in 1885-1886, returns to Hopkins from Chicago and continues arguing for full-time, salaried clinical appointments; L. F. Barker becomes his mouthpiece and makes it almost a national issue with speech in 1902 (Flexner, 300ff.). George Nuttall, Simon Flexner, and Tom Cullen off to Europe, where Nuttall and Cullen studied pathology under Johannes Orth, Virchow’s Lieblingschüler, at Göttingen (Robinson, 103ff.).

First recorded polio epidemic in the U.S. occurs in Ohio Valley, near Rutland, VT. Eighty-four of 123 reported cases were under six years of age (Oshinsky II, 22).

Bubonic plague reaches Chinatown, then San Francisco in 1900.

Publication of W. S. Halsted’s landmark paper on radical mastectomy, “The Results of Operations for the Cure of Cancer of the Breast Performed at the Johns Hopkins Hospital from June 1889, to January 1894,” in Annals of Surgery, 20:497-555, November 1894.

Matas named Professor of Surgery at Tulane & addresses Postgraduate Medical School & Hospital in Chicago (Cohn, 242, 249-55). In January 1895 he finally marries his long-time love/housekeeper, Adrienne Goslee. Announcement of successful treatment of children with diphtheria antitoxin at Int. Conference of Hygiene and Demography in Budapest following Emile Roux and Louis Martin’s production of antitoxin using immune serum from horses (Hammonds, 88, 90-92 ). This leads to public subscription campaign in NYC by New York Herald to support antitoxin production and distribution (Hammonds, 93ff.; Liebenau, 50-53). H. K. Mulford (Phila) and Parke Davis (Detroit) begin private manufacture of diphtheria antitoxin in 1895 (Liebenau, 57-64).

Forlanini induces pneumothorax (collapsed lung) by injecting filtered air into pleural space of 17-year-old girl with advanced TB in right lung; she recovers and the procedure is rapidly accepted in Europe and 15 years later in U.S. (Daniel, 197).

French venereologist Alfred Fournier establishes strong statistical correlation between infection with syphilis and subsequent general paralysis (Micale II, 507).

Coeducation overtakes separation in American medical education (Bonner, 194); by 1910, over 80% of women studying medicine in U.S. and Canada were in coed schools (155). Medical inspection of individual schoolchildren begins in Boston; by 1897, NYC’s program was operating (Kraut, 234),

Crile begins using cocaine for tracheotomy and laryngectomy, and other minor operations; in 1897, performs first amputation under cocaine (Crile I, 80-81). Hunter Robb, at Hopkins, recommends that surgeon himself wear rubber gloves (Davis, 76).

John Murphy’s first successful case of end-to-end arterial anastomosis (Friedman, 25). Establishment of the Institute for Serum Research and Serum Testing at Stiglitz with Paul Ehrlich appointed Director (Bäumler, 61); it was transferred to Frankfurt in 1899 (74, 79).

Journal of Osteopathy begins publication (Whorton, 166).

George Oliver (clinician) and Edward Schäfer (University College London) summarize response of different visceral organs to adrenal extract (adrenaline) as identical to those following stimulation of sympathetic nerves; around 1900, John Langley (Cambridge) begins experiments with adrenaline (Valenstein II, 13-17).

Founding of the National Medical Association by leading African American physicians, with Robert F. Boyd of Nashville, TN as first president. By 1904 it had fewer than 50 members; at which time Daniel Hale Williams attracted a large crowd to observe him do surgery in a white hospital at NMA’s annual meeting in Lexington, and, with Williams’ backing, its membership began to grow (Ward, 195-97). NMA began publishing its official journal (JNMA) in 1909 (Long, 167-177); it presented a unified picture of a class of doctors who saw themselves as “new Negroes” and steered away from radical political messages (169).

Founding in Philadelphia of Frederick Douglass Memorial Hospital and Training School by Dr. Nathan Mossell, to provide surgical and nursing training for black physicians and nursing students. It was privately funded by black community and black churches (Long, 161ff.)

Lillian Wald relocates her Lower East Side settlement house (founded 1893) to Henry Street, where visiting nursing distinguished it from other settlements (Estabrooks, 284).

On November 8, Roentgen discovers X-rays (Kevles, 16ff.); invention of fluoroscope (Ott, 97). In 1896, Edison markets an improved fluoroscope, and NY surgeon William Tillinghast Bull first surgeon to use X-ray as operating guide (Kevles, 33-36); in May 1896, Italy first nation to use x-rays on battlefield, then British in 1897, then US in 1898 in Spanish-American war, where “Wartime use of X-rays gave the specialty of surgery a boost” (40). Outside the military, dentistry only specialty to adopt x-rays immediately into practice (43).

Cushing graduates from Harvard Med School, where, in 1895, J. W. Eliot turned his attention to brain surgery (Fulton, 259-61). He begins a year as an MGH house officer (intern) in August, travels to Baltimore, where he meets Hopkins crowd in November, is offered appointment by Halsted beginning October 1, 1896 (Fulton, 100-104). Cushing helps initiate clinical use of x-rays at MGH and sets up x-ray unit at Hopkins (Fulton, 104-106, 121, 122).

John G. Clark, resident gynecologist at Hopkins (under Kelley), performs first radical abdominal hysterectomy; Wertheim of Vienna followed in 1898, and popularized the procedure (Harvey, 89-90). Crile performs research on surgical shock in London laboratory (University College) of Victor Horsley (Crile I, 68-9, 72). First publication of surgical disaster: Four of five abdominal sections in one week [under Howard Kelly] died from postoperative septic peritonitis) in Johns Hopkins Hospital Reports (Robinson, 122-124).

Crile develops the carotid clamp, whose modification permitted first bloodless operation on head and neck by temporary closure of both carotid arteries in 1897 (Crile I, 63). Alfred Kirstein’s (Berlin) invention of laryngoscope (Richardson, 86-87). McLean Asylum relocates to Belmont, MA; new asylum designed by Frederick Law Olmsted, with separate buildings linked by underground tunnels (Beam, 30-33). Vatican issues ruling against medical abortion (craniotomy) (J. Ryan, 491-92).

Wilbur Atwood publishes famous Department of Agriculture booklet #142 with standard diet and food composition tables that introduced American housewives to protein, carbohydrate, and fat and popularized concept of the calorie (Brumberg, 236-237).

Growing out of his involvement in spiritualism and animal magnetism, D. D. Palmer founds chiropractic in Davenport, Iowa. “In chiropractic, the soul cure of magnetic healing meshed with the hand cure of manipulation.” (J. S. Moore, 19-23, quoted at 19; Porter & Porter, 247ff.).

Smallpox epidemic breaks out in Gloucester, stronghold of Britain’s anti-vaccinationist movement. “

Fernand Widal’s discovery that blood serum of patient with typhoid fever caused a culture of typhoid bacilli to lose motility and to agglutinate (clump together) use of this “serodiagnostic” technique to detect typhoid fever (Reiser, 136). Introduction of aspirin by Bayer.

Joseph Bloodgood (of Halsted’s staff) becomes first surgeon to wear rubber gloves in every operation (Crowe, 50-52; Harvey, 73-74). In 1903, Moynihan brings rubber gloves back to Leeds, England, following visit to U.S. (Bateman, 126-128).

Riva-Rocci introduces prototype of blood pressure instrument used today. Five years later, Harvey Cushing saw it being used in a Turin hospital and brought it to America, where it was used on the wards of Johns Hopkins Hospital (Evans, 789).

Stephen Paget writes in The Surgery of the Chest: “Surgery of the heart has probably reached the limits set by Nature to all surgery: no new method, and no new discovery, can overcome the natural difficulties that attend a wound of the heart.” Ludwig Rehn of Frankfurt am Main successfully sutures with silk threat of .6-inch a knife wound in the right ventricle (Morris states the wound was “in the surface of the cardiac muscle” [loc 412]) , then packing the pleural cavity with iodoform gauze (Richardson, 30-31; Morris, loc 404ff. ). First surgeon to remove a bullet lodged in heart was Estonian Werner von Manteuffel in 1903. He removed bullet lodged in right ventricle by lifting the heart to cut out the bullet (Morris, loc 452).

Welch leads campaign against antivivisectionists (Flexner, 254-62).

Another yellow fever epidemic rips through the gulf states.

Halsted removes Cushing’s appendix following appendicitis (Fulton, 129-135). Welch launches Journal of Experimental Medicine (Flexner, 242-250).

First International Leprosy Conference convenes in Berlin, with Virchow as president and speakers including Koch and Hansen. Hansen’s paper was the centerpiece of the conference, and his argument for isolation as the key to preventing spread of leprosy was adopted by Conference (Edmond, 102-105). A year later a new Leprosy Committee established by London College of Physicians finally conceded the College’s 1867 Report was ill-founded, and that the communicability of leprosy was “an established fact” (108).

Paul Ehrlich, in a seminal paper, established the first practical method for standardization of diphtheria toxin and antitoxin, and also proposed the side chain theory of antibody formation (the affinities of chemicals, nutrients, or antitoxins for target biologicals). Three tenets of side-chain theory: 1. antibodies were normal cell receptors ready, on a best-fit basis, to bind antigen; 2. antibody specificity resided in chemical complementarity; and 3. antigen-antibody binding was a chemical and irreversible process (Tauber & Chernyak, 163-164; Bäumler, 62-67; Silverstein, 64-66. 94-97). According to Ehrlich’s side-chain theory, “the antibodies represent the side chains of the cell protoplasm produced in excess and therefore rejected. These side chains or antibodies were thus bound to have a specific affinity with the toxin” (Bäumler, 66). The cell shed the excess side chains in the blood in the manner of secretory gland cells, but the released side chains possessed one group of atoms capable of linking with toxins; hence they could be regarded as antitoxins (82); “When, however, large amounts or repeated doses of toxin were administered, then the cell would overcompensate for the loss of these side-chain receptors, producing so many that some would be released into the blood” [Silverstein, 65]). Ehrlich believed the causes of immunity were not confined to hapten (linking) action and phagocytosis, but included athrepsia – a model of passive immunity in which antigens died when they were incapable of absorbing their essential nutrient from the host: “. . . microorganisms can only be pathogenic for a certain animal if they find in it possibilities of nutrition” (Tauber & Chernyak, 168). “In summary, both Ehrlich and Metchnikoff recognized the dynamic struggle between host and pathogen, but the former viewed the issue in passive terms, whereas the latter was ever conscious of an active response. . . . The failure then to formalize the question of immune specificity is the central lacuna of Metchnikoff’s later defense of the phagocytosis theory” (171).

Term “synapse” popularized in Sherrington’s new edition of Michael Foster’s Textbook of Physiology (Rapport, 157).

Publication of Richard Cabot’s A Guide to the Clinical Examination of the Blood for Diagnostic Purposes (NY: W. Wood), first American guide to use of hematology.

Almroth Wright publishes paper on his successful typhoid vaccine, though only 14,000 out of 330,000 British troops received the vaccine during the South African War of 1898 (Macfarlane, 54-55). New York enacts first voluntary, then compulsory, notification of TB (Ott, 129). Development of glycerinated lymph (glycerinated vaccine) to preserve and dilute vaccine before it was transferred to sealed glass tubes (Liebenau, 80).

Founding of American Association for Advancement of Osteopathy, renamed four years later American Osteopathic Association, which fought for independent boards of registration and examination (Gevitz, 54-55). D. D. Palmer founds the Palmer School and Cure in Davenport, Iowa, the first school of chiropractic, which he placed in the hands of his 20-year-old son, B. J. Palmer, in 1902.

Society of Superintendents of Training [Nursing] Schools creates the Nurses Associated Alumnae of U.S. and Canada, whose name changed in 1911 to American Nurses Association, at which time it admitted individual states, meaning no black nurses from DC or southern states (Reverby, 123-124; D’Antonio, 135).

In Germany, Magnus Hirschfeld and associates establish the Scientific-Humanitarian Committee, which demanded equal rights for homosexuals and demanded repeal of Paragraph 175 of German legal code on sodomy (Sengoopta, 448). Hirschfeld seized on the developmental hypothesis of homosexuality (contra older degeneration theory) while denying that the developmental error in homosexuality led to the feminization of the psyche alone; he held that the homosexual’s body too “was, rather, a harmonious fusion of the two [i.e., of masculinity and femininity]. . . . Hirschfeld, in short, regarded homosexuality as a morphological but nongenital form of hermaphroditism” (452). Hirschfeld breathed new life into Ulrichs’s idea of sexual intermediacy, which became popular with activists, while its scientific tone and language “facilitated its quick dissemination (although not necessarily universal acceptance in medical circles” (454). Yet, “his [Hirschfeld’s] conceptualization of homosexuality remained essentially pathological – as did that of virtually every contemporary medical writer on sexuality. For Hirschfeld, the world was full of sexually intermediate organisms, but they had come into being owing to anomalous biological processes that needed to be understood” (454-455, emph . in original). . . . “If Hirschfeld was to be believed, then, homosexuality was, at the same time, a form of variation of the human species, a pathological entity, and a protector of the species against degeneration [;] [it developed as a “prophylactic” against degeneration in families sliding toward a degenerative sequence]. These fundamental inconsistencies came into harsh focus when one strand of Hirschfeld’s thought – that male homosexuals were pathologically feminized – compelled him to support the ‘treatment’ of a condition that he claimed was a mere variety of nature and that – he also held – should be left untreated for eugenic reasons” (455).

Bayer markets Glyco-Heroin, a cough suppressant with heroin (Schiff, 191).

Spanish-American War in Cuba, eventuating in vindication of yellow fever transmission (via mosquito) theories of Carlos Juan Finlay, which Matas had supported from the beginning. When yellow fever hit Siboney, Cuba in July, with only the black nurses of the 24th infantry willing to nurse the victims; eight white regiments refused (Cirillo, 92ff.) During yellow fever epidemic in Cuba in 1900, Walter Reed returns to Cuba and conducts experiments with paid volunteers establishing once and for all that mosquitos were the disease vector, not fomites (soiled clothing, bedding, etc.) in transmitting yellow fever, and further that the virus had to mature in the mosquito for two weeks before disease transmission via mosquito bite. Following war, establishment of Typhoid Commission (chaired by Walter Reed), which determined contact or comrade infection was primarily responsible for transmission of typhoid fever in military camps (Vaughan, 369ff., 386). Spanish-American War also “demonstrated the value of both hospital ships and female nursing.” Prior to the war, the Hospital Corps created in the 1880s consisted solely of male attendants. But in 1898, Army Surgeon General Sternberg sought female nurses to help cope with the emergency. Only white, unmarried nurses immune to yellow fever could enlist in the Medical Department. (Byerly I, 71-72). . . . During American occupation, William Gorgas became, successively, head of Las Animas Hospital; chief sanitary officer of Havana; and, in May 1899, chief surgeon of Havana, overseeing all health facilities: “Before the mosquito theory of yellow fever transmission, Gorgas and his staff took patient histories to get clues as to why they had caught the disease, such as if they had bad habits like drinking or visiting houses of prostitution, or had been in ‘infected’ buildings, like those at Siboney” (Byerly I, 86-87). “Yellow fever [after all] is a messy disease, producing all kinds of effluvia – vomit, blood, mucus, feces – so people reasonably believed it was a disease of filth, transferred by fomites on solid linens or other materials” (95).

Merger of NYU Medical College and Bellevue Medical College into the “University and Bellevue Hospital Medical College.” The combined institutions became the New York University College of Medicine in 1935. Cornell, Columbia P&S, and NYU/Bellevue had previously run different Divisions of the hospital (Oshinsky, 191). All three medical schools accepted their first women between 1915 and 1922 (193).

NYC’s Lincoln Hospital opens its nurses training school, with white nursing superintendents teaching and supervising black students (D’Antonio, 73). Persistent racism among black and white nursing graduates: “A Lincoln graduate who wished to work as a private nurse could only do so in African American families, in white families who also employed African Americans in other positions, or in hospitals with an African American training school. The critical issue involved meals. African Americans in the North might eat in the same public dining room as white men and women, but they could not eat in the same space with them in a private home” (74).

A. G. Bernays performs his first (unsuccessful) gastrectomy (total removal of stomach) for cancer of stomach (Bernays, 161-166). Publication of Howard Kelly’s two-volume Operative Gynecology, with Max Broedel’s illustrations (Davis, 115). John B. Murphy’s Oration in Surgery at AMA’s annual meeting promotes his technique for artificial pneumothorax (Ott, 95-96).

James Mackenzie, following disappearance of presystolic (i.e., before beat of the left ventricle, when the mitral valve is still open) murmur (rrrlubb-dup) marked A Dangerous Type of Irregularity in a patient in heart failure. In this patient, it followed recurrent attacks of rheumatic fever, with resulting narrowing of opening between left auricle and left ventricle. This was the discovery of “auricular paralysis,” subsequently dubbed auricular fibrillation by Thomas Lewis (Wilson, 120-125; Mair, 144-147). Lewis’s theory that the condition was caused by muscular fibers of the auricle contracting rapidly and independently of each other was held until 1952, when Prinzmetal and others concluded it originated from a single rapidly discharging ectopic focus rather than from a complete circle of movement around the great veins (Mair, 147).

Bleuler (like Forel, an abstainer) succeeds A. Forel as Professor and Director of the Burghölzli asylum in Zurich (Forel, 241). Forel retires to Morges, where he continues to hypnotize (249, 252) and campaign for abstinence (helping found chapters of Good Templar Orders, speaking at anti-alcohol congresses, etc.). Britain’s new Vaccination Act relaxes terms of compulsion by introducing possibility of conscientious objection of parents re their children (Porter & Porter).

Closing of Blackwell’s Women’s Medical College of the New York Infirmary, with many students migrating to Cornell Medical College, which opened in 1898 and not only admitted women but allowed women to teach and to serve as trustees. The Infirmary itself would remain in existence at Stuyvesant Square until 1981 (Nimura, 264-65).

Establishment of first juvenile court in Chicago, with treatment and sentencing of girls (mainly immigrant working-class girls) based primarily on suspected sexual behaviors. Female moral crimes included prostitution, illegitimate pregnancy, suspected promiscuity, and staying out past curfew. More than 90% of convicted female delinquents classified as “moral offenders” during early 20th c. (Abrams & Curran, 52-53).

Chicago surgeon Albert John Ochsner performs vasectomies on two patients for prostrate problems, and begins to see eugenic possibilities of the operation – article in JAMA in 1901 on vasectomy’s potential to address social pathologies  Henry C. Sharp, an Indiana state superintendent, reads the article, begins performing vasectomies at Indiana State Reformatory, “made a clarion call in favor of sterilization,” and saw through passage of America’s first eugenic sterilization law in April 1907 (Hansen & King, 74-78).

Publication of first edition of the Merck Manual.

Founding of Society of American Bacteriologists, with Frederick Novy, who developed first lab-based course in bacteriology at University of Michigan Med School, among founding members (P. Kazanjian, Intro).

Chevalier Jackson performs his first bronchoscopy and constructs the first practical bronchoscope, using cadavers and then dogs as experimental subjects (Jackson, 115-120; Stevenson, 145;140-49). Edwin Broyles of Hopkins develops the bronchoscope with a series of telescopes inserted into its lumen (Crowe, 175).

Matas develops foot-operated positive-pressure device to keep lungs from collapse (anticipated modern heart-lung machines); Matas performs first American operation under spinal anesthesia (anticipated earlier in 1899 by August Bier in Kiel, Germany). Paul Ehrlich relocates to Frankfurt, to head the Royal Institute for Experimental Therapy (Bäumler, 79ff.).

Prevost and Battelli, Geneva physiologists, reporting on effects of various voltages and currents passed through the hearts of animals, observe that it is possible to convert ventricular fibrillation to regular rhythm by passing strong electric currents through the fibrillating heart (Fye II, 861). In 1933, Hopkins electrical engineer William Kouwenhoven and colleagues at Rockefeller Institute formed a committee to study electrocution to demonstrate electrical defibrillation in animals (Fye II, 862).

Howard Kelly at Johns Hopkins performs first abdominoplasty (“tummy tuck”), i.e., removal of fatty tissue outside the abdominal wall and not in abdominal cavity (Van de Laar, ch 15)

First discovery of a virus: Discovery of yellow fever virus by Walter Reed, studied by Lewis and five other Rockefeller scientists who themselves got infected and died of the disease. But the discovery was based on “an argument by exclusion”: the scientists did not know that a virus is simply a bundle of genes, in the form of DNA or RNA, wrapped in a coating of proteins and lipids. They could isolate it via fine sieve with holes small enough to trap every known microorganism. But the viruses tiny enough to pass through the filter, isolated in this way, infected animals. So they knew there was super-small infectious agent in the filtered fluid (Kolata, 71).

First experiments by Korff with “twilight sleep” (semi narcosis; “obstetric analgesia”) using composite injections of scopolamine and morphine (Fulops-Miller, 358). Woman’s Medical College of the New York Infirmary merges with Cornell (Morantz-Sanchez, 246-47) which, following example of Hopkins, begins accepting women in medicine (Bonner, 152). Publication of Crile’s An Experimental Research into Surgical Shock (Crile, I, 75).

Cajal invited to Clark University on its 10th anniversary and gives three lectures on structure of cerebral cortex (Rapport, 153-55).

Following Bayer’s Hoffman’s success in making acetyl salicylic acid that neutralized the chemical element of salicylic acid responsible for its gastric (acidic) side effects (found in salicin, salicylic acid, and sodium salicylate), Bayer releases aspirin in July, 1899, though it is patented only in UK and US. Bayer lost UK patent in 1905 in court battle with Chemische Fabrik Von Heyden, causing it to fall back on its “aspirin” trademark, pushing the brand name with all its might (Jeffreys, 64-90). In 1915, British Board of Trade made the word “aspirin” public property, meaning anyone could sell acetylsalicylic acid as aspirin, though British wartime product was vastly inferior to Bayer. Australia followed suit with its “Nicholas Aspirin (renamed Aspro in 1917) (98-107). With U.S. patent expiring in 1917 and tainted by the Great Phenol Plot (109-114), Bayer begins marketing aspirin direct to U.S. consumers; AMA is outraged and drops Bayer aspirin from its list of recommended meds (114-115). American manufacturers (Dow Chemical and Monsanto) were ready to begin producing “aspirin” as soon as Bayer patent expired; Americans had consumed almost two million pounds of aspirin with retail value of $25 million between 1914-1917 (115-116). After German surrender on 11 November 1918, Bayer’s U.S. interests put up for sale and were bought for a little over $5.3 million by Sterling Products, a quack medicine maker (122). Sterling got Bayer’s Rensselaer plant, its dyestuffs business and U.S. sales and production rights to 64 of its most impressive meds (145). In 1920, Judge Learned Hand ruled that for general public, word “aspirin” had passed into common usage and consumers had right to buy the drug under that name from anyone who made it (151-152)  explosion of competition in U.S. with several hundred brands of aspirin on sale within 10 years. In 1923, Sterling and German Bayer made deal: Sterling’s Winthrop Chemical Co. to make all Farbenfabriken products in America and would get German Bayer’s help on how to run Rensselaer. Germans would get half profits in return, though Sterling Bayer had exclusive rights to sell those products in U.S., Britain, Australia, Canada, and South Africa (149-150).

Pneumonia, TB, GI infections, and diphtheria (all bacterial) account for more than a third of all deaths in U.S. (Lesch III, 16).

Karl Landsteiner discovers and first describes the ABO system of blood groups, founding the field of immunohematology (Silverstein, 107).

First organized meeting of X-ray operators attended by 150 physicians in NY, which founded national organization the American Röntgen Ray Society (Golan, 483).

Hibbs appointed surgeon in chief at the New York Orthopedic Dispensary and Hospital (Goodwin, 16). Publication of Thomas Cullen’s Cancer of the Uterus, financed by Kelly, dedicated to Kelly and Welch, and leading to Cullen’s offer of Professorship at Yale and promotion to Associate Professorship at Hopkins (Robinson, 157ff.). Switzerland educating more women doctors than the rest of Europe combined (Bonner, 69).

Army Surgeon General George Sternberg sends Walter Reed’s Yellow Fever Commission off to Cuba (Altman, 129-131, 137ff.), where three of the four physician members (Agramonte was considered immune), deciding to test Carlos Finlay’s theory of mosquito transmission, agreed on self-experimentation (Carroll, Reed, and Lazear) on the night of 3 August. Reed, having agreed to the pledge, immediately returned to Washington (Altman, 143).

AMA begins publishing comparative rankings of American medical schools as “A,” “B,” or “C” (Corner, 215-216). One death occurred from pneumonia for every 500 persons in the U.S. ; pneumonia the “Captain of the Men of Death” (Dowling, 45).

Publication of first issue of American Journal of Nursing.

Mary Putnam Jacobi joins Keen, Bowditch, Welch, and Osler in testifying before Senate committee in opposition to Bill for the Further Prevention of Cruelty to Animals in the District of Columbia” (Bittel, 201-204).

First sales catalog of Harvard Physiological Apparatus instruments (kymograph, inductorium) designed by Harvard’s William Townsend Porter as precision teaching apparatus for beginning students of physiology; in 1904, Harvard requested removal of manufacturing from university property and the Harvard Apparatus Company became an independent company (Borell, 301-305). “When Porter began the production of inexpensive precision instrumentation for use by large numbers of students and placed primary emphasis on experiment in physiological teaching, the supporting pedagogical arguments were already in place. . . . Porter’s initiative rapidly secured physiology’s place as an independent experimental science in American universities” (305).

Outbreak of bubonic plague in San Francisco’s Chinatown district (first case 6 March) with death of Wong Chut King, leading to quarantine (which exempted white-owned businesses), opposed by Chinese as act of racial bias, not public health, and led to rioting. Chinese denied existence of plague, strongly opposed to autopsy and the needle (the risky Haffkine vaccine), etc. (Chase). June 14: California Governor Henry Gage denied plague, his manifesto signed by San Francisco’s elite, including the deans of three medical schools (70). Gage dreamed up a plague conspiracy theory which he took to “new and gothic heights” – Federal Quarantine Officer Joseph Kinyoun imported plague bacillus and spread them intentionally (79-80). In 1901, Surgeon General Wyman sent “independent experts” (Simon Flexner, Frederic Novy, Lewellys Barker) to San Fran; they confirmed existence of plague (Randall, 81-84). Following earthquake of 18 April 1906, plague returned, as did Rupert Blue in 1907. Only in 1907 “did the precise role of fleas start to emerge from the shadows” (161) along with understanding that 2% infection rate among rats was “the danger zone” (173, 175). Between 1900 and 1909, San Francisco had 280 confirmed cases and 172 deaths from plague (211) and a total kill of over 2 million rats, 5 times the human population of the city (195). Laboratory confirmation of plague bacilli made by bacteriologist Joseph Kinyoun, banished to the quarantine station at Angel Island by Marine Hospital Service head Walter Wyman, who resented Kinyoun’s laboratory skills and reputation, the city was in denial, even after appearance of additional cases, until Wm. Randolph Hearst published a special edition of the New York Journal that sounded the alarm, followed by sending telegrams to health officers of every major city in the country (Randall, 9-12, 59ff.) Kinyoun’s findings confirmed in 1901 by Commission (Simon Flexner, Frederick Noy, and Lewellys Barker), but Commission report suppressed by Marine Hospital Service head Wyman, after delegation of San Francisco power brokers travel to Washington and made “an infamous compact” with Wyman, i.e., that Commission report would be withheld from public documenting existence of plague in San Francisco if San Francisco and the state agreed to finance a sanitary campaign in Chinatown to identify and treat plague victims, etc. But the report leaked from Marine Hospital Service to Occidental Medical Times, which reprinted the report in full, with the secret meeting revealed by the Sacramento Bee. Wyman was thereupon denounced while Kinyoun was celebrated by the medical press. But Wyman refused to apologize and sent Kinyoun packing to Detroit (Randall, 110-112). Rupert Blue arrives in San Francisco in early 1903, initially as Joseph White’s deputy, taking over for him by June, and finally getting plague under control by focusing on rats and their fleas, not the sanitary habits of the Chinese. He returned to San Francisco immediately after the earthquake of April 1906, and again with a team of 12 doctors in September 1907, after reappearance of plague throughout the city (except for Chinatown) in late May 1907. On arrival, Blue set about eliminating rats and their fleas from the entire city. “The virus festered in areas that afforded food and shelter to rats and their fleas, he believed, and not because of any inherent flaws in a victim’s virtue or race” (Randall, 188; cf. 135, 198-199). Despite Rupert’s heroic efforts – his corps removed 13k rats a day – the situation became critical by late summer, 1907, when ratio of infected rats to total caught each week was 1.5%, with 2% the point of epidemic explosion that would require city-wide quarantine (199). Apathy finally vanished and the city went into high gear to exterminate rats following Blue’s speech to city leaders in January 1908. After rat eradication campaign that killed over two million rats, Blue and Wyman declared San Francisco a safe port in November 1908, but infected squirrels continued to cause plague in East Bay hills (212ff ). Blue appointed head of U.S. Public Health Service in 1912, then off to New Orleans in July 1914 to lead team managing outbreak of plague, dispatching 250 rat catchers that killed and autopsied nearly 359,999 rats (Randall, 225ff).

In Cuba, testing of Finlay’s theory of mosquito transmission of yellow fever at experimental camp (Camp Lazear) in which volunteers, mostly men in their 20s quarantined 24 days prior to study, assigned to “Infected Mosquito Building” or “Infected Clothing Building,” the latter tightly enclosed to prevent mosquitoes or fresh air from entering. First yellow fever case developed on 9 December and others followed, whereas men in the room free of mosquitoes remained healthy. On 15 December, Walter Reed cabled Army SG Sternberg, “’Experimental station established November 20, three cases already diagnosed, confirmed by Guilteras, Finlay, Albertini and Gorgas, theory conclusively proven.” (Byerly I, 100-103).

Cushing begins operating for relief of trigeminal neuralgia (extirpation of Gasserian ganglion) (Fulton, 262-66). Cushing travels to Europe, meets Horsley (Thomson, 94-96; Fulton, 163, 167-168); he also met Sherrington, for whom he surgically exposed anthropoid brains (Thomas, 110; Fulton, 195-200); spends time in Berne, working in Physiological Laboratory (“Hallerianum”) under Kronecker and Kocher (Thomson, 100-106; Fulton, 176ff, 182-184). For Kocher, he studied effect of pressure in brain on circulation/respiration. Cushing saw Kocher as much like Halsted and, apropos Kocher’s clinic, remarked: “—but the operating!! -- the J.H.H. outdone” (Fulton, 177). Cushing the only pupil whom Kocher asked to operate (Fulton, 182). Cushing socialized in Bern with Hughlings Jackson. In fall of 1901, Cushing returns to Hopkins and works out arrangement with Halsted to remain at Hopkins, taking over the neurological side of the surgical clinic (113) (Thompson, 94ff.).

William Gorgas sets in motion first mosquito-destruction campaign in Havana, including elimination of all mosquito-breeding places. Yet, in 1902 and 1903 New Orleans City Council voted down ordinance requiring mosquito-proof screens over all cisterns due to expense, during which time the mosquito theory was openly ridiculed by public press. People of NO simply unwilling to do anything in the absence of an actual epidemic (Humphreys, 152-153). Most physicians and southern public health officials were reluctant to give up belief that fomites (bedding, clothing in contact with the infected) did not also transmit yellow fever (154-155)

Founding of Rockefeller Institute, with William Welch president of board of directors and Simon Flexner as director. It provided $12k in 1901 and $14.5k in grants-in-aid in 1902 (Flexner, 269ff.). First laboratory opened in NY in 1904, with Flexner as director. In 1907, Welch became president of board of “scientific directors,” which position he held for 32 years; in 1910, the Institute’s Research Hospital was opened (294). In 1909 Rockefeller established a $50 million trust, designated the Rockefeller Foundation. It invested in schools of public health, gave scholarships to students worldwide, and created the International Health Board (IHB); it was guided by the vision of eliminating communicable disease, which it deemed “the single greatest measure to improve human health” (Byerly, 230).

Founding of the Army Nurse Corps (ANC) for female nurses unmarried and without dependents; male nurses admitted into corps in 1955 (Vuic, 999-1000). Army automatically discharged pregnant women until 1971 (1013).

Behring receives first Nobel Prize in Medicine for discovery of diphtheria antitoxin and work on antitoxin therapy (Brock, 228-229, 263; Bäumler, 93). In St. Louis, children given injections from one batch of diphtheria antitoxin died with symptoms of tetanus. Similar incident in Camden, NJ, where eight children died from tetanus after receiving smallpox vaccine contaminated with tetanus bacteria. These incidents led to passage of Biologics Control Act in 1902 (Dowling 38; Marks, 73-74).

Willem Einthoven, Dutch physiologist, provides first published description of his string galvanometer type of electrocardiograph, which was used chiefly in large hospitals and research laboratories (Burnett, 61-62; Reiser, 107-108). First commercial model, built by Cambridge Scientific Instrument Company, was sold to E. A. Schafer of Edinburgh University in January, 1908 (Burnett, 53, 64 ).

Parke, Davis releases “Adrenalin,” the relatively pure adrenal extract that quickly dominated the market (Rasmussen II, 293).

Rudolph Brauer proposes and Walther Petersen performs cardiolysis, first operation for chronic adhesive pericarditis (removal of ribs and sometimes part of sternum to free heart and pericardium from anterior chest wall, to which they are bound by adhesions) (Richardson, 45-46). James Mackenzie invents “Mackenzie’s Ink Polygraph” (predecessor to EKG) (Wilson, 133-136) and publishes (at his own expense) The Study of the Pulse (Wilson, 179ff.; Mair, 95, 179-183), which made little impression in London but paved the way for his association with Arthur Keith (University College, London) and Karl Frederick Wenckebach (Holland). Almroth Wright leaves Army Medical School at Netley Hospital and becomes Professor of Pathology at St. Mary’s Hospital (Macfarlane, 55).

Typhoid fever epidemic in Trier (Germany) leads to Koch’s finding that infections derived not from water or sewage but from healthy human “carriers.” Carrier hypothesis “one of Koch’s last significant bacteriological contributions” (Brock, 255-56). Ronald Ross receives second Nobel Prize in Medicine for work on role of mosquito in malaria transmission (Brock, 263). Publication of James Mackenzie’s The Study of the Pulse, Arterial, Venous and Hepatic (Mair, 179-183).

Lina Rogers becomes first school nurse in U.S. (in Lower East Side, NYC) (Kraut, 237-241).

Publication of Meige & Feindel’s Les Tics et leur Traitement, the standard for diagnosis and treatment of motor and vocal tics until the 1960s: a psychopathology of tic disorder that meshed with eugenics (tics as result of degenerative inheritance and hereditary weakness of will leading to infantile fixations) and segued into Freudian explanations of early childhood sexual repressive conflicts (Kushner, 48-49).

Congressional bill renames Marine Hospital Service the Public Health and Marine Hospital Service (abbreviated to Public Health Service). It was universally accepted by state health officials following addition of Section 7i, which required Surgeon General to call yearly conference of state public health official to solicit their input (Humphreys, 158).

Passage of Biologics Control Act, which mandated PHS’s Hygienic Laboratory regulate the interstate commerce of “viruses, serums, toxins and analogous products” (Harden, 17-20; Marks, 73-74). The act, which followed 1901 outbreak of tetanus in Camden, NJ, connected to contaminated smallpox vaccine, specified that manufacturers must be licensed by the Secretary of the Treasury (through the Laboratory of Hygiene) and each package of vaccine must be properly labeled and dated. It also allowed for “reasonable inspection” of company properties at any time (Liebenau, 89-90).

Mackenzie, in association and with support of Dutchman Karl Wenckebach and fellow Scotsman Sir Arthur Keith (who dissected Mackenzie’s hearts at London Hospital), documents and explains ventricular extra-systole as cause of continuous heart irregularity. In Inception of the rhythm of the heart by the ventricle as the cause of continuous irregularity (BMJ, 1904), Mackenzie concluded that “when the rhythm of the heart originates at the auricles, or at the auricular mouths of the veins, it is always regular. When, however, the ventricle takes on the inception of the rhythm the heart is always irregular” (Mair, 123ff; quote at 134).

Carrel improves technique for suturing the cut ends of arteries, thence to grafting lengths of artery or vein to bridge the gap between ends of vessel (Richardson, 81).

Britain forms Committee of Physical Deterioration, through which Cecil Rhodes, Francis Galton, and a young Winston Churchill “were open in expressing the sense that White supremacy was the moral duty of the British: to fill the world with the dominant race of the best type of men” (Rutherford, 57).

Establishment of Rockefeller-funded General Education Board, which became the largest of the Rockefeller philanthropies aimed at influencing public policy (Sealander, 23).

Cushing, Wm. Mayo, and A. J. Ochsner found Society of Clinical Surgery, which they had first planned at Paris in August, 1900 (Thomson, 142; Fulton, 169, 231-32); Crile claims the idea was his, which he first related to Jim Mumford (Crile I, 140-143, 231-232). Founding of Hunterian Laboratory of comparative surgery at Johns Hopkins, where Cushing and residents did surgery on dogs (Thomson, 146-153; Fulton, 217-222). Simon Flexner leaves University of Pennsylvania., which lagged behind in experimental medical sciences, to assume directorship of Rockefeller Institute for Medical Research in NY (Corner, 205-209).

Moynihan publishes Surgical Treatment of Gastric and Duodenal Ulcers (Bateman, 134-136). Crile publishes Blood Pressure in Surgery, where he reported on the use of his pneumatic suits and then adrenalin to raise blood pressure during surgery (Crile I, 144-152). First use of X rays to locate a bullet in the heart (Richardson, 33). Einthoven demonstrates first string galvanometer electrocardiograph.

Estonian surgeon Werner von Manteuffel first surgeon to remove a bullet from the heart. He removed bullet lodged in right ventricle by lifting the heart to cut out the bullet, and was rewarded for this feat by becoming personal physician to Tsar Nicolas II (Morris, loc 452).

Carl Fischer patents a more potent derivative of barbituric acid, synthesized by Adolf von Baeyer in 1904n Veronal (barbital), and he and von Mering conducted and published clinical trials with barbital as a sleeping aid (Jones, 340-1). This was the first commercially available barbiturate.

Francis Galton founds Eugenics Records Office in London, tied to University College London ( Galton Laboratory, Galton Professorship) (Rutherford, Intro).

Thomas Salmon, who received commission by USPH & Marine Hospital Service (= USPHS in 1912) in 1903, arrives at Ellis Island: “to a physician like Salmon the challenge of practicing diagnostic psychiatry at Ellis Island was just the kind he enjoyed. . . . he insisted that medical inspection become a more thorough procedure because he, like so many psychiatrists, believed that many insane aliens were slipping past the guardians of the nation’s borders” (Dowbiggin II, 203, 204). “Predictably Salmon was demoted from Ellis Island to the Boston Marine Hospital,” but his career was saved by admiring NY State mental health care officials and he was offered position of chief medical examiner of the Board of Alienists in NY State in 1911 (205). For most of the pre-WWI period, William Alanson White “supported efforts to improve medical inspection and facilitate deportation of insane aliens; like most psychiatrists of the time, he subscribed to the link between criminality and insanity on the basis of the mental degeneracy of many immigrants (206). “Salmon’s public views on immigration, a mixture of humanitarianism, professional partisanship, and uncritical and ill-informed opinions about national tendencies toward mental illness, closely mirrored those of psychiatrists generally (217). . . . Salmon’s views were far from systematic or consistent, except when it came to psychiatrists’ hegemony over medical inspection of aliens. Like other psychiatrists, he mainly wanted this field free of any influence extraneous to pure psychiatry, especially pressure brought to bear on politicians by steamship companies. To him psychiatrists were locked in a struggle with ‘the interests’ that often poisoned the health of countless innocent men, women, and children, including immigrants; it was a battle in defense of humane values and sentiments” (219).

Cushing makes first report on field of neurological surgery (Fulton, 266-67). Young, with Halsted assisting, removes entire prostate as radical cure for prostate cancer (Harvey, 76-78). Cullen introduces use of blunt needles to suture liver incisions (Robinson, 187-90).

Sauerbruch presents “On the physiological and physical principles involved in intrathoracic operations in a pneumatic operation chamber” at Congress of German Surgical Society in Berlin, and he and Mikulicz perform first intrathoracic operations in negative pressure chamber; Ludolph Brauer advances opposing view favoring positive-pressure technique. He performed tracheostomy through which he passed a tube connected to oxygen cylinder, in such a way that oxygen flowed over flask of ether before entering the lungs: the pressure of oxygen flow kept lungs inflated (Cherian et al., 1013; Richardson, 88-91; Woolmer, 98-101). This was the basis of endotracheal insufflation anesthesia, adopted for human anesthesia by Charles Elsberg in 1910, which gave way to the superior endotracheal inhalational technique with bellows after WWI (Richardson, 93-95).

AMA establishes its Council on Medical Education under chairmanship of Arthur Dean Bevan of Rush Medical College with the power to present suggestions as if they were legally required (Flexner, 307; Stevens, 63-66). Its national rating of medical colleges gave it effective monopoly control of educational regulation (Stevens, 68).

Founding of National Association for the Study and Prevention of Tuberculosis, with Edward Trudeau elected first president (Caldwell, 52). “The War on Consumption was in fact a national mobilization of opinion through advertising” (52-53). “By the 1920s the movement had grown into an industry. Sanatoriums proliferated; health campaigns burgeoned. The Metropolitan Life Insurance Company lent both its prestige and its formidable economic power to the campaign, building its own company sanatorium at Mount McGregor in Saratoga County, NY” [dedicated in June 1914] (57)].

Francis Galton founds the Eugenics Records Office, which institutionalized the British eugenics movement and tied it to University College London for many decades (Rutherford, 14).

First barbiturate (barbital, malonal, gardenal, Veronal) comes to market in Germany as a hypnotic. Followed by phenobarbital, synthesized by Hörlein in 1911 and released as Luminal in Germany in 1912 (López-Munoz, 329).

“Improving greatly upon the American and German models, the Japanese were the first to introduce a thoroughly modern military medical system that integrated all the major elements of casualty care and disease prevention into a complete command structure. The Japanese Army was the first to require a medical plan as part of the combat operations order, the first to place the chief of medical services in the general staff structure, the first to provide full rank and status to medical corps officers in combat theaters of operations, and the first to create an effective, independent medical supply service with its own transport. . . . Its emphasis on disease and infection prevention by applying the lessons of bacteriology, vaccination, and antiseptic surgery resulted in an army losing fewer casualties to disease and infection than to enemy weaponry for the first time in 200 years . . . a level of manpower conservation that remained unsurpassed until the Vietnam war. . . . the Russian Army established the modern foundations of military psychiatry both organizationally and clinically. . . The principles of proximity, immediacy, and expectancy (PIE) . . . still undergird all methods of battlefield treatment of psychiatric casualties (Gabriel, 215).

In Jacobson v. Massachusetts, U.S. Supreme Court issues landmark ruling affirming the constitutionality of compulsory vaccination laws (Colgrove, 170).

Final yellow fever epidemic in country in New Orleans (Cohn, 316-323; Humphreys, 161-165; Olivarius, 86); for the first time, LA governor, NO mayor, and NO public health officials join together in asking federal government to direct the PHS to take over the anti-mosquito campaign. Successful anti-mosquito approach signaled the end of the fomite theory of transmission, yet the 1905 epidemic marked the first time blacks were suspected as carriers of yellow fever, since they had few if any symptoms and ignored quarantine restrictions in travelling from place to place (Humphreys, 164). In 1906, Malloy-Williams Bill passed by Congress established Federal hegemony of southern quarantine; it established four federal stations and sought, inter alia, to put southern state quarantine stations out of business. It was sectional legislation that left untouched the local quarantine systems of Boston and NY (168-9). After 1905, no further yellow fever epidemics in U.S., and southern state health boards become inactive (172). Southern state PH officials were entirely competent in yellow fever eradication by 1905, but their state boards had come into existence solely on account of yellow fever, and they were exclusively concerned with its episodic reappearance, not diseases such as typhoid and diphtheria, which were mild in comparison with the north. Further, the raison d’etre of southern health boards had never been the saving of lives but the protecting of business interests and commerce. The educational efforts of outside influences (e.g., the Rockefeller campaign against hook worm; PHS crusades against syphilis, pellagra, etc.) were necessary to convince indifferent southern legislatures of the region’s unhealthiness and “the costliness of a diseased population. A mercantilist model of the cost-effectiveness of public health had to replace one measured by business losses to major epidemics ” (177). .

Osler leaves Hopkins and becomes Regius Professor at Oxford, after accepting the offer in 1904 while at Oxford with Cushing (Fulton, 235-237); he is replaced by Lewellys Barker, who returned from Chicago where he had served as Professor of Anatomy (Barker, 143-54). Berkeley Moynihan’s publication of Abdominal Operations (Bateman, 128-133). Launching of journal Surgery, Gynecology & Obstetrics, brainchild of Franklin Martin (Managing Editor), with Nicholas Senn as chief of editorial staff (Davis, 3-8, 27-30).

Richard Cabot introduces medical social service at Outpatient Department of MGH (Lubove18, 24ff.; Williams, 468-70). Cabot was concerned that treatment recommendations of the outpatient department were not being carried out, and hoped casework would contribute to development of preventive medicine. “Tuberculosis became a focal point of concern in hospital social work” (Lubove, 29); Cabot influenced by MGH’s Joseph Pratt, who began classes to improve home care of poor TB patients in 1905 (Williams, 469).

James Mackenzie publishes series of five papers in BMA under general title New Methods of Studying Affections of the Heart (Mair, 164ff.). Berkeley Moynihan publishes Abdominal Operations, which gave him an international reputation. Zoologist Fritz Schaudinn discovers causative organism of syphilis, belonging to spirochete family) (Bäumler, 125-26). John Langley at Cambridge suggests axons contain a chemical “synaptic substance” that might stimulate a receptor on neighboring dendrites (i.e., neurotransmitters) (Rapport, 170).

Ernest Starling, Edward Schäfer’s successor at University College, introduces the term “hormone” (Borell), which he defined “as a chemical substance produced in one of the organs of the body and transported via the blood to cause some form of reaction in another part of the body” (Nordlund, 88). In 1902, Starling and William Bayliss, another of Schäfer’s younger colleagues, discovered that a crude extract of duodenal mucosa injected into the bloodstream of an experimental animal effected pancreatic secretion; they named that active substance “secretin’: “After 1902, therefore, internal secretions acquired a new significance as chemical effectors in the body. In 1905 Starling, as noted, introduced the word hormone to signify this role. At the same time, he pointed out that although chemical substances were as important to physiological regulation as nervous stimuli, their study had previously been overlooked. Many unexplained phenomena might now be approached by considering the action of specific chemical messengers called ‘hormones.’ Physiological investigators thus began actively to search for these substances, using a greater variety of physiological tests than previously” (Borell IV, 11).

Founding of Interurban Clinical Club, with 24 members chosen by Osler just before he left for Oxford (Aub & Hapgood, 39-40). Establishment of AMA Council on Pharmacy and Chemistry, which published the handbook New and Nonofficial Remedies (1907), a response to fact that half of all prescriptions were for unregulated proprietary remedies; it was reviewed by Edsall in JAMA in November, 1910 (42-45). The Council was the institutional embodiment of the program for a rational therapeutics, according to which the mechanisms of action of therapeutic agents “were scientifically established prior to their introduction into clinical practice” (Marks, 21-22; Weisz et al., 701). It analyzed chemical identity of commercial products; undertook animal experimentation; and assessed available clinical data via a staff of clinical consultants (32ff.). Passage of the Pure Food and Drug Act in 1906, “merely authorized the Bureau of Chemistry to seize ‘adulterated’ or ‘misbranded’ products” and, as interpreted by the courts, required that the bureau demonstrate “not merely the falsity of a manufacturer’s claims but that he knew the claims to be false” (Marks, 74-75). Without Council approval, drugs could not be advertised in JAMA or other cooperating medical journals (Marks II, 54).

At Harvard Med School, new requirements that all applicants have a B.A. and show evidence of knowledge of physics and chemistry take effect (Rackemann, 33). Women account for 53% of all medical enrollment in Switzerland (Bonner, 76).

Synthesis of procaine (Novocain) by Alfred Einhorn, working out of Bayer labs, imported into U.S. beginning in 1911 by Novocol, which was licensed to synthesize and manufacture Novocain in U.S. when it entered WWI. As a local anesthetic, it lacked the euphoric and addictive qualities of cocaine. It was replaced in 1943 by lidocaine.

Passage of Pure Food and Drugs Act, main thrust of which was to control adulteration of food by providing Department of Agriculture with legal power to enforce reasonable standards of purity for processed foods. Its regulatory work aimed at controlling patent medicine, and its tangible achievement in first years was to reduce the alcohol and narcotic levels in patent medicine and to standardize state laws (Liebenau, 90-97).

Parents of Jewish Lower East Side, NYC, storm neighborhood public schools protesting “murder” of their children by physicians; riots occurred a week after physicians visited P.S. 100 to perform adenoidectomies; the Principal claimed the riots were instigated by community physicians threatened by school officials going beyond health education into health care (Kraut, 226-232).

First bill in an English-speaking country to legalize euthanasia introduced to Ohio legislature, drafted by Anne S. Hall following death of cancer-ridden mother, with support of Harvard’s Charles Norton. But the bill failed out of fear of abuses (Lavi, 93-94). Failed euthanasia bills in Ohio and Iowa reveal three assumptions regarding euthanasia debate at turn of century: (1) both supporters and opponents agreed that the practice already existed sub rosa; (2) both sides conflated voluntary euthanasia with forcible killing of unwilling incurables; (3) opponents argued on practical rather than moral or religious grounds, raising objections that are far less relevant today (Appel, 625ff.).

Thomas Cullen (Hopkins) removes 89-pound uterine cystic myoma (tumor) from a woman who weighted 85 pounds when she left the operating table (Robinson, 204-209).

Perfection of Mackenzie’s ink polygraph by Lancashire watchmaker Sebastian Padiham. Mackenzie used the polygraph to make recordings lasting up to 1.5 hrs, but, on his first visit to the U.S. in 1906, he couldn’t find a local manufacturer to supply the device to Americans (Davis, II, 130).

Crile’s first successful case of blood transfusion via end-to-end suturing (Crile I, 165-167). Crile and colleagues begin histologic research showing that shock or exhaustion involved cellular changes in the brain, liver and adrenal glands (188-193). In France, Bergonie and Tribondeau formulate descriptive law about effects of radiation: Its effect greatest on living cells in earliest stage of cell division; it affects reproductive cells most; and it causes proliferation of cancer cells in proportion to their stage of development (Kevles, 52). In Germany, pathologist A. von Wasserman develops his two-stage test for syphilis (Macfarlane, 70).

Opening of George Speyer Haus, adjacent to the Royal Institute for Experimental Therapy in Frankfurt, where Ehrlich pursued (and named) chemotherapy of infectious diseases (i.e., experimental chemical therapy), especially directed at parasitic/protozoan diseases resistant to serum therapy (Bäumler, 114ff.). Ehrlich, in speech inaugurating his Institute for Experimental Therapy in Frankfurt, introduces term “chemotherapy” “to stand for the destruction of disease-causing microorganisms in the human or animal host by means of chemical compounds introduced into the host organism” (Lesch III, 15ff). British public was introduced to “chemotherapy” in Ehrlich’s sense only in 1938-1939, following discovery of M&B 693 (Sulfapyridine) by May & Baker (Lesch III, 185-188).

Golgi and Cajal first two histologists to win Nobel Prize (Rapport, 160ff.). After winning Nobel Prize, Cajal, applying the recently discussed reduced silver nitrate method, which revealed the neurofibrillar character of the nerve cell, turned to the regeneration of severed peripheral nerves, recognizing that the debate over it – Did the regenerated axons link up with the distal part of the nerve, or did the new axonal growth from the proximal stump cross the gap and go down the distal segment of the severed nerve under trophic influences? – “had important implications for the normal development of the nervous system and for any hopes of promoting regeneration in the injured central nervous system” (Jones, 174). Cajal proved the latter; he “was not alone in revealing the histological basis of peripheral nerve repair. But it was he who clearly derived from it the underlying biological mechanisms that governed this process, and who foresaw their relevance to the development of the nervous system and to any hope of promoting regeneration of the injured central nervous system” (177).

Janet delivers lectures on “The Major Symptoms of Hysteria” at Harvard and another series on psychotherapeutics at Lowell Institute, leading to interest among American neurologists in hysteria, hypnosis, and the psychological point of view. By July, 1907, 79 papers and 10 books under heading “psychotherapy” listed in the Index Medicus (Brown, 8).

Indiana established the first official sterilization program in U.S. California passed its law in 1909 and established “the world’s most aggressive program at the time,” sterilizing over 2,500 people in the first 10 years (Bruirnius, ch 2). “By 1931, thirty states had performed the sterilization of over 12,000 men (via vasectomy) and women (via fallopian tube severing). Half of these were in California” (Rutherford, 64). In all 32 states legalized eugenic sterilization at some point, with number of recorded sterilizations ranging from 30 in Arizona to 20,000 in California (Ladd-Taylor, Intro). By 1933, when Hitler came to power, 18 American states had passed eugenic laws, “an inspiration to the German eugenicists” (122). American eugenicist Madison Grant’s bestselling The Passing of the Great Race, “a treatise of pseudoscientic White superiority that asserted a hierarchy of the world’s peoples” (66), was described by Hitler as his “Bible” (Rutherford, 67, 122). The Nazi Law for the Prevention of Hereditary Diseased Offspring, which took effect on Jan 1, 1934, “cited California and Virginia’s laws as precedents” (Hansen & King, 148). “In its policy implications, negative eugenics in Nazi Germany was, right up to the first murder of mentally handicapped Germans, indistinguishable from negative eugenics in democratic America” (157).

Based on two cases that “the specific excitant of the exophthalmic goiter is the emotion fear,” Crile sought to eliminate preliminary fear in hyperthyroidism by deceiving patients about to receive operations and thereby established the principle of “the shockless operation,” which he termed anoci-association, later anociation: by blocking off the field of operation via a local anesthetic, he prevented harmful associations (noci-associations) that would produce “exhaustion” in nerve cells and the discharge of nervous energy otherwise caused by the trauma (Crile I, 205-208, 218).

Pirquet reports to Medical Society of Berlin on his use of Koch’s tuberculin in a skin test in humans; he deduced from his data that negative tuberculin skin tests generally meant an absence of prior TB infection. In 1931, Florence Seibert at University of Pennsylvania isolated a purified protein derivative (PPD) from tuberculin that was henceforth used as the tuberculin skin test reagent (Daniel,115-117).

Introduction of the unit record (a single record of all interventions received by a patient at a given hospital) at St. Mary’s Hospital run by the 11 brothers (Reiser III, 982).

Hungarian surgeon Hümér Hultl constructs a heavy stapling machine that can simultaneously insert a row of staples in intestinal tissue, a solution to the problem of intestinal joins. It was used in Eastern Europe, but not in the West until 1960s (Van de Laar, ch 26).

James Mackenzie moves to London and meets Thomas Lewis and they begin working together on the irregularly irregular pulse of atrial fibrillation (Howell V, 86-87).

British anatomist Arthur Keith identifies small mass of fibrous tissue embedded in wall of the upper part of the right atrium = sinoatrial node, where the heartbeat originates (K. Jeffrey, 122).

Ehrlich’s chemist E. Schmitz synthesized a new arsenic compound (a new arsenobenzene) – Preparation 418 – with astonishing effects on early-stage syphilis in animal experiments; trials underway on other infections caused by trypanosomes (serum-resistant protozoa), such as African sleeping sickness (Bäumler, 129). Simon Flexner (Rockefeller Institute) reports effectiveness of horse-derived serum for meningococcal meningitis; it was of limited effectiveness but widely used in epidemic that accompanied WW I (Dowling, 52-53).

Publication of Howard Kelly’s and Charles Noble’s Gynecology and Abdominal Surgery, the first gynecology textbook devoid of philosophical theorizing about social role of women (MS2, 133-34).

American pellagra epidemic first recognized at State Hospital for Colored Insane at Mt. Vernon, Ala. (Bryan, 88). On December 30, Babcock submits to SC Board of Health his report on pellagra (which he attributed to bad corn) and Pellagrous Insanity, published in Feb 1908 in J. SC Med Assn. (89-92). Accompanies Benjamin Tilman on European trip after Tilman’s stroke, and in Italy, observes that pellagra is same disease he observed in SC, and was treated in Italy with diet. (Bryan, 89-92)  First Pellagra Conference at Columbia, SC, October 1908 (96ff.) attended by 72 physicians, most from SC, and 20 laypersons: Maize theory and germ theory both defended; nobody brought up Marzari’s “deficiency” hypothesis, all but forgotten after nearly a century. In retrospect, “these speakers had shown that alcoholism, anorexia, and reliance mainly on corn all promoted deficiency of essential nutrients” (98). Babcock himself “was in the main a Zeist [corn], endorsing Lombroso’s ‘spoiled corn’ hypothesis without vigorously defending it” (100). The second national conference took place in Columbia in fall 1909, which led to formation of National Association for the Study of Pellagra. At conference, Lombroso’s version of Zeist hypothesis and Louis Sambon’s version of (direct) infection hypothesis were influential; Sambon’s version “was beginning to work its way to the fore” (108), Conference established (especially via Peoria asylum superintendent George Zeller) that pellagra was a national, not merely southern, problem (110).

In Paris, Alexis Carrel’s dog experiment with aortic homografts (including tubes of dissolving magnesium and even caramel) to replace section of aortic artery lay foundation for work of Arthur Voorhees in late 1940s with different type of cloth tubes, which were intended to function as lattices for formation of new blood vessels. Then, in 1954, Michael Debakey performed first human implantation of his own home-made Dacron graft (Morris, loc 1385ff). Invention of Gore-Tex in 1970s provided alternative to Dacron.

Koch, at International Tuberculosis Congress in Washington, reiterates that bacteria causing bovine TB of little danger to humans: “after the Washington meeting, Koch’s influence in America was virtually eliminated” (Brock, 284), as U.S. proceeded with its agenda to control infectious disease, including universal pasteurization of milk (Brock, 278-285).

Alexis Carrel performs vascular anastomosis to save life of Mary Lambert, daughter of Belleevue Hospital surgeon Adrean Lambert, born with melaena neuonatorum (bleeding from nose, anus, and mouth). At request of the infant’s father, he transfused by anastomosis father’s arm to daughter’s leg, viz, “He teased out the vessels, and using the technique he’d been practicing on all manner of animals, he fastened the two together.” Mary’s bleeding stopped and she survived. This was the first successful use of vascular anastomosis to save a human life (Chaddock, 183-184).

Landsteiner in Vienna discovers cause of polio during autopsy of child victim: Virus in spinal cord. In 1911, Swedish researcher Carl Kling, determined how it spread: autopsies of fluids from throats, windpipes, and intestines of deceased infected children also paralyzed monkeys, therefore virus present in saliva or intestines of infected persons.

Matas loses his right eye to gonorrheal conjunctivitis, when he wiped his face with soiled operating gown following surgical removal of a tubo-ovarian abscess (Cohn, 330-336). In 1901, Tom Cullen’s mentor Leslie Sweetnam died from infection from a prick under fingernail following surgery on a tramp with a gangrenous leg [Robinson, 166]). Babinski first observes anosognosia (i.e., “unaware of illness”) – tendency to ignore or sometimes even deny the fact that one’s left arm or leg is paralyzed (Ramachandran, 128).

Cushing publishes first systematic treatise (monograph) on brain surgery, which was to have been a chapter in W.W. Keen’s textbook (Thomson, 158), but grew from assigned chapter of 80pp. to monograph of 276pp. and 154 illustrations (Fulton, 267-269). Trendelenburg attempts first (unsuccessful) pulmonary embolectomy (“Trendelenburg’s operation”) (Richardson, 65-66). James Mackenzie publishes Diseases of the Heart and meets Thomas Lewis in London (Wilson, 197-199; Lawrence, 18).

Publication of Beers’s A Mind That Found Itself; Welch gets Henry Phipps to underwrite Henry Phipps Psychiatric Clinic at Hopkins, for which Welch secured Adolf Meyer as first director (Flexner, 349-350; Leys, 446). Bleuler introduces notion of schizophrenia. Ehrlich and Metchnikoff shared Nobel Prize for Medicine (Bäumler, 131-135). University of Pennsylvania Medical School finally strengthens admission requirements to two years of college work, rather than high school graduation only (Corner, 216-217). Abraham Flexner begins his study of American medical schools (Bonner II, 73). Re prevention of TB among children, establishment of first open-air schools in Providence and Boston, followed in 1909 by first “preventorium” in Farmingdale, NJ (Bates, 274-275).

Open-drop method of general anesthesia now being replaced by gas anesthesia (i.e., combination of nitrous oxide and oxygen). In 1910, Graham Clarke, founder of Ohio Chemical Company, working in collaboration with Alice MGaw, invents the Ohio Monovalve, one of the most successful early anesthesia machines for administering the mix (Stepansky II, 45-46). George Crille appoints head nurse Agatha Hodgins his personal anesthetist at Lakeside Hospital (44).

Founding of National Association of Colored Graduate Nurses (NACGN), partly to combat system of dual state registration in southern states (Hine, 94-95). It was founded by 52 nurses who gathered at St. Mark’s Methodist Church in Midtown Manhattan and elected Minerva Franklin as president (Smilios, loc. 805-815). It only became viable in mid-30s with support of Frances Bolton (Cleveland), Julius Rosenwald Fund, and GED, which funded recruiting campaigns and networking (NAACP, National Urban League; NCNW) of Estelle Riddle and Mabel Staupers, its first two leaders (Hine, 117ff.).

Fifteen years after Charcot’s death, Paris Neurological Society, led by Babinski, dismantled Charcot’s notion of hysteria, arguing that hysterical symptoms “were in fact the results of organic disease, iatrogenesis, or simulation. . . . the full membership of the organization, with one exception, agreed officially to discard hysteria in reference to each of the symptom categories and to restrict its application to the new concept of ‘the hysterical syndromes’” (Micale II, 519). “Almost immediately upon the death of Charcot, the nineteenth-century pan-diagnosis of hysteria began to break apart under its own weight, and the many clinical states that it had contained began to scatter” (525).

Dutch botanist Wilhelm Johannsen coins word “gene” to denote a (Mendelian) unit of heredity. “The word was created to mark a function; it was an abstraction. A gene was defined by what a gene does: it was a courier of hereditary information.” But the abstraction launched “a thousand questions,” e.g., What was the chemical and physical nature of the gene? How were genes transmitted? Where did they reside? and so forth Mukherjee II, loc 71ff.).

In May, Ehrlich’s colleague Bertheim produces Preparation 606, an arsenic compound, later known as Salvarsan, first found effective with chicken spirillosis and the spirilla of relapsing fever (febris recurrens) (Bäumler, 147-149), and subsequently tested and found effective with the spirochetes of syphilis. The historic experiment with rabbits infected with syphilis was conducted on 8 June 1909 (Bäumler, 150ff.) Salvarsan was produced in quantity by Farbwerke Hoechst and released to the market in mid-December, 1910. Hoechst and Ehrlich supplied 60,000 samples to doctors free of charge (180). In Britain, Almroth Wright, a personal friend of Ehrlich, was among the first to receive a supply of Salvarsan; he passed it on to Alexander Fleming to try out on syphilitic patients: “It had to be injected into a vein, and Fleming was adept at such injections. With his neat, deft fingers, and a virtual monopoly of the drug itself, he attracted patients from all over London and . . . soon found himself with a flourishing private practice” (Macfarlane, 72). In 1911, combination of Salvarsan with sodium phenolate gave birth to Neosalvarsan, with twice the curative effect of Salvarsan and better tolerated by patients (Bäumler, 181).

Publication by Rowntree & Geraghty of Hopkins of phthalein test (purple dye) to determine condition of kidneys: excreted promptly by healthy kidney but much slower and in reduced quantity in diseased kidney (Crowe, 123). Publication of Kelly’s and Cullen’s Myomata of the Uterus, which Cullen alone wrote and which Kelly never saw until it was published (Robinson, 199ff.). Alexander Fleming qualifies as a surgeon, albeit one who never performed an operation (Wainwright, 159-60).

European and American scientists establish viral etiology of polio (Rogers, 74, 78). Thomas Lewis first person in English-speaking world to acquire an electrocardiograph for clinical research; he installed one at University College Hospital. Lewis’s American pupil Alfred Cohn installed first ECG in U.S. at Mount Sinai Hospital (Fye 2, 19).

Cushing’s major early presentation on pituitary in which he introduced terms “hypo” and “hyper-pituitarism” (excess secretion  acromegaly) (Fulton, 299-300). Cushing’s first (successful) surgical removal of part of anterior lobe of pituitary in a case of acromegaly (Fulton, 301-302).

Recognizing William Gorgas’ sanitation and public health work in Cuba and Panama, AMA elects him president. His inauguration speech, The Conquest of the Tropics for the White Race, “focused on malaria and described in detail his department’s malaria mitigation methods – mosquito destruction, swamp draining, brush cutting, screening, the dispensing of quinine pills, and continual inspection and oversight – which enabled him to cut the malaria rate by three quarters” (Byerly I, 182).

Thomas Lewis publishes Auricular Fibrillation: A common Clinical Condition in BMJ and then, in his newly launched journal Heart, the first 66 pages of volume I were given to his Auricular Fibrillation and Its Relationship to Clinical Irregularity of the Heart (Hollman, 237; Lawrence, 30).

Wm. Baer reports eight cases of arthroplasty, five of which included the first clinical use of chromicized pig bladder to make the new joint (Crowe, 133).

Arbuthnot Lane openly advocates colectomy as treatment for difficult cases of “chronic intestinal stasis” (Dally, 149).

Formation of Rockefeller Sanitary Commission, initially to combat hookworm in the south – first entry of private philanthropy into public health (Flexner, 351-353; Altman, 169-170); formation of National Committee for Mental Hygiene, with Welch a member of board of directors (Flexner, 348-349). Moynihan forms Britain’s Chirurgical Club to bring together top provincial surgeons (Bateman, 163-165). Formation of AMA’s Public Health Education Committee, superseded four years later by its Council on Health & Public Instruction (with no women members) (Morantz-Sanchez, 285-288). Formation of American Society for Clinical Investigation with S. J. Meltzer as first president (Howell III, 683-684; Barker, 159-160); the clinical researchers who created ASCI espoused an “aggressive generalist style, actively opposing any hint of specialization; internal medicine long dominated it; growth of specialization in late 1970s and 1980s led to demise of its yearly mega-meeting (Howell III, 691).

U.S. Army makes typhoid vaccination compulsory, reducing typhoid rate from 243 per 100,000 in 1909 to 4.4 per 100,000 in three years (Byerly I, 226).

University of Minnesota establishes the first university-based school of nursing in the U.S.

Metropolitan Life Insurance Company begins “experiment” of insurance payment for home nursing, paying Henry Street Settlement Nurses (NYC) 50 cents per visit. Nursing service used by one to three patients per thousand policies (Buhler-Wilkerson, 147-149) and, by 1915, 14.46 of every thousand policies (153). Recipients of these visiting nurse services were the weekly-premium-paying policyholders of MLI’s Industrial Department (for industrial classes) (152).

Wm. Healy, at invitation of Chicago’s Juvenile Protective Association, organizes the Juvenile Psychopathic Institute (a clinic) to collect and evaluate data on cases brought to juvenile court. As Director of JPI, Healy, with backing of Ethel Dummer, was to serve as both researcher and clinician; he was to determine the “root” cause of juvenile crime from data about the medical, psychological, and social backgrounds of seemingly incorrigible repeat offenders (K. Jones, 41-43). Healy’s understanding of relationship between misconduct and mental processes was built on Meyer’s psychobiological approach to mental illness (52). Healy was supposed to find the root environmental “cause” of delinquency, but his evidence and clinics “represented a fundamental change in the Progressive code of delinquency prevention. The choice of a medical professional as chief researcher tilted the balance away from the environmental interpretations for delinquency that supported community-based solutions sponsored by child savers and maternalists” (57). In 1917, Healy and his psychologist (and future wife) Augusta Bronner relocated to Boston to head the similar Judge Baker Foundation (56-57; Noshpitz , 100-110).

California becomes first state to license naturopaths. Otherwise, they were usually licensed only under a “drugless healers” act: “The majority of state legislatures, however, at first granted naturopaths the right to do little more than massage” (Whorton, 214).

Rapid displacement of pulse palpation by cuff in conjunction with auscultation with stethoscope to measure systolic and diastolic blood pressure, e.g., at MGH. Physicians only accepted blood pressure cuff when it was teamed with a specialized procedure (auscultation with stethoscope) that required skills possessed only by physicians, not nurses, to whom Cushing and his house officers Biggs and Cook initially promoted the blood cuff in 1902-1903 as a simple tool to measure systolic blood pressure by obliteration of the radial pulse (Crenner).

Charles Davenport, with grant from Mary Harriman, established Eugenics Record Office (ERO) as department of Cold Spring Harbor Laboratory in Long Island. The “driving force for the development of studying human heredity, and applying it as [proto-Nazi] ideology,” Davenport switched from animal to human heredity, and “began pontificating on the standard canards of the Victorian eugenicist and social campaigner [Galton]: alcoholism, criminality, feeblemindedness, intelligence, manic depression (and weirdly, seafaringness)”. Davenport established ERO to campaign for deployment of eugenics policies around the U.S. - “specifically, for reduced immigration and the forced sterilization of ‘defective’ – and, principally, to compile records of families and their characters, as if constructing a national pedigree to be pored over, and from which the American stock could be improved.” Research involved construction of family trees and pedigree charts on the basis of questionnaires and fieldwork (Rutherford, 60-63; Friedlander, ch 1 ). Davenport and his ERO administrator, Harry Laughlin, “shaped the movement’s particular kinship with religion, making it more than simply a ‘secular creed.’ To win public support, many eugenicists began to couch their message in religious terms, producing eugenic ‘catechisms, sponsoring contexts for the best eugenic sermons, and conducting ‘Fitter Family’ and ‘Better Baby’ contests based on good moral and mental hygiene” (Bruinius, ch 2).

In a report signifying a watershed in American medicine, the NYC Health Department listed cancer and heart disease as most serious threats to future generations, replacing “standard killers like smallpox, TB, and diphtheria (Oshinsky II, 35).

Richard Cabot begins clinico-pathological “exercises,” which shortly evolve into Clinico-Pathological Conferences, at MGH (Williams, 466-467).

Publication of Abraham Flexner’s report on medical education in U.S. & Canada, under auspices of Henry Pritchett and the Carnegie Foundation (Bonner II, 66-68). Bonner stresses the degree to which Flexner “stood at the vortex of swiftly moving scientific, educational, and philanthropic currents that strongly favored reform,” including the reform-dominated Council on Medical Education of the AMA (73, 88). In writing the report, his brother Simon, then of the Rockefeller Institute for Medical Research, was his “most reliable and helpful critic,” though he also received draft feedback from Pritchett and Hopkins anatomist Franklin Mall (82). Flexner judged two-thirds of the 155 medical schools (5 in Canada) he visited “utterly hopeless” (71). Only Hopkins, Harvard, and Western Reserve received clean bills of health, and only Hopkins “won unstinted praise” (79), though much of the achievement of reform “was less the result of the stick of sanction than of the carrot of foundation subsidy implicit in the Flexner visits” (Stevens, 66-73). Further, Flexner’s twin goals of medicine as a public service and scientific excellence in medical education did not always coincide: “One serious and long-term result of standardization was the closure of schools for black physicians” (Stevens, 71). He surveyed seven black med schools, giving passing grades to two and a marginal pass to one and failing the other four (Long, 158). “Neither Flexner nor the white philanthropists who followed his advice believe in making medical schools for blacks the equal of medical schools for whites. While white schools should focus on scientific medicine and research, Howard and Meharry should focus on sanitation and hygiene (Ward, 26). University of Pennsylvania “in some respects” ranked behind Hopkins, Harvard, Michigan and was not a major beneficiary of grant support from Rockefeller-supported General Education Board (Corner, 231-32).

Bayer Company creates first drug research lab of any pharmaceutical company at Elberfeld, Germany (F. Ryan, 90).

David Edsall and Harvey Cushing poised to accept offers from Medical College of Washington University, at the brink of being Johns Hopkinsized, but, at last moment, Cushing accepts Harvard appointment and Edsall accepts chair of medicine (he had been professor of therapeutics & pharmacology) at University of Pennsylvania (Aub & Hapgood, 66-83). Faculty reform at University of Pennsylvania, to be spearheaded by Edsall, fell through in 1910 owing to faculty opposition, especially of surgery professor J. William White; Provost Charles Harrison and board member Weir Mitchell resign (93). Edsall resigned his professorship on September 1, 1911 though his “young Turk” colleagues Taylor, Richards, and Pearce remained (98-102).

Percentage of women among physicians peaks at 6%, not to regain this level until the 1950s (Morantz-Sanchez, 234). Franklin Martin launches first Clinical Congress of Surgeons around operative clinics of Chicago (Stevens, 86; Martin, 292-298). Establishment of Johns Hopkins’ Henry Phipps Psychiatric Clinic, headed by Adolf Meyer (Barker, 223-225). Nearly every sizable town and city in the U.S. had anti-spitting laws (Ott, 118-119). Fifty percent of all births in the U.S. reported by midwives (Dowling, 63).

Opening of Rockefeller Hospital. Hideyo Noguchi, at Rockefeller Institute, investigating brains of patients who died from either syphilis or paralysis of the insane, concludes that same spirochete was the cause, ending the syphilis-general paralysis controversy (Valenstein, 151).

Peyton Rous, at Rockefeller Institute, demonstrates cancer in chickens could be caused by a virus, soon named the Rous sarcoma virus (RSV) (Mukherjee, 342). In 1970, Howard Temin presented his finding that RSV was no ordinary virus, but a retrovirus that could write genetic information backward, RNA  DNA, i.e., RNA could generate DNA; a cancer-causing virus’s genome could become a physical part of a cell’s genes (350-356).

Cushing’s first successful removal of a meningeal tumor and first complete removal of a tumor (of Major General Leonard Wood, a celebrity) (Thomson, 167, 215). Moynihan’s publication of Duodenal Ulcer (Bateman, 136-37). Elsberg achieves pressure differential between outside of lungs and mouth by blowing air and ether vapor via tube in patient’s windpipe at pressure to keep lungs distended, enabling Sauerbruch’s negative pressure chamber to be discarded (Woolmer, 100-101). Death of Koch on May 27 (Bäumler, 163).

Paul Hallopeau performs first decortication (removal of adherent pericardium from front of heart) in case of adhesive pericarditis (even though Weill and Delorme in 1895 independently proposed the procedure for removal of thickened pericardium in constrictive pericarditis) (Richardson, 44-45).

Graham Clarke, founder of Ohio Chemical Company, working in collaboration with nurse Alice Magaw, invents the Ohio Monovalve, one of the most successful early anesthesia machines for administering a mix of nitrous oxide and oxygen (Stepansky III, 45-46).

James Herrick (Chicago) discovered what would later be termed sickle cell anemia in an African American dentistry student from West Indies. He reported “peculiar elongated and sickle-shaped red blood corpuscles” in his patient” = a “hemoglobinopathy”

Crucial years in establishing the “new cardiology” in Britain (Lawrence, 18). It gained expression in John Marshall Cowan’s textbook on Diseases of the Heart of 1914 and George Sutherland’s Lumleian lectures of 1917: heart failure not a result of back pressure behind a damaged value but diminution of forward pressure exerted by left ventricle; symptoms, as supplemented by ECG and polygraph readings, not murmurs, were most reliable evidence of impaired heart action (19-20).

A year before his election as President, Woodrow Wilson, as governor of NJ, signed legislation to “act to authorize and provide for the sterilization of feeble-minded (including idiots, imbeciles and morons), epileptics, rapists and certain criminals and other defectives” (Rutherford, 15).

Abraham Flexner sent by Frederick Gates (chief administrator of Rockefeller philanthropies) to Baltimore to provide detailed report on costs of transforming medical teaching at Johns Hopkins to full-time system (Bonner II, 100-106). Welch advocates change to full-time system at Hopkins and union of medical schools and public hospitals nationally (Flexner, 309ff.); he succeeds in implementing the full-time system at Hopkins when he was acting head of the University in 1913 via 1.5-million-dollar grant from Rockefeller General Education Board, which underwrote full-time chairs in medicine, surgery, and pediatrics (320ff.). The full-time question split Hopkins community and the big four, with Osler (then in Oxford) and Kelly opposing it (Robinson, 227-234). Full-time system only came to University of Pennsylvania in 1939, with appointment of Joseph Stokes as full-time head of department of pediatrics, though this example was not followed in other departments for some time (Corner, 284-86).

Pediatrician Erwin Lazar establishes “Curative Education” (Heil paedagogik) Clinic at University of Vienna Children’s Hospital – where Hans Asperger would later inherit – to provide expert opinions before institutionalizing or incarcerating children (Sheffer, 32-33).

Eugen Bleuler introduces term autism to describe schizophrenics who appeared disconnected from outside world But Leo Kanner (Hopkins) and Hans Asperger (Vienna) were first to use the term as a standalone diagnosis, with first publications in 1943 (Kanner) and 1944 (Asperger), respectively. Kanner described “classic” autism, i.e., socially and emotionally withdrawn children preoccupied with objects and rituals. Asperger defined autistic psychopathy more broadly, and included children with far milder characteristics (Sheffer, 13-14). Asperger first introduced diagnosis “autistic psychopathy” in a lecture of October 1938 at the University of Vienna Children’s Hospital; it followed the Anschluss by several months: “Had it not been for the Nazi invasion, Asperger may never have envisioned autistic psychopathy as he did.” His October 1938 lecture at University of Vienna’s Children’s Hospital, “The Mentally Abnormal Child,” was ”Much more than a medical diagnosis, it appears less a piece of scientific research than a political and social statement”. . . . He recommended in his second sentence the overhaul of medicine according to guiding principles of National Socialism” (82, 83).

Chevalier Jackson contracts pulmonary tuberculosis (two attacks); during recuperation he writes Peroral Endoscopy and Laryngeal Surgery (Jackson, 121-132). Around time of its publication, “direct inspection became the order of the day” (129). Russell Hibbs performs first fusion operation for tuberculosis of the spine (Pott’s disease) (Goodwin, 33-36). Augustus Hoffman provides first documentation of ventricular fibrillation in man via a published tracing of this arrhythmia (Fye II, 861).

Adolf Meyer refuses Ernest Jones an appointment in Johns Hopkins Department of Psychiatry (established in 1908) after Jones and Loe Kann (a morphine addict) scandalized Baltimore society at founding meeting of APsaA in Baltimore (Leys, 457-59).

Invention of Balkan frame (or beam) by Croatian surgeon Vatroslav Florschutz, widely used in Serbian-Bulgarian War of 1933, and essential fracture wards of WWI. It “comprised single or double longitudinal metal beams placed above a hospital bed and permitted fractured arms and legs, esp. fractures of the femur, to be suspended in traction in a semi-flexed position” (Stepansky II, 75).

Alfred Ploetz, German founder of racial hygiene, discussing his experience at first Int. Congress for Eugenics in London, characterized U.S. as a bold leader in field of eugenics, foreshadowing relationship between German and American eugenicists (Kühl, ch 2).

Cushing publishes The Pituitary Body and Its Disorders . . . a milestone in medicine and history of endocrinology that “opened the book of surgery to a new place” (Thomson, 172-73; Fulton, 320-25). Cushing leaves Hopkins for Harvard, where Peter Brent Brigham Hospital opened in Jan 1913 (Thomson, 177ff.). Moynihan knighted by King George V (Bateman, 165). Tuffier performs first successful finger dilatation of aortic valve (Richardson, 96-97). Edsall accepts Harvard appointment, replacing Frederick Shattuck as Jackson Professor of Clinical Medicine and chief of service at MGH (Aub & Hapgood, 124ff.). Abraham Flexner leaves Carnegie Foundation on appt. as assistant secretary of the Rockefeller Foundation General Education Board (Bonner 2, 113).

Halsted proposes Samuel Crowe to head combined dept. of laryngology and otology (ENT) at Hopkins (Crowe, 148-49). “Tonsillectomy was our most frequent operation, and until the anesthetic was given by a professional anesthetist, it was our most difficult operation” (150). In 1915, Halsted cauterizes tuberculous nodules in Crowe’s pharynx (tuberculous pharyngitis) (Crowe, 153-54).

Hideyo Noguchi, stimulated by von Pirquet’s discovery in 1907 of tuberculin skin test, develops a similar test for presence of Treponema pallidum (syphilis) using an extract of pure strains of the spirochete (luetin). Luetin produced striking reactions in cases of tertiary syphilis missed by Wasserman test. After experimenting with rabbits and monkeys, and on himself and several other physicians, he moved to test the extract on a larger population. With collaboration of 15 physicians in NY area and 400 subjects, Noguchi tested the extract. Use of orphans and nonsyphilitic hospital patients  antivivisectionist uproar (Lederer II, 34ff.), esp. over lack of consent (and violation of individual rights) of the controls. But Noguchi was vindicated in May, 1912 by NYC public prosecutor.

Polish-born English biochemist Casimir Funk isolates crystalline substance from rice bran and then in yeast that cures beriberi [deficiency of vitamin B-1 (thiamine)] and named them “vitamines” (based on mistaken belief that they contained a nitrogen component [an “amine”]) (Altman, 246).

Phenobarbital (Luminal) released in Germany as a hypnotic by F. Bayer & Co. (López-Munoz, 332).

Researchers at Rockefeller Institute’s Hospital publish major review of clinical aspects of polio, “the first substantial clinical investigation of the disease in the United States. . . . Overall, their study suggested that clinical observation remained the most promising, for laboratory tests of body products were confusing and difficult to evaluate” (Rogers, 75, 76).

Establishment of Federal Children’s Bureau within the Dept. of Labor, a female agency imitating on a national scale the technique of the settlement house (M-S, 296, 299-301; Stevens, 136, 144; Leiby, 152-55; Muncy, 141ff.). A 1909 White House Conference on Dependent Children requested it, and TR endorsed it. President Taft appointed Hull House’s Julia Lathrop as its chief. Its first publication was the booklet Infant Care (1914), a product of investigations that revealed that one baby in eight died in its first year – much higher than in most European nations. Women in Children’s Bureau believed that maternal and infant health were more than a medical problem: they “believed that education in its broadest sense should lie at the center of the federal response. As a result, the programs funded by the Maternity and Infancy Act were more educational than medical. After all, public health nurses . . . taught nutrition, the importance of basic hygiene, sterilization techniques, methods to prolong breastfeeding, and the warning signs of complications during pregnancy” (Muncy, 144). “The emergence of the Children’s Bureau and the establishment of the Community Chest system had subordinated maternity homes to the decisions of an alliance of secular social agencies. Once independent, maternity homes were now closely scrutinized and evaluated according to the standards of the social work establishment” (Kunzel, 121, 123). By the 1930s, “Evangelicals might edge social workers off their conference programs, but social workers, with the aid of Community Chests, could close a maternity home down if they chose” (134).

Opening of Boston Psychopathic Hospital under directorship of E. E. Southard; a group of men (Myerson, Lowrey, Solomon, etc.) “who were collectively and determinedly forging a new professional persona for the psychiatrist as a worldly man of science” (Lunbeck, 11-12, 20-24; quote at 28). More than half of patients to Boston Psychopathic Hospital during its first decade were admitted under provisions of various “temporary laws,” according to which patients “were denied any ground on which to protest unwanted confinement,” and their appeal to the law was at work a sign of disease (“litigation psychosis”). Believing that legal niceties stood in the way of psychiatry’s progress, their refusal to entertain rights-based arguments “was at bottom a corollary of their enmeshment within a disciplinary paradigm, according to the conventions of which talk of rights – linked as it was to their discipline’s sorry history – was inadmissible.” Under the temporary laws, “the power to police took multiple forms,” allowing a range of persons – disgruntled husbands, frightened wives, exasperated mothers, annoyed neighbors – to play the police officer’s part (Lunbeck, 89-96). At Boston Psychopathic, 26% of all patients were diagnosed with dementia praecox, 11% manic-depressive, 10% alcoholic, and 8% suffering from the effects of syphilis (120). Psychiatrists’ use of term “psychotherapy” usually meant “persuasive talk,” although they hired a Freudian psychologist, L. Eugene Emerson, to conduct psychotherapy. In point of fact, talk became therapeutic “through the medium of the social worker, not the psychiatrist” (178-179).

J. Whitridge Williams publishes in JAMA his survey of obstetrical departments in American medical schools, finding obstetrics education in even America’s acceptable medical schools to be in a “deplorable condition” (Borst, 106-111).

Alexis Carrel wins Nobel Prize for his work on transplanting and repairing blood vessels, though the prize was not shared with his collaborator Charles Guthrie (Chaddock, 184).

Chartering of the Rockefeller Foundation.

founding of American College of Surgeons, chartered in Illinois, of which Franklin Martin was the first Clinical Director and J.M.T. Finney the first president (Martin, 313, 316; Finney, 132-136; Crile, I, 232-37; Stevens, 85-92). It was dogged by indecision regarding “standardization” versus “elitism” (Stevens, 86-87, 161-63, but its success was assured via its battle against fee splitting (Stevens, 91; Martin, 320, 322-24). General Education Board of Rockefeller Foundation gives Johns Hopkins $1.5 million (the “Welch Fund”) to establish the “whole-time plan” to place clinical depts. on a “full-time” or “true university” basis – opposed by Osler (then at Oxford) and Kelly, who threatened to resign (Barker, 188-90; Davis, 100-102; Aub & Hapgood, 123). Barker’s financial obligations make it impossible for him to accept on salaried basis; he is replaced by Theodore Janeway in 1914 (Barker, 190-206).

Britain passed the Mental Deficiency Act, “but without enforced sterilization included. Instead, it ensured that people deemed undesirable by their categorization of being idiots, feeble-minded or moral imbeciles would be separated and isolated from society under the auspices of the Board of Control for Lunacy and Mental Deficiency. Only three votes were cast against the bill. It stood as law until 1959” (Rutherford, 86).

Theodore Janeway introduces notion of essential hypertension – the concept of high blood pressure as a disease – in “A Clinical Study of Hypertensive Cardiovascular Disease,” Arch. Int. Med., 12:755-98, 1913 (Evans, 784).

Thomas Cullen, as Chairman of Cancer Campaign Committee of Congress of Surgeons of North American, launches first public campaign on early cancer detection, by endorsing article in Ladies’ Home Journal, incurring wrath of many in medical profession (Robinson, 241-251).

Béla Schick (Vienna), publishes results of experiments showing how to test children for presence or absence of diphtheria antitoxin: a positive reaction to an injection of toxin indicated the absence of antitoxin or, in other words, a susceptibility to diphtheria. Absence of a reaction = immunity to diphtheria. The “Schick test” made possible a manageable program of active immunization for diphtheria in NYC, allowing physicians to dispense with active immunization in about 70% of all cases (Hammonds, 178-81). “By 1921, 52,000 children in 44 schools in Manhattan and the Bronx were given the Schick test, retested, and those with positive reactions given injections of toxin/antitoxin” (182-183).

Rockefeller Institute’s Rufus Cole introduced what was arguably the first successful (horse-based) serum for pneumococcal pneumonia, though its benefits were diminished by need for type-specific serum (Marks, 60-61). Identification of pneumonias by type opened the way for effective therapy with type-specific antipneumococcal serums. In 1924, Lloyd Felton devised a workable method of concentrating the serums to preserve antibodies while eliminating unnecessary proteins that caused adverse reactions (Dowling, 48-49). Publication of Milton Rosenau’s text Preventive Medicine and Hygiene, the standard work on public health, reaching its 7th edition by 1951 (Leavitt III, 625).

Opposition to Arbuthnot Lane comes to a head with conference on “Alimentary Toxemia” at Royal Society of Medicine (Dally, 158-159, 164-182; Podolsky, 8-10).

Wm. David Coolidge invents modern high-vacuum tungsten-target x-ray tube; Gustav Bucky (Berlin) solves problem of scattering rays by inserting two metal grids (one bet. patient & x-ray tube; one bet. patient & photographic plate) = collimating the rays (Kevles, 63-66).

Simon Flexner leaves University of Pennsylvania to become scientific director of Rockefeller Institute; appoints Noguchi to an assistantship at the Institute (Lederer II, 34).

Surgeon General Rupert Blue sends USPHS physician Joseph Goldberger to the south to determine cause, treatment, and prevention of pellagra. In September he begins feeding experiments (adding animal protein to diets) in two Miss. orphanages. In June 1914, he begins publishing and presenting on his finds, viz, pellagra not contagious, staff members never contract it, animal protein cures and prevents, milk=most valuable single food,” exclusion of corn from those with symptoms (Kraut II, 115ff.). Then, in collaboration with Governor Earl Brewer of Miss., he induced pellagra in six of 11 prisoners at Rankin State Prison Farm by switching them from normal protein-rich diet to corn-based diet for six months; six developed pellagra ; all were granted pardons by the governor for their participation in the experiment, which ran from April through October, 1915 (121ff.). Then in 1915 “filth parties” in which pellagrin blood transfused and epidermal scales, scabs, secretions, urine, feces consumed in pill form by 16 volunteers, none of whom developed pellagra = conclusive proofs pellagra is not communicable person to person, though not addressing possibility of an insect (per yellow fever) or animal vector, as his critics pointed out (145-50). Then, survey of residents (ca. 4000+) of seven textile mill villages in Piedmont of SC, beginning April 1916 and continuing for 2.5 years = canvassing of homes to det. incidence of pellagra in relation to sanitation, family income, food accessibility. Families questioned about family income, household food supply, household composition. Statistical analysis of 747 household by G’s statistician, with 97 cases of pellagra showed that “When economic data were correlated with data on pellagra incident,” proportion of families with pellagra “declined with a marked degree of regularity as income increases.” “Whatever the course that led to an attack of pellagra, it began with a light pay envelope” (164). Also in 1916, a Concord, NC vet suggested “black tongue” in dogs (severe inflammation of mouth, gums, & teeth, weight loss, bloody diarrhea, death) was canine analogue of pellagra; in 1917, Yale physiologists Chittenden and Underhill reported causing severe illness in dogs resembling pellagra by altering diet; meat cured them (Bryan, 245).

Formation of National Twilight Sleep Assn. in U.S., dedicated to use of twilight sleep (morphine and scopolamine) as developed in Germany by Krönig and Gauss several years earlier (Caton, 132-151). Crile claimed to be using small doses of scopolamine and morphine and atropine, along with nitrous oxide-oxygen analgesia, 1 to 1.5 hours prior to operations, in 1908 (Crile, I, 198).

Russell Hibbs denied admission to American Orthopedic Assn. for the 3rd time; named chairman of orthopedic section of AMA in 1915 (Goodwin, 48-49). Cause of coeducation in medical training “in 1914 was considerably less advanced in Britain than in any other major country (Bonner, 137). University of Pennsylvania admits three women to entering medical class; followed by Columbia (1917); Yale (1917); Maryland (1921); Harvard not until 1945 (Corner, 249). Paul Dudley White buys electrocardiograph for MGH, first in Boston (Fye 2, 35).

Indictment and trial of University of Pennsylvania professor of “surgical research,” J. Edwin Sweet, and five professors of the “animal house committee” by Phila. Anti-Cruelty Society; hung jury discharged without a verdict and defendants never retried: “Justice Bregy startled the defense attorneys . . . by ruling that any physician whose experiments caused pain or discomfort to an animal, no matter how beneficent his aim, was guilty of a crime – an interpretation that would have made criminals out of medical investigators all over the continent” (Corner, 242-244).

Morgan Parker, a 22-year-old engineer, invents two-piece blade-and-handle medical scalpel that is used in ORs today. “It allowed rapid mass-production, sharp blades to be used and exchanged on standard reusable handles (Brill, et al.)

Carrel and Tuffier develop technique for enlarging pulmonary orifice of heart via suturing a patch from a vein to anterior side of the orifice (Richardson, 82).

In March, Belgian Adolf Hustin made first transfusion with blood mixed with anticoagulant sodium citrate (citrated blood), which permitted storage of blood for later transfusion (Fitzharris II, 210).

Franco-American dentist Auguste Charles Valadier receives temporary commission and assigned to British No. 13 Stationary Hospital, where he developed technique for irrigating facial wounds with boiling water via use of an apparatus (“fire engine”) he developed. Established a jaw unit in nearby Wintereux to handle maxillofacial injuries from first battle of Ypres. There Gillies begins collaboration with Valadier (Fitzharris II, 46).

Passage of Harrison Act, which made opiates and cocaine available on prescription only. It sought to coop physicians as a legal source of supply in order to undercut the black market, but physicians generally refused to participate (Healy, II, 166).

Establishment of the Committee on Provision for the Feeble-Minded to get the word out on the “menace of the feebleminded.” It only lasted until 1918, when Mental Hygiene Movement undercut its assumptions about relationship of feeble-mindedness to crime, social vice, etc. (Trent, 169-181).

Alexis Carrel and Henry Dakin, who met in the lab of a French field hospital, jointly develop the Dakin-Carrel Method of deep irrigation of infected wounds using antiseptics; jointly, they “have stretched the first-generation Listerian approach to its curative limit and devised a new method for ‘sterilizing,’ as they say , badly infected deep wounds and saving limbs and lives” (Stepansky III, 52-59, quoted at 52).

Harry J. Haiselden, chief surgeon at Chicago’s German-American Hospital, declines surgery and allows death of newborn of Anna Bollinger with multiple major deformities (absence of a neck, one ear, deformities of shoulders and chest, prematurely hardened skull and leg bones, etc.). He subsequently revealed he had permitted many other infant “defectives” to die over the past decade and would allow at least five more to die over the next three years. Most of these cases riveted the nation, largely because Haiselden publicized them, with letters of support and request for help coming from all over the country (Pernick, 3-6). After two years of intense controversy, after 1917 Haiselden and his cause rapidly dropped from public view (11).

George Minot returns from Hopkins to MGH in January, where, under David L. Edsall, chief of medical services, and in the wake of the Flexner report, “The atmosphere had a critical, scientific fragrance not present before” (Rackemann, 94). Minot studied patients with blood disorders, especially pernicious anemia (97ff.).

Edward Kendall of Mayo Clinic crystallizes the thyroid hormone, named “thyroxine” by him. He patented his preparation and assigned this intellectual property to Univ. Minnesota in 1916 (Rasmussen III, 303).

Opening of the James Buchanan Brady Urological Institute at Johns Hopkins (Young, 224ff.; Lesch III, 20-21), with development of 7-yr residency training program (Young, 241). At the Brady Institute, Young and colleagues developed mercurochrome as a local antiseptic of the genitourinary tract and began administering it intravenously for systemic infection in 1922. He was still using it in 1942, in the face of accumulated evidence against its effectiveness: “Led on by his enthusiasm, Young established an early commanding lead over his evidence, and never lost it” (Lesch III, 20-25, quote at 25).

Founding of Medical Women’s National Assn. (later changed to American Medical Women’s Assn.) by active feminists in Chicago with Bertha Van Hoosen, president (Morantz-Sanchez, 274-75), but only militant feminists joined, never more than 1/3 of women physicians in country (279). Founding of Association for the Prevention and Relief of Heart Disease in NYC, led by Lewis Connor and reflecting public health cardiologists’ commitment to the new notion of prevention (Fye 2, 43-44). Creation of American Board for Ophthalmic Examinations, under Edward Jackson, as first medical specialty board (Stevens, 111-114).

NYC commissioner of accounts published investigation of coroner’s office, a sinkhole of “favoritism, extortion, and malfeasance,”  appointment of Dr. Charles Norris (whose family founded Norristown, PA) as Chief Medical Examiner in 1918, headquartered at Bellevue. Norris appointed NYC chemist Alexander O. Gettler, a Jewish Austrian émigré, and they established the new field of forensic science. Gettler’s experiments relied on dogs and involved many investigations of alcohol poisoning during prohibition. Norris Report of 1927showed that bootleg whiskeys all contaminated with deadly substances, e.g., shellac, antifreeze; all contained denatured alcohol (Oshinsky, 202-213).

Matas delivers annual oration of Miss. State Med. Assn. on “The Soul of the Surgeon” – his reply to G.B. Shaw and other popular attacks on surgeons (Cohn, 336, 347-48). Formation of National Board for Medical Examiners, a voluntary licensing board whose examination, it was hoped, would by recognized by the states as qualifying for their license (Stevens, 62-63).

Jay McLean, then a first-year student at Johns Hopkins Medical School, discovers the powerful anti-coagulant heparin (from the Greek for liver) while conducting research for a professor. According to some, it was the discovery that made heart surgery possible (Morris, loc 1559ff.).

Heinrich Stern founds American College of Physicians to delineate internists, albeit a “pale shadow” of British Royal College of Physicians (Stevens, 92ff.). It was modeled on, and followed by two years, the founding of the American College of Surgeons: “The Standards of the American College of Surgeons were to provide a discriminating mark by which the better trained could be identified form the mass, but the aim was to upgrade the entire practice of surgery. The field of internal medicine never saw itself, in a similar way, as a force for reform throughout the entire medical profession. In standing apart from and above general practice, it continued to adopt an elitist point of view. . . Leaders in the emerging departments of medicine had little interest in Stern or his apparent status seeking. To the stars in academic medicine, the new College appeared pretentious, irrelevant, unnecessary, and perhaps even faintly absurd. . . The leading physicians in academic medicine did not need professional organizations to define their fields; their roles already had been defined by virtue of their rank in university departments of medicine and their positions in national networks” (Stevens, IV, 595).

Cushing and volunteer unit from Harvard (“First Harvard Unit”) journey to Paris to the Ambulance Americaine (American Military Hospital) , and begins his war journal (Thomson, 186ff.). Harvard dentist Varaztad Kazanjian was chief dental officer among the three dentists part of the unit; he formed a 100-bed jaw unit at General Hospital No. 22 (then No. 20) and pioneered reconstructive jaw surgery (V. Kazanjian, 7ff.). Kazanjian, who was asked to stay on after the Harvard Unit returned to U.S. in Sept 1915, the “miracle man of the Western front,” treated over 3000 patients with wiring, bone grafting, etc. (Chambers & Ray, 474). Back to England in 1917, where Cushing’s unit served with British Exped. Force and where, during winter of 1917-18, he operated 16-18 hours a day (Thomson, 194-95). Crile and a unit from Lakeside Hospital (Cleveland) were the first American unit to staff Ambulance Americaine in Jan, 1915. (Crile, I, 247-55). Fleming, working out of Almroth Wright’s unit of bacteriologists attached to a British Army Hospital in Boulogne, published two papers in The Lancet – the first comprehensive study of the bacteriology of wound infections, concluding that antiseptics were not only useless but harmful in the treatment of infected wounds: they did not reach wounds caused by shrapnel and killed white blood cells (Macfarlane, 84-88).

Scottish surgeon Henry Gray removes bullet from heart of a soldier using local anesthesia (morphine) (Morris, loc 474).

First recorded use of term “shell shock” in Lancet by Charles Myers, academic psychologist attached to volunteer medical unit in France. It posited a shell explosion as the central etiological event in these disorders, though Myers was vague on actual relationship between shock and shells (Loughran, 12).

British Army Medical Department allocates 200 beds at Hampstead Military Hospital solely for research into soldier’s heart (Dyde, 236). . . . treatment outcomes had improved significantly, but they could not be sure why. . . . Electrocardiograms found nothing suspicious. . . . despite the brand-new physiological equipment and latest diagnostic techniques – the hallmarks of the new cardiology – there was no firm evidence for any of the explanatory frameworks that surrounded the functional heart disorders: no evidence of poison existed, no structural changes were detected, and no specific nervous pathology was found (239). . . . Lewis decided to rename the disorder effort syndrome: “Furthermore, since the new cardiologists had posited subjective distress [with effort] as their diagnostic starting point, physicians could begin to pay some attention to their patients’ mental states. . . . Psychological states continued to be important at the Hampstead military hospital” (241).

American Psychiatrists place psychopathy “at the center of their social agenda, regularly chronicling the depredations of exemplary psychopaths in support of their contention that what appeared to the lay person to be social issues were in fact properly psychiatric concerns. . . Once delineated as a condition, psychopathy quickly displaced feeblemindedness as the ground from which psychiatrists would choose to speak in the national discourse about defectiveness” (Lunbeck, 65-66).

Publication of Wm. Healy’s The Individual Delinquent, according to which the causes of delinquency were complex and multifaceted and could only be understood at the individual level; his environmentalism was “shallow” compared to Abbott & Breckinridge’s The Delinquent Child and the Home (1912) (K. Jones, 44-50). Healy “psychologized the problem of juvenile delinquency” (49).

Booker T. Washington launches National Negro Health Week at Tuskegee Institute (Ward, 249-250; S. Smith, 33-57). Tuskegee administered the program from 1915 to 1930, at which time USPHS, with support from the Julius Rosenwald Fund, took it over and placed it under the umbrella of a year-round National Negro Health Movement. In 1932, USPHS opened the Office of Negro Health Work, with Dr. Roscoe C. Brown as director (S. Smith, 58-61).

Frederick Twort describes ability of certain viruses to lyse bacteria (bacterial viruses) (bacteriophage); independently discovered in 1917 by Felix d’Herelle of Pasteur Institute and applied therapeutically by d’Herelle in 1917. After promising animal experiments, d’Herelle administered phages to patients with bacillary dysentery in France in 1921 (Wainwright, 105-107; Ho, 1-5).

In June, polio epidemic erupts in NYC, begins in Brooklyn, paralyzing over 8,000 and killing 2,400, mostly children under ten. Polio typically kills 5% of its victims; this epidemic killed 27%. NYC Health Commissioner Haven Emerson blamed epidemic on unclean Italian immigrants, and employs quarantine and heightened sanitation, which failed to control spread (Offit, chap 1).

Wilhelm Roehl, associate of Ehrlich, working at Bayer lab at Elberfeld, discovers Germanin, an azo dye derivative, first treatment for sleeping sickness (trypanosomiasis) (F. Ryan, 90-91). In 1924, Roehl, working with Bayer chemist Fritz Schönhöfer, distilled Plasmoquin, which was 30 times more effective against malaria than quinine (91).

Harold Gillies ordered by British War Office to report to Cambridge Military Hospital, where he establishes his service in facial reconstructive surgery (Fitzharris II, 67ff.). Relocation in early 1917 to Queen’s Hospital in Sidcup, a 320 bed (expanded to 600) maxillofacial specialty hospital with separate British, Australian, New Zealand, and Canadian divisions (132ff.) British artist Francis Woods assigned to 3rd London General Hospital, where he begins constructing masks for soldiers with facial deformities (123ff.).

Chevalier Jackson leaves Pittsburgh and accepts Professorship of Laryngology at Jefferson Medical College (Jackson, 142-144). Second round of abortive merger talks between University of Pennsylvania and Jefferson (Corner, 252-56). Rockefeller Foundation decides to fund Hopkins School of Hygiene and Public Health if Welch will head it (Flexner, 356-58). Establishment of National Research Council (under National Academy of Sciences) to advise Wilson and Congress re impending war (Vaughan, 400ff.; Harden, 73-74). Following his observations of physical characteristics of polio victims during NYC’s polio epidemic of 1916, George Draper establishes first institute for constitutional research in U.S. at NY’s Presbyterian Hospital, where he devised an elaborate personal inventory to screen patients and developed a taxonomy for the human race based on predisposition to disease (Tracy II, 57, 61, 69-70). It was followed in 1926 by Raymond Pearl’s Constitutional Clinic in Johns Hopkins Dept. of Medicine. These were the two clinics for study of constitution prior to 1946 (76-77).

First war-wounded arrive at Britain’s Star and Garter Hotel, an elegant resort of mid-19th century. Through efforts of Sir Frederick Treves, field surgeon in the Boer War and discoverer of the Elephant Man, it became Star and Garter Home for permanently disabled soldiers, esp. paraplegics. Following fund-raising efforts of the British Women’s Hospital Committee, headed by actress May Whitty, the rebuilt home opened in 1924.(Cohen, 132ff.). “Disabled men’s cheerfulness was anything but ‘natural.’ It attested to a resolute masculinity distinguished by the control of emotions; it reflected great courage. . . . The disabled demonstrated the essence of masculine perseverance, independent of physical strength. They represented manhood as nineteenth-century Evangelical reformers had imagined it, an expression of inner moral substance” (141, 143). “At the Star and Garter, sadness remained individual, and grievances private. Those who openly aired complaints faced expulsion” (145). “Reporters who expected the worst could have found it. However, stories of depression and bitterness found no place in narratives of cheerfulness. That was the way visitors – and a number of patients – wanted to represent the Home’s ‘inner life’” (147).

In U.S., summer outbreak of polio epidemic in 26 states, especially mid-Atlantic states: 27,000 cases and 6,000 deaths; in Newark & NYC, about 80% of cases were children under five years old (Rogers, 10ff.). Scientific understanding of polio, guided by Simon Flexner’s work at Rockefeller Institute for Medical Research, was that polio resulted from a filterable virus that entered the body through the nose and mouth (and was spread by sneezing and kissing) and traveled directly to the brain and spinal cord along nerve pathways (21-25, 173). By the 1950s, this model was supplanted by one in which the polio virus entered the body through the mouth, traveled to the intestines via the blood, and only occasionally affected the nervous system (24, 173-176). This followed from the culture work of John Enders and his team at Children’s Hospital in Boston in 1948; they cultivated the Lansing strain of polio (unlike Flexner’s mixed MV strain) (173; Galambos & Sewell, 59). It was also found that polio antibodies in blood were a “defining sign of exposure to polio and that such exposure might provide lasting immunity” (174). In 1916, germ theory (the “New Public Health”) continued to be interpreted in the context of political demands and cultural prejudices; physicians and health officials “did not believe that germs spread disease randomly. Disease germs were associated with specific kinds of places and people. . . . In practice, most official quarantine measures [19th c. “sanitary science”] sought to regulate the behavior of immigrant families as the most effective way to control the spread of the epidemic” (32, 33, 42-43, 46-47, 57). “Polio was explained in both terms of the traditional filth theory and the concepts of modern bacteriology. Even the most up-to-date scientists, who tended to support a theory of personal contact in disease transmission, mixed their analyses of the epidemic with dust and fomites, older symbols of disease” (70, 143-45, 163-64). “A traditional environmental model underlay epidemiologists’ questions but proved inadequate to explain the patterns they found, for researchers were only willing to associate the disease with the presence – not absence – of poverty and dirt” (150). Therefore, appearance of polio among middle-class, nonimmigrant children explained in terms of an insect theory (150-54) and other external factors such as infected milk (157-59), infected food, careless parents. “Despite contradictory evidence, in epidemiological study as in public health work, polio remained firmly linked to filth and poverty” (143), even though “The discrepancy between dirt and disease was the most difficult break from the traditional epidemiological past…. The bacteriological model allowed investigators to transform dirt into infected filth, a sign that individuals, through carelessness and ignorance, had abdicated their responsibility for preventing disease” (162).

Oxycodone is developed at University of Frankfurt by Freund and Speyer, but only comes to US in 1939 and only becomes widely used in 1996, when Purdue Pharma begins manufacturing OxyContin, its controlled-release version of Oxycodone. It became best-selling narcotic pain reliever in US in 2001.

V. P. Filatov (Ukraine), Hugo Ganzer (Berlin), and Harold Gillies (England) independently devise and use the tubed pedicle flap in reconstructive facial surgery of WWI soldiers (see WWI, tubed pedicle flap). Only Gillies used it extensively and refined and developed the technique (Brain 161-164).

Merck (in Darmstadt) releases Eukodal as painkiller and cough medicine. Its active ingredient is opioid oxycodone, synthesized from raw opium. Beginning in second quarter of 1943, Hitler’s personal physician Theodor Morell administered regular injections of it to Hitler, initially for severe stomach pain, probably associated with spastic constipation (Ohler, 136).

Association for the Study of the Internal Secretions (ASIA, after 1952 the Endocrine Society) founded in NYC: “Yet it should be recalled that endocrinology was still highly controversial when the ASIS was created. . . . Early organ therapy had been branded quackery and many reckoned hormone therapy, exploited by the ‘endocrinologists,’ was not much better” (Nordlund, 89).

Howard Kelly takes indefinite leave from Hopkins; Thomas Cullen becomes acting Gynecologist-in-Chief (Robinson, 279).

Passage of War Risk Insurance Act, which undid the Civil War pension system (act of 1862), via: (1) paying money to soldier’s dependents while soldier was away at war or after his death; (2)offering heavily discounted voluntary life & disability insurance to soldiers; & (3) instituting system of disability compensation on fixed rating schedule and mandating medical care and rehab services for all returning disabled soldiers: “Framers of the WRIA incentivized medical care and rehabilitation through law by suspending compensation payments to any disabled soldier who refused to undergo hospital care” (Linker, 29-33, quoted at 33). “In image and text, rehabilitation propaganda frequently used the Civil War pension system as a counterpoint to orthopedic reconstruction” (122). It was Worker’s Compensation legislation, on the books at the state level by 1917, that was the prototype for provision of medical benefits to vets; the federal government assumed responsibility as an employer of men in an extra hazardous occupation (Stevens III, 286-287).

Joel Goldthwait, orthopedist, takes 20 American orthopedists to Britain, at invitation of his British friend and counterpart, Sir Robert Jones, to gather facts and provide aid; on return in August joins army Surgeon General’s Office newly created “Division of Orthopedic Surgery” and becomes chief of military orthopedics for American Expeditionary Forces. He arrived in France in October and began establishing “orthopedic stations,” each with a “splint team,” at every stage of injured soldier’s journey from battlefields to disembarkation to US (Linker, 52-59).

Creation of Commission on Training Camp Activities, 11 days after declaration of war, initiated a two-pronged attack on VD: CTCA “combined elements of uplift and distraction, coercion and repression in its efforts to make the military venereal-free” (Brandt, 59). Its work closely resembled the programs of the Progressive social settlements in ideology and implementation (61). Its campaign was dominated by the threat that VD posed for military effectiveness (62); “The CTCA equated the contraction of a venereal disease with a national betrayal” (66). Prostitution, previously a strictly moral issue, was subsumed during the war by a new emphasis on science, hygiene, and health. . . Closing down red-light districts [around military camps] became part of the ‘hygienic gospel,’ comparable to the anti-tuberculosis and anti-yellow fever campaigns of the Progressive years” (72). In December, 1917, the Council of National Defense establishes the Civilian Committee to Combat Venereal Disease to make the battle against VD a national campaign not limited to areas around training camps (78-79).

Thomas Salmon travels to England to study British treatment of shell shocked solders, where it was by then accepted that shell shock was a real disorder (not malingering) but one that could be readily treated psychologically. Salmon, appointed director of psychiatry for the AEF at year end, accepted the role of psychological factors but stressed the vulnerability of individuals, not the conditions of fighting. He rejected the term “shell shock” because by 1917 evidence showed only small number of cases occurred in presence of shell fire (Brown IV).

Oswald Robertson, Canadian surgeon serving in France with U.S. Army, but sent to British 3rd Army Casualty Clearing Station to consult on blood transfusion. There he developed plans for first blood bank, viz, storage of syphilis-tested and then citrated (to prevent coagulation) blood, to which dextrose was later added. Stored blood was drawn only from universal type O donors and stored in one-liter glass bottles. The bottles were shipped in converted ammunition boxes, with ice and sawdust packed around them. Although the blood could only be stored a short time, it allowed blood to be collected in advance of need (Pierce; Stansbury & Hess).

Immigration Act excluded adult aliens who could not read a short passage in English or some other language (the literacy test opposed by psychiatrists) but was still a milestone for psychiatry by extending the eligibility period for deportation to five years and including ‘constitutional psychopathic inferiority,’ as well as ‘vagrancy’ and ‘chronic alcoholism,’ as grounds for exclusion and – by implication – deportation. . . . But proofs of how little psychiatric opinion had in common with public opinion was the fact that as psychiatrists congratulated themselves, the country was becoming steadily more xenophobic and nativist. . . Nativists, heady with victory, began to position themselves for the next battle: a quota system was implemented in the 1921 Immigration Act and then again in the 1924 Act, which lasted until 1965 (2% quota on each national group based on 1890 census; with upper limit of 150,000 immigrants per year beginning in 1929) (Dowbiggin II, 224-227). The preceding year, 1923, Fritz Lenz, after Ploetz the most prominent advocate of Nordic ideology, appointed to first German chair in race hygiene at University of Munich (Friedlander, ch 1).

Open disputes break out between American College of Surgeons and the AMA when Franklin Martin of the College was the only physician appointed by President Wilson to his Advisory Commission of the Council on National Defense (Stevens, 125). When U.S. entered World War I, the medical committees of both the National Research Council and the Council of National Defense were controlled by Welch, Gorgas (Surgeon General of Army), Vaughan, and the Mayo brothers, all former presidents of the AMA (Barry, 135). ACS formulates and adopts its text of “Minimum Standards for Hospitals” (Martin, 338-40).

Wagner-Jauregg begins using malaria as fever therapy in syphilitic patients with paresis (first American patient receives the treatment in 1922) (Parascandola II, , 17). After studying venereal disease in British and French armies, Young develops venereal disease program for A.E.F. in France, using French drug novarsenobenzol, a modification of Salvarsan, less toxic than Salvarsan. In Karl Landsteiner’s two papers on cross-reactions of antibodies and artificial haptens “we can almost hear the death knell of Ehrlich’s side-chain theory of antibody formation” (Silverstein, 108-109).

Oswald Avery, working at Rockefeller Institute under Rufus Cole, develops serum that cut the death rate of Type I pneumonias from 23% to 10% and pursues a vaccine to prevent pneumonia caused by Types I, II, & III pneumococci, which was successfully tested on 12,000 troops at Camp Upton on Long Island in March, 1918 (Barry, 162ff.)

Congress passes Vocational Rehabilitation Act, providing extensive physical treatment and vocational training for all disabled ex-servicemen. The act also institutionalized a division between physical reconstruction and vocational rehabilitation although, in practice, it was often unclear when one phase ended and the other began. In 1921, newly formed U.S. Veterans’ Bureau took over administration of the act and established 48 all-veteran vocational schools (Kinder, 124-125).

Opening of Rockefeller-funded Hopkins School of Hygiene and Public Health, headed by Welch (Flexner, 358ff.). James Mackenzie retires from his London practice as a consultant cardiologist and returns to Scotland (St. Andrews), where, in 1919, he founds the Mackenzie Institute for Medical Research (Mair, 291ff.).

James Herrick (Chicago) discovers ECG changes associated with myocardial infarction (inverted T waves); the discovery “seemed to endow the newly described syndrome with greater legitimacy. . . after he described ECG changes, the syndrome of myocardial infarction was rapidly accepted in the United States” (Howell V, 90; Lawrence, 26).

Alfred Hyman, then an intern in Boston, was desperate to understand why a patient in heart block whose heart was temporarily restarted with injections of adrenaline directly into the heart lapsed into heart block and died, and then at age 25, “he conceived the idea of an electrical stimulus conveyed to the heart muscle through a needle. . . Hyman constructed a machine which he called the ‘artificial pacemaker’. Like Lidwill’s device, it was intended as a temporary stand-in for the patient’s own sinoatrial node.” In 1936, he replaced his original bulky apparatus with a battery-powered model, but failed to find a manufacturer and faded into obscurity (Morse, loc 2730ff).

Walter Dandy’s paper on ventriculography, “Following the Injection of Air into the Cerebral Ventricles” “was the greatest single contribution ever made to brain surgery” (Crowe, 88-89). Via ventricular puncture he removed cerebrospinal fluid and injected air into the ventricles, so that the ventricles could be seen in clear outline on x-ray film. This resulted in an objective and accurate method to localize brain tumors at an early stage of their development (88-92).

Florence Sabin is appointed first full-time female professor (of histology) on Johns Hopkins faculty; had been passed over in 1917 for chairmanship of anatomy dept. following death of Franklin Mall (Morantz-Sanchez, 162-163).

George Minot begins work on leukemia (tumor of the blood) at Huntington Memorial Hospital (Harvard’s cancer hospital) (Rackemann, 109ff.), where he became chief of the medical service in 1921, on resignation of Francis Peabody (118-119).

Placebo, debate over in Lancet: Debate in pages of Lancet over Dr. Hildred Carlill’s sham surgical procedure (risky removal of a small piece of skull bone) as effective placebo treatment for patient suffering from debilitating attacks of sleepiness (Crenner II, 131-133).

Publication of America’s first best-selling weight-control book, Lulu Hunt Peters’ Diet and Health with a Key to the Calories (Brumberg, 241-242).

Outbreak of influenza pandemic (erroneously called “Spanish influenza” because it was first reported from neutral Spain), first in Camp Funston (Kansas), then to other army camps, thence to France (via troops disembarking at Brest) and the rest of Europe. During Germany’s final Hundred Days Offensive in March, 1918, American Expeditionary Force alone reported approximately 360,000 cases of influenza (Hallett, 229). In U.S., spring (March-April) first wave was mild; virus adapts to humans via “passage,” abetted by tightly packed trenches and transport trains, which left infected, but not yet symptomatic soldiers in the trenches to pass the virus on to healthy replacements. In U.S., epidemic likely originated in the military installations, viz, Camp Funston in March and Camp Devens (north of Boston) in September (Byerly II, 79. 93-94). The second wave (beginning in August) was deadly (Barry, 169-184). Philadelphia authorities refused to cancel Liberty Loan Parade of September 28; in three days all hospital beds in Phila’s 31 hospitals were filled; in 10 days the epidemic there had exploded to hundreds of thousands ill and hundreds of deaths each day (Hallett, 221ff.). In 25 of the 40 largest army training camps, at least one quarter of soldiers reported sick with influenza and pneumonia, and eight camps reported more than 500 deaths. Unlike regular influenza, Spanish flu could produce fevers up to 106 degrees that led to delirium or lethargy to the point of prostration. Patient bled from the nose and ears and coughed up bloody sputum . . . Medical officers found cyanosis from lack of oxygen among most alarming symptoms (Byerly II, 77-78). Outbreak at Camp Devens (north of Boston) on 8 September, with 6,000 patients crammed into a 2,000-bed hospital. It led to inspection by William Welch, Rufus Cole (Rockefeller Institute), Victor Vaughan, and Simeon Walbach (Harvard) (Barry, 188ff.; Byerly II 74-75; Crosby, chap 1); Welch sent for Rockefeller Institute’s Oswald Avery, who found Pfeiffer’s B. influenzae, but pneumococcus, hemolytic streptococcus, and staphylococcus aureus as well, and remained unconvinced B. influenzae was root cause (Hallett, 288ff.). His research tended to finding that an antipneumococcus serum, rather than a vaccine against B. influenzae, addressed the primary infection (296). During autopsies, Welch could not believe the condition of the lungs resulted from flu, and speculated the disease was a new kind of infection or return of the plague. By end of October, 17,000 had contracted influenza and/or pneumonia, one-third of the command (Crosby, chap 1). During 1918-1919 epidemic, 47% of all deaths in U.S. were from influenza and its complications, with death toll in excess of 675,000 and – unlike typical influenza -- with young adults 20-40 the most likely to die (Hallett, 238-239). Data from 10 American cities showed an average influenza sickness rate of 28%, comparable to that in the army training camps. In the camps, the average was at least 20-30% sick rates, but they only capture soldiers who reported sick and received medical attention (Byerly I, 79, 86). The lungs of victims resembled those of only one known disease: a virulent form of bubonic plague known as pneumonic plague (241). “In 1918 the immune systems of young adults mounted massive responses to the virus. That immune response filled the lungs with fluid and debris, making it impossible for the exchange of oxygen to take place. The immune response killed” (249-50). In 1918, ARDS (following from a violent infection of the influenza virus itself) had virtually a 100% mortality rate, though doctors could treat the pneumonia caused by secondary bacterial infections (via Avery & Cole’s serum for Types I & II pneumococcus; surgical draining of empyemas; drugs; x-rays; oxygen), though the resources were scarce and unavailable to doctors in Public Health Service. Out of 100,000 civilian doctors, 72,000 joined the Volunteer Medical Service, but only 1,045 enlisted in the PHS (Hallett, 316ff). Death toll estimated at 50-100 million; up to 5% of world population (Hallett, 397). In research beginning in 1919, Park & Williams reversed their position on causal role of B. influenzae; many researchers moved to filterable virus as the cause, though the only evidence was negative evidence as to a bacterial cause (Hallett, 415-417).

Formation of Society of Neurological Surgeons, with Cushing first president (Thomson, 209-210); founding of Archives of Neurology and Psychiatry by AMA in reaction against Jelliffe’s Journal of Nervous and Mental Disease (Burnham, 310ff); formation of International League of Red Cross Societies in Cannes, under leadership of Welch (Flexner, 377-81). American College of Surgeons produced first list of approved hospitals, but list was suppressed owing to “horrifying conditions” at many larger, better hospitals encountered by Bowman during site visits of 1918-1919. (Stevens, 128-129). AMA Council on Medical Education brought out “The Essentials of an Approved Medical College” (129).

Howard Kelly resigns from Hopkins, with Thomas Cullen appointed his successor as head of Department of Gynecology (Robinson, 295; Davis, 103-112), and led fight to prevent gynecology from being absorbed in obstetrics under J. Whitridge Williams, who turned down professorship in NY on condition that most of the clinical material allotted to gynecology under Kelly would be turned over to obstetrics, with gynecology receiving a new clinic building, as planned in 1920. The planned building would allow gynecology less space “by a fifth” than it had been occupying since 1896 (294ff.).

Development of Mercurochrome by Young and staff as local antiseptic often superior to iodine because it does not injure tissue cells, which dead cells “produced an excellent pabulum for the growth of bacteria” (H. Young, 254-262). Successful use of intravenous Mercurochrome to combat septicemia (257ff.). Young’s “beloved Mercurochrome,” which he had injected into his trachea for chronic bronchitis or bronchiectasis (Crowe, 125-126).

Moynihan delivers “The Ritual of A Surgical Operation”: “Infinite gentleness, scrupulous care, light handling, and purposeful, effective quiet movements, which are no more than a caress, are all necessary if an operation is to be the work of an artist, and not merely of a hewer of flesh” (Bateman, 148-151; cf. Selzer).

Publication of Harold Gillies’s Plastic Surgery of the Face, growing out of his experience with burn and gunshot victims in WWI (Woolmer, 107). Stevenson comes to London as subeditor of BMJ (Stevenson, 5).

Congress makes Chemical Warfare Service (CWS), established in 1918, a permanent branch of the army. In 1922, CWS creates a Medical Division, so “Chemical warfare research thus continues, if slowly, even after the war ended” (Susan Smith, II, loc 446). The ongoing research flew in the face of the Geneva Protocol of 1925, which banned the use of chemical and biological weapons. But many of the 38 signatories signed only with stipulation that they supported policy of “no first use of chemical weapons. Nor did the Protocol prohibit the possession of chemical weapons” (S. Smith, II, loc 440-461). In WWII, the CWS had 65,000 soldiers (loc 622). Most mustard gas experiments took place under the auspices of the CWS and the Office of Scientific Research and Development (OSRD), and affected more than 60,000 Americans, along with over 2,500 Canadians, 2,500 Australians, and 7,000 Britons (loc 160-62). After WWII, practically the entire program and staff of the CWS would be assembled into the drug research program of the Sloan-Kettering Institute (DeVita & Chu, 8045).

Germany’s National Pension Law sought to protect war disabled for their economic disadvantages and, unlike Britain, supplemented pensions when veterans married and had children: “ . . . the central objective of German welfare programs for the disabled was rehabilitation. . . . Unlike the British government . . . German authorities sought from the beginning of the war to return even the most severely disabled to work, preferably to their former occupations” (Cohen, 154-55). Law of the Severely Disabled required business and government offices that employed at least 25 people to hire the incapacitated as at least 2% of their workforce (157ff.).

Admissions at Bellevue Hospital increased from 6,546 in 1879 to 45,470 by 1920. Growth signified era of the “private” patients, which began with St. Vincent’s in 1860s; NY Hospital in 1900 opened 10-story bldg. of private rooms. Nineteen twenty four survey of NYC hospitals showed 30% in private or semiprivate rooms (Oshinsky, 188-189). Competition for payments  opens hospitals to family physicians, who admitted their paying patients and decline of charity cases. Public hospitals like Bellevue had to pick up the slack (190).

Founding of the Tavistock Clinic by Hugh Crichton-Miller (1877-1959) reflected “small but growing interest in psychodynamic concepts” in post-War Britain. Edward Mapother, who took command of the Maudsley in 1923, was “highly critical of most psychodynamic hypotheses and regarded the Tavistock Clinic with disdain.” ( Edgar Jones, 13, 23). Aubrey Lewis arrived at the Maudsley in 1929 and Mapother appointed him clinical director in 1936 (21). He shared Mapother’s distrust of Tavistock (24-25). During the 1930s, many of the famous names of postwar British psychiatry (including John Bowlby, John Sutherland, and Wilfred Bion) learned clinical skills there under Mapother (22). The Maudsley closed in August, 1939 and reopened in September, 1945 (26, 31). Lewis prepared at request of Medical Research Council and then published in Lancet in 1942 a report on civilian neuroses in Britain, in response to American concern that British were downplaying and underreporting incidents of neuroses arising from air raids: “Lewis had adopted the explanation that most of the patients with neuroses would have developed them anyway. That these symptoms appeared in the context of the war was coincidental” (Casper I, 342) . . . Although there is no definitive evidence that it was propaganda, the document possesses an undeniable aesthetic quality, especially in the testimonials about the stoicism and courage of the civilians whose lives were ravaged by the bombardment. . . . Boundaries between the social and the professional had vanished within a narrative of resistance, patriotism, and commitment to maintain the morale of the nation” (343).

Passage of French law prohibiting all sale, distribution, advertisement, or promotion of female contraceptives and birth control as well as stiffened penalties for abortion: “[Nelly] Roussel’s campaign for freedom of motherhood may have done more to frighten nervous senators into passing the 1920 law than it did to change public opinion.” Then again, few French women were “open to the new contraceptive methods intended for them even prior to the war” (Accampo, 255-256). In France, “the demographic transition [lower birth rates] occurred without a fundamental shift in gender relations with regard to sexual practices or mores. Coital control remained primarily in the bodies and minds of men; abortion remained the last resort of women, even long after female contraceptives became available, simply because it was psychologically less trying than contraception, despite its physical risk” (260).

Soviet Union legalizes abortion. In U.S., Red Scare after WWI prevented development of abortion-reform movement: “. . . the association of legal abortion with Soviet socialism surely tainted the notion among American birth control supporters, who were themselves under assault” (Reagan, 142).

Passage of Civilian Vocational Rehabilitation Act (CVRA), an expansion of WRIA to civilian sector that sought to make worker protection a federal matter. But the bill only paid vocational counselors to make home and worksite visits to injured industrial workers (for occupational training and job placement), it did not make health care services available to the industrially disabled. As a result, US provided medical and vocational rehabilitation to disabled soldiers but only the latter to nonmilitary disabled citizens: “America’s two-tier system of socialized medicine for soldiers and privatized health care insurance for the rest of its citizens persisted for the remainder of the twentieth century” (Linker, 148-149, 164-165).

American engineer William Bovie invents electrosurgical generator (the Bovie) in which level of energy in tissues could be much better regulated by increasing frequency of alternating current and supplying it in pulses (i.e., as modulated alternating current), enabling the effect of the heat applied to tissue at tip of scalpel to vary from coagulation to cutting. The Bovie was introduced into surgery by Harvey Cushing in 1926 (Van de Laar, ch 28).

Invention of Band-Aid adhesive bandage by Earle Dickson, a cotton buyer at Johnson & Johnson, in response to his wife’s kitchen cuts and burns. First commercial Band-Aids were made by hand and sold in sheets 3” wide and 18” long; they had to be cut to size. In 1924, manufacture was automated, and J&J began producing individually wrapped singles in different sizes. In 1926, a small red strip to open the wrapper was added and cardboard containers were replaced with tin.

Percy Oliver and his family, operating out of their house with index cards and a phone, establish the London Blood Transfusion Service, the world’s first voluntary blood panel, “a register of reliable blood donors who would never ask for payment” – unheard of at the time. Hospitals would call for blood, and the Olivers would have it delivered “in the shape of a person.” Donors at hospitals were often treated with “puzzling disdain,” as the staff assumed, erroneously, that the donors were being paid and could therefore be treated carelessly (George, 75-76).

Creation of U.S. Veteran’s Bureau (later VA and now Veterans Affairs), which consolidated work of War Risk Insurance Bureau, USPHS, and rehab division of the Fed Board of Vocational Education (FBVE), and also instituted federally funded system of hospitals solely for health care of America’s soldiers (Linker, 166-167). “It was obvious [in 1918] to all concerned that a national veterans hospital system could not be planned in Congress without an out-and-out contest for federal funds [re location of new hospitals], with vote trading, logrolling, and the general ‘odor of pork’ . . . the only fair way to design a national hospital program for veterans was to remove it from the political process altogether. A prime ingredient of the eventual veterans hospital program, then, was the inability of Congress to design a national program itself. Consensus was to be achieved . . by the displacement of political decision making to the realm of experts, who were to be drawn from the national organizations of health and medicine” (Stevens III, 291). The “military efficiency” of the four consultants, who reported directly to Sec. Treasury Andrew Mellon, contrasted with “the sprawling muddle of the Veterans Bureau,” whose first director, Charles R. Forbes, was indicted for bribery and fraud in administration of the hospital program of the Veterans Bureau in 1923 (295). In 1924, veterans became eligible for care for conditions unrelated to their service if hospital beds were available: “With one stroke of the pen, then, the original hospital and medical program, which had been designed as workers’ compensation, was translated into comprehensive hospital insurance” (296). The AMA now became apprehensive about this extension of veterans care as “socialized” and, as of 1930, “communistic” (296). But, like Medicare after it, it became accepted as the status quo and there was little talking of turning over veterans’ care to civilian hospitals after WWII, despite concerns elsewhere about “socialized medicine,” states’ rights, etc. (297).

Passage of Sheppard-Towner Maternity and Infancy Act, “women’s legislation”: government provides states with matching funds to establish prenatal and child-health centers, to be administered by the Children’s Bureau. Its passage was orchestrated by the Bureau’s head, Julia Lathrop, who mobilized the states’ child hygiene divisions that were created under the Women’s Committee of the Council of National Defense during the war and harnessed the lobbying power of the Women’s Joint Congressional Committee (WJCC) organized in 1920 and initially representing 10 national women’s organizations (Muncy, 101ff.). The Children’s Bureau administered the act; it recommendations re the acceptability of state programs were rubber-stamped by the special Board of Maternity and Infant Hygiene set up under the act: “Passage of the Sheppard-Towner Maternity and Infancy Act, then, expressed women’s power at this unique juncture to determine federal child welfare policy even despite the legal ability of a male Congress to prevent it, and success was due in large part to the professionalization and institutionalization of the female movement for child welfare reform. . . . [By 1927, only three states remained outside the Shepard-Towner fold, so] The Maternity and Infancy Act thus legalized the previously unofficial relationship between the Children’s Bureau and analogous agencies in the states” (196, 107). An annual average of 750 nurses worked around the country as home visitors, driving “health cars” loaded with films, charts, posters, and pamphlets; they preached the behaviorist canon of “habit formation.” S-T opposed by AMA as “un-American” and was allowed to lapse in 1929 (M-S, 301-302; Stevens, 143-144; Sealander, 226-234), owing, inter alia, to fractionation of female voting bloc, marginalization of activist female reformers (“Bolsheviks”), and capitulation of congressional democrats to governmental inactivism following Coolidge’s election in 1924 (Muncy, 128-131). In both the Children’s Bureau (which administered the act) and the state maternity and infancy programs, “women also ran the show” (108). Other S-T activities included health conferences, birth registration, training midwives in 31 states; 40 of 89 full-time docs in state child health bureaus that relied on S-T funding were women. Failure to renew S-T in 1929 owed, inter alia, to AMA, which criticized S-T as harboring “communistic” sympathies and characterized its clinics as second-class clinics run by second-class docs. It was also opposed by clinical (but not academic or research) pediatricians, who viewed it as a challenge to private practice. Its nonrenewal signified the marginalization of public health during the “private practice” response to S-T to promote for first time “periodic health exams” for children and adults (More, 155-158). For AMA leadership, it was all about money and the “hoarding” of professional knowledge: “. . . leaders in the AMA understood rightly that the professional code embodied in the Sheppard-Towner Act clashed utterly with their own: while public service values were central to the professionalism of women in the child welfare dominion, profits were central to that of the AMA leadership” (Muncy, 139). In Appalachia, “private physicians eventually moved to limit the boundaries of public health as well as the parameters of acceptable nonprofessional involvement in advocating and financing medical care . . . If doctors rejected the concept of educating lay midwives and elevating nurse-midwives to a professional level, they were equally wary of the increased autonomy of public health nurses” (Barney, 134, 137). “As independent field nurses, public health educators, and school inspectors, these women gained legitimacy and furthered their professional maturity. . . .Public health nurses . . . were both unwilling and unable to accept the absolute authority of the medical community. . . . many doctors feared the presence of public health nurses (Barney, 138, 139). Conservatism of late 20s  replacement of independent women’s organizations by women’s auxiliaries of state and local medical societies: “Physicians helped develop these dependent auxiliaries into the perfect propaganda machines” (150).

Founding of Thorndike Memorial Laboratory (of Boston City Hospital) under Francis W. Peabody (Rackemann, 162-64).

In July, Banting and Best inject liquid extract of degenerated pancreas (“isletin”) into a diabetic dog whose pancreas had been surgically removed and had their first success on August 3 (Bliss, 66-67). Jan 11, 1922: first formal test of B&B’s extract with a human diabetic, which failed (79-80); Jan 23: first successful test on same patient with Collip’s purified extract (82).

In The Glands Regulating Personality: A Study of the Glands of Internal Secretion in Relation to the Types of Human Nature, a best-seller, Louis Berman “proposed that human beings be categorized in various types, so-called ‘master types,’ according to their respective endocrinal complexion. Thus there were those who were thyroid gland-centered, pituitary gland-centered, adrenal gland-centered and so on” (Nordlund, 92).

French surgeon Henri Hartmann devises “Hartmann’s operation,” creating a stoma, in which damaged portion of sigmoid colon is removed without connecting the two open ends back together. The lower one is simply closed off while the upper one is used to make a stoma. The operation is safe, since the intestinal tear is not sutured, which could later leak (Van de Laar, ch 6).

FDR, vacationing on island of Campobello, off coast of Maine, contracts polio (Gould, 29ff), initially misdiagnosed by W. W. Keen, whose prescription of heavy massage may have done “considerable harm” to FDR’s chances of recovery (32). Shortly thereafter, Robert Lovett, professor of orthopedic surgery at Harvard and author of The Treatment of Infantile Paralysis, arrived at Campobello and made the correct diagnosis and appropriate course of rehabilitation (Oshinsky II, 42-43).

George Minot diagnosed as diabetic by Elliott Joslin; Minot began insulin treatment on January 12, 1923: “The discovery of insulin was directly responsible for George’s being able to carry on and to make his own discovery of the treatment for pernicious anemia (Rackemann, 129). In 1945, Laurence Ellis pointed out “how much the world owes to Dr. Joslin for preserving the health of [Minot]” (259).

Jan Sicard discovers lipiodol, iodine compound suspended in oil, to be remarkable new contrast agent, initially for spinal region (myelography); introduced in US by Ethel Russell at PGH in 1924 (Kevles, 103-104). Discovery of tomography in France, though first instrument not built until 1931 and, in U.S., in 1937 in St. Louis, where Jean Kieffer’s (French immigrant who worked in X-ray dept. of Conn. TB sanitarium and made his discovery as a patient, not a doctor) version of the tomograph went into production in 1939: “By the fall of 1939, more than a thousand patients had had what they were calling ‘laminagraphs’ in St. Louis” (Kevles, 108-110). Fleming discovers lysozyme, a lytic agent (an enzyme) from mucous and other body secretions (Wainwright, 97-98; Macfarlane, 98-103); lysozyme was bacteriolytic with A. F. coccus (the large, gram-positive coccus, that likely came from air or dust in the laboratory, not from Fleming’s nose). A. F. coccus (M. lysodeikticus) was Fleming’s other discovery: it was the best indicator of lytic activity he and Allison were investigating for the next five years . In his first paper on lysozyme (1922), Fleming showed that 75% of 104 strains of airborne bacteria and other strains of nonpathogenic staphylococci and streptococci were destroyed by lysozyme (Macfarlane, 107). Ernst Chain and Leslie Epstein showed that lysozyme was an enzyme in 1938, but found that the molecule it dissolved was not present in any microbes that caused serious diseases (Lax, 77-78).

Founding of American Assn. of Plastic Surgeons, with 20 men as founding members: “What linked these men together, despite their diverse training, was their common interest and their experience in reconstructive surgery during World War I” (Haiken, 18); followed by American Society of Plastic and Reconstructive Surgeons in 1931 and American Board of Plastic Surgery in 1937 (which was given the status of a major specialty in 1941) (47-50; 88-90). Still, during the 1920s and 1930s, “most of those who called themselves plastic surgeons remained unaffected by professional organization” (p. 48).

With homeopathic institutions in decline, Hahnemannians Julia Green & Julia Loos spearheaded efforts to found a joint physician-lay organization to prevent disappearance of ‘pure’ homeopathy: the American Foundation for Homeopathy was incorporated in 1924 (Kirschmann, 30-32).

Death of Halsted; John Finney declines offer to succeed him, owing in part to his objections to the “full time” system (Finney, 229-31); Cushing presents Bigelow Medal to W. W. Keen. Banting brings back “good” insulin from Lilly Labs (Indiana) in July and begins treatment of Elizabeth Hughes in August (Bliss, 99ff., 115). AMA House of Delegates puts on record its opposition to all forms of “state medicine” (Stevens, 144). Howard Florey comes to Oxford as a Rhodes Scholar, where Charles Sherrington takes him under his wing (Lax, 32ff.; MacFarland II, 156-58).

Following discovery of asymptomatic heart disease in NYC schoolchildren and WW I recruits, AMA officially sanctions periodic health examinations (Fye 2, 63). Sullivan arrives at Sheppard-Pratt Hospital, outside Baltimore, where he became director of clinical research in 1925 and designed his “Sullivan’s Ward” of male homosexuals in 1928 or 1929 (Wake II).

US Supreme Court, in Zucht v. King, determined that “no constitutional right was infringed by excluding unvaccinated children from school.” Louis Brandeis wrote the opinion (Colgrove, 190).

Establishment of Britain’s Cardiac Club at Oxford to address postwar “soldier’s heart” (“effort syndrome”), though the condition was not the glue that held the group together: “Perhaps there was no hidden professional focus for the club. The members probably constituted a social group who enjoyed a yearly meeting in which the shared professional discussion was only a minor component” (Howells, 47-51, quoted at p. 51).

Tallant affair at Woman’s Medical College: the board, under autocratic president Sarah Logan Wister Starr, refused to reappoint 19-year Professor of Obstetrics Alice Weld Tallant without explanation: faculty resign, students strike for a week, WMC nearly commits suicide (Peitzman, 147-153). Opening of Tuskegee Veterans’ Hospital; in November, four black physicians appointed, but work under supervision of hospital’s white physicians; by end of 1924 black physicians quietly gained control of the facility under direction of Dr. Joseph Ward (Ward, 169).

Dedication of Thorndike Memorial Laboratories, built and Directed by Francis Peabody, housed in Boston City Hospital and supported by the city (Williams, 478-9).

Abraham Flexner provides GED funding for Stanley Cobb’s two-year trip to Europe, where he was to learn French and German and acquire culture. He began in London with Henry Head and S.A. Kinnier Wilson (from NJ), then Paris with L’Hermitte, Berlin (with Vogt and Bielschowsky at Univ. Berlin’s Neurobiological Institute (White, 101ff). “One night the Cobbs went to Bielschowsky’s home for a musical evening. Bielschowsky and three other violinists played as a quartet. The playing was good . . .” (116). During his European trip, his stammering became worse and after his return he resumed treatment with speech therapist Samuel Robbins, whose approach was not helpful (154-55). He was helped by the Adlerian Seif, both in Boston and then in Munich, during his second European trip of 1928 (155-56). He thought Seif “a better man than Adler.” (156). After Cobb’s return in 1925, Flexner engineered a $350K grant from GED to Harvard to establish academic dept of neurology, based at Boston City Hospital, headed by Cobb, and with Cobb and Abraham Myerson joint heads of the neurological service (138-39). Cobb was to be full-time and was promoted to Bullard Professor of Neuropathology and senior in charge of neurology (140). New building at BCH, housing the neurology facilities, only completed in 1930 (142). Tracy Putnam and Houston Merritt came to the City Hospital service in 1928 (143). In 1934, by then involved in Freudian psychoanalysis (176) and having begun his own analysis with Hanns Sachs (173), Cobb left BCH to set up a new psychiatric liaison service at MGH; his collaborator Jacob Finesinger was Sach’s first analysand in Boston in 1933 (169).

Founding of Committee on Maternal Health under medical reformer Robert Dickinson, to promote scientific study of conception control; in 1929, with support of Bureau of Social Hygiene, it sponsored a major study of efficacy and safety of chemical contraceptives (spermicides) conducted at F. A. E. Crew’s laboratory at University of Edinburgh between 1929 and 1932; CMH “hope to control venereal disease, as well as to reduce poverty and its related afflictions, through improved methods of contraception” (Borell V, 68). A later BCIC (Birth Control Investigation Project conducted in England developed the spermicide Volpar in 1938 (74-75). Major advances in efficiency of spermicides did not occur until the 1950s, when new bases were developed as vehicles for spermicides (76).

Formation in MA of American Association for Medical Progress, a lay group of academics and civic leaders that advocated for scientific medicine and criticized the propaganda of anti-vivisection and anti-vaccination groups (Colgrove, 183)

Lung cancer, very rare, codified in Classification of Diseases (Tate, 139). Doctors “were particularly reluctant to accept evidence of an apparent connection between lung cancer and cigarette consumption” (141) and, from early 30s until mid-50s, JAMA “accepted advertising that implied smoking was healthful, as did most other medical journals” (142).

On October 4, Freud undergoes first of three operations for maxillary jawbone cancer by Austrian surgeon Hans Pichler (Stepansky I, 132ff.) Freud was subsequently dependent on Pichler for ongoing adjustments of his large jaw prosthesis (140-145).

Bubonic plague appears in Mexican district of LA; by mid-Nov, 40 people had died, all in some way connected to a single individual, Luciana Sanarano (Randall, 234ff.). Final urban outbreak of plague in the U.S., although, although U.S. continues to average seven cases a year.

German scientist George Hass performs first dialysis on human patient (hemodialysis), albeit absent any filtering method for removing urea from the blood. At the time, dialysis was simply a temporary treatment for acute renal failure ( K, Tracy, 11)

After attending Jefferson Medical College for two years, J. E. Coleman is asked not to return for his third year. “The problem was not his grades, as his course averages ranged from 87 to 95 and he had received an honorable mention for the school’s anatomy prize. He was asked not to return because the school did not want to instruct a black man in clinical work” (Ward, 50).

University of Tennessee affiliates with Memphis’ General Hospital in order to gain access to sick black patients for educational purposes. This attested to the new urban economy, in which “the dense accumulation of the poor and the diseased actually constituted a net economic gain for teachers and students” (Waterloo IV, ch 1).

Wilhelm Roehl, working with Bayer chemist Fritz Schönhöfer, distilled Plasmoquine, which was 30 times more effective against malaria than quinine (F. Ryan, 91).

Hopkins Hospital gets an audiometer; Crowe correlates functional tests with histologic findings (when patients died, temporal bones removed and sectioned) = beginning of Otological Research Laboratory (154-57). Establishment of Natl. Board of Examiners in Otolaryngology, whose examination would be a specialist gateway and badge of competence (Stevens, 159-60).

Congress enacts Immigration Restriction Act.

Establishment of American Heart Association, following orientation of public health cardiologists and led by Lewis Connor of NYC and guided by the successful antituberculosis movement; its prevention campaign initially focused on rheumatic heart disease and expanded to include prevention of arteriosclerosis and coronary artery disease (Fye 2, 54-58, 64-65; Howell II, 773-75). AHA was reorganized in 1947 to allow lay persons to be members and to serve on board of directors (Howell II, 775). Founding of Journal of Clinical Investigation with Rockefeller support through 1928; JCI struggled along with only 319 subscribers in 1926 and 577 in 1933 (Howell III, 685-86).

Dandy performs the first of his 692 operations for Méniere’s Disease (vertigo, tinnitus, & hearing impairment) via intracranial division (section) of the vestibular nerve. Martin Kirschner’s first successful operation for pulmonary embolism (Stevenson, 66-67).

George & Gladys Dick (Univ. Chicago) definitively link hemolytic streptococcus with scarlet fever and also show that the injection of filtrate (the erythrogenic toxin secreted by streptococcus in tonsils) produced round area of redness which resembled scarlet fever rash in those not exposed to the bacteria – the Dick test. In 1926, Francis Blake & James Trask (Yale) disproved the Dicks’ claim that the important features of scarlet fever were caused by the erythrogenic toxin rather than by the streptococcus per se (Dowling, 58-61).

Stevenson begins abstracting for The Practitioner, of which Arbuthnot Lane was then controlling editor; his appreciation of Lane (Stevenson, 14-19).

B. J. Palmer introduces neurocalometer, which he deems a new requirement for proper management of chiropractic patient (Martin, II, 826-831). It was widely attacked, esp. re Palmer’s violation of chiropractic’s religious and moral basis. By removing palpation from its central position in chiropractic diagnosis, Palmer was diminishing the practical and symbolic importance of the ‘laying on of hand.’ Adoption of neurocalometer represented “a change in the social construction of chiropractic.” By allowing chiros to portray themselves as technologically sophisticated, this device emphasized chiropractic’s professional status. The experience of visiting a chiro was transformed” (831).

BASF, Beyer, Hoechst, Agfa, Weiler-ter-Meer, and Griesheim sign agreement to form IG Farben (Interessen Gemeinschaft Farbenindustrie Aktiengesellschaft). Carl Duisberg, head of Bayer and leader of the predecessor Interessen Gemeinschaft, was devastated by the decision and resigned his chair (Jeffreys II, loc 1924). IGF was modeled on the great American cartels and sought to make and sell thousands of products (drugs, explosives, dyes, synthetic petroleum) worldwide (Jeffreys, 169; Jeffreys II, loc 1927ff.)). Its managing board was led by Carl Bosch (BASF) who functioned as chief executive. Beginning in 1933, Farben bankrolled the Nazis to the tune of some 80 million marks; IG acceded to Aryanization of its workforce and, through its Degesch subsidiary, manufactured the Zyklon B gas used in the death chambers (179-73). It also helped finance construction of Auschwitz and build and ran an adjacent chemical plant, IG Monowitz, where tens of thousands of slave laborers died; and financed and participated in Nazi medical experiments (189-192). After Nuremberg, IGF was broken up by Allies and three new companies arose from its ashes: Hoechst, BASF, and Bayer (192).

Publication of Cushing’s Life of Osler (Oxford) (Thomson, 234ff.); Dandy’s advance in surgical treatment of trigeminal tic (tic douleureux) by exposing and sectioning the sensory root of the trigeminus through posterior cranial fossa (as opposed to the existing lateral temporal-fossa approach) (Crowe, 99-100). Florence Sabin becomes first woman Fellow of Rockefeller Institute (Morantz-Sanchez, p. 163). Henry Souttar (London), “a generation ahead of his time, performs successful finger dilation of mitral valve (Richardson, 102-03). Department of Surgery at University of Pennsylvania first department to introduce extended hospital training beyond internship via salaried fellowships of three years (Corner, 278).

Publication of Abraham Flexner’s Medical Education: A Comparative Study comparing three types: (1) practical/clinical type native to France and England; (2) university type developed in Germany; and (3) discredited commercial type of America. Only the German approach made sense “in a time of scientific medicine” (Bonner 2, 185). He attacked growing standardization of the American curriculum as alien to the spirit of scientific medicine (186).

After being certified by England’s Central Midwives Board, Mary Breckinridge returns to Kentucky and opens first Frontier Nursing Service clinic in Hyden. FNS work consisted of: midwifery, general care of families, and disease preventive measures (Crowe-Carraco, 184, Dawley II, 88). In June, 1928, the 12-bed hospital and health center at Hyden opened (186). It was followed by Maternity Center Association’s (MCA, of NYC) opening of its home birth practice in 1931 and their educational midwifery program (under Hattie Hemschemeyer) in 1932 (Dawley II, 88).

Dutch firm Organon releases it first sex hormone preparation before the (disappointing) results of clinical trails were known, advising German and Dutch gynecological clinics to test Ovarnon first in female patients with menstrual disorders; then in 1926, it released an improved version, Menformon, as the “first standardized female sex hormone” (Oudshoorn II, 11-14). “In less than two years, the medical indications for female sex hormone therapy were thus extended from the treatment of menstrual disorders to the treatment of menopause, sterility, and the problems of the genital organs. After 1927, Organon extended the clinical trials for female sex hormone therapy to the psychiatric clinic, thus creating an even broader market in female sex hormones for treatment of schizophrenia and melancholia” (14). In clinical trials of 1932, Menformon was used with a complex of symptoms attributed to menopause, such as high BP, increased heart rate, headaches, and depression (15). In another trial of women being treated for rheumatism, “the hormonal treatment of these patients gradually extended from a specific therapy for obesity and rheumatism to a therapy for other diseases in elderly women” (15, 16). Standardized preparation of male sex hormones released by Organon in 1931 as Hombreol, as a treatment for prostate hypertrophy (17-18). Isolation of testosterone in Laqueur’s lab in 1935  Organon’s release of Testosteron in 1937 (19).

Sergei Brukhonenko invents a heart-lung machine, the “autojector,” that anticipates John Gibbon’s heart-lung machine of 1953. It used two pumps to push deoxygenated blood through the lungs of a recently killed dog; the lungs were attached to bellows to simulate breathing; The blood passed through the dog lung was collected and used to perfuse a living animal, and then through the severed head of a dog. In 1926, he became “the first to achieve total cardiopulmonary bypass” by attaching the autojector to major blood vessels of a dying dog; the machine kept the dog alive for two hours before it died from unexpected bleeding (Morris, loc. 1647ff.)

NY State health dept. launches statewide drive to encourage people to immunize their children against diphtheria, “using the full range of techniques in the advertising and public relations armamentaria.” In NYC, “the scope and reach of the anti-diphtheria drive that kicked off in January of 1929 were remarkable” (Colgrove II, 507).

American Orthopsychiatric Association, formed by some preeminent child guidance psychiatrists, reorganized to include psychologists and psychiatric social workers as members. “Orthopsychiatry, psychiatry to straighten crooked personalities, to rectify the problem of troublesome children, was a voice more powerful than that of the psychiatrists alone” (K. Jones, 90).

Duke Endowment, established by James B. Duke, provides grants for construction, improvement, and maintenance of hospitals, churches, and schools in the Carolinas: “It was a critical ally to black health care in North and South Carolina, and as a result of its aid, those states did not suffer the same dearth of hospital facilities as did many other southern states” (Ward, 161).

National League of Nursing Education’s Committee on Grading begins its five-year (extended to eight year) program of surveying and documenting nursing’s ills: “The argument had to be made boldly and statistically that overproduction of graduates was the root of nursing’s difficulties and that nursing education and a hospital’s nursing service had to be separated” (Reverby, 169). This led to publication of “Nurses, Patients and Pocketbooks in 1928. Six years later, in its final report, the Grading Committee “recommended the expected: reduction in the number of schools; high entrance requirements; separation of nursing education and nursing service in hospitals; aid to hospitals to assist in the funding of nursing services; and public funding of nursing education. . . . hospital administrators, to a large extent were unsympathetic to the reform effort” (171). . . . The most serious problem with the Grading Committee’s work was its failure to prepare either a public ‘white list’ of the best programs or a ‘black list’ of the worst schools” (173). . . . Although the committee did not develop a mechanism for grading, its ideological impact should not be underestimated. It provided, for those willing to use it, concrete evidence of overproduction and exploitation. . . . it legitimated nursing’s push for reform. In no small way, it prepared the way for the acceptance of graduate staff nursing in the hospital. It also focused much of the political effort on establishing collegiate programs for an elite” (175).

Louisiana Senator Joseph Ransdell, won over by Charles Herty, chairman of the American Chemical Society’s Committee on an Institute for Chemo-Medical Research, introduces bill S. 4540 that provided for establishment of a National institute of Health in the PHS (Harden, 99-103).

Cushing’s first use of electric cautery apparatus in a brain operation: success (Thomson, 247-48); Cushing and Bailey publish volume on tumors of glioma group (tumors of the glial cells found in brain and spinal cord (Thomson, 240-41). Welch becomes first occupant of new chair in History of Medicine at Johns Hopkins (Barker, 227). New York practitioner cardiologists, excluded from leadership in public-health oriented American Heart Association, form their own Mackenzie Society, renamed two years later the New York Cardiological Society (Fye 2, 72-73).

Minot reports on successful treatment of 45 cases of pernicious anemia via a diet rich in liver, which stimulated bone marrow function as demonstrated by reticulocyte counts. The active agent, unknown at the time, was Vitamin B12 (Rackemann, 141ff.).

Mark Lidwill, Australian physician and anesthetist, uses his artificial pacemaker to start heart of newborn without heartbeat. It established heartbeat that remained stable after machine was turned off 10 minutes later. He presented his pacing device at a meeting of the Australasian Medical Congress. In 1929, but it attracted little interested and led nowhere. The device was designed with help of Edgar Booth in the physics department at the University of Sydney; it was intended for resuscitation, not long-term pacing, but was almost certainly the first pacemaker used successfully on a human (Ball & & Featherstone, 2019).

Thomas Rivers defines difference between viruses and bacteria, creating field of virology (Barry, 417). Hermann Joe Muller, bombarding fruit flies with X-rays, demonstrates that genes can mutate, with their offspring sporting new deformities. . . Artificial mutation kick-started modern genetics (Ridley, 46-47).

first case of sickle cell disease reported in Memphis, conflated with malaria which, allegedly, was also associated with sickle cells . . Local diagnostic custom prevailed, especially where chills, shakes, fevers, and painful episodes were found clumped together” (Wailoo, 62).

Two Berlin scientists, Ascheim and Zondek, analyzed urine from pregnant patients and discovered that human pregnancy urine was far more active than best ovarian extracts as source of female sex hormones  gynecologists temporarily regained stronger position in emerging field of sex endocrinology, as gatekeepers of supply of urine (in 1930, urine of pregnant mares replaced human urine). Within two years, research groups in U.S., Germany, and the Netherlands reported isolation of female sex hormone from human pregnancy urine (Oudshoorn I, 16-17). Research on sex hormones was increasingly controlled by laboratory scientists and pharmaceutical companies, and within the laboratory, biochemists partly replaced the physiologists (18).

Harvey Cushing uses William Bowie’s electrochemical generator, which was able to regulate high-frequency, pulsing AC current so that heat applied to tissue at tip of scalpel could vary from coagulation to cutting. Cushing used the instrument to stem bleeding and remove brain tumor. Cushing was not the first to use the instrument, but his successful application in neurosurgery, when published, “proved decisive in advancing the use of the method” (Van de Laar, ch 28).

German eugenicist Eugen Fischer published book on racial hygiene, Medizinische Erblichkeitslehre und Rassenhygience, growing out of collaboration with Charles Davenport on mixed-race marriages: “The connections between U.S. eugenics and German racial hygiene were already in place.” Also in 1927, Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics founded in Berlin. It provided “much of the key scientific justification for the Nazis’ ideology on racism, eugenics and racial hygiene, with Fischer its first director: “a significant chunk of money to pay for multiple research programs in the KWIA came from the Rockefeller Foundation in the United States” (Rutherford, 119).

Jackson’s lobbying leads to passage of federal Caustic Act providing for poison and antidote label. His efforts followed seeing “many heartrending cases of lye burns of the esophagus in children” (Jackson, 162, 162-165). Wm. Matheson, wealthy patient activist, established Matheson Commission for the Study of Epidemic Encephalitis through his friend Wm. Darrach, Dean of Columbia College of Physicians & Surgeons, which included NY Neurological Institute (Kroker, 132ff.)

Egas Moniz introduces cerebral angiography, “a diagnostic technique second in importance only to the ventriculography of Dandy” (Crowe, 105). His original contrast agent was sodium iodine, which he soon replaced with thorium dioxide, a radioactive compound used through early 1950s (Kevles, 105). Synthesis of the barbiturate sodium amytal (followed by sodium pentothal in 1929), used as surgical anesthetics, then as psychoactive agents by Bleckwenn & Lorenz at University of Wisconsin-Madison: “In the late 1920s, Bleckwenn and Lorenz began to use amytal to produce states of profound unconsciousness in patients who had been catatonic for long period – months, and even years. They found that this allowed them temporarily to revive activity, communicativeness, and some element of the former normal selves of their patients” (Winter, 374-75).

Death of Francis Peabody at 46; his “The Care of the Patient” published that same year. In 1928, George Minot becomes Director of Thorndike Memorial Laboratory (established by Peabody) at Boston City Hospital (Rackemann, 168-169).

Supreme Court, in 8-1 decision, rules in favor of sterilization of feebleminded Carrie Buck in Buck v. Bell, with Oliver Wendell Holmes arguing that “the same principle that justifies compulsory vaccination – that is, precedence of the public welfare over the rights of the individual in the prevention of infectious diseases – holds in regard to involuntary sterilization as well” (Davidovitch, 25-26; Hansen & King, ch 6). In case in question, Holmes ordered sterilization of allegedly imbecilic poor white girl Carrie Buck, remarking, with reference to Carrie, her mother, and her infant daughter, “Three generations of imbecility are enough” (Montgomery, 280). Holmes’ claim and the trial, as the preceding trials in Appeals Court and Va. State Supreme Court were all fraudulent, with the facts and circumstances of Carrie’s life “have been exposed as partially inaccurate or entirely false”, e.g., she was pregnant because the nephew of her adoptive parents . . . had raped her” (111). The case was brought by Albert Priddy, superintendent of the State Colony for Epileptics and Feebleminded, and State Senator Aubrey Strode, who drafted the state’s coercive sterilization bill of 1924. Priddy had been sued successfully by the husband of a resident he had sterilized, and sought an air-tight guarantee of the constitutionality of involuntary sterilization per the State’s 1924 state law of “insane, idiotic, imbecilic, feeble-minded, or epileptic, and by the law of heredity is the probably potential parent of socially inadequate offspring likewise afflicted” (Hansen & King, 104). After Buck, eugenic sterilization became lawful in the U.S., “fusing sterilization and eugenics in the public mind” (Ladd-Taylor, Intro; Hansen & King, 110). But the case itself, culminating in “the extraordinary pro-eugenic argument endorsed by an almost brazenly biased U.S. Supreme Court . . . manipulated the judicial system not to serve justice but, rather, to produce a predetermined result” (Hansen & King, 113-114).

Fleming discovers penicillin, but cannot purify his “mold juice.” His assistants F. Ridley and S. R. Craddock, to whom he assigned the task of producing it in quantities to supply his experiments and to find out something of its chemical properties, found it to be soluble in alcohol, and thus unlikely to be either a protein or an enzyme like lysozyme (Macfarlane, 124-26). Publishes first paper on penicillin in J. Experimental Pathology in May 1929, where he mentions its potential medical use (Wainwright, 14ff.).

George Papanicolaou, Cornell cytologist, published “New Cancer Diagnosis” introducing Pap smear as diagnostic tool for cervical cancer, but it was neither accurate nor esp. sensitive. It was only in 1952, that he convinced NCI to launch the largest clinical trial of secondary prevention in history of cancer using his smearing technique to detect preinvasive cancers and precancerous changes, with respect to which it was totally successful (Mukherjee, 286-290): “The Pap smear had, in effect, pushed the clock of cancer detection forward by nearly two decades, and changed the spectrum of cervical cancer from predominantly incurable to predominantly curable” (290).

Abraham Flexner resigns (viz, forced out) from General Education Board of Rockefeller Foundation, following restructuring of Rockefeller philanthropies that terminated the GEB’s program in medical education and the humanities, leaving it responsible only for elementary, secondary, and black education and teacher training (Bonner 2, 208ff.).

Hoover’s Committee on the Costs of Medical Care (CCMC) conducted first major survey of American health care spending, which showed that 10% of most affluent families (with annual incomes over $5k ) account for 30% of spending on physician fees, hospital services, and drugs (Tomes, 530). CCMC surveys also showed that 18% of health care dollars was being spent on drugs, including 10% on patent medicines, compared to 28% for physician services, and another 3.5% on “cultists” (osteopaths and chiropractors): “This evidence suggests that many families allocated scarce resources to patent medicines and alternative healers rather than to more orthodox medical advice” (534). . . . “substantial numbers of Americans continued to vote with their pocketbooks against the rising cost of medical treatment and in favor of more autonomous forms of self-care.” Products such as laxatives, Listerine, and Phillips’ Milk of Magnesia “were successfully promoted as ‘magic bullets’ against the perils of overconsumption” (535).

Invention of the iron lung by Philip Drinker, “the first assemblage of parts . . . that transmitted energy and motion (via electrically driven blowers) from one segment to another for the purpose of performing a life-saving task” (Rothman II, 42). It was only effective for those polio patients in which the virus paralyzed the intercostal muscles of the diaphragm, impeding the ability to breathe. It was not useful for other forms of polio (e.g., bulbar polio, which damaged the nerve cells in the brain’s breathing center). “Even as the strengths and limitations of the technology were better appreciated, the drive to make the machine available to all who might possibly need it accelerated” (48). The drive was spearheaded by the NFIP which, beginning in 1941, began purchasing machines and distributing them to regional centers around the country (50).

Following JAMA publication of George Minot and William Murphy of 1926 and ensuing collaboration of the Harvard Pernicious Anemia Commission with Eli Lilly, Lilly releases Liver Extract No. 343, the production and availability of which “helped ensure that Minot’s [hematologic] definition of pernicious anemia would become, for this crucial period, the definition of penicillin anemia. ” In fact, by 1928, liver treatment was being used as a “de facto diagnostic technique for pernicious anemia.” (Wailoo I, 168-170). By 1934, when Minot, Murphy, and Whipple won the Nobel Prize in medicine or physiology for path-breaking work on pernicious anemia, “the disease had been reconstructed around the antidote. Pernicious anemia was a disease curable by liver therapy” (175, emp. In original).

First unit of radiation dosage, the Roentgen, was established.

First use of Weigl typhus vaccine by Pasteur group in Tunis (lice injected anally with Rickettsia bacteria; after additional feeding their intestines are removed, mashed, neutralized with phenol = Weigl dead bacteria vaccine, which was partially effective). (A. Allen 50; “Weigl clamp held as many as 50 lice at a time immobile, with their rear ends presented for injection [56-7]). Three shots of Weigl vaccine provided a year of protection (168). By Nov, 1941, 15,000 Soviet prisoners were dying of typhus every day, and the Russian’s warm winter coats became a primary means for spreading typhus to the Wehrmacht (169). First epidemic wave of typhus swept Wehrmacht in Dec, 1941 (171). [Weigl’s] laboratory smuggled thousands of vaccines to the desperate ghettos of Poland, while providing a haven for the Polish resistance movement. The Weigl lab was a force for good. It could not achieve moral perfection” (263).

Prototype of Blue Cross plan devised and implemented in Dallas by Justin Ford Kimball at Baylor’s University Hospital. Dallas public school teachers enlisted and coverage began December 20, with 21 days of hospital coverage provided for $6 a year. Within five years the “Cross” plan included 408 employee groups with 23,000 members (Cunningham & Cunningham, 3-7). The Dallas model was a not-for-profit arrangement that guaranteed a service rather than the dollar indemnity paid by insurance companies (10). First joint hospital prepayment was in Sacramento in June, 1932. First multihospital plan in what would become the Blue Cross system was organized by Frank Van Dyk in Newark and Essex County. The “Newark Plan” began in 1933 and offered up to 21 days of semiprivate hospitalization for $10 a year (11-12). In 1934, AHA and American College of Surgeons gave formal approval to group hospitalization (19). In 1936, AHA created a Committee on Hospital Service, headed by Rufus Rorem, to study hospital insurance: “This group was the embryo from which a formidable national organization of Blue Cross Plans would eventually develop” (27). Rorem called first national meeting of Plan executives in Feb, 1937, and in 1938 plans that met the 14 standards adopted by AHA in 1937 qualified as approved Plans that could display “a symbol of affiliation in the form of a blue-colored cross with the AHA seal at its center” (28-30). Percentage of Americans with hospital coverage went from less than 10% in 1940 to nearly 70%in 1955 (90).

Formation in Germany of Nationalist Socialist German Physicians League, “a step toward the unification of state and medical goals, and built upon the singular centralized organization of the eugenics movement that Ploetz had started . . . . By 1942, half of the doctors in Germany had joined the Nazi Party” (Rutherford, 117; Hansen & King, 143). After 1933, “surprisingly only a few of the prestigious and influential chairs in psychiatry changed occupants” (Friedlander, ch 1).

Presbyterian Hospital and NY Neurological Institute move to Washington Heights together, joined by three other hospitals and Columbia College of Physicians and Surgeons: “This was the first joint project in the United States of a medical school and its affiliated hospitals to create an ‘academic medical center’; the Columbia-Presbyterian Medical Center became the model for other medical schools” (Rowland, 43). . . . in 1937, the Presbyterian managers took control of the Neurological Institute, which became a unit of a general hospital (43, 38).

Dedication of Welch Medical Library and Institute of History of Medicine at Johns Hopkins, with Welch (per Rockefeller Foundation [RF] stipulation) the first Professor of the History of Medicine. Welch chose his successor, Henry Sigerist (Karl Sudhoff’s successor at the Univ. of Leipzig), who came to Hopkins in 1932 (Brown & Fee, 340-342). In 1933, Sigerist began publication of the Bulletin of the Institute of the History of Medicine (as special supplement of the Bulletin of the Johns Hopkins Hospital (343); in 1939 it was renamed the Bulletin of the History of Medicine and became the official organ of both the American Association for the History of Medicine and the Johns Hopkins Institute (348).

Rockefeller Foundation reorganized, with Division of Medical Education becoming Division of Medical Sciences, “reflecting a new policy of extending knowledge through support of scientific research, and eventually [ as of 1933] with a new focus on psychiatry, encouraged by Pearce’s successor Alan Gregg “ (Angel, 47). David Edsall’s (Dean of Harvard Medical school and Rockefeller trustee) 1930 report on the state of psychiatry, which urged the need to make psychiatry more scientific like medicine, helped launch the psychiatry program, which emphasized projects that were physical and laboratory based or at least experimentally based (45-48, 50). In 1935, RF made three-year $100K grant to Franz Alexander in the hope the Chicago Psa Institute would “protect and foster its relationship of medicine and psychiatry,” though by 1937 Gregg and his RF colleagues “became irritable and exasperated with Alexander and Stern, experiencing difficulties in persuading Alexander to steer clear of speculative work and focus on sound experimental work on psychogenic and somatic factors” (Angel, 51, 52; cf. T. Brown, 23-25).

Werner Forssmann’s self-experiments demonstrate right heart could be safely catheterized (Richardson, 110-111; Kevles, 106; Fye 2, 112). Diagnostic cardiac catheterization introduced by André Cournand and Dickinson Richards in early 1940s, and selective coronary angiography described by Mason Sones in the early 1960s (Bourassa).

70% of physicians in U.S. have some type of hospital affiliation (Stevens, 145). Dedication of William H. Welch Medical Library at Johns Hopkins (Davis, 98). NYC Diphtheria Prevention Commission launches massive public health campaign: “the highly visible and focused health campaign against diphtheria filled the void created by the failure of organized medicine, the city, and private philanthropy to fully mobilize against diphtheria. . . In this campaign, as in other Progressive Era reform programs related to children’s health, maternal ignorance was blamed rather than the failure of private medicine or the state in providing preventive health care for all children” (Hammonds, 191ff; quote at 193; J. Baker, 200).

Fritz Lickint publishes statistical evidence linking lung cancer and cigarettes; his monumental Tabak und Organismus, published in 1939 in collaboration with Reich Committee for the Struggle against Addictive Drugs and the German Antitobacco League, “arguably the most comprehensive scholarly indictment of tobacco ever published” (Proctor, 183-186; 227). Franz Müller’s (Cologne) 1939 paper, a survey-based retrospective case-control study (“an exquisite piece of scholarship” [194]), concluded that rise in tobacco use in Germany was “the single most important cause of the rising incidence of lung cancer” in recent decades. This claim was “stronger even than any of the claims made by British or American scientists until the 1960s” (196). In 1938, legal sanctions against cigarettes began (203ff.). Publication of Schairer and Schöniger’s 1943 paper was the most convincing early demonstration of role of smoking in lung cancer; it “provided the most conclusive epidemiological evidence up to that time, anywhere in the world, that smoking posed a major lung cancer hazard” (213-17).

Acetylcholine isolated; first human EEG performed. Gordon Alles presents results of first trials with phenylethanolamine (amphetamine) as decongestant and in treatment of asthma and hay fever at AMA meeting in Oregon (Rasmussen II, 297).

Australian physician and anesthetist Mark Lidwill presents to Australasian Medical Congress on pacemaker intended to revive surgical patients whose heart stops while under general anesthesia; also in 1929, Albert Hyman, NYC cardiologist, makes seminar presentation proposing the concept of pacing the heart by pulsed electrical stimuli; his own pacemaker, designed with brother Charles, relied on a spring-driven mechanism to provide six minutes of pulsing current. It was also intended to resuscitate intact heart arrested through accidental causes and was announced in 1932 (Jeffrey, 27ff.). The Hyman pacemaker had technical problems, and Hyman was not well versed in electrical matters. Moreover, “No demand developed in the 1930s or the 1940s for an artificial pacemaker that would perform emergency resuscitation . . . electrotherapeutics had long been associated with medical quackery. . . . More broadly, the medical profession in the 1930s regarded cardiac arrest as an unusual and generally irreversible condition. Most doctors apparently considered it a hopeless situation when it occurred or believed that injections of stimulants stood as good a chance as anything to revive the stopped heart” (31-32).

Austrian-born Leo Kanner, who emigrated to the U.S. in 1924, is asked to establish first child psychiatry dept. in U.S. at Johns Hopkins. In 1935, he published Child Psychiatry, the first such textbook in English (Sheffer, 59).

After papal encyclical Casti Connubii (On Christian Marriage) by Pope Pius XI, “Catholic opposition to eugenic sterilization was categorical” (Hansen & King, 137.

Re instructional theories of antibody formation, first proposal of “antigen-as template” by Topley, Breindl & Haurowitz, and others: B & H “proposed that an antigen would be carried in the body to the site of protein formation, where it would serve as a template upon which the nascent antibody molecule might be constructed” (Silverstein, 68-69). First documented (but unpublished) cures with impure penicillin (of two infants with ophthalmia neonatorum) by C. G. Paine, former student of Fleming (Wainwright, 42-47).

William Baer begins using maggot therapy (successfully) to treat osteomyelitis at Baltimore Children’s Hospital (Wainwright, 110-111). This followed up on Baer’s experience in 1917 as a consulting surgeon to the American Expeditionary Force in France, when he was brought two injured soldiers left on the battlefield for a week; their wounds, to his amazement lacking any systemic infection or purulence (Manring & Calhoun).

Popularity of artificial pneumothorax and other surgical procedures as treatment for TB peaks in U.S. during the 1930s (Ott, 96-97; Bates, 269-70, 286, 321).

Publication by Oxford University Press of Abraham Flexner’s Universities: American, English, German, preceded by a month by announcement of establishment of the Institute for Advanced Studies, funded by five million dollars from the Newark dept-store Bamberger’s (Bonner 2, 233-35; Penfield, 216, 256-57). American obstetricians and gynecologists create the third medical specialty board (Stevens, 200ff.)

Cushing begins working on relationship of hypothalamus to visceral function; finds that only brain operations encroaching on base of brain were followed by gastric complications. Cushing announces retirement as surgeon-in-chief of Brigham, where he performs his last operation there on Aug, 2, 1932; Fuller urges him to come to Yale, and he returns to Yale as Sterling Professor of Neurology in 1933.

Franz Alexander spends year at Univ. Chicago as visiting professor of psychoanalysis. “Hutchins and McLean supported this experiment, but Bailey, Herrick, and Lashley were ‘sharply opposed to recognition of psycho-analysis,’ and the vogue of Alexander’s seminars and lectures among nonmedically trained people did nothing to reassure them. They effectively sabotaged Alexander’s visit, and when he returned to Chicago a year later it was to pursue psychosomatic medicine at his own, independently funded, Chicago Institute for Psychoanalysis (Blustein III, 102).

Richard Shope (Rockefeller Institute at Princeton, raised on Iowa farms, discovers swine flu (traced to Cedar Rapids Swine Show in October 1918 and returning annually with onset of winter), and its close antigenic relationship to human influenza virus. In 1934, Thomas Francis (Michigan) isolated Type A influenza virus by discovering antibodies in bloodstream of animals that convalesced from influenza infection; Shope, also in 1934, found that swine flu antibodies could protect ferrets and mice against human influenza and vice versa, though human and swine viruses were not identical (Kolata, 77). Drawing blood in 1934 from survivors of 1918 epidemic, Shope and British scientists Smith, Andrewes, and Laidlaw found that people who had survived the 1918 flu had antibodies that completely blocked Shope’s swine flu virus. People who were born after 1918 did not have those antibodies . . . They were the antibodies left behind in the flu’s survivors and they showed that the human flu virus was, in fact, one and the same as the swine flu. The 1918 influenza virus, it seemed, may have survived after all, in the bodies of the pigs. . . .There was a swine flu connection – probably people had given the flue to pigs, scientists proposed, and the virus may have remained in pigs, lying dormant until, one day, it might strike back at people. . . .The 1918 epidemic came in two waves, a mild flue in the spring of 1918 followed by the killer flue in the fall. And it seemed that the two flu strains were closely related. Infections with the first strain protected against the second.” (78-81). In 1941, Francis isolated Type B influenza virus (Galambos & Sewell, 45-46).

Pediatrician Franz Hamburger, anti-science, anti-Semitic proto-Nazi and then (in 1934) Nazi who replaced von Pirquet as Director of University of Vienna Children’s Hospital in 1929, appoints Hans Asperger to staff as postdoctoral advisee and placed him in the Curative Education Clinic in 1932. Asperger idolized him (Sheffer, 41-44). In April-May 1934, Asperger served an internship with Paul Schröder at Leipzig University ‘s psychiatric hospital, where he became an enthusiastic convert to Nazi-fied Gemüt and Nazi approach to development and psychopathology (Sheffer, 62, 67-68). In late 1941, Asperger, with Max Gundel (director of Spiegelgrund), Erwin Jekelius (med. Director of Spiegelgrund), and Franz Hamberger, founded Vienna Society for Curative Education, successor to German Society for Child Psychiatry and Curative Education (127ff.). As co-founder, Asperger “was collaborating with three top perpetrators of Child killing in Vienna. . . as he admitted later in life, he was fully aware of the euthanasia program . . . . After all, the Vienna Society was run by notorious Spiegelgrund leaders” (137-138). Asperger “publicly encouraged his colleagues to transfer ‘difficult cases’ of children to Spiegelgrund – and he followed his own recommendations. . . . Asperger had a hand in the transfer of dozens of children to their deaths at Spiegelgrund ,” e.g., all 35 youths transferred by a seven-member Vienna commission he served on in 1942 (141-142).

Howard Florey accepts chair of Professor of Pathology at Sheffield University, where he and H. E. Harding developed a treatment for tetanus using curare and mechanical artificial respiration “that is the basis of the modern practice” (Lax, 46-47; Macfarlane, 163).

Rudolf Nissen, who operated on Einstein in 1948 for abdominal aorta aneurysm, performs first successful resection of whole lung on an 11-year-old girl. Two years later, in 1933, Everts Graham performed first successful pneumectomy for lung cancer in St. Louis (Van de Laar, ch 19)

Cushing discovers pituitary basophilism, symptom cluster associated with increased basophilic cells of the pituitary (“Cushing’s disease”) (Thomson, 284-5).

Report of Committee on the Costs of Medical Care recommend hospital-based group medical practices including physicians, dentists, nurses, technical personnel, supported by an extension of public health services, government and private, and with group prepayment schemes: each person would purchase an insurance policy or contract for specified services to be given by a health service organization – killed by AMA, which identified any group, collective, or institutional mode of practice with “outside or governmental influence” (Stevens, 183-88). American College of Surgeon joined American Hospital Association – and disagreed with AMA – in endorsing voluntary hospital insurance schemes in 1933 (Stevens, 190).

Danzig surgeon Erwin Liek, “father of Nazi medicine,” publishes The Spread, Prevention, and Control of Cancer, propounding view of cancer as a disease of civilization, a “cultural disease” whose incidence was on the rise and against which a natural way of life was the best protection. Faulty nutrition as the single most important cause of cancer (Proctor, 22-25).

First multihospital plan in what would become the Blue Cross system was organized by Frank Van Dyk in Newark and Essex County. The “Newark Plan” began in 1933 and offered up to 21 days of semiprivate hospitalization for $10 a year (Cunningham & Cunningham, 11-12).

Initiation of Tuskegee syphilis study (halted only in 1972) by U.S. Public Health Service (Gould, 84). Point of study was to observe progress of untreated syphilis in black sharecroppers in Macon Country, AL. Among the multiple deceptions perpetrated on the sharecroppers: (1) insisting that they were being treated, not merely observed. “Treatment” consisted of aspirin, iron tonic, and vitamins delivered in Nurse Eunice Rivers’ house calls; (2) withholding study requirement of post-mortems by making sure they died under care of Eugene Dibble, African American directory of Tuskegee Hospital, who was given a PHS appt; (3) never letting study participants know Nurse Rivers was hired to track their movement and report on their deaths; (3) promise participants free burial, funded by Milbank Fund: “But this reassurance was illusory, because the chief reasons they feared indigent burial was their fear of being autopsied first – and this as to their precise medical fate” (Montgomery, 232).’ (4) keeping study participants out of WWII draft “because the PHS feared that they would be treated for syphilis in the military” (233). (5) keeping study participants away from penicillin, which became available in 1943, later putting “fictious spin” on number of those who had received adequate treatment, while reiterating the fiction that blacks did not want or see real medical care. As it turned out, 7.5% of infected study participants managed to obtain “an effective degree of treatment” (233).

At I.G. Farben Industrie’s Bayer & Co. in Germany, Gerhardt Domagk observes that one of the azo dyes with sulfa side chain given to him by chemist Josef Klarer (KI-695, then more potent Kl730, first dubbed Streptozon, then released as Prontosil) protected mice given lethal doses of hemolytic streptococci. Clinical trials in Germany from 1933-1935 showed the drug effective in treating Streptococcal sore throat, erysipelas, and puerperal fever/sepsis (Lesch III, 85-90). Domagk did not publish the finding, and Bayer did not release the drug, until 1935 (Hager, 133-138, 151-152; F. Ryan, 95-97; Dowling, 107), the year investigators at the Pasteur Institute determined that it was the sulfanilamide liberated from Prontosil – the sulfa side chain attached to the azo dye in Bayer’s Prontosil -- that cured bacterial infections (Hager, 169-172; F. Ryan, 106-07; Dowling, 107; Lesch III, 82). According to Ronald Hare, the Bayer team at Elberfeld knew about the action of sulfanilamide before the Pasteur Institute publication but chose to conceal it because sulfanilamide (in his 1970 book on penicillin), a simpler compound, was not covered by patents and would therefore be less profitable. Daniel Bovet and Lesch disagree, because the Bayer group was committed to the idea that therapeutic activities were linked to coloring properties in the dye molecules under test (Lesch III, 82-84) and because “the dye molecule was regarded as a whole, and sulfanilamide as a mere part” (Lesch III, 91). Rhone-Poulenc then brought Septazine, a variation on pure sulfa, to the market in May, 1936 (172); Britain’s May & Baker introduced Sulfapyridine in 1938; and IG obtained patent for Marfanil (effective in treatment of anaerobic infections, esp. gas gangrene) in Oct, 1941 (Lesch III, 96-97),

Using crude penicillin (“mould juice”), Sheffield pathologist C. G. Paine cures two cases of gonococcal conjunctivitis and one case of staphylococcal conjunctivitis in newborn babies and “achieved something of a clinical triumph” with a colliery managed with a penetrating injury of his right eye: irrigation with crude penicillin cleared up the infection permitting surgery to remove the foreign body (Macfarlane, 164). British physician Ranyard West reports on use of minute doses of curare to treat patients with tetanus and other muscular disorders (Dowling, 42).

SKF of Philadelphia releases OTC cold/congestion Benzedrine inhaler, of which the base ingredient was amphetamine. By 1946, by one count, amphetamine had 39 indications, e.g., low blood pressure, seasickness, chronic hiccups, and caffeine dependence. College kids used it for all night parties (Courtwright, 78).

Evipal, sodium salt version of hexobarbital becomes the first barbiturate agent that induces anesthesia in surgical patients. In 1935, its successor, the thiobarbiturates (Thionembutal, with sodium salt version Pentothal) revolutionized intravenous anesthesia: “This agent rapidly displaced the rest of the barbiturates as an anesthetic, partly due to the swiftness of its onset and its short action period, and it currently remains the preferred intravenous anesthetic in many types of surgical intervention” (López-Munoz, 337).

According to AMA Council of Medical Education & Hospitals, 1,911 Americans studying medicine in Europe; by mid-30s, it was estimated that 95% of them are Jews. From 1925-1940, 96% of American Jewish graduates of Scottish medical schools were from New York and New Jersey (Halperin, 157-1 58).

Survey by W. Montague Cobb reveals that many southern med schools of early 20th c. still used only black cadavers for teaching anatomy (Washington, 195).

Aryan clause of the Law for the Restoration of the Professional Civil Service deprives Jewish doctors of their positions in public hospitals; then of jobs in private non-Jewish clinics by Nuremberg racial laws in 1935; then all 3,000 Jewish physicians in Reich stripped of their medical licenses by decree in July, 1938; in Sept, 1938, about 700 Jewish doctors were allowed to practice as Krankenbehandler, but were restricted to Jewish patients or working in Jewish institutions (Silver, 42). In March, 1943, staff purged by 50%, with victims personally chosen by director Lustig (Silver, 87, 142, 186-87, 222).

SKJ patents base form of amphetamine and markets it OTC as the Benzedrine Inhaler; in 1937, AMA gives “Seal of Approval” to SKF’s Benzedrine Sulfate tablets for narcolepsy, postencephalitic Parkinsonism, and minor depression; in late 30s, amphetamine therapy for minor depression gained acceptance among psychiatrists, led by Abraham Myerson. “Thus, by World War II, amphetamine in tablet form was finding commercial success and gaining credibility as a prescription psychiatric medication (the first “antidepressant”), despite sporadic reports of misuse. . . . The US military also supplied Benzedrine to servicemen during the war, mainly as 5-mg tablets, for routine use in aviation, as a general medical supply, and in emergency kits” (Rasmussen IV, 974, 975).

First successful one-stage pneumonectomy for lung cancer by Evarts Graham of St. Louis and William Rienhoff of Hopkins (Crowe, 175-76). Formation of Advisory Board for Medical Specialties, a coalition of the National Board of Medical Examiners, the four existing specialty boards, and emerging specialist groups (Stevens, 212-213).

Following “gold rush” atmosphere of university-industry collaboration in 20s (e.g., re insulin and vitamin D), “The entrepreneurial atmosphere eventually generated a backlash: in 1933 Johns Hopkins emulated Harvard in formulating a policy prohibiting the patenting of medical inventions by faculty, and in 1934 the University of Pennsylvania followed suit . . . Plainly, it was perceived by some leaders of medicine at Penn that drug firms used academic research in advertising to an extent that could threaten the reputation of collaborating scientists and their universities, and that drug firms sometimes meddled with the publication of results from sponsored research (Marks II, 56, 57). . . . The major ethical firms made science into a commercial ally. Just as they learned to obtain new products by collaborating with leading academic biochemists and physiologists, they learned to engage skilled clinical researchers in order to provide high-quality scientific evidence of therapeutic efficacy and safety as required” (78).

Debate in Archives of Neurology and Psychiatry on education of neurologists and neurosurgeons, punctuated by war metaphors pointing to “the contested nature of the boundaries between these related specialties as well as to the belligerent enterprise in which these doctors felt they were engaging” (Gavrus, 68-71, quoted at 68).

As part of New Deal, federal government institutionalized black health work by establishing the Office of Negro Health Work, which paved the way for interaction between government and private initiatives in black health, e.g., with funding from Julius Rosenwald Fund to promote hiring of black public health nurses (Schoen, 46).

Establishment of American Board of Psychiatry and Neurology, with separate examinations and certifications for each specialty (Stevens, 222-225; Gavrus, 71). Hallowell David at Harvard approaches Albert Grass (’34 MIT grad) to build first EEG machine: “As epilepsy centers proliferated through the country, the Grass Company flourished and became the leading commercial enterprise in manufacturing EEG machines” (Rowland, 30). After Hallowell recorded his own normal EEG, Fred and Erna Gibbs were first to record a petit mal seizure, and they induced Albert Grass to build a practical EEG machine in 1936 (34).

Founding of clinically oriented New York Cardiological Society, incorporated in 1935; half of the incorporators were Jewish, Columbia-trained practicing cardiologists denied academic posts or admitting privileges at most of NY’s elite teaching hospitals (Fye 2, 74-76).

With Rockefeller Foundation backing, Wilder Penfield establishes McGill University’s Montreal Neurological Institute and Hospital, where he perfected the “Montreal Procedure” for treating epilepsy and went on to develop somatotopic mapping (Penfield Homunculi) located across sensory and motor cortices.

Mary Walker (London) discovers physostigmin (then prostigmine), the antidote to curare poisoning, was effective in treating myasthenia gravis (Keynes, 319-20). In 1936, Blalock (Baltimore) performed first successful surgical removal of a thymic tumor for myasthenia (321). In myasthenics, partial nerve block results from a substance in the circulation that interferes with production or action of acetylcholine, an effect countered by prostigmine, acting as an anticholinesterase factor (324).

First polio vaccines developed by John Kolmer (ricinolate [element of castor bean, as in oil] to weaken virus from ground spinal cords of infected monkeys) and Maurice Brodie (formaldehyde to kill virus also found in monkey spinal cords); both rejected at 1935 meeting of APHA in St. Louis after several children’s’ infections/deaths following inoculation (in study samples of 10K and 7ik, respectively). Brodie, who had used a control group, was ruined: Brodie “was one of the first to show that formaldehyde could kill polio virus; he was the first to figure out that formaldehyde-treated virus induced polio antibodies in children; he was the first to advance the notion that overtreatment with formaldehyde rendered the virus incapable of inducing polio antibodies; and he was the first to claim that a killed polio virus vaccine might induce long-lived protection” (Offit, loc 225). He died in 1939, rumored as suicide, though his ideas were later championed by Salk.

Kendall first to crystallize an adrenal hormone capable of maintaining adrenalectomized animals (Rasmussen III, 305). In 1937, work of Tadeus Reichstein (Switzerland) and Cyril Long (Yale physiologist) “left little doubt that the hormones of the adrenal cortex active in mineral metabolism and in energy metabolism [via regulating of carbohydrate metabolism] were distinct” (310). By mid-1943, interim assessment of military potential of Compound E (later, cortisone) provided “equivocal and unimpressive evidence (317) and in late 1943, the physiological research on adrenal hormones was declassified, though the Committee on Medical Research and Vandevar Bush agreed that the effort to synthesize the cortical hormones should continue (318). Still later in 1943, Reichstein beat the American in the race to synthesize the (intermediate) Compound A, and in Dec, 1944, Merck chemist Lewis Sarett finally achieved synthesis of Compound E (319). In 1947, Sarett found an economical route to synthesize Compound E, then dubbed cortisone, and Merck “promptly set about producing a large batch, supplying the material for the famed 1948 clinical trial in which patients long crippled by rheumatoid arthritis walked (indeed, danced) with ease again, leading to the 1950 Nobel Prize for Kendall, Reichstein, and Philip Hench, Kendall’s rheumatologist colleague” (320).

Founding of British Society for Legalization of Voluntary Euthanasia, which won immediate recognition with members that included George Bernard Shaw, Havelock Ellis, George Trevelyan, Lord Moynihan, its first president (Lavi, 113-114).

Alexis Carrel’s successful use of his perfusion device, and was constructed and refined by Charles Lindberg (who developed the perfusion pump). In April, Carrel kept a cat’s thyroid alive and infection-free for 2.5 weeks; it was “the first time anyone had ever sustained an entire organ outside the body,” and after the experiment, Carrel began envisioning the possibility of human immortality, suggesting the desirability of killing the worst and keeping the best of the human race, as in the breeding of dogs. These views were echoed in his “impressively offensive book” of 1935, Man, the Unknown. “In it, Carrel expanded on the importance of propagating the best elements of his ‘great race’ (Chaddock, 193-194).

Nuremberg Race Laws and Jewish Physicians: Dismissal of remaining professors of medicine and other state-employed Jewish physicians; Nazis disallow medical licensure for full or half Jews of German citizenship unless they had commenced medical studies before summer of 1933. “Exceptions were possible only when the candidate had a valorous World War I record and a Nordic physique and composure.” Jewish medical students also excluded from nationally sponsored financial aid. By October 1948, quarter- Jews could again be admitted to medical examinations (Kater, 170-71). Finally, via Reich Physicians’ Ordinance of Dec, 1935, no new Jewish candidates (including Mischling down to a quarter Jewish) could henceforth be licensed for medical practice, as long as there was a danger that the proportion of Jews in total Reich’s physicians would exceed that of Jews in the general population (Kater,193). Finally, as of Sept, 1938, all Jewish physicians professionally decertified; those remaining in Germany no longer designated physicians but “sick-treaters” (198, 200).

Jackson accepts presidency of Woman’s Medical College of Pennsylvania (Jackson, 192-93) after AMA Council on Med. Educ. withdraws approval of WMC, which thereby lost membership in AAMC (Peitzman, 167ff.). Establishment of American Board of Internal Medicine by Board of Regents of American College of Physicians (Rackemann, 232; Fye 2, 85, 88-89). In 1936, ABIM decided it would specify training guidelines for the medical subspecialties; this policy “institutionalized a philosophy that the career path to nonsurgical fields like cardiology and other medical subspecialties would go through internal medicine” (Fye 2, 89).

George Hevesy injects radioisotopes into lab rats and established that the different isotopes went to particular organs and tissues, triggering avalanche of radiopharmaceuticals (Kevles, 203).

Introduction of sulfa drugs (sulfonamides), following Bayer’s Gerhard Domagk’s discovery of an orange-red azo dye (an azo dye to which a sulfonamide radical had been added =Sulfamidochrysoidine = Prontosil) that protected mice from streptococcal infections (causative in most wound infections, childbed fever, tonsillitis, endocarditis, appendicitis, many kidney & joint conditions) (Lesch III, 60-61). “A considerable body of literature from the 1910s and 1920s pointed to the antibacterial effects in vitro of azo compounds. By the early 1930s, several azo compounds had been recommended for use in urinary tract disinfection” (Lesch III, 59). Researchers at Pasteur Institute soon discovered the active antibacterial agent was sulfanilamide (Lax, 48-50, Dowling, 107-08, Lesch III, 123-132). Within Pasteur Institute, reception to discovery outside of Fourneau’s service was cool, perhaps because it threated the Institute income from development of vaccines and serums: “By early 1936, Prontosil/Rubiazol had already begun to render antistreptococcal serums obsolete, and the prospect that other serums, for meningococcal and pneumococcal infections, dysentery, and plague, would suffer similar fates was clearly discernible” (Lesch III, 131). Calco Chemical Co., a dye-making company in Bound Brook, NJ, a division of American Cyanamid Co., first American firm to begin research on sulfonamide drugs; its highly effective sulfanilamide was sent to physicians and researchers in fall of 1936 and commercial delivery began in February 1937 (Travis).

Arthur Master, cardiologist at NYC’s Mt. Sinai Hospital, develops first cardiac stress test, i.e., the Master two-step. But Master only got his ECG strip after exercise, which compromised the test’s accuracy. In 1963, Robert Bruce, a cardiologist at the University of Washington, developed the Bruce protocol for exercise stress testing using a treadmill.

John Gibbon, assisted by wife Marty, has first successful demonstration of their first heart-lung machine in their home lab using a cat, which they kept alive almost four hours (elsewhere 2 hr 51 min) while its pulmonary artery was obstructed: “We finally found that it was possible, using the extra corporeal circulation, to completely occlude the pulmonary artery without any change in the blood pressure or respirations. Such a result had always been secretly hoped for but never admitted. When we did succeed, we were filled with joy and astonishment and danced around the laboratory in glee” (Gibbon, 613). In 1939 Gibbon announces to surgical conference that four cats were kept alive by the machine for up to 20 minutes had all made complete recoveries (Morris, loc 1704ff.). After returning from service in WWII in 1945, one of his med students introduced to Thomas J. Watson, who agreed to construct a heart-lung machine at IBM’s expense (loc 1730). The first IBM-built machine (the Model I)was delivered to Gibbon at Jefferson Hospital in Phila in 1947, and in 1949 he announced that he now saw the machine as a means of enabling open-heart surgery (Morris, loc 1704ff.). Problems addressed by IBM optimizing flow oxygenator by introducing turbulence into the stream to increase oxygenation and replacing cylindrical design with design that included six steel screens suspended from wires (Bauer). First successful use of the machine, following two failures unrelated to the machine, was on 6 May 1953; patient was 18-year-old Cecelia Bevlek, had a silver-dollar size atrial septic defect (Morris, loc 1763ff.).

Howard Florey appointed Professor of Pathology at Oxford (51ff.). Rockefeller Foundation (Alan Gregg) begins funding psychiatric research at the Maudsley, with Frederick Golla heading the Maudsley Pathological Laboratory (Edgar Jones, 18-20). George Canby Robinson spends five months as visiting professor at Peking Union Medical College, where he meets Richard Lyman and Walter Cannon and becomes enthused about psychosomatic medicine. On his return, he received Rockefeller grant for “A Study of the Accessory Factors on Health” at Johns Hopkins Hospital; the study and grant support was expanded and incorporated into the 3rd-year med school curriculum in 1936-37 (T. Brown III, 144ff.). Robinson’s major publication on the Hopkins project, The Patient as a Person, was published with Commonwealth Fund support in 1939 (149-151), but it offered “no social, economic, or class analysis, skirted the presumption of victimization, and placed the burden on individuals whose ‘faulty habits’ or inappropriate means of ‘adjustment’ caused them difficulties” (1950).

Abraham Myerson’s transformation from Free-Lancer to Friendly Expert for SK&F re his investigations of Benzedrine Sulfate (Rasmussen II, 65-66, 73-76). He began independently investigating effect of Benzedrine on blood pressure and digestion, and then investigated its CNS action, discovering elevated mood in normal and mildly depressive patients. Late in 1935, he approached SF&F for further supplies of the drug, and was immediately offered a grant (73).

Mississippi Health Project, sponsored by Alpha Kappa Alpha sorority and headed by Dr. Dorothy Ferebee of Howard and Tufts, visits homes and plantations, emphasizing, especially, immunization of children against diphtheria and smallpox (Ward, 240-48).

In United States v. One Package of Japanese Pessaries, U.S. Court of appeals held “that medical prescription of contraceptives for the purpose of saving a life or promoting the well-being of women was not condemned under the Comstock Act. The decision had tremendous ramifications for the establishment of birth control services throughout the country.” Opposition to birth control clinics came from health/welfare officers who viewed it as governmental intrusion into medical practice; as immoral; as tampering with God’s work; some physicians saw it as endangering private medical practice. Institutional opposition came from the Children’s Bureau, which refused to fund dissemination of birth control advice until the 1950s. “Other states were threatened with the withdrawal of federal funds if they established state-supported birth control programs. . . . Clinic personnel complained about the stifling effect that opposition from Catholic agencies had on private and state-supported birth control clinics” a (Schoen, 32=33).

Ernest Lawrence and colleagues complete work on “cyclotron,” which facilitated production of radioactive isotopes, enable isotopic techniques to test function of thyroid gland, pumping activity of heart, etc. (Reiser, 219). First investigations with radioactive iodine, I128, at MGH thyroid clinic; First therapeutic use of artificially produced radioisotopes on Christmas eve; (Lenoir & Hays, 31).

Publication of Maude Abbott’s Atlas of Congenital Cardiac Disease, of which Abbott was world’s acknowledged expert. She was enormously helpful to Hellen Taussig, then a young pediatrician interested in congenital heart disease, who came to visit her at McGill before Abbott’s death in 1940 (Morris, loc 779).

First year pneumonia no longer leading cause of death in U.S. (Barry, 152). Colebrook and his team at Queen Charlotte’s Hospital in London successfully use Prontosil (sulfanilamide) to treat puerperal infections caused by hemolytic streptococci; a year later it successfully treated erysipelas (Dowling, 109-110) and was shortly thereafter shown to be effective with pneumococcal pneumonia (113-14) and meningococcal meningitis (114-116).

Neuropsychiatric market for SK&F’s Benzedrine Sulfate (amphetamine) blossoms following Myron Prinzmetal’s 1935 studies on effectiveness of drug for narcolepsy (Rasmussen II, 303-304) and then Abraham Myerson’s report that the drug had an ameliorative effect in “certain depressed neuroses” (305). Myerson became the drug’s most influential advocate: “. . . by 1938 there was substantial clinical evidence that amphetamine was not effective for schizophrenia or for the severe depression treated mainly in mental institutions, and was only useful as an adjunct to talking therapy, if at all. In contrast, expert opinion held amphetamine to be a promising therapy for milder neurotic depressions, whether caused by adverse events (“reactive”) or by constitutional factors (“endogenous”) (312). In Dec, 1937, AMA Council accepted Benzedrine for use in narcolepsy and postencephalitic Parkinsonism and also for mood elevation in depression, but only among institutionalized patients. By then, there was already underground usage of the drug among college students (312-13). Despite AMA proviso, SK&F marketing from the start included generalists and stressed the kind of depression (re Myerson’s Anhedonia) seen by GPs, e.g., elderly, menopausal, chronic illness sufferers (316-17). By end of WWII, about a million tabs of amphetamine were being consumed daily in America for psychiatric illness, and at least as much again for weight loss. “Benzedrine thus can fairly be called the first ‘anti-depressant,’ a term that appears in promotional material for the drug in the mid-1940s, if by this we mean a drug widely prescribed and consumed to elevate mood for indefinite periods in depressed outpatients” (319). Marketing and widespread use of amphetamine as an anti-depressant in 40s & 50s, may have “played an important early role in advancing the recognition of Anhedonia as a fundamental feature of depression” (321).

British psychiatrist Stephen Horsley announces development of narco-analysis “by announcing that sodium amytal provided a means of carrying out ‘exploratory surgery’ on the mind.” During the trance state, “repressed traumatic memories could be retrieved and examined and then the application of posthypnotic suggestion could integrate this mental content into the patient’s mind; hence narco-analysis as “the poor man’s psychoanalysis” (Winter, 381-83). In WW II, this approach and explanatory carried over by Roy Grinker and John Spiegel in their narcosynthesis, which gave rise to the U.S. Army Signal Corp’s 1943 film Combat Exhaustion” (Winter, 385ff.).

In Sex and Personality: Studies in Masculinity and Femininity, Terman and Miles developed the “M-F Test” (“Masculine-Feminine Test”) to help make more “objective measurements of individual adherence to masculine and feminine norms. “In the 1940s, ‘normal male’ behavior involved an expectation about assertiveness and power, while ‘normal female’ behavior meant softness and accommodation to others. Psychiatric patients did not necessarily fit these expectations, and their deviation from the expectation was both explained by and appeared to be a cause of their mental illness” (Hirshbein III, 162).

Establishment of American Board of Internal Medicine, with five representatives from the American College of Physicians and four from the AMA Section on the Practice of medicine; in 1941, allergy, cardiovascular diseases, gastroenterology, and tuberculosis (later pulmonary medicine) were incorporated into the board as subspecialties with their own certification (Stevens, 231-235). (In 1970-71, six more subspecialties – endocrinology and metabolism; hematology; infectious disease; nephrology; and rheumatology – were added). Last two homeopathic medical schools, New York Homeopathic Medical College and Flower Hospital and Hahnemann Medical College and Hospital of Philadelphia relinquish their homeopathic status and become regular medical schools (Haller, 292).

Frederick Taussig publishes book arguing for “moderate” reform of antiabortion laws, allowing physicians to perform “a few more therapeutic abortions.” He sought to legalize what had become a medical reality during the 30s, when physicians, without politically challenging the law, “liberalized access to ‘therapeutic’ abortion” (Reagan, 142-143).

Founding of Euthanasia Society of America (ESA) by Charles Potter, incorporated in New York in 1938, and counting among its influential members many supporters of birth control (e.g., Margaret Sanger). It differed from previous advocates by viewing euthanasia as part of a broader struggle for social betterment, including birth control and eugenics: “the struggle for euthanasia was the immediate successor of the struggle for birth control, ” i.e., the struggle to make birth control more publicly available (Lavi, 102). Eugenic reasoning was popular among euthanasia supporters: “euthanasia was closely tied to birth control in that both sought to use medical means to minimize social suffering by regulating undesired life. It is, therefore, no accident that the initial discussion of euthanasia as a eugenic solution was raised in the context of deformed babies” (108). ESA drew inspiration and advice from British Society for Legalization of Voluntary Euthanasia, founded in 1935 (113-114). In the face of Nazi euthanasia, the ESA “did not change its course of action, or its name, until the late 1960s” (121), and “The ESA continued to toy with the possibility that nonvoluntary euthanasia could be offered to the unfit in the United States” (123). “. . . the problem of the Nazi euthanasia was its unlawfulness, while the moral superiority of the ESA proposal was its lawfulness” (124).

Founding of Sterilization League of New Jersey by Marian Olden with support of director of NY School of Social Work(Hansen & King, 68-70). It evolved into, and was later renamed, Birthright, Association for Voluntary Sterilization (60s & 70s), and now NY-based Engender Health.

Founding of Pioneer Fund by Harry Laughlin and Frederick Osborn, supporters of Hitler’s race policy. Its stated purpose was to “improve the character of the American people” by encouraging procreation of descendants of “white persons who settled in the original thirteen colonies prior to the adoption of the constitution and/or from related stocks” by funding research on “race betterment.” “The support of the Pioneer Fund is not limited to Jensen, Shockley, Pearson, Rushton, Gordon, and the Minnesota [twins] Project. The list of other recipients of Pioneer Funding grants reads partly like a ‘Who’s Who’ of scientific and political racism in the United States, Canada, Great Britain, and Ireland” (Kühl, ch 1).

Surgeon General Thomas Parran publishes Shadow on the Land that detailed his campaign against syphilis. In May, 1938, Congress passed the National Venereal Disease Control Act, the crowning achievement of Parran’s campaign against VD (Brandt, 142-147). The Act marked, along with other New Deal welfare legislation, “a shift in notions of federal responsibility for ameliorating social problems.” The Act provided federal grants to state boards of health to develop antivenereal measures (144).

Establishment of American Board of Surgery and American Board of Anesthesiology, the latter remaining hostile to nurse anesthesia (supported by surgeons) as a rival profession (Stevens, 237-42).

Protamine insulin (as of 1950, in crystal form, NPH insulin), first longer-acting insulin, developed by Nordisk in 1936, becomes available. The protamine was obtained from the “milt” or semen of sea trout.

German drug company Temmler’s head pharmacist Fritz Hausen develops new method of synthesizing methamphetamine, which is patented by Temmler Pharma on Oct 31. Unlike adrenalin, it did not cause sudden rise of blood pressure, “but works more gently and lasts longer. The effect occurs because the drug tickles out the messenger substances dopamine and noradrenaline from the nerve cells of the brain and pours them into synaptic gaps. This puts the brain cells in excited communication with each other and a kind of chain reaction takes place. A neuron firework explodes and a biochemical machine gun starts firing an uninterrupted sequence of thoughts. All of a sudden, the consumer feels wide awake and experiences an increase in energy; the senses are intensified to the extreme” (29, 70 ). In 1938, Otto Ranke, director of Research Institute of Defense Physiology at Military Medical Academy, conducts probably first systematic drug tests in military history, comparing effects of Pervitin to Benzedrine, caffeine, and placebo among 90, then 150 medical officers (46-49). As a result of study, “methamphetamine spread like wildfire and would pass through every barracks gate over the next weeks and months” (51). But not all of Ranke’s findings had been positive: Despite its performance-enhancing effects, “Procedures that demanded greater abstract achievements from the cerebellum were not performed well by consumers of Pervitin. Calculations . . . contained more mistakes. Neither was there any increase in capacity for concentration and attention during more complex questions” (49). Ranke himself used Pervitin regularly and became addicted in propagating the norm of keeping soldiers awake for two days and two nights (58). On 17 April 1940, “stimulus decree,” written by Ranke and signed by army commander in chief, Walther von Brauchitsch, circulated among Wehrmacht doctors advising them of successful use of Pervitin in overcoming fatigue and sleep loss in Polish campaign and noting it was included in medical equipment (63-64). For the western campaign, Wehrmacht orders 35 million Pervitin tabs from Temmler for army and Luftwaffe (67, 99).

Hungarian chemist Albert Szent-Györgyi identifies ascorbic acid (vitamin C) and wins a Nobel Prize (Altman, 249). Tuberculosis the most common cause of death in USA (Wainwright, 120).

By spring sulfanilamide (displacing Prontosil and Prontosil Soluble) on the market in France, Britain, and U.S. (Lesch, 155). Delayed response in Britain and U.S. linked to skepticism regarding the very possibility of bacterial chemotherapy; in U.S. the response to Prontosil “occurred against a background of failure of mercurochrome and numerous other compounds from the 1910 to the early 1930s” (157). Most American physicians learned of the new drugs only in December 1936, when president’s son, FDR, Jr., was cured of a life-threatening streptococcal infection by Prontylin (= PABS, given generic name of sulfanilamide) and Prontosil Soluble, amid great publicity (151).

Tracy Putnam and Houston Merritt, working at Harvard neurology unit at Boston City Hospital, publish seven papers on anticonvulsants, reporting that, in contrast to bromides and phenobarbital, the sedative and anticonvulsant effects could be separated; In third paper, they report on beneficial effects of phenytoin (Dilantin), which controlled epileptic seizures without the sedative effects of phenobarbital (Rowland, 5-7).

FDR establishes National Foundation for Infantile Paralysis, with Basil O’Connor as his hand-picked Director (Rogers, 170; Oshinsky II, 79-80), since, owing to FDR’s reduced popularity, his identification with Warm Springs had become detrimental (Gould, 73). “The National Foundation became the gold standard for private charities, the largest voluntary health organization of all time” (Oshinsky II, 79). The Foundation “contributed significantly to the development of the discipline of virology in the United States” (173). At Yale, John Paul and Trask discover polio virus in stool of polio patients during acute stage of illness and conclude that polio was an enteric viral infection that entered the body through the alimentary tract (Gould, 120).

Health plans that met the 14 standards adopted by AHA’s Committee on Hospital Services established in 1937 become approved plans entitled to display “a symbol of affiliation in the form of a blue-colored cross with the AHA seal at its center” (Cunningham & Cunningham, 28-30).

Publication of Cushing’s final book, his meningioma volume, coauthored with Eisenhardt, his greatest clinical monograph. With this volume he completed studies of the more important types of brain tumor: those impinging on the pituitary body, of the nervus acusticus, of the gliomas, of the blood vessels, and the meningiomas (Thomson, 316). “By 1938, Boston seemed to have outpaced the others [NY, Phila.] in neurological research. . . . The neurology leader was Stanley Cobb, and all research in the department radiated from his interest in epilepsy, which took him to studies of cerebral blood flow and metabolism. . . . he managed to keep together a team [at Boston City Hospital] that included Putnam and Merritt; Fred and Erna Gibbs, who developed the electroencephalogram; William Lennox, the dean of epilepsy research; Frank Fremont-Smith, a pioneer in characterizing the constituents of CSF; and Raymond Morrison, an early neuropathologist” (Rowland, 50).

In a landmark operation, Robert Edward Gross (Boston Children’s Hospital) successfully closed a patent ductus in seven-year-old girl (Richardson, 106). This ushered in the era of closed heart surgery (Miller, 30). Robb and Steinberg (NYC) develop practical method of visualization of heart chambers via catheterization (111). Patent ductus arteriosus = a congenital heart abnormality in which the ductus (a short vessel which joins the aorta and pulmonary artery near their origin at top of heart), which is supposed to close with the onset of respiration through the lungs within a week of birth, remains open; the ductus prevented the fetus from using its lungs while receiving oxygen through the placenta. The feasibility of ligaturing shut the ductus was propounded by John Munro in 1907, and Evans Graham was ready to do it in early 20s at St. Louis Children’s hospital, but his colleague wouldn’t refer him a suitable patient for operation (Morris, loc 795ff.)

Pres. Roosevelt’s Interdepartmental Committee’s “Report on Health Needs of the Nation” recommended expansion of public health and maternal & child health services under existing titles of Social Security Act and interlocking system of federal grants to states – AMA, in Sept, 1938, reiterates opposition to any form of compulsory health insurance (Stevens, 193). “It was this lack of experiment with new ways of organizing and providing care which was the real tragedy of medical conservatism in the 1930s” (Stevens, 195).

AMA House of Delegates prohibits professional consultation between M.D.s and osteopaths.

Creation of first of the quasi-independent migrant health plans, the Agricultural Workers Health and Medical Association, in Cal. and Arizona (Grey, 83): “the overarching organization and philosophy of the migrant health programs were consistent from region to region: comprehensive acute medical care, government subsidization of costs, emphasis on prevention and health education, and accommodation of the local medical community.” Coverage for health conditions was generously defined. Health services provided to agricultural workers were comprehensive; they included medical, surgical, hospital, and dental care; prescription drugs; diets; and nursing. . . . Preventive services included “immunizations, prenatal and postnatal care, health education, and even sanitation services” (85). “In the migrant health programs, Farm Security Administration nurses were given unusual latitude in their clinical roles,” including writing of prescriptions and dispensing of drugs (94). FSA purchased two hospitals in Arizona (1941) and FL (1942). FSA transferred to War Food Administration in 1943 (132, 135). Number of farm labor camps, which included foreign farm workers from Mexico, etc., grew during the war, and by 1945, farm labor medical programs operated to some degree in virtually every state and Puerto Rico (137). During war, AMA growing concerns about FSA health programs at loggerheads with widespread approval at state and county levels (139-43).

Establishment of national Blue Cross program for regional hospital prepayment plans (of which there were 38 Plans with 1.365 million subscribers) that met the 14 standards adopted by AHA in 1937; they qualified as approved Plans that could display “a symbol of affiliation in the form of a blue-colored cross with the AHA seal at its center” (28-30). The standards required payments to hospitals based on costs; imparted values in tradition of private, voluntary, not-for-profit hospital; and offered same rates to all subscriber groups regardless of age, sex, occupation, or other characteristics (“community rating”), which violated insurance principle of tailoring rates to risk potential of a subscriber group (30-31).

Founding of Euthanasia Society of America (Lavi, Intro).

London surgeon Philip Wiles performs first, albeit unsuccessful, total hip replacement, using stainless steel components that were attached to the bone with bolts and screws.  While the artificial joint worked well in the short-term, it was a long-term failure, as the screws and bolts came loose and the implant was subject to wear. Successful hip replacements awaited the 1960s, when Sir John Charnley introduced “low-friction arthroplasty” using acrylic cement for fixation (Learmouth, et al.).

Publication of Louis Berman’s New Creations in Human Beings, with its utopian vision of endocrinology as the pathway to the “Ideal Normal” human: Hormones would cure endocrinal disease and imbalance and lead to the development of ideal normals (re physique and beauty; vitality and energy; intelligence and imagination; sexuality and maturity, etc.) (Nordlund, 94ff.).

Israel Wechsler appointed Director of Neurology at Mt. Sinai; in 1939, Lawrence Kubie appointed head of the Psychiatry Division in the Neurology Service; Kubie expands service with refugee analysts to staff his psychosomatic program. Tension developed in 1942 over Kubie’s request to expand the psychiatry division (already at almost 40) with more refugee analysts at the same time as the Neurology Service was depleted by the war, leaving a staff of only five. In Jan, 1943, Kubie and most of his staff resigned. In 1946, the Dept. of Psychiatry was launched as an independent service under M. Ralph Kaufman (Stein, 296-303)

Following 106 deaths in 1937 arising from the drug firm S. E. Massengill’s (Tenn.) use of the antifreeze additive ethyl diglycerol as a buffer in a liquid preparation of Elixir Sulfanilamide (Marks, 82; Hager, 209-222; Lesch III, 178-181), Congress passes Federal Food, Drug and Cosmetic Act, authorizing the FDA to review the safety and composition of new drugs: “FDA officials adopted a regulatory policy that seemed – to them – minimally intrusive on the prerogatives of practicing physicians and drug manufacturers. The FDA would contribute to the public good largely by regulating what manufacturers said about drugs, while leaving other efforts to improve the use of drugs to medicine’s scientific and professional authorities” (Marks, 73, 81). FDA early focused attention on sulfanilamide (the first of the sulfonamides, introduced in US in 1936), whose healing potential, esp. in treating pneumococcal pneumonia (but also gonorrhea and cerebrospinal meningitis), was tempered by knowledge of its toxicity (anemias, depressed white-cell counts, etc.). First delineation of prescription-only drugs in 1938 Act in terms of labeling: The 1938 Act permitted companies, at their discretion, to substitute for the information about certain drugs the phrase: “Caution: To be used only by or on the prescription of a physician [or dentist or veterinarian],” but this warning only increased consumer demand and consumers got the drug without prescriptions over-the-counter and also from pharmacists. Additional regulations in 1940 did not help the problem of “fence-straddling” manufacturers and sales by druggists (Rasmussen IV, 110-11). The FDA’s effort at regulation became law in 1951. Temin sees it somewhat differently: Re the warning label, “It allows the drug companies to create a class of drugs that cannot legally be sold without a prescription by putting the appropriate label on them. . . . Far from encouraging self-medication, as [FDA commissioner] Campbell had said the 1938 act would do, this provision sharply curtailed it. Previously, the consumer was allowed to judge for himself whether he wanted to take any drug on the market. Now the drug manufacturers and the FDA would decide for him which drugs he could select on his own. . . . The FDA had appointed doctors as the consumer’s agents in selecting drugs (Temin, 98). . . . The regulation grew out of conditions which existed before the revolution in drug therapy produced by the wonder drugs of the 1940s. The dangerous component of Elixir Sulfanilamide was the solvent, not the sulfa drug. . . . The FDA assumed that adequate directions for self-medication could not be written for some drugs” (99). The codification of the prescription-OTC distinction in 1951 in the Durham-Humphrey amendment to the 1938 bill still prevented FDA from interfering with drug companies’ rights to determine which drugs required prescriptions: “Instead of an administrative decision, which the drug companies could appeal, the FDA would have to sue the companies for misbranding if it disliked their decisions.” Also the law dealt only with drug safety, not efficacy (Temin, 103).

FDR’s “Report on the Health needs of the Nation” recommended expansion of public health and maternal/child health services under Social Security Act; also new systems of federal grants to states for hospital construction, subsidy of state programs for medically needy, and state programs of general medical care. AMA’s House of Delegates, in a special session, reiterated opposition to establishment of any form of compulsory health insurance (Stevens, 193). Strengthening of FDA and FTC “constitute the most important health-related legislation passed during the New Deal. While other developed nations such as Canada and Great Britain moved decisively toward programs of national health insurance during the 1930s, Americans moved instead to strengthen the individual consumer’s protections within the marketplace of health-related goods. Perhaps because they appeared less ideological and more pro-market, arguments rooted in the need for consumer protection and ‘getting one’s money worth’ proved much more effective than those couched in the language of social justice and citizen entitlements” (Tomes I, 541).

Ernst Chain, working under Florey at Oxford, begins investigation of three antibacterial substances, one of which was Fleming’s strain of penicillin (P. notatum) (Macfarlane, 169ff.). In January, May & Baker chemists begin work on first large batch of T693 (M&B 693 =sulfapyridine), the first and only sulfa drug effective against pneumococcal infections, esp. pneumococcal pneumonia; it was released on British market in October as Dagenan and in US was licensed to Merck approved for interstate commerce by FDA in March, 1939. It was one of the first important drugs approved by the newly empowered FDA under the Federal Food, Drug & Cosmetic Act of 1938. Sulfapyridine replaced serum therapy (via antipneumococcal serums) for treatment of type I pneumonia only (= 30% of all pneumonia cases) which was problematic, difficult to administer , and costly (Lesch, 108-110; Lesch III, 158-183; Hager, 236-245). It was also effective for other bacterial infections, esp. gonorrhea and cerebrospinal meningitis (Lesch III, 171-175).

Conference on “Experimental Neuroses and Allied Problems,” attended by two representatives of Macy Foundation  Macy Foundation backing of new journal on psychosomatic medicine, with Flanders Dunbar as managing editor; Stanley Cobb agreed to integrate his Harvard University Press monograph series into the journal  publication of first issue of Psychosomatic Medicine on Jan 1, 1939. Franz Alexander, first name on editorial board, put issue #1 together with Dunbar (Levenson, 34ff.). “The influence of Alexander on the first issue of Psychosomatic Medicine was overwhelming. The bulk of the material originated in Chicago, written by Alexander, his colleagues at the Institute for Psychoanalysis, or friends at other institutions in the city” (39).

Yale professor of preventive medicine John Paul coins term “clinical epidemiology” as way to study the “ecology of human disease,” whereby clinicians started with the individual patient but used epidemiological knowledge to “take account of the communities and setting in which these patients lived and became” (J. Daly, 123).

Ernst Chain, Howard Florey, Norman Heatley, and rest of Oxford Unit at Dunn School of Pathology work to purify penicillin, succeeding in 1940, with first major test on lab mice ”as British troops were scrambling off the beaches at Dunkirk” (Wainwright, 53-59; Lax, 85ff., 114-125 on the mice experiments; Macfarlane, 169ff.).

NFIP approves grant of $161,350 to Tuskegee Institute’s Hospital to build and equip a 36-bed “infantile paralysis center for Negroes” (first grant to a black institution) (Mawdsley, 227).

Margaret Sanger’s American Birth Control League merges with Clinical Research Bureau to form Birth Control Federation of America (BCFA), which proceeded to establish the Negro Project, forerunner of Planned Parenthood clinics, a network of family planning centers for benefit of blacks, esp. black women, which sought to reduce black population by promotion of negative eugenic principles. Had support, inter alios, of Adam Clayton Powell and Martin Luther King. The clinics were so successful they live on today. Critics, including president of NAACP, saw the clinics as reminiscent of forced sterilization programs to reduce black births and eventually eliminating the race (Montgomery, 273-276).

Cushing’s death, even as he was working on his bibliography of Vesalius. Neurologist/Neurosurgeon Tracy Putnam arrives at NY Neurological Institute (Rowland, 57), pushed out by Presbyterian Hospital president Charles Cooper, an anti-Semite, who persuaded the hospital’s Medical Board to eliminate Putnam’s position of Director of Neurological Institute in 1947 though he retained his tenure professorship of neurosurgery until leaving for California (Rowland, 71-73).

Large-scale trials in U.S. attest to effectiveness of the sulfonamides (esp. sulfapyridine) with pneumococcal pneumonia, leading to disuse of serum therapy for this condition: “Within a short time most doctors had abandoned the typing of pneumococci, pneumonia control programs had closed down, and pharmaceutical companies had stopped producing the serums because they were no longer profitable” (Dowling 1, 113-14).

Introduction of hormone therapy, when Charles Huggins, based on Beatson’s 1899 observation of effect of estrogen on breast cancer, treated men with prostate cancer with hormones and showed decreases in acid phosphatase levels (Devita & Chu).

Crowe and associates at Hopkins begin study of hearing loss in school children via nasopharyngeal examination and irradiation of lymphoid tissue and hearing tests (Crowe, 164-167). Establishment of Tuskegee Infantile Paralysis Center following grant from National Foundation for Infantile Paralysis (Gould, 81-84). Advent of a drug treatment – sulfapyridine – for pneumonia (Marks, 67).

Abbott Labs receives U.S. patent for first intravenous anesthetic, sodium thiopental.

George Alexander’s published report on an anorexic attributed onset to fear of pregnancy, with food symbolizing impregnation, was first psychiatric elaboration of psychosexual dysfunction in anorexia (Brumberg, 220-224).

Launching of journal Psychosomatic Medicine, with Rockefeller Foundation influence “evident on almost every page.” The Journal’s editors included Flanders Dunbar, Franz Alexander, & Stanley Cobb, all Rockefeller grantees (T. Brown, 25). Publication of George Canby Robinson’s The Patient as a Person, whose program for treating the whole patient had three components: (a) integration of psychiatry and general medicine; (b) restoration of family physician in modern form; (c) recruitment of medical social workers to aid in assessment of personality, home environment and work relations (Tracy II, 64).

Anticoagulant Dicoumarol, a derivative of the coumarin in moldy sweet clover hay that caused cattle to bleed to death from minor surgeries, jointly discovered by Karl Link at University of Wisconsin and Jorgen Lehmann in Sweden. It was a vitamin K antagonist used in treatment of life-threatening thrombosis or embolus. (F. Ryan, 138-144).

Rene Dubos discovers soil-based tyrothricin and then he & Rollin Hotchkiss isolate gramicidin as one of two active agents. It was a powerful gram-positive antibacterial (strep, staph, pneumococcus) in test tube and peritoneal cavity of infected mouse but like tyrothricin proved extremely poisonous unlike penicillin, with its similar antibacterial spectrum F. Ryan, 151-161).

Initiation of child euthanasia program in Nazi Germany, following request of parents of Gerhard Kretschmar, a severely deformed infant, that the infant be euthanized. Appeal was made directly to Hitler, and was carried out on July 25 by one of his personal physicians, Karl Brandt. It was followed by the first phase of the T-4 (located at Tiergartenstrasse) program, which euthanized ca 275,000 children and adults between October 1939 and August 194. Between 5,000 and 10,000 youths were killed in the child euthanasia program between 1939 and 1945. Hans Heinze, star student of Paul Schröder, established Nazi’s first child killing center at his State Institute Görden in Brandenburg in 1939 (Sheffer, 100-101).

John Crandon’s self-experiments demonstrate the relationship between vitamin C and surgical wound healing (Altman, 250-55). (Depletion of vitamin C leads to scurvy, which loosens the walls around capillaries causing bleeding of gums, skin around hair follicles, and in bones.) Cf. Rackemann, 181. Karl Astel, Nazi director of antitobacco institute at, and president of, University of Jena, tours local hospitals to encourage physicians to kill their psychiatric patients (Proctor, 209, 241).

APHA passes resolution codifying “basic six” services provided by local health departments: (1) collecting vital statistics; (2) controlling communicable diseases; (3) ensuring environmental sanitation (e.g., re municipal water supply); (4) providing lab services permitting diagnosis by doctors & hospitals; (5) providing maternal, infant & child health services; (5) education (Colgrove III, Intro).

In March, Norman Heatley discovers how to extract penicillin from an ether solution without its vanishing in the process: he transferred penicillin (an acid) out of ether into water made alkaline; the back-extracted watery solution, which contained penicillin, was stable and remained active after 11 days at room temperature (Lax, 103-06). “Mouse protection trial” begins on May 25 at Florey’s lab in the Dunn School of Pathology (Oxford), demonstrating effectiveness of penicillin (thought to be pure but actually less than .5% pure) against deadly dose of streptococcus in mice (Lax, 118-120). On June 22, Pétain surrenders France to Nazis and becomes head of Vichy government; on July 10, Battle of Britain begins. On August 24, Lancet publishes Oxford Unit’s initial publication, a two-page article entitled “Penicillin as a Chemotherapeutic Agent” (138-39). Jan-June, 1941: first human tests of penicillin for various staphylococcal infections by the Oxford Unit (152-56;165-68; Macfarlane, 183-87).

Eward Abraham and Ernst Chain report first instance of antibiotic resistance: a strain of E. coli that inactivated penicillin by producing the enzyme penicillinase. (The mechanism of deactivation: beta-lactamase enzymes hydrolyze [break down with water] the beta-lactam rings of the penicillins and, in another variant, cephalosporins [Lin, et al.] . The spread of this resistance was documented by 1942, when four strains of Staphylococcus aureus, which inactivated penicillin among hospitalized patients. The spread was temporarily halted in the 1960s with introduction of the semi- synthetic methicillin, but methicillin-resistant strains of S. aureus shortly emerged, and it was only in 1981 that the mechanism of resistance was unraveled. By then strains of pneumococcus had also proven penicillin-resistant (beginning in 1967) and in 1976 beta lactamase-producing gonococci were isolated in England and the U.S., followed by rapid spread of gonococcal penicillin-resistant strains, esp. in Asia (Lobanova & Pilla).

On 17 April 1940, on eve of German invasion of France through Luxemburg and the Ardennes, “stimulus decree,” drafted by Ranke and signed by army commander in chief Walther von Brauchitsch, circulated among Wehrmacht doctors, advising them of successful use of Pervitin (methamphetamine) in overcoming fatigue and sleep loss in Polish campaign and noting it was included in medical equipment (Ohler, 63-64). Recommended dose was one tab during the day and two at night.

Linus Pauling’s advance in instructional theory of antibody formation, whereby “Antigen would serve as the template for the final step of protein formation in which the coiling of the nascent polypeptide chain of the antibody molecule would conform more or less precisely to the template offered by the surface determinant of the antigen molecule. Once the appropriate configuration had been attained, it would be stabilized by familiar interatomic bonds and thus satisfy all of the requirements of specific antibody” (Silverstein, 70-71).

Drew becomes medical supervisor for the Blood for Britain program (Wynes, 93). Publication of Lewellys Barker’s Psychotherapy (Barker, 172). In December, H. S. Sullivan appointed consultant on psychiatry to director of the Selective Service; he sought to apply medical model to the screening of soldiers; supported US intervention in WW II; and believed psychiatric screening would improve the status of psychiatrists (Wake, 467-68). He was unhappy when the CACSS’s Medical Circular of May, 1941 added “homosexual proclivities” to list of deviations that should be referred to SS advisory boards (475). For Sullivan, “psychiatric selection was not for eliminating the unfit, but for selecting those who were particularly suited to military service. . . . To put the burden on the shoulders of the mentally ill in general and homosexual men in particular was not what Sullivan wanted. He had fought against this in his earlier clinical work with ‘schizophrenic’ patients, most of whom he believed to be homosexual” (466-67). At the same time, “he recognized a certain need to screen out homosexual men from the military” viz, that “homosexuals were . . . particularly vulnerable to psychological strain in military life. He could see the point of excluding homosexuals from the service so as to protect their mental health.” (478-80). Sullivan resigned from CACSS in early 1942 owing to differences with new SS director Lewis Hershey, who believed a standardized psychological examination at an induction center was more efficient and dependable than the psychiatric screening at local and medical boards (491).

Some 70% of physicians in U.S. still in general practice (Rothman, 114). Three of every four physicians thought of themselves as generalists; by 1966, the proportion was less than one of three (Stevens, 312). Publication of 1st edition of the Directory of Medical Specialists by the Advisory Board for Medical Specialties (Stevens, 260, 266). Approx. 1,000 American physicians view themselves as heart specialists, but few had any formal cardiology training; at the time, there were 451 official residency positions in internal medicine but only four in cardiology (Fye 2, 86). ABIM establishes subspecialties of cardiology, allergy, gastroenterology, and pulmonary disease (Howell II, 772-73).

55% of America’s births took place within hospitals; by 1950, it was 88%; by 1960,outside of isolated rural areas, there were no home deliveries (Leavitt, 171). By 1938, half of America births occurred within medical institutions (205).

U.S. Hospitals: “At the very least, a well-equipped hospital of 1940, even if it served only 10,000 people, required good laboratory and X-ray services; but a radiologist needed a population of 60,000 to earn a living, and a pathologist 100,000. Half of all hospitals had fewer than 50 beds, too small to offer a full range of care in the specialties – and there were marked disparities in the receipt of hospital care by biography and size of the area” (Stevens II, 194).

In November, Nazis seal Warsaw ghetto, with nearly a half million people. It was rationalized by German and Polish physicians in terms of the Geomedizin notion “that typhus was a Jewish disease, one that moreover did not do real harm to Jews, since they were the racial and geographical carriers of it.” This “seemed to justify a policy of keeping Jews locked behind ghetto walls, where typhus could be confined without threatening the vulnerable Aryan population, especially the German occupants” (A. Allen, 106, 79-80). Cramming a half million people into a few square blocks in the dead of winter created a typhus epidemic, which German doctors then blamed on the Jews (108). Weigl, through two employees, smuggled at least 30,000 doses of his typhus vaccine into the ghetto (109). This lasted until the Germans arrived.

Joseph Wortis, David Impastato, and Lauretta Bender pioneer ECT at Bellevue; over 8-year period beginning in 1942, Bender administered ECT to over 100 children in her Unit (PQ6), some as young as 4. Her goal was to use ECT to make the children more amenable to therapy and counseling. Criticism came in 1954 from researchers who interviewed parents who reported that that ECT had made things worse for their children; study implied Bender ignore the potentially catastrophic risks of ECT for children; it was borne out by interviews with the children themselves, who displayed anger, humiliation, and pain (which Bender never commented on) (Oshinsky, 230-237). Bellevue abandoned ECT for children in 1956 when Bender moved to Creedmoor State Hospital, where she began experimenting with LSD on children. Bellevue resumed ECT on limited basis in 2015. (234-237).

Charles Drew named Assistant Director of National Blood (bank) Program (i.e., medical director in charge of collecting blood for use by armed forces), though armed forces stipulated only white donors could be accepted (Wynes, 67). Opening of Tuskegee Infantile Paralysis Center, “a poor imitation of Warm Springs” (Mawdsley, 228). Harvard Medical School initiates course on “Treatment of Patients as Persons” (Barker, 167-168). Alfred Richards (chairman of U.S. Committee on Medical Research and Development) meets with executives of Merck, Lederle, Squibb, and Pfizer, conveying national interest in development of penicillin and making clear that sharing their results would not be an antitrust violation (Lax, 187; Macfarlane, 191).

In November, John Romano leaves Peter Bent Brigham (Harvard) to accept Chair of Psychiatry at University of Cincinnati College of Medicine, taking George Engel with him. There he introduced psychiatry into the pre-clinical med school curriculum (Kaufman, 214-15) and, toward end of War, was appointed by State Dept. and Army to small group – with Karl Menninger, Leo Bartemeier, John Whitehorn, and Lawrence Kubie – to study psychiatric problems of troops in Europe (217-18).

Cournand and Richards demonstrate right-heart catheterization could be safely performed in humans; by 1945, Warren and Stead had used right-heart catheterization to diagnose atrial septal defect (Howell IV, 288).

Farm Security Administration establishes six rural health services and two “special area” demonstration projects, which operated for four years before the FSA was terminated by Congress. Common to all were group prepayment, voluntary membership, local administration, and income-based annual dues. Six used modified fee-for-service financing similar to that used in the medical care cooperatives: Participating physicians billed a pooled fund generated from annual membership dues and were paid on a monthly basis (Grey, 113ff.). Plan enrollments peaked in 1943 with 42,000 enrollees, with eligibility keyed to annual income below $1,800 and only $1,200 in the Taos (NM) plan; 50% of eligible persons joined the program (117-118).

Establishment of American Society for Research in Psychosomatic Problems (Levenson, 55-56); Dunbar deposed in 1947, and society renamed American Psychosomatic Society, with Carl Binger new Editor of the journal (76-80).

“Miracle cures” of Harry Lambert in England (treated by Fleming) and of Mrs. Ogden Miller at Yale convinced British and American officials, respectively, of the importance of penicillin to war effort (Macfarlane, 193-96). Use of penicillin to treatment victims of Cocoanut Grove fire of 29 Nov in Boston; surgeon Champ Lyons given penicillin to treat 13 fire victims with staphylococcal infections of the respiratory tract: owing to lose dose of penicillin, Lyons couldn’t accurately appraise efficacy of penicillin therapy (Neushal, 203, 207-209). First penicillin-resistant strains of staphylococci isolated (Wainwright, 85; Dowling, 142-44). Feldman & Hinshaw (Mayo Clinic) conduct trial of Promin (created by manipulation of the sulphonamides molecule) in treatment of TB; it was the first trial in history “in which a drug had been shown favorably to influence the course of the disease in human beings” (F Ryan, 227-28).

Walter Cannon publishes his essay “‘Voodoo’ Death,” a scientific analysis that sought to make sorcery and voodoo legitimate objects of knowledge. According to Cannon, voodoo death was a state of intense emotional “excitement” (Dror). He sought to “subjugate alternative knowledge” via a concept (emotion) that “held a leading and visible position in feminized, oppositional, and alternative political and medical discourses” (79, 80). . . voodoo’s blackness, its American habitation, its popular register, its Christian associations, and its subversive significations were never mentioned in Cannon’s published Essay. Cannon . . . fashioned voodoo death into a characteristic phenomenon of ‘primitive’ societies, granting a similar status only to presurgical patients or soldiers during war. . . Postwar authors took a radically different stance. Instead of relegating voodoo death to the exotic, they universalized voodoo death, ultimately transforming it into one of the distinct characteristics of modern life – sudden death resulting form the acute stress of modernization” (81).

small group of counselors establish American Association of Marriage Counselors, “the first professional organization dedicated solely to marriage counseling.” “The war marriage phenomenon, however, gave marriage experts an entrée onto an expanded public stage (Celello, 58). Marriage experts portrayed themselves as vital to the war effort (62). “This idea that anticipating and coping with postwar disappointment in their marriages was women’s work became a common refrain in wartime marriage discourse” (63). . . . “in the postwar years, marriage was properly women’s primary occupation and the very fate of the institution rested on their shoulders” (65).

From December 1941 until end of 1942, Lustig could grant medical deferrals to Jews too ill to be deported: “Making the Jews believe that seriously ill people would not be transported contributed to the Nazis’ ability to hide the true nature of the deportation and thus prevent Jewish resistance” (Silver, 68). By end of 1942, deportation had robbed Berlin Jewish Hospital of several of its principal remaining doctors, and in March, 1943, it was decided 50% of hospital personnel would be deported together with their families (87, 142, 186-87). Nursing staff, around 70 before deportation, was around 20 at liberation (186-87). After liberation, 24 April 1945, the Hospital again became available to non-Jews (189).

NY and MA the only states where immigrant physicians fleeing Nazis (viz, German Jews) could take licensing examination; otherwise they had to become citizens, which took five years. “Infrastructure of bigotry” of many southern and Midwestern states results in some of the toughest entry specifications. Until 1945, Georgia, Alabama, Mississippi and Idaho “appeared to be leading the other states, not excluding New York, in an exercise of xenophobic execration” (Kater, 211)

Harvard Med School faculty, by 5 to 1 vote, decides to admit women, beginning with the new class of Sept 1945 (in which 5 of 52 women applicants were accepted). Minot opposed the decision (Rackemann, 252-53; Bonner, 152).

Bowing to public pressure, American Red Cross to abandon racially separate blood transfusions. “But the blood transfusion debate had a lasting impact, putting the American system of health care and segregation on public trial. The notion that hidden dangers lay nascent in “Negro blood” or “Jewish blood,” or that special virtues existed in “Aryan blood” or “white blood,” came under an international microscope” (Wailoo III, 80).

American Academy of Pediatrics approves pertussis (whooping cough) vaccine after a third study confirmed study results of Pearl Kendrick and Grace Elderling of Michigan Health Dept. published in 1939 (J. Baker, 202).

In May-June, pilot units for penicillin therapy at Bushnell General Hospital (Utah) and Halloran General Hospital (Staten Island) convince U.S. army that penicillin was vital to war effort (Neushul, 209-212). Penicillin also shown to be effective against gonorrhea bacilli (Mayo Clinic) and syphilis (John Mahoney at PHS hospital at Staten Island (Parascandola II, 20-21). Use of Salvarsan for treatment of syphilis begins to decrease, giving way to far less toxic penicillin (Bäumler, 235). Waksman, at Rutgers Agricultural Experiment Station, identifies a strain of actinomycetes cultured from throat of a chick as Streptomyces Griseus, which yielded a substance that inhibited a number of common gram-negative and gram-positive bacteria (streptomycin) (Dowling, 159). Cf. account of F. Ryan: On 19 October Waksman’s doctoral student Albert Schatz discovered two colonies of actinomyces that killed gram-positive and negative bacteria (including TB germs), one sample from a throat swab of a sick chick and the second and more productive from a sample of heavily manured soil (F. Ryan, 218-221). Cf. account of Daniel (207-214), who admits that Schatz, albeit a student, “did most of the actual work,” but “Waksman was the expert” who, with other members of his group, “had developed the methods of investigation that Schatz used so assiduously and effectively” (213).

Introduction of Wagner-Murray-Dingell Bill that proposed great extensions in the federal social security system, including a federal system of compulsory medical and hospitalization insurance to be financed by a 6% tax from both employers and employees on wages and salaries up to $3K a year.

Congress passes Emergency Maternal and Infant Care (EMIC) program that provided federal funding for pregnancy/delivery/postpartum/pediatric care of servicemen’s wives and infants. Mother was understood to be part of the war effort (Temkin, 588ff.). For EMIC mothers, “there were no financial barriers to hospital care” (589). EMIC was one factor associated with expansion of nurse-midwifery education and practice in the 1940s (Dawley II, 89)

Vivien Thomas devises surgical solution to tetralogy of Fallot with dogs: “Thomas decided to leave the pulmonary circulation intact and create a different shunt. He sutured the end of the divided subclavian artery to the side of the pulmonary artery, creating an artificial ductus arteriosus,” which increased blood flow to the lungs (Timmermans, 209).

William Kolff, working in Germany-occupied Netherlands, begins using the dialyzer he constructed in 1942, viz, a method to filter patient’s blood through semi-permeable cellophane sausage casings affixed to a rotating wooden drum in an enamel bath; a Ford engine pumped patient’s blood into the sausage casings. The dialyzer permitted diffusion of smaller urea cells, but not larger blood cells, into salt rinsing solution, as area of high urea concentration flowed through the casing into area of low concentration. His first 16 patients died, though one was kept alive for 26 days, at which point she ran out of veins and arteries. The 17th patient (an imprisoned Nazi sympathizer), who came to Kolff in the summer of 1945, lived, and Kolff even gained her release from prison. From 1947-1960, it was used to treat acute and temporary injury to kidney (Rothman II, 88-89; Chaddock, 211-212; K. Tracy, 25-30). Kolff continued to encounter strong resistance from colleagues, who doubted the viability of the dialyzer, including administration at Mt. Sinai in late 40s, where the rogue procedure could only be performed at night. He emigrated with his family to Cleveland Clinic, where dialysis became routine in 50s and 60s.

Leo Kanner publishes seminal article on autism, “Autistic Disturbance of Affective Contact,” in The Nervous Child. Based on observations of 11 children since 1938, it defined the diagnosis in terms of: children’s social withdrawal, restricted emotional relationships, repetitive language and behavioral, limited speech, preoccupation with objects, and preference for routine” (Sheffer, 59).

Theodor Morell, Hitler’s personal physician, begins giving Hitler injections of Eukodal (with active ingredient oxycodone, released by Merck in 1917) for relief of severe abdominal pain, enabling Hitler to travel by train to Italy for a state meeting with Axis powers, where his agenda was to keep Mussolini from withdrawing from the war. Hitler “was hyped up at his meeting with Mussolini . . . [and] talked for three hours without a break in a dull voice to his beleaguered fellow dictator” (Ohler, 138). Between September and December 1944, after attempt on his life, the injection became so frequent “one must consider the possibility of a physical dependency. The happy fix came at a cost of unpleasant side-effects: insomnia, tremors, and constipation” (182). The Eukodal was often administered with anti-convulsive Eupaverin, a synthetic analogue of paverine from the opium poppy (164, 181).

On December 2, German bombing of Bari Harbor (eastern Italy) destroys 14 of 30 Allied ships, including U.S. Liberty (transport) ship John Harvey, which carried 2000 100-pound bombs filled with mustard gas (sulfur mustard and derivative nitrogen mustards) and took a direct hit. One-hundred tons of liquid mustard gas was released into harbor, where it mixed with fuel oil that floated a foot thick on the surface. The mustard gas poisoned hundreds of sailors and about 1000 Italian civilians. Investigation of injured and killed sailors thrown into Harbor  preliminary medical report of Steward Alexander suggested that toxic effects of mustard gas might be useful in treatment of certain types of cancer, since destruction of white blood cells (along with destruction of bone marrow and lymphatic system) suggested a systemic effect (R. Singh, et al.; S. Smith, II, loc 2192ff; Devita & Chu, 8043-8044)  findings shared with medical researchers at Yale (where Goodman & Gilman tried nitrogen mustard injections with “J.D.” and five other terminal patients in summer of 1942). Goodman & Gilman then conducted nitrogen mustard with mice with transplanted lymphoid tumors and observed marked regression; they shared results with Yale surgeon Gustaf Lindskog, who treated a patient with non-Hodgkin’s lymphoma with nitrogen gas and also observed marked regression. Owing to wartime secrecy, his results were only published in 1946. Bari Harbor preliminary report also shared with researchers at Univ. of Chicago and NYC’s Memorial Hospital, where team led by David Karnofsky and Cornelius Rhodes (who also had access to Alexander’s preliminary Bari Harbor report) conducted first therapeutic experiments with intravenous injection of mustard agent into veins of 60 cancer patients with lymphomas and leukemia (S. Smith [2]loc 2378-2427)  Controlled study at Yale in 1946  release of Mustargen (mechlorethamine) in 1949. But the drug-induced remission proved brief and incomplete, leading to pessimism about the potential of chemotherapy in the literature of the 1950s (DeVita & Chu, 8043, 8046).

Massive polio epidemic throughout the U.S., beginning in in Hickory, North Carolina, dubbed “Polio City.” National Foundation for Infantile Paralysis funded a makeshift polio hospital, which was up and running in 54 hours and treated 454 patients (Oshinsky II, 101ff.).

On November 29, Blalock team operates successfully on 15-month “blue baby” Eileen Saxon, who developed bilateral pneumothorax at home, followed by recurrence of cyanosis, from which she died two months later (Timmermans, 211-212)

Publication of Dandy’s monograph on surgical treatment of intracranial aneurisms (Crowe, 106-07). Oswald Avery (Rockefeller Institute) demonstrates that DNA carries genetic information, that genes lay within DNA; DNA was the substance that transformed a pneumococcus from one without a capsule to one with a capsule, and its progeny inherited the change (Barry, 424-25). Allied supplies of penicillin officially described as “unlimited.” Fleming, Chain, and Florey share Nobel Prize for medicine (Wainwright, 67, 75). First publication of discovery of streptomycin by Schatz, Bugie, and Waksman (122). In Sweden, Ferrosan begins synthesizing Lehmann’s PAS (para-aminosalicylic acid [aspirin altered via an amino acid side chain added to the carbon atom at the bottom of the carbon hexagon); first child treated in March, 1944, followed by more extensive testing by Gylfe Vallentin, head of Renström’s Sanitorium in Gothenburg; followed by first publication in Lancet in January, 1946, reporting, inter alia, on bacteriological and animal experiments first performed in Jan, 1944. PAS was synthesized at precisely the same time streptomycin was discovered by Albert Schatz, and was administered to first patient with pulmonary TB a month earlier than streptomycin (F. Ryan, 243-261). Schatz left Rutgers in 1946 and brought suit against Waksman and the Rutgers Research and Endowment Foundation in 1950, demanding that Waksman refrain from representing himself as sole discoverer of streptomycin and that Rutgers provide an account of royalties received from license grants by the defendants; case settled in Schatz’s favor in December 1950 (F. Ryan, 332-339).

Pepper subcommittee of Senate Committee on Education and Labor published findings documenting widespread deficiencies in prewar medical care: of 22 million men of military age, 40% could not meet requirements of general military service; up to May 1, 1944, 35.2% of total registrants rejected in WWII failed because of nervous and mental diseases compared to 12% in WWI (Burrow, 297-99).

Public Health Service Act authorized Surgeon General to award extramural grants; PHS extramural funding grew more than ten-fold in first four years after the war, leading to appointment of civilian consultants to “study sections” to advise about grant funding. “Disease-oriented institutes were established, and the grant-making structure reflected those divisions” (Howell III, 688).

Charles Bynum hired by National Foundation for Infantile Paralysis (NFIP) as director of “Negro Activities” (Mawdsley, 232-234).

(Oct): Clarence Crafoord (Stockholm) performed first successful surgery for Coarctation of the aorta = construction of a section of the aorta, with pressure increased above the construction and decreased below it  striking symptom in which patients have much higher bp in their arms than in their legs. Blood vessels in thorax become enlarged as body struggles to supply blood to abdomen via collaterals. But serious symptoms remain and life expectancy of patients just 34. Crawford clamped the aorta and cut out the constricted portion of aorta, and sutured the ends together. Body deprived of oxygenated blood from aorta (relying on collateral circulation) for the two-hour operation; circulation to brain via two carotid arteries at top of arch unaffected. (Morris, ch 2).

Year-long starvation experiment conducted by Ancel Keyes at University of Minnesota with 36 conscientious objectors who were members of CPS (Civilian Public Service) created by the Selective Service Act of 1940 (41): 3-month control phase followed by 6-months of starvation with each man’s diet cut roughly in half; then 3-month rehabilitation period: “The point, after all, was not to learn how to starve people, it was to learn how to rehabilitate them” (Tucker, 37). Many volunteers came from the Historic Peace Churches (Brethren, Friends, Mennonites)(43-45). Study was conducted at Keys’ Laboratory of Physiological Hygiene– the subground level of the football stadium. The volunteers were sold on the experiment as a means “to acquire basic knowledge on how to achieve the highest food relief with fixed and obviously inadequate food resources” (Keyes, 83). Participants lost 25% of their body weight by end of starvation period.

In June, isolation of first post-penicillin antibiotic-generating mold in sewage dump in harbor off Sardinia by Italian pharmacist Giuseppe Brotzu . He had noticed that sewage infested with Salmonella typhi was all but gone when it was dumped into the harbor, and bathers who occasionally drank it did not develop typhus, nor did those who ate raw shellfish from around the sewage outfall. The water contained the fungus from which cephalosporin C derived (Bo; Hamilton-Miller). In 1953, Edward Abraham, a member of Florey’s Oxford group, isolated Cephalosporin-C as the third antibiotic contained in Brotzu’s mold. It differed from penicillin by having much greater stability to acid, no penicillinamine or hydrolysis, and resistant to penicillinase (an enzyme, secreted by certain bacteria0 that can inactivate penicillin (Hamilton-Miller).

In August, authorization of the MASH, which differed from augmented surgical teams at field hospitals and clearing stations by permanently assigning rather than temporarily attaching surgeons to the mobile surgical hospital. It was based on understanding that postoperative hospitalization rather than just surgical intervention needed to be forward; reflected need for forward SHs rather than some form of forward surgical unit without hospital beds and nurses (Marble, 97-99).

Newly formed National Science Foundation creates the Artificial Limb Program, which targeted the need for advances in prosthetics owing to sheer volume of soldiers requiring focused care in this area.

Founding of Sloan-Kettering Institute for Cancer Research (SKI) on August 8th.

After WWII, 25% or more of medical students in France, Germany, and Britain were women; 80% in Soviet Union, but only 8% in U.S. (Bonner, 167). First cure of TB using streptomycin (Wainwright, 127). President Truman proposes the National Health Bill (a new Wagner-Murray-Dingell bill) to provide compulsory comprehensive national health insurance, to be financed by a 4% increase in the social security tax; it was killed by AMA; he tried again in 1949 (Stevens, 273-274; Burrow, 343-345).

Following misdiagnosis and death during surgery of one of his “blue babies” (who was found to have transposition of the great vessels rather than tetralogy), Blalock hires Richard Bing to organize world’s first diagnostic cardiac catheterization laboratory at Johns Hopkins (Fye 2, 113-114). Walt Lillehei returned from Europe and entered Wangensteen’s surgical training program at Univ. Minnesota (Miller, 29-32).

Duke surgeon David Wilson invents “Wilson’s balls,” i.e., Lucite spheres used in treatment of pulmonary TB (cavitary TB of the upper lobe), whereby the spheres were implanted in a surgically created cavity under the ribs in the upper chest to sustain the collapse of a surgically collapsed lung (thoracotomy) (Namana). Keeping the infected lung at rest thought to promote healing and restoration of normal functioning. “Lucite’s ability to be shaped into complex curves made it an ideal material for plombage (from Latin plumbum [lead]). Supporting Wilson’s pioneering procedure, the university laboratory technicians at Duke set to work developing one-inch spheres – and trials began” (Gowing, ). Treatment complications included hemorrhage, infection, fistulization to bronchus, great vessels of thorax like the esophagus, and skin (Namana).

Hahnemann Medical College placed on probation by AAMC, AMA’s Council on Medical Education, and Pennsylvania’s State Board of Licensure (Rogers, III, 139158).

Establishment of CDC “as an outpost of the nation’s malaria eradication effort in the South” (Colgrove III, Intro).

National Foundation for Infantile Paralysis names its first poster child, six-year-old Donald Anderson from a small-town in Oregon. Though depicted on the poster as “’a vibrant model of the ideal polio survivor . . . well-dressed, well-groomed, full of vitality,’” in actuality, he was far from fully recovered, with a memo of 1948 rating his condition as only ‘somewhat improved’.” The promotional use of the poster child followed the Foundation’s creation of a Women’s Division and March of Dimes Fashion Show in 1945 (Oshinsky II, 119-125).

Robert R. Wilson, a designer of the Harvard Cyclotron Laboratory, suggests proton beam therapy (i.e., energetic protons) as a form of medical treatment. The first treatments were performed using a particle acceleratory at UC Berkeley’s radiation laboratory in 1954, and then in Upsala, Sweden in 1957.

Psychiatrist John Romano leaves Cincinnati for University of Rochester and brings George Engel with him to play major role in Rochester’s psychosomatic teaching (T. Brown II, 10). Frank Berger publishes article on tranquilizing properties of mephenesin – predecessor of meprobamate – which he tested as a penicillin preservative in 1945 (Tone, 35-37).

Women’s Medical College’s abortive merger into Jefferson Medical College (Peitzman, 179-1781). Approximately one-half of all hospital beds in U.S. occupied by psychiatric patients (Valenstein, 169). NIH transformed and expanded into the peacetime CMR (Committee of Medical Research) (Rothman, 51ff.). Cooperative investigations of effectiveness of streptomycin in treatment of pulmonary TB conducted by VA and PHS, the latter with a control group: “ . . . the PHS’s studies of streptomycin served as an example of scientific progress in therapeutics. Along with centrally controlled randomization, their use of objectively measured indicators of progress and blinded assessments of therapeutic outcomes constituted adherence to a program of methodological reform in the postwar era” (Marks, 113ff., quote at 127; Dowling, 163). Dowling claims the VA study, in which “ each patient was used as his own control (50 days before streptomycin treatment compared with the course during 120 days of treatment), with x-ray films read by doctors unfamiliar with the cases” became “a landmark in clinical medicine” (Dowling, 164-65). British Medical Research Council also conducted blind trial of streptomycin for pulmonary TB, and its celebrated 1948 report of the trial contains “the earliest clear description of concealment of the allocation schedule . . . The reason that the Medical Research Council’s controlled trial of streptomycin for pulmonary tuberculosis should be regarded as a landmark is thus not, as is often suggested, because random number tables were used to generate the allocation schedule (as shown above, random allocation had been used at least a decade earlier). Rather it is because of the clearly described precautions that were taken to conceal the allocation schedule from those involved in entering patients” (Chalmers, 1162).

Passage of Hill-Burton Act under President Truman, “the most important piece of health legislation in the postwar decade (Stevens, 269; Burrow, 338). It subsidized the building of hospitals in rural areas through grants to state agencies (275-276). Hill-Burton had a major impact on hospital costs, since hospitals had to raise $2 for every federal dollar received, so that “debt service on the local matching funds became a significant new expenditure” (Cunningham, 92). While the act contained a nondiscrimination clause re provision of service, it provided a loophole allowing segregated states to maintain racial separation, whereby states that already had separate hospitals for black and whites could ignore the nondiscrimination clause as long as hospital facilities “of like quality” were provided for black citizens. “In the wake of Hill-Burton construction, black physicians were still excluded from the staffs of most public and nonprofit hospitals in the South.” Black physicians still benefitted from Hill-Burton, as its mandate for equal facilities for the races led some cities and counties to build new all-black hospitals with federal money, most open to black physicians. More commonly, Hill-Burton allowed southern cities and counties to turn over existing public hospitals to black community and build new, federally funded hospitals for whites (Ward, 176-177). In Memphis, “Cautious general practitioners regarded new hospitals and more specialists as unwelcome competition; they looked upon national health initiatives with hostility, and they braced themselves for the trouble such federal activism might stir up” (Wailoo III, 93).

Passage of National Mental Health Act (Burrow, 339). American Heart Association reorganizes as a voluntary health organization dedicated to funding cardiovascular research (Fye 2, 100-101). Founding of Society of Biological Psychiatry (Grob, 214).

Founding of Group for the Advancement of Psychiatry (GAP), a “mobile striking force for American psychiatry” (Will Menninger) that used the media to “sell” psychiatry and the “product” of mental health (Dowbiggin, 137-140).

In Germany Domagk’s Coneben (a thiosemicarbazone) proves effective against lupus vulgaris, a mutilating tubercular infection of the face (F. Ryan, 303-307).

First IBM-built heart-lung machine delivered to John Gibbon at Jefferson Hospital in Phila, and in 1949 he announced that he now saw the machine as a means of enabling open-heart surgery (Morris, loc 1704ff.)

Nuremberg Doctors’ Trial, focusing on crimes of Karl Brandt (Hitler’s personal physician and the chief accused ) and other Nazi doctors (Tucker, 72-75). Brandt had designed euthanasia program. American prosecutors were less concerned with criticizing scientific practices than with demonstrating how the depravity of the Nazi system had penetrated the medical profession; there was concern among American and British scientists lest the trial “turn the public’s stomach against human experimentation in general” (Allen, 254-256). “For all the defendants, the impulse and strategy was to blame the dead. Himmler, the master deviant, was dead, as were Grawitz and Ding-Schuler” (256).

Charles Drew writes bitter letter to JAMA editor protesting AMA’s racially based denial of membership to qualified black applicants whose local chapters retained racial restrictions – like Drew’s own District of Columbia and the whole south (Wynes, 89-90).

Establishment of American Academy of General Practice, which began publishing GP in 1950; general practice was defined through continuing education rather than through a specified residency program (Stevens, 303-304; Stepansky II, 164-172); it began pressing for a certifying board only in 1965 (Stevens, 313). Federal Security Administrator Oscar Ewing releases report to President Truman embodying recommendations of Truman’s National Health Assembly and adding to them a proposal for national system of health insurance: AMA goes ballistic (Burrow, 352-353). Joslin begins awarding his “Victory Medals” to 25-year diabetes survivors in perfect health (Feudtner, 175-176).

Western Reserve surgeon Claude Beck reports first case of a patient who survived after the use of countershock in treating intraoperative ventricular fibrillation (open-chest defibrillation via emergency thoracotomy); in 1941, he had published two case reports of unsuccessful resuscitation, first attempted in 1938 (Fye II, 864; Jeffrey, loc 219-220). Paul Zoll’s experiments on application of current across closed chest to terminate ventricular fibrillation in early 50s(Morris, loc 2872ff.); Kouwenhoven’s (at Hopkins) development of technique of closed-chest cardiac message in 1960; and introduction of continuous ECG monitoring of high-risk patients along with personnel trained in techniques of cardiopulmonary resuscitation and electric countershock – these three developments taken together enabled “defibrillation to have a meaningful impact in reducing the incidence of death from cardiac arrest” (Fye II, 864).

Jonas Salk accepts Directorship of Virus Research Laboratory at Univ. of Pittsburgh Medical School, with NFIP grant for mop-up studies to confirm previous research on the three strains of polio virus (Offit, loc 362-382).

Launching of Framingham Heart Study, which popularized the term “risk factor” and mapped the relations of coronary heart disease to factors such as serum cholesterol, blood pressure, and cigarette smoking and followed its cohort for more than a half century (Oppenheimer, 602). Owing to its careful nurture of the community’s elite and the community’s early adoption of the research, after almost 30 years of follow-up, the study had only a 3% drop out rate (606). In 1949, the study was taken over by the newly established National Health Institute, which “stood the previous investigation on its head. Framingham would be a ‘follow-up’ study, 20 years in duration, of individuals free initially of atherosclerotic or hypertensive cardiovascular disease” (607). In the 1950s, “Framingham first reported significant correlations between CHD and blood pressure, obesity and cholesterol, as well as pivotal techniques for analyzing such multiple factors simultaneously” (609). Zoll’s first successful use of external pacemaker on patient with regular Stokes-Adams attacks, was in 1952: the device kept him alive for 25 minutes; his second patient made a full recovery (Morris, loc 2878ff. ).

Establishment of Montefiore Home Care Program, first hospital-based back-to-the-home program, i.e., coordinated home care program (CHCP). “By the 1950s, home care programs claimed that even paracenteses, infusions, and blood transfusions were offered at home” (Buhler-Wilkerson, 190). . . . “Most patients were medically indigent, chronically ill, and female. . . . any economic advantages of home care probably derived from the unpaid contribution of family members – primarily women” (191). Most persistent difficulty with the programs was “the antagonism toward home care among visiting house staff. Attending physicians fear that extension of hospital services into homes was a step in the direction of socialized medicine” (191). . . . With the exception of the indigent, the savings from shortened hospital stays – or no hospitalization at all – accrued to the patient or community, not to the hospital or insurance company. An estimated 15 to 20 percent of hospital patients with acute illnesses qualified for home care” (192).

Creation of Britain’s National Health Service (NHS), a continuation of the Emergency Hospital (later Medical) Service of 1939 that brought the nation’s hospital services – voluntary, municipal, and Poor Law – under state control. It was “driven primarily by a concern to promote national efficiency and competitiveness by providing a system of mass health care. With the creation of the NHS these values came also to dominate what had previously been the elite voluntary hospitals, while the interests of private doctors were relegated to a distinctly inferior, if still potent, place in the organization of health care. . . individualized forms of medical practice were to a large extent displace by teamwork and managerialism in hospital medicine, and by standardization and routinization in general practice” (Sturdy & Cooter, 15, 16). It included a Social Medicine Research Unit that was influenced by Major Jerry Morris’s handbook Unless We Plan Now: Health, which he published from India in 1944, and focused on infant mortality, coronary heart disease, and the provision of health services (J. Daly, 145).

Jonas Salk leaves Univ. Michigan and mentorship of Thomas Francisis to head newly launched virus research program at Univ. Pittsburgh Medical School at a time when Pitt “was off the map as a research institution. . . The faith in a killed-virus vaccine, the experiments with formaldehyde, the use of adjuvants, the mass testing technique – all had come from his association with Tommy Francis” (Oshinsky II, 153). The NFIP gave Pitt $30k in seed money, and Salk was given two bare rooms in basement of Municipal Hospital. At the time of his appointment, Salk’s primary area of expertise was influenza, and the Army allowed him to take his influenza grant to Pitt. In 1947, the possibility of a polio vaccine was still very much in doubt (156-158). It was only when Salk agreed to undertake the enormous (and lower-level) research task of determining how many different types of poliovirus existed and developing a steady supply of each virus type to be used in a vaccine that the extra-institutional funding flowed in. The typing program lasted from 1949 to1951 (163-167).

Congress passes National Heart Act to support cardiovascular research and training; act established National Heart Institute as division of NIH and the National Advisory Heart Council (Fye 2, 106; Burrow, 339). Hahnemann surgeon Charles Bailey, after four failures, succeeds in mitral valve surgery at Episcopal Hospital (he widened valve with a hooked knife, then with his finger) (Miller, 59-60).

Lily introduces first oral penicillin (V-Cil-K) (Wainwright, 86). John Enders and his team at Children’s Hospital in Boston cultivate the Lansing strain of polio in nonneurological tissue, leading to discovery of new properties of polio virus and ways to asses v v crust (i.e., purified crystals of polio virus) in tissue culture rather than through laboratory animals (Rogers, 173; Gould, 123-125).

Introduction of first commercial dissolvable aspirin (Disprin) at London Medical Exhibition (Jeffreys, 203-205).

Lederle Labs (owned by American Cyanamid) receives U.S. Patent for new soil-based bacterial antibiotic, Aureomycin (tetracycline, the first broad spectrum antibiotic effective against both gram-positive and gram-negative bacteria (e.g., tetanus, typhoid fever) and initiates advertising blitz that inaugurates “the new marketing campaigns that quickly became standard practice” (Herzberg, 23). A year later, in 1950, Pfizer received a patent on its own tetracycline, Terramycin (oxytetracycline), essentially the same as Aureomycin (both Actinomyces), but with a side-chain difference that enabled Pfizer to get a separate patent.

Governors from 11 southern states form Southern Regional Education Pact (SREP) with Meharry Medical College (Nashville). Under this plan, Meharry reserved 75% of places in freshman class for students from participating states and received $1,500 per med student and $750 per nursing student (Ward, 41). Following Supreme Court rulings in Gaines (1938) and Sipuel (1948), Univ. of Arkansas becomes first white Southern medical school to admit a black applicant to its medical school, Edith Mae Irby (54). Ditto re postgraduate medical education in 1930s and 1940s: “In lieu of creating postgraduate programs for black doctors – or integrating their current programs – a number of southern states provided scholarships for black doctors to study at Meharry” (86). Black doctors in Lynchburg, VA granted admitting privileges in city’s public hospital after 12-year campaign, but only on “Negro floors” and only black nurses could work with them (Ward, 158-159; cf. 175).

Establishment of American Academy of Neurology, at a time when ANA had fewer than 200 members: “Experience in World War II with central and peripheral nerve injuries had stimulated a rejuvenated interest in the treatment of neurological patients and the training of a young generation of practitioners to perform this treatment; indeed the numbers of such patients was sizable, with 44,000 of the 74,000 Veterans Administration hospital beds filled with neuropsychiatric patients in April 1946” (Louis, 344). Main opposition to AAN was in Boston-NY-Phila. area (349) . . . “The long-existing ANA actively resisted the new organization” (353). Establishment of National Institute of Neurological Diseases and Blindness provided “the true impetus for the development of clinical neurology” (Rowland, 108).

Sister Kenny testifies before House Committee on Interstate and Foreign Commerce – which was gathering support for its position in favor of including special disease commissions in the proposed NSF -- as “a medical populist who transformed the Washington hearings into a platform to attack organized medicine, especially . . . the National Foundation for Infantile Paralysis” (Rogers II, 97). Its director, Basil O’Connor “relied on his friend Morris Fishbein to promote the Natl. Foundation’s interests in his public role as editor of JAMA and, behind the scenes, as private censor” (107). Kenny “was unable to muster support for a government research agency that targeted polio, much less for her distinctive theory of the disease, and the National Foundation was able to make sure no National Polio Institute was ever established. But the 1948 hearings did help legitimate the mixing of populism into the politics of science research” (102). By the time she came to Washington “Kenny was struggling not just for legitimacy (on her own terms) but also for her legacy. Even as medical texts and public health bulletins on polio came to reject splinting in favor of hot packs and muscle training, they often left out Kenny herself . . .” (106; cf. Oshinsky II, 107-113 on Kenny’s repudiation by the Funding [Basil O’Connor] and medical [Morris Fishbein] establishments).

Wilfred Bigelow, working out of Toronto General Hospital, repairs cardiac lesion using deep hypothermia, believing that metabolism would diminish to the point that circulatory arrest could be tolerated for the short period required for the repair (Furman, 2014).

Charles Bailey (Hahnemann Hospital) performs first successful surgery of stenotic mitral valve using a knife attached to his finger like an extended claw (valvulotome), but surgeons soon found that this approach, while alleviating stenosis, often prevented the valve from closing fully, resulting in valve regurgitation, and opted for Souttar’s “finger-fracture” technique of using a forefinger to break open the fused valve leaflets. Further improvement came in 1954, when French surgeon Charles Dubost invented a dilator more efficient than finger in opening stenotic valves (Morris, loc 2280ff.).

In December, working out of Brooklyn Jewish Hospital, where he was chief of surgery, Berlin surgeon Rudolf Nissen operates on Albert Einstein for an aneurysm of the abdominal aorta the size of a grapefruit (4” diameter). Absent prosthetic tubing, he wrapped the aneurysm in cellophane, on the theory that it would stimulate a connective tissue reaction, leading to formation of scar tissue that would strengthen the thick wall of the distended artery and perhaps postpone rupture for some time. Einstein lived another seven years in Princeton, dying in April 1955, when he refused further surgery (Van de Laar, ch 15).

42,000 cases of polio reported in U.S., making it the worst year on record by far. At Lederle Labs in Pearl River, NY, Hilary Koprowski tested his live-virus polio vaccine on himself (1948) then, in 1950, on feeble-minded and epileptic children at Letchworth Village (Oshinsky, 134-135) and found that all the non-immune vaccinated kids developed Type II polio antibodies (Oshinsky, 134-136).

Ferdinand Sauerbruch’s resignation (owing to cerebral sclerosis) as Director of Surgical Clinic of Berlin’s Charité Hospital.

Harold Gillies performs first successful phalloplasty on a trans man (Fitzharris II, 345-46).

North Carolina’s State Association of Negro Registered Nurses dissolves itself voluntarily after agreeing on “merger” with the North Carolina State Nurses Association (founded in 1902). The merger presented no immediate threat to white supremacy and Jim Crow laws; it included the high $13 NCSNA dues to impede black membership and a new organizational structure that planned education presentations in desegregated venues but social gatherings in those that prohibited African American clients” (D’Antonio, 155). Two years earlier, in 1947, the NCSNA quietly removed “white” from its by-laws; “It had no choice because it had to comply with federal regulations if the association were to represent nurses as a collective bargaining unit” (150).

Franz Groedel creates American College of Cardiology as counterpoise to American Heart Association; ACC focused on continuing medical education for practicing cardiologists and appealed to cardiologists excluded from the AHA’s elitist Scientific Council. It was bitterly opposed by AHA leaders, who thought it would cut into their local fund-raising (Fye 2, 118ff.)

Philip Hench and colleagues at Mayo Clinic announce dramatic effects of “Compound E” (cortisone, a steroid found in minute amounts in the adrenal cortex) on arthritis sufferers. Results of first 16 patients published as “Preliminary Report” on 13 April 1949 issue of “Proceedings of the Staff Meetings of the Mayo Clinic” (Hetenyi & Karsh). The drug could only be produced in minute quantities, so the manufacturer, Merck, requested that the National Academy of Sciences establish a committee (which was headed by A. N. Richards) to allocate it among researchers. The NAS had directed the clinical evaluation of penicillin during WWII. “. . . the failure of Merck’s efforts to have the NAS direct the evaluation and allocation of cortisone reinforced existing pressures for proprietary control over clinical drug research” (Marks III, 421). The rise of NIH’s research empire “may equally be regarded as the response to a deadlocked system of private agencies and interests. In this interpretation, the cortisone episode represents in microcosm a recurring dilemma of postwar science: the search for authoritative, disinterested scientific advice in circumstances where no single authority appeared disinterested to all parties. Merck began the quest for authoritative science by delegating its authority to the NAS. The NAS and the Richards committee seemed disinterested to Merck but not to the disease specialists or the disease foundations . . . . Similarly, to the medical scientists on the NAS committee, the disease specialists seemed excessively self-interested. Officials of the Bureau of the Budget and officers of the Rockefeller Foundation were similarly skeptical of the disease foundations. . . . Meanwhile, the disease foundations, having undermined the NAS committee, found themselves on the NIH’s doorstep” (438-439).

first effective cancer drug, Mustargen, effective in treating lymphomas, comes to market (S. Smith II, ch 4). David Karnofsky and Joseph Burchenal, working out of NYC’s Memorial Hospital, create Karnofsky performance status scale, still used by oncologists to assess cancer patients’ health, specifically, dose tolerance and patients’ ability to perform normal activity (S. Smith [II], loc 2422-2427).

Linus Pauling and colleagues discover that abnormal hemoglobin molecules play major role in formation of sickled red blood cells  reductionist belief that discrete molecular-level anomalies caused disease, spurring growth of molecular biology and search for desickling agents for sickle cell anemia (Wailoo I, 123). “Pauling’s discovery immediately made sickle cell disease into a researcher’s cash crop . . . sickle cell disease became a researcher’s commodity for doing science as well as a social commodity for building awareness of the African American condition. At the same time, it continued to be a commodity of increasing value in medical education, highlighting the links between molecular biology and clinical medicine . . . sickle cell disease was the quintessential stock example of how molecular-level mechanisms could lead to clinical disease. The malady’s unique molecular characteristics drew sickle cell patients into a new economy – one in which the drive to publish new findings, get grants, and build research programs increased the value of the patients themselves” (Wailoo II, 115, 116). In mid-80s, bone marrow transplantation as “a perverse therapeutic lottery,” on account of high-risk of death during procedure (as high as 25%) and likelihood of graft-versus-host disease (GVHD) among survivors (Wailoo I, 147-149). In 1995, hydroxyurea (HU), used to treat leukemia and believed to be a genetic switch, shown to reduce number of crises and produce a milder form of SCA, albeit with heightened risk for leukemia (Wailoo III, 142-147). The ethical dilemma: “Should medicine be offering these kinds of odds and choices at all? Should such dangerous life-sustaining techniques be part of the American medical marketplace?” (155). “Unlike the CF [cystic fibrosis] ‘gene doctors’ who came out of the subculture of research entrepreneurism, most sickle cell researchers weighing the evidence on BMT had no financial stake in the outcome. On weighing all the evidence, most agreed that BMT [bone marrow transplantation] remained too risky and that ‘the search for other therapies not based on marrow transplantation should be continued’” (157). “For sickle cell researchers and physicians, the racial experiences of patients have been considerably more than a convenient and vague allusion. For practitioners and patients, pain and infection management, the unfulfilled dream of desickling agents, and the gamble inherent in BMT were routinely racialized – and made to resonate with social and political meanings” (159).

Denton Cooley devises “clamp and saw” technique of repairing aorta aneurysm: clamping the aorta, excising aneurysmal sac, and sewing up the hole. This was the first successful means of removing aneurysms (Morris, loc 1258).

Raul Leborgne (Uruguay) demonstrates importance of high-contrast breast images (via visualization of microcalcifications in 30% of cancer cases); this was “major leap forward for breast cancer imaging” (Kevles, 252).

John Cade’s initial report on success of lithium in treating “psychotic excitement” in Medical J. of Australia has no impact, owing to his obscurity and concern over lithium toxicity. Lithium treatment received major boost from Mogens Schon (Denmark), who confirmed its therapeutic value in what may have been the first double-blind psychopharm study, published in 1954. Schon et al.’s subsequent double-blind study, published in Lancet in 1970, finally put the critics to rest; Lithium received FDA approval (but only for treatment of mania) in 1970 (Valenstein, 45-49).

British Medical Council study on PAS and streptomycin for TB shows that combination treatment vastly superior to treatment with either drug alone in reducing risk of development of streptomycin-resistant tubercle bacilli during the six months following start of treatment (F. Ryan, 330-331).

Establishment of National Science Foundation, which included a Division of Medical Research (Burrow, 323-324). Establishment of American College of Cardiology, an outgrowth of the New York Cardiological Society founded in 1927 and formally established in 1934 (Howell II, 775).

Publication of Ancel Keys’ The Biology of Human Starvation (2 vols., 1,385 pages) by University of Minnesota Press. “The scale of the work reflected Keys’ outsized ambition” (Tucker, 194).

Synthesizing of meprobamate by Frank Berger and colleagues at Wallace Laboratories. Small-scale trials began at end of 1951 and confirmed Berger’s monkey trials re reduction of anxiety. But Henry Hoyt, president of Carter Products, parent company of Wallace Laboratories, put the project on hold. It was only released by Wallace as Miltown and by Wyeth (licensee; a division of American Home Products) as Equanil in May 1955 (Tone, 32-52). Wallace Labs was Carter Products’ effort to gain new respectability as a manufacturer of “ethical” drugs (Herzberg, 21, 24-25). It was the product of Frank Berger’s and Wm. Bradley’s search for drugs effective against gram-negative organisms in 1945-1946 (Valenstein, 52-54), which led to synthesis of mephenesin (predecessor of meprobamate) in 1945, released by Squibb in Britain in 1947 and in U.S. in 1948 as Tolserol, used to produce muscle relaxation during light anesthesia, and still used today as a muscle relaxant (Tone, 35-36).

Publication by Doll and Hill in UK (relying on a study population of smoking British physicians), followed by 1954 U.S. study of Hammond and Horn (with study population of 192,174 males with lung cancer) that cigarette smoking led to lung cancer. Both studies identified a several-year latency period before lung cancer was manifest. Subsequent lung cancer research reaffirmed the linkage, and U.S. Surgeon General and UK Research Council to issue official public health reports that cigarette habit was dangerous to health (Ruegg; Use).

Wangensteen and his team operate on Walt Lillehei for lymphosarcoma (malignant neck node) (Miller, 38ff.).

In Germany, establishment of Department for Psychosomatic Medicine at University of Heidelberg, following Mitschlerlich’s proposal for a university setting to link psychoanalytic psychotherapy to all other medical specialties and, at the same time, to open it to the behavioral sciences. The department was not part of the psychiatry department but attached to Weizsächer’s neurology section of the department of internal medicine (Roelcke, 484). The new department was a result of Mitscherlich’s and Weizsäcker’s political maneuvering and attested to the fact “that the success of postwar psychotherapy and psychosomatic medicine in and outside German universities was not a consequence of an acceptance by physicians of the merits of psychoanalysis, or psychotherapy, but the result of outside political pressures” (482, cf. 491).

Durham Humphrey Amendments to FDCA of 1938 created a statutory definition of prescription drugs; primary purpose was to avoid patient self-diagnosis and self-administration of complex and potentially harmful drugs (Donohue, 667). It used the language of the FDA’s 1944 prescription regulations: A drug could be dispensed “only upon a written prescription” if “because of its toxicity or other potentiality for harmful effect, or the method of its use, or the collateral measures necessary to its use, [it] is not safe for use except under the supervision of a practitioner licensed by law . . .” But the initiative remained with the drug companies [not the FDA], who would decide which of their products met the statutory criterion” (Marks IV, 112). “Instead of an administrative decision, which the drug companies could appeal, the FDA would have to sue the companies for misbranding if it disliked their decisions.” Also the law dealt only with drug safety, not efficacy (Temin, 103). “In the Cold War era, the regulated [drug] industry imparted ideological significance to the prescription drug regulations in a successful campaign to maximize the industry’s control over prescription labeling. . . . The industry’s success in Congress depended on the powerful appeal of antistatist and anticommunist rhetoric in postwar America” (Marks IV, 113).

Eli Robins, Harvard-trained, joins psychiatry dept. of Washington University, joined a few years later by Samuel Guze and George Winokur. The Wash. University triumvirate advocated a return to Kraepelinian principles and “were instrumental in fomenting a counter-revolution that overthrew the power of psychoanalysis in American psychiatry” (Paris, 75-78, 84-85). Psychiatric researchers at Washington Univ. and New York State Psychiatric Institute (Columbia) later “constituted an ‘invisible college’ of neo-Kraepelinians” (Kirk & Kutchins, 49). Erik Erikson accepted Robert Knight’s offer to join staff of Austen Riggs Center in Stockbridge, MA (L. Friedman, 253-254).

Carl Djerassi, working out of Syntex in Mexico City, patents norestheisterone (or norethindrone), synthetic hormone (type of steroid) eight times more powerful than natural progesterone (Asbell, 109-110).

In Paris, Charles Dubos performs first successful opination to replace an AAA (abdominal aortic aneurysm), using piece of aorta from a deceased donor (Van de Laar, ch 16).

Bayer in Germany and Squibb and Hoffman La Roche in US simultaneously discover isoniazid (Neoteben, Marsilid, Rimifon) as final “wonder drug” in war against TB. Isoniazid was a derivative of the thiosemicarbazones discovered by Domagk and colleagues at Bayer in Germany. First report in US was by Robitzek and Selikoff on their six-month trial of isoniazid with 97 consecutive patients with pulmonary TB at NJ’s Sea View Hospital, published in Am. Rev. Tuberculosis in April1952 (F. Ryan, 351-357; Daniel, 217-18). But neither La Roche, Squibb nor Bayer could patent isoniazid, since two Prague chemists had synthesized it back in 1912 (albeit not apropos any medical therapy) (359). And tubercle bacilli developed resistant to isoniazid with “effortless ease” so that its future “could only lie in combination therapy” (377). In 1953, isoniazid became generally available to all TB patients, and the 839 TB hospitals in the US rapidly closed down; by 1972, there were only four TB hospitals in US (Daniel, 219).

In US, launching of massive campaign against overweight led by Louis Dublin of MLIC and deriving from his flawed studies on weight and mortality. E.g., his policyholders were a self-selected population of Anglo-Saxons insured between 1925 & 1934; many were probably overweight to begin with (healthy overweight persons didn’t buy life insurance; unhealthy overweight sought out the policies); applicants were weighed clothed and shod, at least 20% reported their own weights, they were weighed only when they bought their premiums, so that age and weight gain over time were not factored into the MLIC studies that led to his notion of “ideal weight” (first published in 1942 & 43). He didn’t consider other variables (e.g., chronic illness among elderly) that correlated with weight (older people weigh more) but was not a product of obesity. Overweight is a symptom of mature-onset diabetes, not its cause (Seid, 116-119).

Birth of Paul E. Stepansky (June 7), who assembled the Stepansky Medical-Surgical Timeline between 1998 and 2024, and of Deane Rand Stepansky (June 26) , immensely gifted collaborator without whose inestimable assistance and loving support, the Timeline would never have come into existence.

Surgeon David Hume at Pent Bent Brigham in Boston performs series of kidney transplants, all of which led to patients’ deaths owing to rejection, which Peter Medewar would shortly explain (Craddock, 216). This followed Hume’s dialysis operation of 1946 in which he taped a human kidney to the top of patient’s arm, connecting it via vein and artery (214). Joseph Murray and his team, also at the Brigham, performed the first kidney transplant with identical twins, Richard and Ronald Herrick, on December 23, 1954; the recipient brother, Richard, lived eight more years before the transplanted kidney became infected. By 1966, 23 kidney transplants with identical twins had been performed (218-221).

Following Wilfred Bigelow’s (Toronto) report of ice water anesthesia on dogs to lower core temperatures, in Minneapolis, F. John Lewis, assisted by Lillehei and Varco, performs first successful open-heart operation to repair ASD (atrial septal defect) in a five-year-old girl, relying on hypothermia, which lowered the core temp to 82 F., to create the five-and-half minutes needed to make the repair (Miller, 79-82; Jeffrey, loc 202-203).

Paul Zoll builds and successfully employs first external pacemaker, a box worn around the neck with leads attached to chest skin, but it could not be worn for more than seven days, causing skin burns around the electrodes and painful contraction of skeletal chest muscles, and frequently required sedation owing to the degree of discomfort. In early 1953, he announced effectiveness of pacing in managing Stokes-Adam Syndrome (associated with total heart block since late 19th c.), and this attracted both professional public interests. In 1946, Leatham and colleagues developed an external transcutaneous pacemaker that incorporated automatic onset and termination of stimulation (Furman; Jeffrey, ch 2). Zoll’s most important insight at this stage of the field was his recognition that he should pace the ventricle, not the atrium. . . . Zoll also recognized that pacemaker stimuli might be able to restore a normal heart rhythm in circumstances other than Stokes-Adams attacks. . . . After 1952, Zoll developed an external AC defibrillator and a cardiac monitor that would enable the attending physician to diagnose instantly the onset and nature of a dangerous arrhythmia. Together with the external pacemaker, these machines provided the initial technological basis for the cardiac intensive care units that mushroomed in U.S. hospitals during the 1960s: (Jeffrey, loc 244-246).

Paris military surgeon Laborit publishes first article on chlorpromazine’s usefulness in surgery (re “potentiator” of anesthesia and prevention of postsurgical shock), rendering patients calm, relaxed, and detached; they used it as part of a “lytic cocktail” designed to reduce surgical stress in multiple body systems (Healy, II, 79-80). Drug was synthesized by Paul Charpentier of Rhone-Poulenc as RP4360, on December 11, 1950. It was a chlorinated form of the antihistamine Promazine, sold as Sparine (Healy, II, 81). Laborit encouraged J. Hamon to try it on psychiatric patients at Val de Grace Hospital in February; then French psychiatrists Jean Delay and Pierre Deniker at Hopital Ste-Anne published six papers between May and July describing psychiatric trials with chlorpromazine (Healy, II, 85-93; López-Munoz II). They referred to the clinical picture of slowing down of motor activity, affective indifference and emotional neutrality as neuroleptic syndrome (neuroleptic from the Greek “that take the nerve”). Drug firm Rhone-Poulenc began making it available for clinical trials, exploring various applications as an anesthetic, to induce “hibernation” during surgery; as an antiemetic for seasickness; a treatment for burns, stress, infections, obesity, Parkinson’s disease, epilepsy. By 1953, following reports of Delay and Deniker (Paris), Heinz Lehmann (Montreal), and Winkelman (Phila), clinical trials centered on psychiatric applications (Valenstein, 24-25; Healy, I, 43-48). Smith Kline & French acquired U.S. rights to the drug, which it initially hoped to market to surgeons and psychiatrists; it licensed chlorpromazine as an anti-emetic, not as an antipsychotic (Healy, II, 84-85). But by end of 1953, it was concentrating on marketing chlorpromazine in psychiatry, naming it Thorazine in May, 1954 (Valenstein, 30-31; on marketing of Thorazine by SK&F, 167-69). Healy (II, 97) says that when SK&F finally launched Thorazine in 1955 (Valenstein puts launch at end of 1953), even though the license application had been for an anti-emetic, “the take-up in psychiatry was astonishing – SK&F reportedly took in $75 million the first year the drug was sold.” Release of Miltown in second half of 1955 popularized the term “tranquilizer” (coined by Ciba’s F F. Yonkman in 1953 to describe reserpine) and led to Thorazine’s designation as a “major tranquilizer” whereas Miltown and later Librium and Valium were “minor tranquilizers” (Healy, II, 99).

Publication of results of isoniazid (an antitubercular hydrazide) in treatment of TB; it “not only appeared to be more effective than streptomycin but also could be given by mouth and rarely caused serious adverse reactions.” It was most effective in combination with streptomycin (Dowling, 168). APHS trial found isoniazid was as effective as streptomycin and PAS together, but that isoniazid combined with streptomycin was much better (F. Ryan, 363). A side-effect of isoniazid was its psycho-stimulative effect, which proved even greater in iproniazid. A group of researchers (from Baylor, Minnesota, and Univ. Córdoba, Spain) saw that the mood-raising effects of hydrazide therapy in tuberculosis patients could become the primary indication for use of the drug in psychiatry. Nathan Kline, then assistant professor at Columbia, published a report on first neuropsychiatric experiences with iproniazid in 1957; by 1958, though only marketed as an antitubercular agent (Marsilid), it had been given to over 400,000 depressed psychiatric patients. Iproniazid withdrawn from US market in 1961 owing to alleged linkage to cases of jaundice and nephrotoxicity/. Today, MAOIs are second-choice drugs in cases of refractory atypical depression (López-Munoz III; Tone II, 128-9)

Joint Commission on Accreditation of Hospitals, with representatives from AMA, AHA, American College of Surgeons, and American College of Physicians, begins evaluating hospitals in order to ensure standardization (Stevens II, 246-48). American Psychiatric Assn. publishes its first DSM, developed by members of GAP and consistent both with psychoanalysis and with ideas of Adolf Meyer. At least 10 of the 21 members of APA Committee on Nomenclature & Statistics belonged to psychoanalytic organizations (Paris, 81; Kirk & Kutchins, 28; Valenstein, 157). Establishment of National Resident Matching Program, a private, nonprofit corporation (Cheng, 181-2).

59,000 cases of polio in U.S.; in national poll, polio second only to atom bomb as most feared among Americans (Offit, 386).

Selman Waksman receives Nobel Prize for discovery of streptomycin; Albert Schatz, co-discoverer, ignored (Wainwright, 132ff.). Committee also denied prize to Jorgen Lehmann, Swedish discoverer of PAS, which was discovered same years as streptomycin (1944) but only reached publication in 1946 (F. Ryan, 367-370). Salk’s first trial of his dead-virus polio vaccine (made from monkey testicles and kidneys, with live viruses killed with formaldehyde) on polios at the D. T. Watson Home for Crippled Children (outside Pittsburgh) to see if it would boost their antibody levels – a complete success (Gould, 132), but Offit says results were disappointing, as only vaccines containing type 2 strain (not 1 or 3) of the virus were effective. The breakthrough was in the follow-up study in May at Polk State School for mentally retarded boys, where a vaccine containing all three strains, suspended in mineral oil (an adjuvant) generated antibodies in both blood and serum (Offit, loc 431).

Mental (i.e., antidepressive) effects of iproniazid (an MAOI), initially developed and used for its tuberculostatic properties, first noted by several investigators. By 1956, mental side effects of iproniazid caused it to fall out of favor in treatment of TB (Healy, I, 61-63).

Sanford Palay at Rockefeller University, using electron microscopy, publishes first reports on fine structure of the synapse – including the vesicles on the presynaptic (axonal) side of nerve endings in which neurotransmitters are manufactured and stored -- confirming Cajal’s deductions (Rapport, 171, 173, 177).

Virginia Apgar’s development of neonatal scoring system led to concern with correlation between low Apgar scores, neonatal asphyxia, and cerebral palsy, and thence to public attention to potential for drug damage to fetus during pregnancy (Caton, 201-205).

Mary Calderone accepts part-time position of medical director of Planned Parenthood of America (More, 207). “By the time Calderone resigned from PPFA [in 1964], the APHA in 1959 and the AMA in 1964 both had issued policy statements supporting the inclusion of family planning in general medical practice – in large measure because of her behind-the scenes lobbying” (209).

Utilizing the Siemens Ultrasound Reflectoscope, Edler & Hertz (Holland) launch echocardiography (ultrasound cardiography [UCG]) by applying ultrasound to heart in vivo and getting real-time images of cardiac structures via M (motion) mode ultrasound (Kevles, 241-42; Singh & Goyal, 433). “During the course of subsequent examinations, Edler observed that the typical UCG finding from the anterior wall of the left atrium of patients with mitral stenosis was different from that recorded in patients with mitral regurgitation. . . . The original goals that had spurred the development of this technique had been met; in addition to establishing a diagnostic distinction between stenosis and regurgitation, echocardiography made it possible to determine the severity of the stenosis. A correlation had been found between the speed of diastolic downstroke and the size of the mitral ostium” (Singh & Goyal, 434). Note: M-mode echocardiogram was not a “picture” of heart but a diagram that showed how the position of heart structures changed during the course of the cardiac cycle. It was in the early 1970s, that Reggie Eggleston, using a Sunbeam electronic toothbrush, produce first commercially successful 2-dimensional echocardiogram, which enabled visualization of actual images of the heart (436).

On May 6, John Gibbon’s first successful use of his IBM-built heart-lung machine, which kept patient alive for 26 minutes while he repaired the ASD of 18-year-old Cecelia Bavolet at Jefferson Hospital in Phila . “This operation was the first successful open- heart operation in the world using a heart-lung machine” (Gibbon, 619). But his next two attempts in July were disasters and he suspended open-heart surgery at Jefferson for a year and never again performed open-heart surgery himself (Miller, 87-90; Morris, loc 1763ff.).

NIH opens its Clinical Research Center (a 500-bed research hospital): “The Clinical Center set neither formal requirements to protect human subjects nor clear standards for its investigators to follow in making certain that subjects were well informed about the research protocols. . . .This policy reflected, first, a faith at the Clinical Center that the researcher-subject relationship was identical to the doctor-patient relationship (Rothman, 55, 57).

Establishment of Department of Health, Education, and Welfare, which “embodied political expediency more than any coherent vision of a healthy nation,” and became important to local health was via grants to states and cities (Colgrove III, Intro).

Merger of Rahway, NJ-based Merck and Baltimore-based Sharp & Dohme (which had acquired H. K. Mulford in 1929 and acquired Mulford’s line of vaccines and serum antitoxins). Sharp & Dohme’s first success was sulfathiazole, a heterocyclic derivative of sulfanilamide that was as effective as sulfapyridine against bacterial pneumonia (Lesch III, 202). Merck centralized all R&D under the Merck Sharp & Dohme Research Laboratories in 1956, and appointed Max Tischler president of MSDRL in 1957 (Galambos & Sewell, 56-58), and Tischler appointed Maurice Hilleman director of Virus and Cell Biology Research in the Merck Institute for Therapeutic Research (64ff.). Expansion of both firms since the 1930s was squarely based on the sulfa drugs

Nathan Kline tests reserpine on patients at Rockland State Hospital (NY) and was soon promoting it as an “effective sedative for use in mental hospitals” (Valenstein, 69; Healy, I, 59-70; Healy, II, 104-05). At symposium at Ciba headquarters in Summit, NJ in 1953, Yonkman first uses the term “tranquilizer” to characterize mixture of sedation and well-being produced by reserpine (Healy, I,103-04). In 1955, Steve Brodie and colleagues at NIH reported that reserpine reduced the level of brain serotonin (I, 70 II, 106). Amine neurotransmitters are stored in small protective pouches, the synaptic vesicles, located at terminal endings; neurons adjacent to the synapse. Reserpine causes the biogenic amines to leak out of the vesicles, thus stimulating neighboring neurons and leading to the initial excitatory effect of the drug (I, 71). “Throughout the 1950s, reserpine was far more frequently mentioned in the scientific literature than chlorpromazine” (II, 106).

George Engel and Franz Reichsman at Rochester begin naturalistic experiments with “Monica,” an infant admitted to Strong Memorial Hospital with congenital atresia of the esophagus that required two fistulas be established: she enabled them to explore the connections between her behavioral responses, object relationships, and gastric secretory activity (T. Brown II, 17-19).

John Bonica publishes The Management of Pain, which launches the concept of multidisciplinary pain clinics (Baszanger, 121-122).

Plastic surgeon Robert Alan Franklyn published “The Operation that Remolds Flat-Chested Women” in Pageant, proposing breast augmentation via the Ivalon (or polyvinyl) sponge, launching debate and incurring criticism for self-promotion among colleagues (Haiken, 237-245).

Opening of first ICUs (including at Chestnut Hill Hospital, PA), usu. of 4-6 beds (Fairman & Lynaugh, 12-13). ICUs neutralized patient stratification via gender and economics and race (16) and promoted equality with physicians: “physicians would have to relinquish their traditional monopoly on clinical knowledge and decision-making (18). ICU nurses organized into American Association of Cardiovascular Nurses in 1969, renamed American Association of Critical-Care Nurses (AACN) in 1971, but ANA refused affiliation with them as an ANA interest group (18-20). ICUs are response to several post-WWII developments in hospitals: (1) increased utilization (via Hill-Burton Act); (2) newly complex and demanding (e.g., postsurgical cardiac patients [now with early postsurgical ambulation (31)]l; stroke patients; dialysis patients; more complicated drug regimens; (3) shift to predominantly semiprivate (covered by private insurance) and private rooms and elimination of large (e.g., 30-50 patient) wards (also promoted by Hill-Burton Act). Nurses could no longer monitor critically ill patients in semiprivate rooms: privacy always entailed sacrifices of continuous supervisions; nurses’ work moved from patient’s room (general ward) to hallways between rooms, etc. (40-43). Division of labor within ICUs results from grassroots movement outside of hospital bureaucracy “as nurses and physicians informally negotiated, through trial and error, new boundaries in patient care” (84) . . . . Emotional and geographic closeness, in turn, supported informal knowledge ‘trades.’ Nurses’ strategic position at the patient’s bedside enabled them to trade knowledge of the patient’s condition for physician’s knowledge of physiology or interpretation of data” (85). Yet, “By sharing decision-making, physicians yielded some level of responsibility and conceded the expertise of nurses without relinquishing any real power or control. Nurses gained only uncodified authority in physicians’ absence” (80). In physicians’ absence, they followed prescribed protocols and, absent protocols, they relied on “informal contracts defining expanded boundaries of nurses’ authority and responsibility (e.g., re, beginning in early 60s, performing closed-chest cardiac massage for cardiac arrest (82).

John Wild and his group at Minnesota build first B-mode (2-dimensional) hand-held echoscope that enabled imaging of cancers in patients scheduled for surgery (Kevles, 238).

At Minnesota, John Lewis fails to repair VSD (ventricular septal defect) via hypothermia and bows out of open-heart surgery (Miller, 111-13). On March 24, Lillehei repairs VSD on baby Gregory Glidden using cross circulation (with the father) but lost the patient on 6 April owing to postsurgical pneumonia (125-39). Later in April, he operated on two more children with VSD using cross-circulation and was successful with eight of his next 11 patients. But from Sept to mid-Nov, only one of seven cross-circulation patients lived (141-52). On Oct 5, 1954, one of his donors (the patient’s mother) was neurologically damaged when the anesthesiologist subjected her to an air embolism (156-58). In March, 1955, Lillehei successfully repaired a 13-year-old black boy’s VSD using a dog lung for cross circulation (after state penitentiary inmates failed to provide a donor as “none would let a black man’s blood mingle with his.” Lillehei deployed dog lung in another 12 cases, with mixed results (162-64). “Dog lung, self-lung, arterial reservoir, cross-circulation – none was ideal for open heart surgery” (164).

Electrodyne releases commercial version of Zoll’s external pacemaker, and external pacing came into use in U.S. hospitals, esp. teaching hospitals, in 1950s. The version of pacing provided emergency resuscitation in hospital from ventricular standstill. A pulse generator was plugged into the AC electrical system at patient’s bedside, supplying high voltage for very short periods (minutes to hours) (Jeffrey, loc 251-52). At Univ. Minnesota, Lillehei asks resident Roland DeWall to design a practice bubble oxygenator, simpler than other designs being tested elsewhere; prototype ready in May 1955. Also in mid-1955, Lillehei switches from epinephrine to newly available asthma drug Isuprel (isoproterenol), which speeds up heart rate and improves his success rate in the 10% of patients who develop post-surgical heart block after repair of ventricular septal defect owing to surgical stitches damaging conduction cells (Jeffrey, ch 3).

Michael DeBakey implants first home-made Dacron graft (Dacron rolled into tube) into patient with abdominal aortic aneurysm. He was sold fabric by his local haberdasher, who was out of the silk he intended to purchase. New lining of endothelial cells quickly appeared on inner surface of cloth, preventing blood from coming in contact with synthetic material. Patient lived another 10 years (Morris, loc 1415ff.).

On December 23, Joseph Murray and his team at the Brigham perform first kidney transplant between identical twin humans, Richard and Ronald Herrick. The transplant was a success, with the recipient, Richard, living eight more years when his transplanted kidney became infected; his brother, the donor, lived to age 79. By 1966, 23 kidney transplants between identical twins had been performed (Chaddock, 218-221).

John Enders, Thomas Welles, and Fred Robbins receive Nobel Prize in Medicine for work, begun in 1948, showing that polio virus could be successfully grown in cells not obtained from nervous tissue (of monkeys) – in cells from human fetal arm, foreskins (from circumcisions), human and monkey kidneys. This meant that large quantities of polio virus could be grown in cells in the lab, with animals no longer needed to the virus; that polio virus could be grown outside of nervous tissue (relieving concern about [very rare] paralysis and death arising from nervous tissue vaccines; and that live polio virus could be detected quickly by looking at infected cells through a microscope (not be seeing if it paralyzed live animals (Offit, loc 319-340).

Trial of Salk’s killed-virus polio vaccine from April to June, with vaccination of 1.8 million children between six and nine, 420,000 of whom received Salk vaccine manufactured by Parke-Davis or Eli Lilly; 200,000 received placebo; and 1.2 million got nothing. “Although several cases of polio occurred within two months of vaccination, Thomas Francis concluded that Salk’s vaccine was not causing paralysis.” (Rogers, 178; Gould, 147ff.; Offit, loc 595ff.). Thomas Francis reviewed the data on 1.8 million children who had participated and announced the results at University of Michigan on 12 April 1955: “Inside the auditorium Francis finished to restrained applause. Outside the auditorium Americans tearfully and joyfully embraced the results. By the time Thomas Francis stepped down, church bells were ringing across the country, factories were observing moments of silence, synagogues and churches were holding prayer meetings, and parents and teachers were weeping. One shopkeeper hung a banner on his window: Thank you, Dr. Salk. ‘It was as if a war had ended,’ one observer recalled” (Offit, loc 548). That same day (12 April 1955), after only 2.5 hrs. of discussion (it now requires a year), Laboratory of Biologics control recommended licensure of Salk vaccine for all five companies, though only Eli Lilly and Parke-Davis had manufactured vaccine for the field trial. It never saw information Bernice Eddy had given William Ward that three of the six samples of vaccine submitted by Cutter Laboratory to the laboratory months earlier contained live polio virus (Offit, loc 720ff.).

Radiometer develops the world’s first commercially available blood gas analyzer. Specifically, as polio epidemic swept across Europe, Professor Poul Astrup and anesthesiologist Bjørn Ibsen discovered that Radiometer pH meters could be used to measure the pH value in blood (Livsværk).

Squibb begins marketing of Mycostatin, first antifungal antibiotic (Wainwright, 150).

Harvard gynecologist John Rock and Gregory Pincus begin first trials of new progestin in Boston (Enovid, developed by Frank Colton for Searle as a menstrual-cycle regulator) as a blocker of ovulation (though cloaking their trials under the cover story of Rock’s studies in fertility, in which the drug “rested” the reproductive system to get a fertility “rebound.” They announced their findings in 1955 (Asbell, 132-37). Ensuing field trials involved 20,000 women in Puerto Rico, Haiti, and Mexico (143-155).

President Eisenhower has severe heart attack and relies on Demerol, morphine, sedatives, anticoagulants, etc. during 1956 reelection campaign (Wailoo II).

After ANA’s rejection of nurse-midwifery as a medical practice and refusal of ANA and ALA to grant nurse-midwives status of an autonomous section that controlled its own educational and practice standards, nurse-midwives form their own American College of Nurse-Midwifery (ANM) (Dawley, 151, 156; Dawley III, 74-78). By 1971. There were 1,256 certified nurse-midwives, with 37% providing full scope clinical nurse-midwifery care (152).

Congress passes Poliomyelitis Vaccination and Assistance Acts following federal approval of Salk vaccine (Sealander, 337-339) following unanimous approval of committee of Laboratory of Biologics Control on 12 April after only 2.5 hours of discussion (it now requires one year to get new vaccine approval). The Laboratory never saw information. Bernice Eddy, responsible for polio vaccine, had given to William Ward that three of the six samples of vaccine submitted by Cutter Laboratory to the laboratory months earlier contained live polio virus. Within nine days of receiving Cutter Lab injections of vaccine, between April 25-37, 1955, six children in Chicago and CA. developed paralysis, initially at site of Cutter injection (Offit, loc 720ff.). By 30 April, within 48 hours of Surgeon General’s recall of all Cutter vaccines, the vaccine had killed or paralyzed 25 children (loc 891). In all, two lots of Cutter vaccine, contained live virus of the most virulent Mahoney strain, paralyzed 51 and killed 5 children; plus, extrapolating from 1957 study of Idaho school children, one of three children (at least 40k) contracted abortive polio. Since abortive polio develops in about one of three children infected with natural polio, “it is likely that all 120,000 children were injected with live virulent polio virus” (loc 984). In all 9 of Cutter’s 27 lots failed to pass safety tests. Actually, all five labs licensed to produce Salk vaccine were having trouble producing lots with 100% killed vaccines with formaldehyde within the 14 days stipulated in the protocol. One, Wyeth, brought to market a single bad lot that caused paralysis, but it was hushed up and never released to media, lest the public lose confidence in the entire program. Better to pin it all on Cutter, the smallest and least well known of the manufacturers. Seven events at Cutter that resulted in its contaminated polio vaccine: (1) It used the deadly Mahoney strain (like the other four companies); It used the troublesome glass filtration method rather than the reliable Seitz filters; (3) safety tests were inadequate: “Of all the companies, Cutter used the least amount of vaccine to test for safety – one-tenth as much as Lilly”; (4)Cutter, alone among the five companies, let filtered virus sit in refrigerator for long periods before inactivating it with formaldehyde; (5) Cutter, alone among the five companies, never constructed a graph to determine how long to treat polio virus with formaldehyde; (6) Cutter never told other polio researchers it was having problems; (7) fed. govt didn’t know Cutter was having a problems. The fed. govt dropped consistency requirement of 11 consecutive lots of vaccine that passed safety tests than the Natl. Foundation had imposed on Lilly and Parke-Davis during the field trial of 1954 (Offit, chap. 6).

Three months after Cutter incident, Laboratory of Biologics Control became Division of Biologic Standards, a division of NIH; by 1956 number of professionals regulation vaccines increase from 10 to 150. In 1972, vaccine regulation moved from NIH to FDA.

McNeil Labs releases liquid acetaminophen as prescription pediatric drug (Tylenol) for children; then in 1958 as pill for adults; then in 1967, J&J (which bought McNeil) makes it OTC; Tylenol sales soar (212-13). Sterling Products blew it when it decided to limit 1956 release of Panadol (acetaminophen) by Bayer Ltd to Britain (207).

John Kirklin at Mayo Clinic successfully repairs VSD of 5-year-old using his “Mayo-Gibbon” Wurlitzer-size heart-lung machine (Miller, 172-75); Walton Lillehei and Richard A. DeWall succeed on third try in July (first two tries led to postsurgical death within days) with a heart-lung machine, called a helix reservoir bubble oxygenator, which bubbled oxygen through the blood during an operation (176-80). Dewall’s oxygenator “consisted of a 60-centimeter vertical plastic cylinder; blood was pumped upwards through this column, while oxygen bubbles were injected into it through eighteen hypodermic syringes at the bottom. . . . The tubing – and the antifoaming agent with which it was treated – came from the dairy industry. . . . [Dewall’s oxygenator] was the kick-start that open-heart surgery needed” “ (Morris, loc 1990). Next major improvement in oxygenator came from Willem Kolff, the pioneer of kidney dialysis, who invented a new kind of machine in which blood was kept separate from the gas by a semi-permeable membrane through which gas exchange took place: “Kolff’s membrane oxygenator was not perfected until the 1970s, but thereafter became standard technology in heart surgery (loc 2007).

Death of Alexander Fleming at age 73 from massive coronary thrombosis.

Meprobamate (Miltown) brought to market in U.S. (Metzl, 73, 98ff.). At May, 1955 meeting of APA, interest in meprobamate dwarfed interest in chlorpromazine and reserpine, because it “promised to be a drug for office-based outpatient psychiatry. . . . Meprobamate opened up the question of the mass treatment of nervous problems found in the community (Healy, I, 65). “Whereas psychoanalysis posited that anxiety resulted from early-life developments with mothers and fathers, developments later mapped onto husbands and wives, meprobamate worked on the thalamus, the substrate, the alimentary tract, and other sexed structures that functioned independently of gender. . . . The argument that Miltown revealed a biological substrate of anxiety, a finding that then unhinged psychoanalysis from its point of capitation, became a common theme among early biological psychiatrists” (Metzl 100, 101). “Miltown set the stage for psychotropic medications to become known as mother’s little helpers, possibly overprescribed to women, and surely considered cures for ‘women’s discontent. . . . Biological psychiatrists may well have announced a new formulation of anxiety, couched in the rejection of the ucs. and the replacement of a cultural model with a scientific one. But, in popular print culture, this formulation was called into question by depictions of the new tranquilizers in Newsweek, Time, Science Digest, Cosmopolitan, and other sites where pharmaceuticals were posited as treatments for marriage phobia, women’s frigidity, castrating mothers, and other psychoanalytically inflected conditions” (102, 103). But cf. Nancy Tone: “Never conceived simply as a tool to tame women, tranquilizers were a medical technology that became feminized in a complicated process that included a wide range of historical actors. Miltown became an overnight sensation, the first psychotropic wonder drug in medical history. In the US, more than 35 million prescriptions were sold in 1957 alone, the equivalent of one prescription per second” (Tone, 377). “ . . . although a gendering of the tranquilizer market was clear by the late 1960s, when women accounted for two-thirds of the consumer market, it was not obvious to doctors, pharmaceutical executives, or patients in the 1950s. . . . Pharmaceutical firms had no financial incentive to confine these drugs to women. Indeed, the surest path to profit was to position them as a panacea for all anxious Americans. In fact at least in the beginning, tranquilizers were very much a man’s drug (Tone II, 107-108).

Alice Stewart’s (Oxford epidemiologist) publication of impact of fetal exposure to X-rays with deaths of children under 10 from leukemia or malignancies, led to use of ultrasonography in the clinic (Kevles, 230, 245). Introduction of orally administered tolbutamide for adult-onset diabetes (Marks, 203). Cooley and DeBakey completes nearly 100 open-heart operations using the DeWall-Lillehei oxygenator (Miller, 181).

Miltown and Equanil leapt from less than 1% (in 1955) to nearly 70% of new tranquilizer prescriptions (Herzberg, 26).

Passage of amendments to Social Security Act establishing social security disability entitlement. Eisenhower opposed it, but LBJ maneuvered it out of committee and to a Senate vote: “the bill’s narrow passage forced the president to sign or veto a sweeping new law establishing benefits for disabled Americas. Political expediency prevailed.” Eisenhower signed the bill much to the AMA’s dismay. Law ushered in a new era in disability relief and altered the landscape of the nation’s pain politics (Wailoo II).

AMA formally endorses view that alcoholism is a disease and public health problem rather than a moral failing or crime.

Development of thiazide diuretics to lower blood pressure, without side effects of ganglion blocker drugs introduced in 1951. “In hindsight, it is clear that the availability of these therapeutic regimens provided the impetus for the medicalization of blood pressure. Epidemiology has identified more than 140 risk factors for cardiovascular disease, including short stature, baldness, and being married to women in white collar jobs. Yet only a tiny fraction of risk factors has been medicalized so far, one reason being that there are no drugs available to treat the majority of identified risk factors” (Kawachi & Conrad, 30).

Birth of the New Immunology, when Bruce Glick discovered the role of the bursa of Fabricius (in birds), and Robert Good of the thymus (in mice), in immune functioning, leading to abandonment of Ehrlich’s theory of the origin of antibody via specialized type of cell that manufactured antibody. Bursa subsequently linked with antibody-producing cells (B-cells) and thymus with cells that recognized antigens (T-cells) (Desowitz, 82-86; Hall, 169-173). “ . . . among all the chickens whose bursas had been removed, only hatchlings later became immunologically impaired, incapable of making antibodies. . . . Somehow the bursa controlled antibody production, and it exercised this control fairly early in an animal’s life, because the gland typically shriveled and atrophied in chickens in two or three months” (Hall, 168, 169).

Paul Zoll reported successful use of external shock to defibrillate the heart (Howell IV, 285) that utilized a standard physiological stimulator . Lillehei, at Univ. of Minnesota, begins use of cross-circulation (a person, preferably a parent, as a live oxygenator) and then cardio-pulmonary bypass in surgical repair of cardiac defects of children, with some 10% of those who underwent ventricular septal repair developing heart block. After winter storm knocked out power in 1957 (with no hospital backup) Lillehei had Earl Bakken (Medtronics rep working in hospital) build a battery-powered external pacemaker , which enabled the post-op children to be maintained “with the wire-suture electrodes and am external, battery-powered pacemaker” (Furman, 2026).

Andre Cournand and Dickinson Richards win (with Werner Forssmann) Nobel Prize in Medicine for work in cardiac catheterization; they were part of Columbia’s First Division at Bellevue, which ran the Chest Service, where they had worked together since ‘30s. News of the prize was “a tremendous coup for Bellevue,” though it came when Richards was attacking Bellevue for “abysmal conditions in the TB wards” (Oshinsky, 238-41, 245). Structural and financial plight of Bellevue beginning in ‘50s, owing to, inter alia, exodus of tax paying whites to suburbs (including NJ), appeal of better housing, cars, escaping poor blacks and PRs crowding into NY, expansion of insurers like BC that made semiprivate rooms in voluntary hospitals possible (249). Medicare and Medicaid led to steep patient decline in NYC public hospitals. In 1966, Columbia left Bellevue; only NYC medical school remained (252-3). Federal loans and billions borrowed from union pension funds saved NYC from default in 1976. New 25-story building at Bellevue made it under the wire and was begun in 1973, replacing old-style wards with 4-to-a-room semi private rooms (per Medicare guideline) (257-58). In 1980s, Bellevue became an AIDS factory, with medical students and residents working “in a climate of such relentless gloom” in which AIDS “saturated our training” (266-69). By mid-80s, 5% of public hospitals were treating 50% of nation’s AIDS patients, most in CA and especially NY (270).

Isaacs and Lindenmann discover interferon, an “antiviral penicillin” that was cellular rather than a virus and was identified in 1957 by their collaborator, biochemist Derek Burke, as a protein: “Burnet’s intuition [that interferon was a cellular rather than a virus product] proved sound. Interferon ultimately turned out to be a molecule made by cells in response to infection by viruses; under duress, these cells oozed the molecule into the broth of biochemical liquid outside the cells in order to alert other cells in the vicinity to steel themselves against impending viral attach. It was, in short, a cell-to-cell signal, a neighborhood alert, a civil defense siren at the level of cells. Many years later, this family of molecule – there are now known to be many – would become known as cytokines” (Hall, 139ff; quote at 145).

In an encyclical, Pope Pius XII endorsed lethal dosing, because “death is in no way intended or sought, even if the risk of it is reasonably taken; the intention is simply to relieve pain effectively, using for this purpose painkillers available to medicine.” This justification became known as the doctrine of double effect; it was imported from medieval Christian morality rooted in the thinking of Aquinas (Lavi, 130-131).

In Bing v. Thunig, NY Court of Appeals put responsibility for quality of hospital service on the hospital itself, not on the doctors who practiced there. Case involved a patient, Isabel Bing, who was severely burned during the course of an operation. The hospital’s legal responsibility for patient care was confirmed and extended by the Darling case of 1965, which involved an 18-year-old college football play who fractured his leg during play and received deficient treatment that eventually led to amputation. Illinois Supreme Court held hospitals legally and financially responsible for medical care given by all employees including attending physicians (Stevens II, 249).

First successful use of myocardial electrode and artificial pacemaker (wearable transistorized) by Walton Lillehei and his team at Univ. Minnesota (Richardson, 62). New version of DeWall-Lillehei oxygenator brought to market at under $100 (Miller, 182). Bakken delivered prototype of battery-powered external pulse generator to Lillehei in January 1958; after a few dog experiments, he used it on a patient (Jeffrey, ch 3). Lillehei completes his 413th open heart surgery and is voted Minnesota’s man of the year (Miller, 187).

In 1952, following Deniker & Delay breakthrough with the phenothiazine chlorpromazine, Geigy, seeking part of this new market, retrieved “some hitherto useless antihistaminics from their reserves, and recruited Roland Kuhn to test them in antipsychotics. In 1956, they sent him a preparation called G22355, which he employed at his Münsterlingen Hospital; he found no neuroleptic potency but marked effectiveness in “vital depressive mood disorder” (Fangmann et al., 2). In 1957, Kuhn reported positive results of treating 500 patients with imipramine (tricyclic antidepressant) at Int. Congress of Psychiatry in Zurich. Imipramine released in Switzerland and then in spring, 1958 in various European countries under brand name Tofranil (Healy, I, 54). Claims imipramine effects vital (i.e., endogenous) depression. “For Kuhn vital depression was a state that did not necessarily reveal itself in overt sadness but involved a lowering of central vitality in a manner that might well contribute to the development of phobic, obsessive, or hysterical reactions” (Healy, I, 53). Kuhn “was at pains to deny that imipramine had euphoriant effects. . . . Kuhn’s report conveys the implicit idea that imipramine reverses the biochemical or physical substrate of depression” (Moncrieff, 2350). Geigy begins marketing imipramine (Tofranil) in 1958 (Valenstein, 39-40). Amitriptyline (Elavil), the second tricyclic antidepressant was released in 1961. Among the tricyclics that followed was doxepine, released in US in late 60s as Sinequan; it “found broad acceptance, particularly for severe depressive episodes with suicidal ideations” (Fangmann, 3).

Appearance of methicillin, first semisynthetic penicillin (Wainwright, 155). Trials of Sabin live-virus polio vaccine begin in Russia, though results not reported until mid-1959 (Gould, 172-73).

Macfarlane Burnett propounds clonal selection theory of antibody diversity, according to which 1. We are all born with a pool of cells (B lymphocytes), each cell of which has potential to produce a specific antibody; 2. When an antigen is introduced into the body it unites with that single cell (lymphocyte) for which it is specific; 3. The union ignites a reaction in the lymphocyte which causes it to divide repeatedly; a clone of that cell line is formed; and 4. The cells (lymphocytes) in that clone mature and begin producing the antibody specific for the antigen (Desowitz, 80-81; Silverstein, 79-81). Burnett, Talmage, & Lederberg relied on Niels Jerne’s and Ehrlich’s postulate that antibodies are natural products that appear on the cell surface as receptors with which antigen can interact, but they held that the interaction signals clonal proliferation of a population of cells phenotypically restricted for the given antibody specificity; some daughter cells of the clone differentiate into antibody-forming cells while others remain as immunological memory cells able to participate in an enhanced booster antibody response (Silverstein, 117-18; 82).

John Crofton and colleagues at Edinburgh University initiate huge international trial that demonstrated that with adequate triple-drug therapy (streptomycin, PAC, isoniazid), TB was 100% curable (F. Ryan, 381). In 60s, Rifamipicin (discovered 1963) replaced streptomycin and ethambutol (discovered 1967) replaced PAS, while isoniazid remains among the three modern drugs in current triple-drug therapy (384). In U.S., number of infected TB patients fell through 50s, 60s, and 70s, before beginning a progressive rise in 1985 (390).

FDA approves Syntex-Parke-Davis’s Norlutin and Searle’s Enovid (the Pill), but only for treatment of menstrual disorders; in 1960, Searle applied and received approval to market Enovid as a contraceptive “The Pill” was formally approved on May 11, 1960 (Asbell, 159, 164-67). By end of 1961, estimated 408,000 American women were taking the Pill; it increased to 1,187,000 in 1962 and 2.3 million in 1963 (168).

Steenberg et al. first successful pulmonary embolectomy in U.S. 1961: Denton Cooley performs first successful pulmonary embolectomy using cardiopulmonary bypass (Stevenson, 69-72).

Surgeon Francis Usher successfully uses polyethylene plastic (developed for use in space program parachutes and in 1957 used to make hulu hoops) in a woven mesh to repair groin hernias: “Scar tissue fuses the synthetic material with the surrounding tissues, restoring their original solidity. Usher placed the mesh deep in the abdominal wall, between the hernial sac and the muscle layer” (Van de Laar, ch 22).

Lillehei’s first use of portable (smaller than a pbk. book) battery-powered pacemaker (designed and built by his Bakken, whose company [Medtronics] repaired and modified electric devices for surgery department) on child who developed heart block during open heart surgery (Miller, 197). The device, used with surgically implanted wire electrode, was a godsend for children who, following heart surgery to repair congenital defects, developed heart block. They couldn’t tolerate the voltage of external electrodes, so the device was attached to a needle that went through the chest wall into the myocardium, which permitted drastic reduction of voltage necessary to “capture” the child’s heartbeat (Jeffrey, ch 3). The portable battery-powered pacemaker, strapped to chest, made post-op children mobile in the hospital, and eliminated dependency on hospital AC power . Commercial version of the portable pulse generator delivered to Lillehei was the Medtronics Model 5600. (Jeffrey, ch 3).

First implanted pacemaker, with rechargeable nickel-cadmium battery, designed in Stockholm by Rune Elmqvist, and implanted in a pocket behind the abdominal muscles by Elmqvist and cardiologist Ake Senning. It used the silicon transistor, and lasted only eight hours; a second one implanted the next day only two days. The patient, Arne Larsson, survived without a pacemaker until November 1961, when he received a redesigned Elmqvist pacemaker. He was alive in 2000, then on his 26th pacemaker (Jeffrey, 90-92; Morris, loc 2942ff.). First successful implanted pacemaker was implanted on Feb 3, 1960 in Montevideo, Uruguay. The next one, in April 1960, was invented by Wilson Greatbatch, who (by mistake) invented an electrical circuit capable of delivering an electrical impulse at a fixed rate minute per minute. The pacemaker was sutured to the heart via open-heart surgery at Millard Hospital in Buffalo; it kept the patient, a 77-year-old man suffering from total heart block, alive for 18 months. Today the electrodes are connected to the heart through the veins (transvenous) in a simple procedure under local anesthesia. Among the problems with the early pacemakers: (1) they were unsophisticated devices that only emitted a preset pulse, so that hearted rate did not vary between rest and exercise. (2) It took no account of heart’s underlying rhythm, permitting the external pulse to compete with that of the sinoatrial node; (3) battery life , estimated by Greatbatch at five or more years, was at best 18 months. With the advent of lithium iodine batteries, pacemaker batteries became non-rechargeable, highly reliable, and lasted for years. A third major advance came with the development of rate-responsive pacemakers that made real time automatic adjustments of stimulation frequency (Arzua). Early pacemakers “were barely more than a battery and a timer. They did not have sensing capabilities; the pacing rate was fixed; and there was no communication with device for programming or diagnostic information retrieval. The first pacemaker invented by Greatbatch included only eight components” (DeForge, 41). Contemporary pacemakers include a sensing circuit, a logic circuit, and an output circuit, with the ability to communicate with a pacemaker programmer and a remote monitoring device. The logic circuit determines whether to deliver or inhibit an output pulse. If an output pulse is needed, the output circuit takes over and paces the heart (42).

Edward Hon’s article AJOG establishes foundation for clinical use of fetal monitoring, which was in clinical use as early as 1965 (Sandelowski, 144-45). By 1976, virtually all obstetrical residencies included electronic fetal monitoring (149). But fetal monitors use was not widespread in 70s and was resisted by “older” physicians and nurses; furthermore, conflict ensued when “better-trained nurses had to work with poorly trained and/or antagonistic physicians” (151). . . . “Indeed, machine monitoring of the fetus depended not only on the machine alone but, rather, on the nurse’s ability to properly interpret fetal heart rate patterns, to recognize patterns requiring immediate intervention, and to act appropriately in a timely fashion. The fetal monitor engaged the obstetric nurse even more fully in the diagnostic process, even if she was not officially seen as properly involved in diagnosis. The nurse was the one who was in the best position to ‘see’ fetal distress as soon as it occurred” (154-55). . . . Machine monitoring thus affirmed the value of the obstetric nurse and of obstetric nursing. Like the Cinderella status obstetrics occupied in the rank of medical specialties, obstetric nursing had a comparably low position in the nursing hierarchy. . . . After World War II when maternal mortality rates had declined sharply, childbearing women were seen as basically healthy and not requiring the nursing care sick patients needed” (155).

Paul Janssen of The Janssen (pharmaceutical) Company produces molecule R1625, later known as haloperidol. It was effective with Tourette’s patients and, as a neuroleptic, more much less sedative, and worked better managing hallucinations, than chlorpromazine. It was more likely to cause extrapyramidal symptoms than chlorpromazine. It became available in U.S. only in 1965 and in the 80s was the most commonly used antipsychotic in U.S. (Healy, II, 119-24).

Roy Grinker founds AMA Archives of General Psychiatry and is replaced as editor by Daniel Freedman in 1970 (Paris, 121-122).

With support of top-flight Russian virologist Mikhail Chumakov, Albert Sabin tests his live-virus polio vaccine on 10 million children in Russia; no control groups (Oshinsky, 252-254).

Congress passes Federal Employees Health Benefits Program, which became effective 1 July 1960. It provided for “controlled competition,” with federal employees offered a choice between Blue Cross/Blue Shield; commercial indemnity insurance from a syndicate headed by Aetna; and whatever other prepaid group plans available in their area; each plan offered two benefit tiers, and a third tier for major medical coverage was also allowed (Cunningham, 111-113). The Blue Cross/Blue Shield offering, the Federal Employee Program (FEP), enrolled one million federal workers plus their dependents, “the largest single group ever enrolled by an insurance carrier” (116).

Everett and Toman offer one of first explicit statements that the level of biogenic amine activity determines mood: “they were among the earliest to propose that depression was caused by a deficiency and mania from an excess in biogenic amine activity. The biogenic amine theory relied heavily on the fact that the effectiveness of drugs to alleviate either spontaneously occurring depression or what was called ‘reserpine-induced depression’ seemed to be determined by their capacity to elevate biogenic amines” (Valenstein, 72). “Despite the wide promotion of the biogenic amine deficiency theory of depression, most researchers working in the field recognize its inadequacy and are trying to come up with alternative theories. . . . our theories have changed very little in the past fifty years. . . most of the biochemical research on emotional states is concerned with at most three or four [norepinephrine, serotonin, dopamine] of the over one hundred neurotransmitters now estimated to be present in the brain. Moreover, the newest antidepressant drugs still act only on the same two or three neurotransmitters, although the receptor targets are more specific. Drug development is driven more by market considerations than by any clearer understanding of what causes depression or how drugs sometimes alleviate this condition” (Valenstein, 109-110).

Launching of The University Group Diabetes Program Study (RCT using insulin, tolbutamide, and diet) to resolve long-standing controversy about the effects of diabetic control on future vascular disease. By 1967, there was a clear trend for patients on tolbutamide to die of cardiovascular causes (versus placebo) and in 1969, UGDP’s executive committee voted to stop using tolbutamide. Critics of the decision pointed out that deaths were concentrated in four clinics, raising questions about selection or management of patients in these clinics; proponents of UGDP study found that, statistically, variations in mortality among the clinics were no more than expected by chance and that known differences in risk factors could not explain the increased mortality in these clinics. Critics also held that tolbutamide had been administered in inappropriate high dosage and that many patients at study onset were sicker than UGDP assumed and so should not have been on oral hypoglycemics in the first place. To a minority, “the debate raised questions concerning the appropriate role of statistical methods in clinical investigation” (Marks, 204ff; quote at 213). In fall of 1970, FDA decided to alter the package label that accompanied tolbutamide, which led to a crisis for the proponents of oral hypoglycemics and to a 15-year legal battle to reverse the FDA’s decision. Only in 1984 did the FDA take final action on the drug (215ff.). . . . “The FDA’s ruling had become a measure of the scientific community’s judgment. Either the agency issued a warning to physicians, or it did not. The idea that the FDA might have issued a warning and acknowledged uncertainty about the study met with studied incomprehension. . . . To the study’s critics, the controversy represented the usurpation of clinical expertise and physician autonomy in favor of statisticians and bureaucratic dictates” (225).

Invention of implantable pacemaker (Howell IV, 285). First long-term external pacemaker (Medtronics 5800 ) with new myocardial lead terminating in the Roth-Hung electrode platform sewn on to heart. Implanted in Warren Mauston by Hunter on 14 April and kept him alive for 6.5 years (Jeffrey, 75ff.).

U.S. Senator Estes Kefauver begins historic Senate hearings on drug industry, targeting corticosteroids, tranquilizers, oral antidiabetics, and antibiotics (Lasagna, 324; Hines, 129-143).

Congressional passage of Kerr-Mills bill, stepping stone to Medicare. It provided increased medical assistance for welfare recipients under OAA program (Old Age Assistance program of SSA), with additional aid, called Medical Assistance to the Aged (MAA), available to people 65 and older who were of low or moderate income and ineligible for public assistance. But the measure was contingent on states’ ability to supply matching funds, and many states didn’t have the money or wouldn’t participate in the program. Plus “There were embarrassing differences in the quality of care offered, and the quantity of care also, as measured in limits on the duration of a covered hospital stay” (Cunningham & Cunningham, 131ff., quoted at 140).

FDA approves Enovid, manufactured by G.D. Searle, as first oral contraceptive. It had been approved in 1957, but only for treatment of menstrual disorders.

FDA approves chlordiazepoxide, marketed by Hoffman-La Roche as Librium. It was a product of chemist Leo Sternbach’s work with quinazoline compounds as dyes in the early 1930s at University of Krakow; he was trying to identify new dyestuffs (Valenstein, 54-56; Tone, 377; Tone II, 126-140). In 1958-1959, trials of Librium had been conducted on adults in prisons, hospitals, outpatients, and office settings, and showed unanimity of results (Tone II, 135). The marketing campaign made two main points: (1) Librium was a new chemical agent and not a manipulated molecule; (2) Librium was versatile in treating a multiplicity of anxiety states (Tone II, 136-137).

Belding Scribner of University of Washington Medical School designed a permanent in-dwelling cannula and shunt that transformed dialysis from short-term to long-term treatment. The shunt allowed the patient to be connected to the dialysis machine over time without a new surgical procedure each time. Teflon, so inert chemically that the body did not reject it, was the critical material used in the in-dwelling cannula (Rothman, 149-150; Rothman II, 89).

Value of external cardiac massage established by Wm. Kouwenhoven of Johns Hopkins (Richardson, 58-59). Lillehei performs 1,000th open heart operation (Miller, 197). Shumway and Lower present paper on transplantation of dog hearts to American College of Surgeons (Miller, 208). Robert Egan (Houston) revolutionized diagnosis of breast cancer by adapting high-resolution industrial film to a mammographic technique (Kevles, 253). A. Govaets discovers hitherto unknown type of lymphocyte --- a cytotoxic killer lymphocyte (killer T-cells) that exerts its effect differently from all other lymphocytes: it has to get close to its target and actually make contact with it in order to kill it. Its major targets are viruses and “foreign” major histocompatibility complex antigens (as in a mismatched skin graft or organ transplant) (Desowitz, 103-104).

First successful implantable pacemaker, developed by engineer Wilson Greatbatch and the surgeon William Chardack in Buffalo, New York. Implanted on June 6 and patient lived 30 months. It ultimately revolutionized the treatment of complete heart block (Ball & Featherstone, 2019). Licensed to Medtronics, whose “dominant position in the world pacemaker industry dates from the 1960s, when the company manufactured a succession of devices vetted by Chardack and Greatbatch and bearing the name Chardack-Greatbatch Implantable Cardiac Pacemaker” (Jeffrey, 103ff., quoted at 104). Surgeons and cardiologists were hopeful the early pacemakers would last 3-5 years, but they often failed within a few months, e.g., wire leads would break in patients’ bodies; pulse generators stopped working for no apparent reason; mercury batteries provided power for only 18 months or so (Jeffrey, 108). Standard pacemaker design of early 60s embodied physicians’, not engineers’, choices, viz, device had to be fully implanted; battery would not be rechargeable; and idea of AV synchrony was abandoned, with only ventricle paced (105-106).

Albert Starr’s (a protégé of Alfred Blalock) successful surgical implanting of “ball and cage” prosthetic mitral valve. The Starr-Edwards artificial valve dominated the market until 1979, when the Bjork-Shiley convex-concave valve was released. Within months of first implantation, reports began appearing of patients dropping dead without warning: owing to a production fault a part was prone to come loose, “falling into the bloodstream and causing catastrophic regurgitation, but – disgracefully – almost 85,999 devices were implanted in patients before the faulty models were finally withdrawn from sale. By 2005 more than 600 of them had failed, making the Bjork-Shiley valve the most dangerous medical device ever to be used clinically. It later emerged that Pfizer,. . . had long known about the problem and hid the evidence from regulators, a transgression which cost it hundreds of millions of dollars in compensation and fines” (Morris, loc 2473ff.).

Michael Shepherd’s (Maudsley) epidemiological studies of psychiatric morbidity in primary care finds depressive disorders extraordinarily common and frequently undiagnosed. Only in late 70s, as “storm clouds gathered over the benzodiazepines,” did pharmaceutical companies become interested in detection and long-term treatment of depression in primary care: “The availability of this research probably played a significant part in company decisions to proceed with the development of SSRIs like Prozac when there was little evidence that they were any more efficacious than the older generation of compounds” (Healy, 229).

NCI launches VAMP trials (high-dose, life-threatening, four-drug combination therapy) for childhood leukemia. After initial remission, 95% of patients relapsed with leukemia cells colonizing the brain, as the blood-brain barrier directed the leukemia cells to the nervous system as the one place unreachable by chemotherapy (Mukherjee, 143-150).

Two clinical randomized trails begin that suggest the new psychiatric drug therapies were particularly effective in dealing with severe mental disorders. They were undertaken by NIMH’s Psychopharmacological Service Center and Benjamin Pasamanick et al., respectively (Grob, 214-215).

First published report of success with haloperidol in inhibiting dopamine transmission in part of brain that regulates movements associated with tics, viz, the substantia nigra to basal ganglia circuit [133]), thereby useful in treating tics (Kushner, 134). By 1968, a consensus among North American psychiatrists and neurologists emerged regarding effectiveness of haloperidol in management of motor tics and coprolalia: “The most influential voices, however, continued to accept a modified version of Mahler’s belief that even if tics had an organic substrate, their underlying enabling factors were psychodynamic” (141).

Introduction of amitriptyline.

First use of Bernard Lown and Baruch Berkowitz direct current defibrillator, with treatment termed cardioversion. In 1960, Kouwenhoun and two colleagues rediscover that compression of chest rhythmically with the hands as effective cardiac resuscitation procedure; proposal for coronary care units by Desmond Julian of Edinburgh Royal Infirmary (Morris, loc 3093f.).

AMA endorses Sabin vaccine in June; U.S. Surgeon General licenses Sabin’s live-virus polio vaccine in mid-August (Rogers, 182; Gould, 183ff.).

AMA changes position regarding osteopaths, permitting voluntary professional relationships between M.D.s and D.O.s and allowing accredited hospitals to have osteopaths on staff. Merger of California Medical Association and California Osteopathic Association, intended, inter alia, to reduce competition (Blackstone, 15). In 1965 Osteopaths included in Medicare, and in 1966, Defense Secretary McNamara brings them into the military (Whorton, 236-241).

Georgia State Nurses Association was the last state association to officially desegregate. It did so only after the American Nurses Association threatened to expel Georgia from the national organization if it failed to do so (D’Antonio, 130).

AMA reluctantly supports the Health Professions Education Assistance Act, which acknowledged the doctor shortage and extended direct federal support to medical schools. Then, in 1966, the AMA established the Citizen’s Commission on Graduate Medical Education, chaired by John Millis, which recommended central coordination of all graduate medical education (Stephens, 78).

Britain’s Boots Pure Drug Co. introduces ibuprofen, which was released as a prescription drug in UK in 1969 as Brufen and in U.S. by Upjohn as Motrin in 1974, and when it became OTC in 1984 by American Home as Advil (Jeffreys, 217).

British chemists patent tamoxifen, originally invented as a birth control pill, but found to have the opposite effect of shutting off estrogen in many tissues (i.e., an estrogen antagonist); in 1973, it was found to destroy breast cancer cells in those patients whose cancer cells expressed the estrogen receptor (ER-positive cancer cells): These patients’ cancer cells were dependent on estrogen for survival, unlike those with ER-negative cancer cells (Mukherjee, 215-217). “For the first time in the history of cancer, a drug, its target, and a cancer cell had been conjoined by a core molecular logic” (217).

Passage of Kefauver-Harris Amendments to the Federal Food, Drug and Cosmetic Act which, in the wake of tragedies, (a) tightened federal control of drug industry’s interstate commerce; (b) required additional evidence [“substantial evidence” deriving from “adequate and well controlled investigations”] of effectiveness of drugs proposed for regulatory approval; (c) increased drug clearance from 60 to 180 days; (d) required “adequate” preclinical toxicity studies prior to human studies; (e) required informed consent for all IND research, “a change without precedent in the U.S. law” (Lasagna, 330-332; Speaker, 367; Hilts, 144-165; Donohue, 670-671). Under FDA Commissioner James Goddard, FDA collaborated with the National Academy of Sciences, National Research Council (= Drug Efficacy Study of the NAS, NRC) reviewed 80% of the 4,000 drugs on the market. Study lasted three years and removed some 300 drugs from the American market, including the entire category of “combination antibiotics” (Hilts, 166-177). The homeopathic position on the amendment “was that their medicines should not be studied, as they could not be evaluated by ‘allopathic review’” (M. Kaufman, 118).

Opening of St. Jude’s Research Hospital for Children in Memphis. Spearheaded by Danny Thomas and his organization of Lebanese and Syrian Americans (ALSAC) and its grant of $159,000 in 1958, the hospital was nondenominational and dedicated to study of catastrophic childhood diseases, especially leukemia and sickle cell anemia. Its creation “offered a sharp break with Memphis’s past – a break with its civic disdain for ‘indigent outsiders’ and with its previous low national profile as a research center” (Wailoo III, 152). The hospital banned racial segregation, e.g., in its wards, bathrooms, and clinical services, and in nearby hotels (e.g., Claridge’s) that received the families of patients. “The coming of St. Jude’s thus pointed to the ascendancy of research medicine with its new economy, an economy with the ability to change the local conception of the infirm as well as to influence local values . . . it represented a consolidation of public attention and cultural authority around new and feared childhood diseases, and around the specialists who studied them” (154-155).

Sones and Shirey (Cleveland) show how to get contrast medium into the mouths of coronary arteries (coronary arteriography) by maneuvering tip of catheter from brachial artery, under x-ray control, into immediate area of coronary orifice (Richardson, 114-115). This procedure “may have led physicians to deemphasize any role for coronary thrombosis in acute myocardial infarction,” since it revealed the gradual progression of coronary lumen narrowing in coronary atherosclerosis (Weisse, 74).

McCarty and Faires publish in Lancet validation of McCarthy’s findings regarding uric acid crystal. Using themselves as subjects, they injected purified uric acid crystals into one knee, and saline solution into the other knee as a control. “A few hours later, both experienced excruciating inflammatory gout-like sensations in the knees injected with uric acid crystals. Although they had not initially planned on it, the two ultimately opted to take pain medications and hydrocortisone due to the severity of their symptoms. A complementary study in JAMA the same year by J. Edwin Seegmiller injected microcrystalline particulates of solid sodium urate into one knee of 12 gout volunteers, and a non-crystalline solution of sodium urate into the other knee  pain in the knee injected with microcrystalline particulate sodium urate, but not the other knee.  This was consistent with reports from the 1920s that shows absence of inflammatory response to injection with non-crystallized solution of sodium urate (Hickman). Critics of dominant rule of uric acid levels could, in the 60s and now, point to two facts: (1) that marked hyperuricemias occurred in people who never develop gout; and (2) drugs like colchicine, with have no effect on uric acid levels, were effective in treating acute gout attacks (Hickman).

Joseph Murray at Brigham perform what is considered the first successful kidney transplant with immunosuppressive drugs (Imuran [azathioprine]) on 5 April (Chaddock, 230).

First Silastic mammary prosthesis, a silicone rubber envelope filled with liquid silicone, was implanted (i.e., the Cronin-type silicone gel prosthesis) (Haiken, 256-258).

In Page v. Celebrezze, Judge John R. Brown (Eisenhower Republican) rules that subjective pain is “real,” even in absence of objective clinical and laboratory findings, and deserving of compensation (via Social Security disability payments): “The Brown ruling established a liberal pain standard in American litigation and jurisprudence. . . . A generous theory of felt pain as true pain emerged” (Wailoo II).

First kidney transplant. AMA establishes Committee on Quackery “to contain and eliminate chiropractic.” AMA continues to refuse to support repeal of the Hill-Burton Act’s “separate but equal clause,” which allowed for construction of segregated hospital facilities with federal funds (Baker, 311). U.S. President John F. Kennedy signs in to law the Health Professions Educational Assistance Act, providing construction grants for teaching facilities and student loans to physicians, dentists, and nurses (Lynbaugh,18).

MS&D begins shipping its live-virus measles vaccine, trade marketed Rubeovax – which had to be administered with standardized immune globulin – trademarked Gammagee; in 1967, it released a combination measles/smallpox vaccine (Dryvax), and in 1968 it released a more attenuated live measles virus vaccine (Attenuvax) that did not require coadministration of immune globulin (Galambos & Sewell, 96-98).

FDA approves release of Valium, “the most widely prescribed drug of any kind in the West world between 1968 and 1987” (Tone, 377).

In U.S., severe outbreak of rubella (German measles), which lent further support to those urging Congress to approve Title XIX (the Medicaid provisions) of the Social Security Act of 1965. “Congress responded with the Early and Periodic Screening, Diagnosis, and Treatment amendments to Title XIX, mandating the right of every American child to receive comprehensive pediatric care, including vaccinations” (Galambos & Sewell, 106-107).

Passage of Civil Rights Act, which brought integration to all southern hospitals; among the casualties were the South’s all-black hospitals, none of which qualified for Hill-Burton funding (Ward, 188-190). Still, by 1965, only one county medical society in Louisiana and two in Mississippi had admitted black physicians. In Georgia, 68 of 78 county societies refused memberships to black physicians; and only four of Alabama’s 70 local societies had black members (210).

Passage of Nurse Training Act authorizing construction grants for new schools of nursing, grants and loans to students, but it “sustained long-standing ambivalence about higher education for nurses” by supporting three different levels of training: college (B.A.) programs; hospital training programs, and community college programs (Lynaugh, 19-20). By 1970, there were 700,00 RNs vs 550,000 in 1964 and the number of nurses with bachelor’s degrees increased by 84% (21).

Creation of Helsinki Declaration by World Medical Association. It created a new set of standards for human experimentation, being “at the same time less rigorous but more effective than the Nuremberg Code.” It made room for incapacitated and incompetent experimental subjects, requiring only that consent be procured from legal guardians (Tucker, 198).

Irving Lichtenstein, owner of private surgical clinic for hernia repair in Beverly Hills, reports method of local anesthesia for repair of groin hernias and sending patients straight home immediately after surgery, a “truly revolutionary concept” that left his audience of surgeons dumbstruck (Van de Laar, ch 22).

First NCI test of intensive combination chemo for advanced-stage Hodgkin’s disease (MOPP) struck gold: more than half initial cohort would be cured (Mukherjee, 164-166).

Following release of Surgeon General Luther Terry’s report on causal relationship between cigarette smoking and lung cancer in January, 1964, Congress waters down FTC’s cigarette warning label, “Caution: Cigarette Smoking Is Dangerous to Health. It May Cause Death from Cancer and Other Diseases” to “Caution: Cigarette smoking may be hazardous to your health.” In 1968, John Banzhaf won court case providing “proportional airtime” to pro- and anti-tobacco advertising on TV; In late 1970, tobacco makers voluntarily withdrew cigarette advertising from broadcast media; last cigarette commercial for Virginia Slims aired at 11:59pm on 1 January 1971 (Mukherjee, 258-267).

Schildkraut’s paper in Amer. J. Psychiat. formulates catecholamine hypothesis of depression (the amine theories): “The argument was that as reserpine was known to deplete catecholamines and as it was also known that reserpine could lead to depression and in some cases make people suicidal, there were strong suggestions that the depletion of catecholamines might be associated with the generation of depressive states. Because tricyclic antidepressants inhibited reuptake, it could be inferred that the effects of this would be to increase catecholamines in the synaptic cleft, thereby leading to a functional increase in the level of these neurotransmitters. Because the MAOIs also led to an increase in catecholamine levels, by blocking their metabolism, the inference was that both major groups of antidepressants led to increased amine levels. . . . this particular statement in 1965 came to dominate the field, set research agendas, and direct drug company efforts for the following two decades. It crystallized a split in psychiatry between biological and psychodynamic branches, each group having its own journals, its own meetings, and de facto very little to do with each other. Although the introduction of the drugs had thrown differences into relief, psychiatrists of all orientations could nevertheless use them. The catecholamine hypothesis, however, emphasized the advent of the psychiatric researcher who was conversant with the details of neurotransmitter metabolism, receptor binding, and endocrine changes – a researcher who spoke a different language from the analyst (Healy, 156- 157).

Presentation of gate control theory (of pain) by Melzack and Wall; it proposed “that a gate-like mechanism exists in the somatic transmission system, allowing pain signals to be modulated before they evoke perception and responsive. The gate can be opened or closed by variable amounts, depending on factors such as relative activity in large and small peripheral nerve fibers, and various psychological processes such as attention and prior experience” (Baszanger, 122).

Eugene A. Stead, Jr., M.D. develops the first formal training program for physician assistants at Duke University (Holt, 247, 257-262), with two-year training program (nine months of basic sciences + 15 months of apprentice-like clinical training) operated by Department of Medicine. It had no ties to Duke Nursing School, and nurses were not the recruiting pool for the new role; male, especially military corpsmen returning from Vietnam, were the preferred candidates. When the AMA finally decided to support the program in 1970, it reinvented the physician assistant concept, proposing that inactive registered nurses become PAs with higher pay and new status. This further antagonized the ANA, with which it never communicated, much less collaborated, in a manner that “cast the physician assistant as protagonist in the historical drama between the AMA and the ANA” (267). It was also in 1965 that the nurse-practitioner movement began with Dr. Henry Silver and Loretta Ford training pediatric nurse practitioners and clinical nurse specialists at University of Colorado (264, 272). There were, however, reports of “newly negotiated nurse-physician practices” in the literature of the early 60s in which nurses assumed tasks upon which many patients judged the quality of the physician-patient relationship, e.g., psychosocial care, well-child care, patient education, and dispensing minor medical advice. More frequently, however, nurses performed tasks physicians considered less complex, routine, and time consuming – well-child examinations, typical cold or flu, sick-child visits – the very tasks that “made primary pediatric practice intellectually unstimulating and boring” (Fairman, 120-121).

Vatican II adjourns without setting Church policy re the Pill. It did acknowledge the right of couples to limit the size of their families by “moral methods” of birth control, but without stipulating which methods were moral (Asbell, 255).

Passage of Medicare predicated on exceptionalism re the elderly middle-class: “The elderly were carved out as an exception – but an exception that would allow the traditional mechanisms to continue to enjoy their dominance (Rothman II, 69). . . . The defense of Medicare, and the design of Medicare, made it the more likely that its passage would mark the end, not the beginning, of national health insurance (72). . . . So intent were the champions of Medicare in demonstrating the exceptionalism of the elderly that they ignored the deficiencies of private insurance for the young. Rather than issue a broadside attack against a system of health care delivery that depended upon voluntary insurance, rather than calculate whether part-time employees could afford the rates or the deductibles, rather than analyze whether other Americans had difficulty coping with policy exclusions, Medicare’s advocates made it appear as if the elderly were the only victims of these stipulations” (77). Medicare’s pragmatic rebuttal to the proposition that health care was a right was to adopt “the position that Medicare benefits would be paid for by the recipients during their working years, and to this end, they made Medicare part of the Social Security system, not a program standing alone” (83-84). Home care (“home health care”) was a provision of Medicare; it was “a political strategy, more symbolic than emblematic of true budgetary considerations. The perceived capacity of home care to empty hospital beds destined it to become a post-hospital benefit in the Medicare program. Following a hospitalization of at least three days, patients could receive up to one hundred home care visits” (Buhler-Wilkerson, 199). . . . Medicare redefined home care to include only those selected functions and prescribed circumstances that were reimbursable. This time, a federally sponsored insurance system sought to establish home care as an alternative to institutional care. Once again, the payment system created a narrowly defined, fragmented, and uncoordinated set of acute-care services ill adapted to the needs of the chronically ill at home” (201). . . . “The maze of entitlements, functional eligibility requirements, and continuous shifts in reimbursement sources proved self-defeating for a policy created to encourage community rather than institutional care” (202).

Medtronic’s release of the flexible transvenous lead contributes to shift toward transverse implantation in cardiac pacing in U.S. In 1963 London surgeon Harold Sidons began locating pacing generator in patient’s left or right chest just below collarbone, but in 1965 Furman advocated crucial improvement in transvenous pacing: abandon jugular and insert the permanent lead via left or right cephalic vein. By 1970, experienced pacers had switched to transvenous pacing, and four-fifths of all pacemaker breakdown were due to battery exhaustion (Jeffrey, 122-124, 128).

Medicare Parts A&B become effective: “Thus with a stroke of the pen the elderly acquired hospital benefits, the hospitals acquire cost reimbursement for these benefits, the Blue Cross Association [chosen as intermediary by 90% of hospitals] was precipitated into prominence as a major national organization (since the national contract was to be with the association, with subcontracting to local plans), and the Joint Commission [of Accreditation of Hospitals] was given formal government recognitions. “Simultaneously, through the implementation of federally subsidized Medicaid programs in the various states, the poor, like the elderly, were brought into the ‘mainstream’ of medicine. In theory, at least, most Americans might now be fully insured. . . . Medicare was a catalyst, testing the organizational resilience and the social altruism of the voluntary enterprise – testing, that is, its essential character. But some lines of development were already evident. Medicare and Medicaid together were to support the voluntary over the governmental hospital system. They affirmed the central importance of the hospital in American medicine, but left to individual hospitals the translation of this importance into networks and systems. There was little to push hospitals much beyond their exciting space-age image on TV. The altruistic aspects of voluntarism remained appealing, as did the continuing strategic connotations: freedom of action, political immunity local initiative, and noninterference of government in caring for the sick. But maintaining voluntarism carried the paradox of voluntary controls, if strong government controls were to be avoided, as well as opportunities for voluntary initiative” (Stevens II, 281-282).

J. M. Van Rossum (The Netherlands) proposes that antipsychotic drugs might alleviate schizophrenia and therefore that schizophrenia involved an overstimulation of dopamine receptors = the dopamine hypothesis (Valenstein, 84-86).

Macy Foundation Conference on Women in Medicine  publication in 1968 of Carol Lopate’s Women in Medicine, which analyzed discriminatory culture that discouraged women from entering medicine (More, 213)

Henry Beecher’s Ethics and Clinical Research published in NEJM, providing 22 examples of investigators who risked “the health or the life of their subjects” without informing them of the dangers or obtain their permission (Rothman, chs 1 & 4; Howell III, 690). This led to new NIH guidelines, promulgated by the U.S. Public Health Service, covering all federally funded research involving human experimentation; at their core was the peer-review committee, known as the institutional review board (IRB), though, through the 60s, membership on the IRB generally restricted to fellow investigators (Rothman, 89-91). The FDA went further, setting down comprehensive rules re patient consent in clinical drug trials and spelling out the meaning of consent (93). Recognition that “the traditional ethics of medicine no longer held in the laboratory and that a fundamental conflict of interest characterized the relationship between the researcher and the subject and had an extraordinary impact on those outside of medicine” (95). Philosophers like Paul Ramsey and Hans Jonas moved into medical ethics and arrived at the conclusion that the only escape from the dilemmas in experimentation “was through a revitalization of the principle of consent. Human subjects had to become their own protectors” (98).

Forty seven of 87 southern medical schools receive less than half of their cadavers through volunteers and family donations, the rest supplied by “entrepreneurs” (Washington, 195).

Passed over for University of Minnesota surgery department chairmanship following Wangensteen’s retirement, Lillehei leaves Minnesota and accepts offer to be professor, chief of surgery, and chairman at NY Hospital-Cornell Medical Center Department of Surgery (Miller, 202).

First dedicated imaging device for the breast comes on the market (Charles Gros’s Senograph). Siemens, Philips, and Picker begin selling special mammography units by early 1970s (Kevles, 253). Papers coauthored by Jacques Miller and Graham Mitchell establish that lymphocytes that passed through the thymus were the most important immune cells accounting for acquired immunity: T- (thymus) cells, “educated” in the thymus, would “roam the body via the bloodstream, return to the lymph nodes and the spleen (as Gowans had observed), and thus perform immune surveillance (Hall, 171).

MS&D releases its live-virus Mumps vaccine, Mumpsvax (Galambos & Sewell, 103).

In December, South African heart surgeon Christian Barnard performs first human heart transplant on Louis Washkansky at Groote Schuur Hospital in Cape Town. The donor was a white woman, Denise Darvin; a previous suitable donor was passed over on account of being black. After two weeks, owing to the anti-rejection drugs that had wiped out his immune system, Washkansky’s breather started to fail and he developed pneumonia in both lungs and died from the pneumonia shortly thereafter (Chaddock, 233-239; Williams, 205-206). “Barnard’s surgical rivals have all since admitted intense disappointment that they weren’t the first to transplant a human heart, but Norman Shumway’s and Richard Lower’s professional wounds were perhaps deepest. They’d done more work than anyone on developing the surgery itself, and when Barnard was interviewed, he’d say only that ‘we were all at the same stage in this work” (Chaddock, 237). Washkansy’s operation was quickly followed by four more, with Adrian Kantrowitz performing the second tragic heart transplant in Brooklyn, attempting to save the life of 17-day-old baby with heart of an anencephalic baby (240). By end of 1968, 102 heart transplants had been performed, with an additional 64 by end of 1970 (Mezich, 155).

David Kuhl (University of Pennsylvania) invents three-dimensional emission imagers by adding a computer to SPET (Single Photon Emission Tomography). His SPECT (Single Photon Emission Computed Tomography) machine produced a crude but useful three-dimensional image of the distribution of radioisotopes in an organ (Kevles, 207).

Federal Uniform Anatomical Gift Act modernizes the distribution of cadavers for medical use, with each state then passing its own version of the act. Still, “In general, the bodies that are used for anatomical dissection and research without the person or his family’s permission are today’s version of the ‘friendless poor’ – the homeless, and proportionately more blacks than whites are homeless” (Washington, 195). . . . Medical policies include bias in organ recruitment and human leukocyte antigen (HAD) matching requirements, which exclude more black than white organ recipients and thus render transplant kidneys unavailable to blacks” (196).

AMA amends its constitution to forbid racial discrimination in membership at any level, and to authorize House of Delegates to bar seating of delegates from any state where such practices existed (Wynes, 88). Arthur and Elaine Shapiro publish first article on successful treatment of Tourette’s Syndrome with haloperidol and lambast “the therapeutic and intellectual paucity of psychoanalytic psychiatry.” It was published in British Journal of Psychiatry, since it was rejected by every major American psychiatric journal (Kushner, 172).

Walter Mondale holds hearings on his proposal to establish a National Commission on Health Science and Society, which failed to win initial passage owing to opposition of physicians and researchers, who saw it “as a major battle in the war to rule medicine” (Rothman, 178).

AMA opened up internships and residencies to osteopaths and even provided for their membership in AMA. AOA saw it as an attempt to sap strength from osteopathic hospitals and to dilute programs of osteopathic specialty training (Blackstone, 16-17).

Report of Harvard Brain Death Committee, authored especially by anesthesiologist Henry Beecher and neurologist Robert Schwab: Death could be declared if three criteria were met: no movement or breathing; no reflexes; and flat EEG. Brain death justifies pronouncement of death for patient in irreversible coma. Report was not an attempt to expand transplantation, but rather a focusing on “The contingent balance of specific purposes, risks, and similarity to therapeutic ends in routine medical practice”; this was held to be “a better guide for an ethic of experimentation [i.e., transplantation] that protected persons (Belkin, 354). . . . “[Influenced by philosopher Joseph Fletcher] Beecher struggled with the morality of relationships, like between researcher and subject, based on the results of the particular way others were treated. He came to rely on a situation ethics in which the specific good at stake was critical for moral judgment. But means had to live up to their ends. The use of informed consent, although necessary, was unreliable as a guarantee for the protection of subjects from the vested interests of investigators or of society. . . . “Beecher described how this connection between his ethics of how to protect the individual and the need to set limits in uses of medical technology could be guided via a definition of brain death. He suggested that criteria developed by Schwab was the place to begin setting such limitations. Treatment of no value was ethically suspect as a waste of resources and an intrusion into the rights of the individual to the degree that it strayed from a compelling balance. At the core of his experimentation ethics was therapeutic purpose and appropriate means as judged within the context of the given situation, in this (355). . . .case, that of the irreversibly comatose. For Beecher, concerns about transplant, his call to limit treatment in the irreversibly comatose, and experimentation ethics were each a reflection of the larger problem of how to reconcile benefits of medical technology with personal dignity, with what he called ‘the right to be let alone’ (356). . . . Transplantation was ethically clarified as a subset of the primary problem of coma and hopelessness. . . Using intrusive techniques to support a hopelessly unconscious patient without brain function could neither summon itself as an appropriate end nor a valuable basis to evaluate means, except as an attempt to harvest organs for others. “Transplantation did not cause the Ad Hoc Committee’s pursuit of irreversible coma; it redeemed medical treatment in those cases” (357). . . . In the context of increasingly interventionist medical practice, irreversible coma offered a bottom-line standard for consensus that reliably indicated both the point at which treatment became ethically unacceptable, and at the same time framed when experimentation (transplant) could be considered” (358).

Donald Pinkel’s team at St. Jude’s in Memphis runs eight trials of “total therapy” (“total hell”) for children with lymphoblastic leukemia. Of the entire cohort of 278 patients, one-fifth had relapsed and 80% were “cured” as far as anyone could tell (Mukherjee, 166-170).

Ion Gresser, American (Harvard) researcher working in France, published experiments showing that interferon prevented cancers in mice: “Cancer changed the whole ball game for interferon once again. It went from the ‘antiviral penicillin’ to the ‘magic bullet’” (Hall, 155-156). Hans Strander, in Stockholm, begins testing his and Kari Cantell’s leukocyte-derived interferon with bone sarcomas, incorrectly believed to be caused by viruses (162).

Okada & O’Brien’s identification of enzyme (Hx-A) responsible for normal breakdown of lipids, which was missing in children with Tay-Sachs disease (TSD). It “opened up the possibility that fetuses could be diagnosed in utero – and that abortion could save parents from the anguish of watching their apparently normal child degenerate and die” (Wailoo & Pemberton, 24). TSD redefined as a Hex-A deficiency, which included forms other than TSD as lethal disease of Ashkenazi Jews (25). “In the cultural terms of the day, the movement to eradicate TSD in the 1970s and 1980s was a success story – one that stood in stark contrast to other prevention efforts. It was an exemplary case of genetic information positively applied to the eradication of disease, an affirmation that scientific intervention can be carried out in a way that respects community values and cultural self-determination” (56).

Denton Cooley, without FDA approval, implants first artificial heart in a patient, who lived for three days.

NIH’s Division of Biologic Standards (DBS) licenses MS&D rubella vaccine (Meruvax) (Galambos & Sewell, 113).

Britain’s Boots Pure Drug Co. releases Brufen (ibuprofen) as prescription drug, licensed in U.S. by Upjohn as Motrin in 1974, and when it became OTC in 1984, released in U.S. by American Home as Advil (Jeffreys, 217).

Woman’s Medical College of Pennsylvania – last woman’s medical institution -- becomes coed, dropping “Woman’s” from its name and admitting six men to freshman class in 1971 (M-S, 349-350). Men to be admitted only if they did not displace women, though the board’s subsequent compliance with Title IX (1972) effectively rescinded its earlier commitment to reserve a minimum number of places for women (Peitzman, 221-229).

Establishment of certifying board of family practice, which administered its first certifying examinations in 1970 (Stevens, 313), and had no “grandfathering” and mandatory recertification from the beginning. By 1978, there were 342 FP residency programs with ca. 5,500 residents (Stephens, 79).

Richard Smith at University of Washington develops MEDEX program for military corpsmen returning from Vietnam; it was intended to place students in underserved areas before they graduated and included a matching plan that paired students with practicing physicians who urgently needed help (Fairman II, 106). MECEX program was more successful than Physician Assistant (PA) programs in meeting needs of underserved rural and urban communities (106-107).

American Chiropractic Association and the International Chiropractic Association officially state that subluxation was not the sole cause of nearly all disease (Baer, 189).

By 1970, experienced cardiac pacers had switched to transvenous pacing, with insertion of lead via left or right cephalic vein (Furman), while four-fifths of all pacemaker breakdowns were due to battery exhaustion (Jeffrey, 122-124, 128).

Gerald Klerman coins term “pharmacological Calvinism” to denote belief system in which drug use is held to be bad and potentially dangerous if it makes you feel good: “A drug that makes a subject feel good either is somehow morally wrong or is going to be paid for with dependence, liver damage, chromosomal change, or some other form of secular theological retribution” (Healy I, 227). Congress replaces Harrison Act with Comprehensive Drug Abuse Prevention and Control Act, which classified drugs into five schedules. Schedule 1 included drugs with high potential for abuse and no accepted medical, e.g., cannabis and LSD, even though cannabis had been a staple of psychiatric pharmacotherapy in 19th century and LSD still held promise as a therapy and research tool (Healy II, 164).

John Vane and Priscilla Piper publish paper in Nature on action of aspirin, “Inhibition of Prostaglandin Synthesis as a Mechanism of Action for Aspirin-like Drugs” (Jeffreys, 231).

Passage of Comprehensive Health Manpower Training Act, which provided federal funding for Physician Assistant (PA) programs, finally pushed AMA to adopt guidelines for PA program accreditation (Fairman II, 107, 110-11).

Publication of Our Bodies, Ourselves by Boston Women’s Health Book Collective, aimed primarily at gynecologists and urging “wary consumerism” rather than “docile obedience” (Rothman, 143-144). Patient Bill of Rights promulgated by Joint Commission on Accreditation of Hospitals and in 1973 by American Hospital Association (Rothman, 143-147).

First crude CT scanner demonstrated in London (Kevles, 146). American chemist Paul Lauterbur discovers one-dimensional imaging (viz, primitive MRI): “zeugmatography,” the joining together of a gradient magnetic field and the radiofrequencing that corresponds to it in a single image” (Kevles, 181). Lauterbur’s discovery published in Nature in 1973.

Nixon signs Educational Amendments Act, of which Title IX requires any institution receiving federal aid to adopt gender-neutral educational policies. The goal was for girls to get their fair share of athletic budgets; the results was a fall in the workplace and schools of sexual harassment litigation (Sealander, 316-317).

Nixon signs Sickle Cell Anemia Control Act, though observers feared it would stigmatize and discriminate, e.g., by coercive testing, counseling carriers not to have children, employment restrictions. Others resented the fact that political pressure had influenced the direction of NIH research dollars (Wailoo, III, 7, 125).

Passage of Section 2991 of Social Security Act, where Congress provides funding for all costs of treatment for end-stage kidney disease (i.e., dialysis) (Rothman II, 96-109). “Once the line was sharply drawn between money and life, the answer in a democratically elected political forum had to be life. No politician would wish to defend the proposition that the rich could live because they had access to a machine, while the middle-class died because they could not afford it. One might ask why a similar reaction did not promote preventive health measures, or to move down the social scale, why when comparative statistics demonstrated unequivocally that the rich lived longer than the poor and that rates of mortality in black ghettos were many times greater than those in other communities, no reforms were initiated, including national health insurance? The answers, however, are relatively clear. For one, the middle-class character of the dialysis advocates and dialysis patients was a distinct advantage. For another, statistical overviews can never match the power of the particular case” (102-103). . . . In the 1970s, dialysis patients received preferential treatment because of the power of technology creep, middle-class advocacy, American attitudes toward life-saving machines, and a political process which, when the case was framed specifically and dramatically, elevated life over money (107).

Vaccine regulation moves from Division of Biologic Standards, a division of NIH, to FDA.

Founding of Tourette Syndrome Association in New York (Kushner, 176ff.). In classic article in Amer. J. Psychiatry, Washington University psychiatric researchers developed diagnostic criteria for 15 mental disorders, referred to as the Feighner criteria (Kirk & Kutchins, 51). George Ashcroft and others at MRC Brain Metabolism Unit at Edinburgh put forward the first receptor hypothesis in psychiatry, “essentially reformulating the amine hypotheses in receptor terms.” Psychopharmacologists began using the new technology within a few years, “placing psychiatry, almost for the first time, not just within medicine, as the discovery of the psychotropic drugs had done, but at the forefront of medical developments.” In 1975, the antidepressants were all found to down-regulate Beta-adrenergic receptors (Healy, 162).

Walton Lillehei indicted by St. Paul, Minn. grand jury for evading $125,100 in U.S. income taxes, convicted in 1973, and, having developed cataracts, performed his last open-heart surgery on 30 December 1973 at NY Hospital (Miller, 227ff.).

David Kuhn (University of Pennsylvania) realized that the image-retrieving formulas (first an iterative algorithm and later Fourier transforms) that worked to reconstruct a slice with transmission tomography would also work for emission tomography (tracking radioactive source within), leading to PETT (positron emission transaxial tomography) paper published with Phelps in 1975.

“While Roe v. Wade granted women the right to choose abortion in consultation with their physicians, it rejected the notion that women had a right to abortion on demand. By doing so, it upheld states’ right to limit access to abortion if they found that they had an interest in doing so. . . . states were under no obligation to guarantee women equal access to the procedure. As Rosalind Petchesky has noted, Roe v. Wade fit abortion within the market paradigm. Access continued to depend on a woman’s ability to find a sympathetic physician and pay for the procedure . . . Roe v. Wade did not grant women a right to abortion . . . However, the decision gave physicians the right to perform abortions, elective or therapeutic, whenever they found the operation necessary. . . it still meant that a woman seeking an elective abortion had to find a physician willing to perform it” (Schoen, loc 2646ff.).

Whereas Supreme Court’s Roe v. Wade legalized abortion,Congress’s Vocational Rehabilitation Act (Section 504) forbade discrimination against handicapped. Both were relevant to decision making in neonatal units; “The difficulty was that the principles of the Court and the Congress were at conflict, pointing policy in opposite directions. . . . at the very moment the Supreme Court was expanding the scope of family privacy, Congress was expanding the rights of the disabled. Although the two developments might appear part of an enlargement of individual liberties, they were in fact on a collision course, destined to meet head-on in the newborn nursery” (Rothman, 204-205).

Board of trustees of American Psychiatric Association votes unanimously to delete homosexuality from its nomenclature and replace it with diagnosis of sexual orientation disturbance. In a 1974 referendum forced by Charles Socarides, entire APA membership voted to accept this decision by 58% for to 37% against (Kirk & Kutchins, 87-88). IRS declares the Pill a deductible medicine (Asbell, 243).

Stanley Cohen proposes the word “cytokine” as an umbrella term for the proliferating number of cells of the immune system that communicate with each other when aroused. He defined cytokine as “the family of molecules manufactured and secreted by a variety of cells engaged in immunological or inflammatory responses” (Hall, 176).

Walter Mondale and Edward Kennedy finally prevail re regulation of medical research with creation of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which followed revelations of Tuskegee syphilis research and University of Cincinnati General Hospital research for Department of Defense (applying whole and partial body radiation to patients with terminal cancer). It also came after Edward Kennedy’s hearings on “Quality of Health Care –Human Experimentation” of 1973. The National Research Act “began the requirement for institutional review boards that had to rule on protocols of federally funded medical research” (Rothman, 182ff; Reverby, 100-103). In 1978, it was transformed into the President’s Commission for the Study of Ethical Problems in Medicine and given the scope Mondale had urged back in 1968 (Rothman, 189).

David Clyde begins self-experiments that show that malaria parasites from infected, irradiated mosquitoes provided a short-term vaccine (3-6 months) for malaria (Altman, 159-163). Production of Salvarsan ended (Bäumler, 235). Spitzer & Fliess publish “A re-analysis of the reliability of psychiatric diagnosis” in Brit. J. Psychiatry, which, in belittling the reliability of past psychiatric diagnoses, pointed to the innovations of the Washington University and Columbia groups (viz, structured interview schedules and explicit diagnostic criteria) as pointing to a solution to problems of validity and reliability, and thereby “carefully and dramatically sets the stage for DSM-III” (Kirk & Kutchins, 56-63; quote at 58; Valenstein, 157).

Melvin Sabshin becomes medical director of American Psychiatric Association; the Task Force on Nomenclature and Statistics reconstituted with Spitzer as chairman and including Andreasen and Woodruff (from St. Louis), Donald Klein (Columbia), and Saslow. They outline the approach and structure of DSM III: “. . . there were no major divergent viewpoints, and the primary psychodynamic perspective in psychiatry had no representative at the table . . . Klerman has identified them as neo-Kraepelinians” (Kirk & Kutchins, 98). “For the new classification system, etiology took a back seat to rigorous description; thus, the distinction between endogenous and exogenous depression did not matter if a patient met the criteria. As with the medication trials, patients with alcoholism or drug dependence were not included” (Hirshbein, 212).

Burlington randomized trial on health outcomes (with 1598 families randomly assigned to FP [family practice physician] or NP [nurse practitioner] groups working in consultation with physicians: NPs able to safely and effectively manage 67% of their patient visits without physician consultation (DeAngelis, 1994, citing Spitzer, et al., NEJM, 290:251-56, 1974). BUT: “. . . although NPs may be able to manage two thirds of single patient encounters without physician consultation, that is not the same as managing two thirds of the patients over time. Any single patient would probably need the expertise of a physician at some point in time (DeAngelis, 870).

Chiropractic admitted into Medicare system.

Asilomar conference in CA, whose organizers were led by MIT’s David Baltimore, discoverer of “reverse transcription” (transcription of RNA into DNA), debates the need for, and nature of, safeguards to allow resumption of genetic engineering research while keeping it free from governmental regulation. At end of conference, a small group led by Paul Berg (discoverer of recombinant DNA technology) and Baltimore prepare list of safety provisions that labs pursing genetic engineering research must follow. “The restrictions agreed to at Asilomar were accepted by universities and funding agencies worldwide. . . . Restrictive national legislation was avoided” (Issacson, 270-273).

U.S. Supreme Court strikes down 1879 Connecticut law prohibiting release of advice on contraceptives (Asbell, 239-241).

President Ford reluctantly signs the Education of All Handicapped Children Act (EHCA), which demanded that “all handicapped children between the ages of three and eighteen have available to them . . . a free and appropriate education.” They also had the right to nondiscriminatory testing, evaluation, and placement procedures, the right to be educated in the “least restricted environment” available, and the right to challenge school decisions (Sealander, 167, 278ff.). EHCA gave handicapped students a right ‘regular’ ones [students] never possessed – to an ‘individualized education plan’” (279).

First positron emission tomography (PET) scanners reach the clinic (Kevles, 204). Hand-held arthroscopes for orthopedic surgery available in most large hospitals (Lenoir, 29).

Dutch surgeon Henk de Kolk performs first laparoscopically assisted appendectomy: “With the laparoscope in one hand, he located the appendix and, with the other, he determined the location on the abdomen where he could make a minuscule incision through which he could extract the appendix” (Van de Laar, ch 17).

Identification of Ebola virus in Zaire centered around Belgian Mission Hospital, where almost 90% of the infected died (Farmer, ch 1).

Following unanimous 9 March recommendation of the Advisory Committee on Immunization Practice of the CDC, for whose members “the odds of a catastrophic flu epidemic had risen to a near-certainty” (Kolata, 139, 145), and accompanying nine-page memorandum by CDC head David Sencer (his “action memorandum” (144), U.S. President Gerald Ford announces swine flu vaccination campaign. Then, following refusal of insurers to provide coverage to the four vaccine manufacturers, Ford signed into law on 12 August a bill whereby the federal government would provide liability coverage from claims resulting from the vaccine. First immunizations on 1 October  three deaths of elderly people in Pittsburgh  suspension of swine flu campaign in Allegheny County and nine states. “The press began a national body count” (Kolata, 164-165). On 16 December, by which time 40 million Americans had received the swine flu vaccine, the CDC, led by Sencer, ended the immunization campaign, by which time not a single case of swine flu had been reported. The reason was reports of Guillain-Barré syndrome (GB) among immunized people. But many experts disputed the causal relation between the vaccine and GB, arguing that the disease was poorly described, and doctors – newly sensitized following the CDC’s disclosure – could include a variety of symptoms under the rubric of GB. Moreover, the primary symptoms of GB – nerve weakness and weakened reflexes – were associated with diseases other than GB. Finally, the alarm came about because the Minnesota physician who first reported GB in a flu shot patient “misheard” an audio tape (172-173). Withal, the CDC concluded that the vaccine increased the risk of getting GB eightfold, with the risk period extending 10 weeks after immunization. Other virologists and epidemiologist supported the causal connection, and “a tidal wave of litigation” ensured, as vaccinated people with putative GB demanded compensation from the federal government (174ff.).

NJ Supreme Court hands down opinion in case of Karen Ann Quinlan, authorizing Quinlan family to have her taken off respirator. By accepting the argument, built on Roe v. Wade, that “a constitutionally protected right to privacy overlay the doctor-patient relationship,” it “installed judges at the bedside” (Rothman, 225ff.). “How could [the court] substitute legal rulings for bedside ethics? The answer was by impeaching medicine; that is, by insisting that what doctors testified to in court and what they did at the bedside [arbitrarily deciding to discontinue treatment via DNR, etc.] were two different things, and that physicians’ efforts to smooth over the contradictions were lame” (226). “Decisions to terminate or withdraw treatment that individual physicians had once made covertly now would take place before an audience. The stage was likely to be a courtroom, and lawyers and judges, the leading actors” (228).

Following problems involving the Dalkon shield and defective cardiac pacemakers, Congress passed the Medical Devices Amendments that effectively gave the FDA authority to regulate medical devices in a manner similar to its regulation of drugs (Weisz et al., 710).

Amendments to 1938 Food, Drug, and Cosmetics Act establish three classes of medical/surgical devices requiring different levels of approval to ensure safety and effectiveness: Class 1 = simple devices like tongue depressors requiring little if any scrutiny; Class 3 = devices with “life-threatening or life sustaining” impact and attendant risks (e.g., pacemakers) extensive testing; and Class 2 = intermediate type devices to be governed by the 510(k) program, under which “companies had only to claim that their new device was ‘substantially equivalent’ to a product already sold in the United States and used for the same purpose. The program defined ‘substantially equivalent’ in vague terms that device company lawyers would come to love and exploit: ‘Not intended to be so narrow as to refer only to devices that are identical to marketed devices, not so broad as to refer to devices which are intended to be used for the same purposes as marketed products’.” Class 2 clearance quickly became the fast track to profitability for device manufacturers, as the FDA spent about 20 hours evaluating 510(k) requests compared with 1,200 hours for class 3 devices. “Suddenly, most applications were submitted as class 2 products,” with the surprising results “that today there is generally far less careful scrutiny of new devices than of new drugs” (Rosenthal, 132-133).

Harold Varmus and Michael Bishop’s proto-oncogene theory reorganizes cancer biology, retuning genes again to its center. Their experiments demonstrated “that a precursor of a cancer-causing gene – the ‘proto-oncogene’ . . . was a normal cellular gene. Mutations induced by chemicals or X-rays caused cancer not by ‘inserting’ foreign genes into cells, but by activating such endogenous proto-oncogenes. . . . Cancer genes came from within the human genome” (Mukherjee, 363-364, quoted at 364). In 1982, three labs published finding of isolation of same fragment of DNA, containing a gene called ras, from their respective cancer cells: “they had purified a mutated oncogene from a cancer cell” (376).

Documented successful use of maggot therapy at Univ. Texas Health Science Center to treat mastoiditis of 67-year-old man (Wainwright, 112).

U.S. Senate’s Select Committee on Nutrition and Human Needs, chaired by George McGovern, published Dietary Goals in the United States, which put the diet-heart hypothesis “on the national agenda” (La Berge, 146). It “promoted increased carbohydrate and reduced fat consumption along with less sugar and salt. . . . With the publication of the Dietary Goals, the federal government officially supported the low-fat approach” (149).

Sheldon Kaplan registers patent for EpiPen (epinephrine autoinjector), which FDA approves for commercial release in 1987 (Thomas).

passage of federal sterilization guidelines that recognized sterilization as a violation of civil and human rights.

Birth of Louise Brown, the first human birth from in vitro fertilization (the first test-tube baby).

Al Alberts and his team at Merck Research Labs discover Aspergillus terreus, a common soil microorganism active against a targeted rate-limiting enzyme (HMG-CoA reductase) in cholesterol synthesis  lovastatin (Mevacor), the first statin in the world to become a drug. This discovery vindicated Roy Vagelos’s commitment to molecular (i.e., enzyme) targeting – i.e., finding a target enzyme molecule in the disease process and then finding a substance that inhibits it – as the preferred scientific strategy for discovering new drugs (Vagelos & Galambos, 132-136). But the drug wasn‘t approved by the FDA until 1987 (155), and was followed several years later by MRL’s second HMG-CoA reductase inhibitor, simvastatin (Zocor).

Genentech makes a synthetic version of insulin to treat diabetes (Issacson, 99).

Consumer-survivor Priscilla Allen included in the Carter Commission and patient activists invited to participate in newly formed Community Support Program of NIMH. In this way “consumer/survivor perspective began to attract more policy interest (Tomes III, 724).

China implements its one-child rule, followed in 2010 by Iron Fist Campaign, led to compulsory sterilization, over course of three months, of 10,000 women who had violated law by having more than one baby. Two-child law began in 2015 and three-child policy in 2021 (Rutherford, Intro).

Founding of National Alliance for the Mentally Ill (NAMI), which subscribed to biological psychiatry: “NAMI helped to foster cozy relations between patients’ organizations and the pharmaceutical industry. Indeed, with half of its funding coming from pharmaceutical companies, NAMI had no sympathy for Szasz’s theory that mental illness is a myth” (Dowbiggin, 168).

Production of the radiopharmaceutical FDG (deoxyglucose), key to clinical investigations of Parkinson’s and Huntington’s diseases and activational studies of the working brain (Kevles, 210). First reported cases of AIDS following CDC shipments of pentamidine to LA for treatment of adult cases of Pneumocystis pneumonia (Desowitz, 177).

Establishment of Veteran Centers for Vietnam Vets: This outreach program of outpatient clinics, headed by Arthur S. Blank, Jr., “was probably the most ambitious attempt at collective psychotherapy in history, based on an idealistic hope that mass treatment could transform the lives of up to half a million people. Yet . . . the experience in the 1920s – which, apart from Kardiner’s writing was, for some reason, completely ignored – had shown that once war veterans become chronic patients they tend not to recover, just as large caregiving bureaucracies, once assembled, tend not to dismantle themselves. . . . Nor was the inherent difficulty of applying a model of ‘trauma’ based on the stresses of battle to hundreds of thousands of people who clearly had not been in battle ever really addressed” (Shephard, 396, cf. 392).

Publication of Barbara Gordon’s I’m Dancing As Fast As I Can on her addiction and unsupervised withdrawal from Valium (Tone, 192-195).

Baruch Blumberg and team devised vaccine for hepatic B virus (HBV), which caused an inflammation in liver cells that, in turn, caused liver cancer: “Blumberg had thus made a critical link from cause to prevention. He had identified a viral carcinogen, found a method to detect it before transmission, then found a means to thwart transmission” (Mukherjee, 281).

World Health Organization certifies eradication of smallpox from the world, with the last naturally occurring case appearing in Somalia in October 1977. Repositories of the virus in the U.S. and Russia were scheduled to be destroyed on June 30, 1999, but in April of that year, the U.S. announced that it would retain its stores of the virus, a response to recent intelligence that clandestine supplies of Variola were at large as a potential agent of biological terror (Fenn, Introduction).

Dewood et al. publish results of 1971-1978 study conclusively establishing the predominant role of coronary thrombosis in myocardial infarction. In patients studied within four hours of onset, 85% showed occluding coronary artery thrombus on angiography; among those studied 12-24 hours after onset of symptoms, frequency of thrombi declined to 65%, evidence that soon after formation coronary thrombi begin to undergo lysis (Weisse, 76-77).

First implantable cardiac defibrillator (ICD), designed by cardiologist Mieczyslaw Mirowski and electronics expert Morton Mower, implanted at Johns Hopkins Hospital on 4 February. By 1983, a second-generation device (a cardioverter-defibrillator) could also convert tachycardias into normal rhythm (Morris, loc 3121ff.).

Brazilian plastic surgeon Ivo Pitanguy, develops cosmetic abdominoplasty; it became the basis of all present variants of abdominal wall correction (Van de Laar, ch 15).

American Psychiatric Association publishes DSM-III, developed by Robert Spitzer (influenced by Columbia colleagues, especially Donald Klein) and with a third of the task force’s members trained at Washington University. Central principle of DSM-III was reliability, arrived at through a “Chinese menu” approach: “it was an innovation to define disorders entirely on the basis of clinical symptoms and their course, rather than on the basis of any theory. (This is more or less what Kraepelin had in mind.) . . . Ironically, the DSM solution to diagnostic unreliability created a new problem. We don’t know if its categories are real, and reliability has trumped validity. To be fair, DSM was never meant to describe diseases in the same way as internal medicine or surgery might, but only to provide a common language for the discipline” (Paris, 86-88; Kirk & Kutchins, 1-12). “DSM-III and ‘the new psychiatry’ that it reflected were important features in the effort made by a new generation of psychiatrists to gain control over the infrastructure of the psychiatric profession and to reverse the diffusion of power to other professions in the mental health enterprise” (Kirk & Kutchins, 7-8). DSM-III included as new entities “social phobia” (which provided a rationale for use of the MAOI phenelzine), which blossomed into “avoidant personality disorder” and Donald Klein’s “panic disorder” (which helped Upjohn find a market for its novel benzodiazepine, alprazolam) (Healy, 187-199). It also introduced PTSD.

Closing of Blackwells’ Infirmary for Women and Children which merged with Beekman Downtown Hospital to create first community hospital in Manhattan’s Financial District; Downtown Hospital now part of NY-Presbyterian (Nimura, 264, 268).

Norman Shumway, with fellow surgeon Bruce Reitz, perform first heart-lung transplant, with FDA granting permission to use the immunosuppressant cyclosporin to prevent rejection. The recipient, Mary Gohlke, lived five years and autopsy showed no evidence of rejection (Chaddock, 245).

First DTC advertising of a prescription drug, when Boots pharmaceutical used print and TV ads to promote Rufen, a prescription pain reliever. Then in 1982, Merck and Dohme advertised its pneumonia vaccine, Pneumovax, to people over age of 65. From 1983-1985, FDA called for voluntary moratorium on DTCA (Donahue, 675).

Upjohn releases Xanax, with a half-life of only six to 12 hours vs. Valium’s 20-100 hours; it overtook Valium as country’s leading benzo by 1986 (Tone II, 212-213).

Results of National Surgical Adjuvant Breast and Bowel Project’s(NSABP) large-scale trials of breast cancer treatment made public: rates of recurrence, relapse, death, and distant cancer metastasis were statistically identical among groups treated with radical mastectomy, simple mastectomy, and surgery followed by radiation: “The group treated with the radical mastectomy had paid heavily in morbidity, but accrued no benefits in survival, recurrence, or mortality” (Mukherjee, 200-201).

Bonadonna and Veronesis (Italian surgeon & chemotherapist) NCI trial in Milan shows that “adjuvant chemotherapy” with tamoxifen among women surgically “cured” of breast cancer led to relapse rates 50% lower than surgically cured women who did not. The effect was pronounced among women over 50; Bernie Fisher reanalyzed the cures in 1985 and found the effect of tamoxifen treatment was even more dramatic (Mukherjee, 220-222).

CDC’s first report in June on five young LA men, “all active homosexuals,” treated over the past year for Pneumocystis carinii pneumonia (PCP); in May, 1982, CDC officially named the epidemic acquired immunodeficiency syndrome (AIDS) (Epstein, 45, 55).

Dana Farber Center approves clinical trial of Emil Frei’s Solid Tumor Autologous Marrow Program (STAMP) – megadose combination chemotherapy with autologous bone marrow transplant (Mukherjee, 308-320). By the mid-90s, aggressive chemotherapy and marrow transplant were the rule, even as “the scientific evaluation of the protocol fell further and further behind) (325). Once the procedure was reimbursable, no woman wanted to be a trial participant who might be assigned to the nontreatment group. The treatment’s lack of efficacy and discontinuance followed the fall of South African surgeon Werner Bezwada, who in 2000 admitted to falsifying his data from the only trial to claim tremendous success (326-329).

On 2 December, Williman C. DeVries implants Jarvik-7 artificial heart in Barney B. Clark, who survived for 112 days. Originally envisioned as a permanent heart, it was later used as a temporary heart for those awaiting transplants (DeVries, 2019; cf. J. Rothman, 2021).

First CCD (charge-coupled device) marketed, and “within a few years, the latest models were small enough for a surgeon’s assistant to hold the camera while the surgeon stood upright, watching the screen.” First video-assisted laparoscopic gall bladder removal performed in Lyon in 1987 by Phillipe Mouret (Van de Laar, ch 17).

FDA approval of immunosuppressive cyclosporin, leading to “True success with organ transplantation” (Mezrich, Note from the Author).

Publication in Science of Gallo, Essex, and Montagnier’s papers on viral (retrovirus) cause of AIDS; Gallo wrote the abstract to Montagnier’s paper to make it sound like the Pasteur researchers had discovered a “C-type retrovirus” similar to Gallo’s own THLV: “Gallo had effectively enlisted the Pasteur researchers behind his own HTLV [human T-cell leukemia virus] (Epstein, 70).

Passage of Orphan Disease Act that gave drug companies financial incentives to conduct research on these rare diseases, e.g., Gaucher’s disease, a lysomal disorder like Tay-Sachs for which only 30% carrying the gene ever manifest the disease, and for which an effective enzyme replacement therapy was approved by FDA in 1991 (Wailoo & Pemberton, 52-53).

In December, following Oxford statistician Richard Peto’s explanation of meta-analysis of six previous aspirin studies indicating aspirin improved odds against second heart attack death by between a fifth and a quarter, FDA allows Sterling Product’s change in aspirin labelling. Less than a year later, U.S. Health Secretary, Margaret Heckler, told media that one aspirin tab a day could prevent secondary heart attacks (Jeffreys, 256-257).

Discovery of AIDS retrovirus: Luc Montagnier’s LAV; Robert Gallo’s HTLV-III; and Jay Levy’s ARV (Epstein, 181-186).

Via hypervariable “minisatellites” – neat little sequences found on all human chromosomes with a series of repeats unique to the individual – lead to Alex Jeffreys and Vicky Wilson’s discovery of each individual’s unique genetic fingerprint (a string of black marks that looks like a bar code) that was first used to exonerate an accused murderer and identify the actual murderer in England in 1986 (Ridley, 131-135).

Introduction of FirstTemp, the first tympanic thermometer. But this and subsequent ear thermometers did not really measure temperature of the tympanic membrane, but rather the ear canal. So the devices added a fudge factor, an “offset” to convert the reading to the equivalent oral or rectal measurement.

Hatch-Waxman amendment to Food, Drug, and Cosmetics Act (viz, “Drug Price Competition and Patent Term Restoration Act”) sought to clarify length of patent protection for drug makers, as well as offering makers of generic drugs financial incentives to bring cheaper version of brand name drugs onto the market as soon as the patents expired = abbreviated application process for generic makers, whereby they no longer had to include fresh clinical trials in their applications. But the intent was undercut by concessions to brand manufacturers via “a host of new ways to extend their patents . . . allow[ing] up to a five-year extension for claims of ‘time lost in regulatory review’ during which makers of generic drugs could not even submit an application.” In sum, the amendment instead ushered in an era in which multimillion-dollar court battles over patents now precede (and delay) each generic entry, driving prices up in the process” (Rosenthal, 94-95).

Publication of British Medical Research Council (MRC) trial on mild hypertension shows that drug treatment “did not appear to save lives or substantially alter the overall risk of coronary heart disease” (Kawachi & Conrad, 14).

FDA approves Genentech’s Protropin, first synthetic human growth hormone, for people with growth hormone deficiency (hypopituitary dwarfism) and chronic renal failure (Conrad, 74).

Novo Nordisk releases the NovoPen, the first commercially available insulin pen, a user-friendly replacement of the vial and syringe for diabetics. diabetes (Selam).

Beginning of progressive rise in new cases of TB in U.S. (F. Ryan, 390). In 1992, New York Times published series of articles under title “Tuberculosis: A Killer Returns” (394).

Four plaintiff psychologists file lawsuit against American Psychoanalytic Association, NY Psa. Institute, Columbia University Center for Psa. Training and Research, and the International Psychoanalytic Association alleging violations of Sherman Act (intended to eliminate unfair, anticompetitive trade practices) that excluded non-MDs from obtaining psychoanalytic training. Settlement of 1989 was a victory for plaintiffs.

FDA withdraws moratorium of print (but not broadcast) advertising of prescription drugs directly to consumers (Conrad & Leiter, 831, 834).

Following publications in 1960 and 1972 from Yugoslavia and France on use of leeches to prevent vein congestion and postop blood clotting, Boston plastic surgeon Joseph Upton reattached severed ear of 5-year-old, but reattached ear blackens because blood can’t escape it. Solution: leeches. “Joseph Upton attached two [leeches] to the boy’s congested ear, and in minutes it began to recover its healthy color. After a couple of days the organ was fine, and Upton became the first doctor to have successfully reattached the ear of a child using microsurgery. Plus a couple of vampiric slugs.” Upton’s success  renaissance in leeching, and in 2004, FDA approved leeches as a “medical device” (preceded by FDA approval of maggots in January 2004), enabling new leech-farming companies from other countries to enter the market” (Poole). As a leech bites, it releases an anti-coagulant, a vasodilator, and a spreading factor from tissue farthest from the bite (liquefying any hardening blood). These chemicals created an “artificial circulation” that keeps a reattached appendage alive while the patient grows new veins (Colapinto).

Establishment, following act of Congress, of VA “national center” to develop a model treatment program for PTSD, which was based on the “psychodynamic core” of a repetition compulsion, with recovery based on recall and disclosure of the traumatic memory (H. Young, 184-185). “In many cases, symptomatic behavior is altered at the moment that the patients arrive at the inpatient unit. . . . While the staff attributes the changes to their therapeutic practices, it is doubtful whether this is the best explanation. The changes are more plausibly attributed to the patients’ adaptation to daily life in a highly structured social environment, in which prescribed behavior, including nonviolence, is a precondition for continued treatment. . . . For the therapists, the most unequivocal evidence of progress is that most long-stay patients eventually provided satisfactory narratives and interpretation” (186-187).

Congress passes National Childhood Vaccine Injury Act, with National Vaccine injury Compensation Program designed to protect drug companies from lawsuits not supported by scientific evidence. It was intended to protect industry from specious claims brought by personal injury lawyers, and was funded by federal excise tax on every dose of vaccine. One problem with the program: people bringing specious suits could opt out of it (Sealander, 345).

Bailar & Smith article in May issue of NEJM “shook the world of oncology by its roots” by showing, via age-adjustment normalization of populations, that between 1962 and 1985, cancer-related deaths had increased by 8.7%, reflecting, most potently, an increase in smoking rates in the 1950s that led to increase in lung cancer. Cancer mortality was not declining in the U.S.; “Some thirty-five years of intense effort focused largely on improving treatment must be judged a qualified failure” (Mukherjee, 229-233, quoted at 231).

International Committee on the Taxonomy of Viruses rebuffed Robert Gallo (HTLV-III) and agreed on a new name for the retrovirus causing AIDS: HIV, human immunodeficiency virus (Epstein, 77). Phase II trial of AZT ended early because “the drug was so effective that it would be unethical to keep the control group on placebos any longer” (Epstein, 198). On 20 March 1987, FDA approved AZT for use by the 33,000 Americas with AIDS (199).

March and Vannier develop first simulator for craniofacial surgery, using commercial CAD software to provide an automated optimization of bone fragment position to best fit normal form (Lenoir, 34).

American Psychiatric Association quietly eliminates “Ego-Dystonic Homosexuality” from DSM III-R (Kirk & Kutchins, 90). DSM III-R also introduced “new entity” of “delusional disorder” (DD) “that appeared perfectly suited for the purpose of distinguishing one [antipsychotic] compound from another” (Healy, 184-85). U.S. District Court for the Northern District of Illinois decides against organized medicine and for chiropractic in Wilk v. AMA.

Enalapril (Vasotec) becomes Merck’s first billion-dollar drug (Vagelos & Galambos, 162).

Texas, then California (1990) legislatures pass Intractable Pain Treatment Acts (IPTA) to protect physicians from intrusion by federal and state regulatory agencies in treating chronic pain with federally controlled substances (Wailoo II).

Seiji Ogawa, at Bell Labs in NJ, discovers key to rapid MRI (fMR), which permits real time pictures of organ functioning (Kevles, 197-198). French surgeons perform first laparoscopic cholecystectomy (Lenoir, 1989).

First publication from Yale-based NIMH studies comparing IPT, CT, imipramine, and “optimal therapeutic encounter” (placebo). It showed that, as severity of depressions increased, both imipramine and interpersonal therapy, but not cognitive therapy, were significantly more effective than clinical management. “The results were very dispiriting to the cognitive therapists, but somewhat more encouraging for Klerman and the advocates of interpersonal therapy” (Healy, 239-245).

FDA finally approves clozapine, discovered in 1958 and effective with treatment-resistant schizophrenia and in eliminating tardive dyskinesia (Dowbiggin, 151).

Establishment of federal Agency for Health Care Policy and Research (AHCPR) with mandate to produce practice guidelines. It was a response both to need for cost containment and new data (some collected by PSROs) that revealed “ alarming discrepancies, institutional as well as regional, in the incidence of medical and especially surgical procedures” (Weisz et al., 708; J. Daly, 214). In 1999, it was recast as the Agency for Healthcare Research and Quality, which, instead of developing guidelines itself, “provided funding for a series of twelve external evidence-based practice centers to conduct systematic reviews of the evidence on topics nominated for their relevance to factors like disease prevalence, significance to health programs, and cost, as well as the availability of scientific data. This evidence could be used directly by health plans and payers, and by public and private organizations to develop practice guidelines” (J. Daly, 220-221).

U.S. Federal Agency for Healthcare Research and Quality (AHRQ) joins AMA and other institutions to create the National Guidelines Clearinghouse (Weisz et al., 712). Congress passes Patient Self-Determination Act to secure patients’ right to refuse unwanted life-extending treatment (Halpern, 841).

In Wilk v. American Medical Association, a federal anti-trust case brought by chiropractor Chester A. Wilk and co-plaintiffs against the AMA and 10 co-defendants, the 7th District Court ruled against the AMA, finding it in violation of paragraph 1 of the Sherman Act by conducting an illegal boycott. The verdict was affirmed by the U.S. Court of Appeals on 7 February 1990.

In December, FDA approves Norplant Contraceptive System, six small rods surgically implanted into upper arm, which slowly dispense progestin levonorgestrel (a form of female hormone progesterone) over five-year period. It was developed by NY’s Population Council and selectively marketed to poor black women and young black girls. A “national experiment with a racial agenda” took place in Baltimore public schools, where it was deployed via school-based health clinics (Washington, 285ff.).

At McMaster University, Gordon Guyatt devises and uses term “evidence-based medicine”: “David Sackett popularized ‘critical appraisal’ to describe the process of assessing the literature according to explicit rules of evidence. . . . Guyatt took the next crucial steps in naming an approach in which clinical decisions were justified by reference to a systematic assessment of the medical literature” (J. Daly, 88). He first used the term scientific medicine, which drew strong criticism from colleagues who took it as implying that what they did was unscientific, so he switched to “evidence-based medicine”: “Since evidence is what clinical epidemiology produces, evidence-based medicine is the practical application of clinical epidemiology in patient care. The textbook, Evidence-Based Medicine: How to Practice and Teach EBM, was published in 1997 and revised in 2000 and has sold more than 70,000 copies (89). . . . With his fine focus on generating evidence that will produce more effective practices, he does, however, ignore evidence from social science that identifies the structural and professional determinants of clinical decision making” (91).

First use of preimplantation genetic diagnosis, which “involves fertilizing an egg with sperm in a Petri dish, doing tests on the resulting embryos to determine their genetic characteristics, and then implanting into a woman’s womb the embryo with the most desire traits. It allows parents to choose the gender of their and avoid having a child who carries a genetic disease or some other attribute the parents find undesirable” (Issacson, 274).

Francisco Mojica, graduate student at University of Alicante (coast of Spain) determines the function of the repeated sequences in bacteria cells, identifying 14 identical DNA sequences repeated at regular intervals in the archaea. In 1995, by which time researchers had found the repeated clusters in 20 species of bacteria and archaea, Mojica came up with name CRISPR (clustered regularly interspaced short palindromic repeats). The name was formalized by Dutch scientist Ruud Jensen in a paper of 2002, where he reported his discovery that CRISPR sequences were flanked by a gene that encoded directions for making an enzyme. He named these CRISPR-associated or Cas, enzymes (Isaacson, 71-73).

Human Genome Project, with $3 billion funding by U.S. Department of Energy and the NIH, maps the human genome, relying on an automated, high-throughput version of the Sanger sequencer. The first draft of the sequenced human genome (albeit with gaps) announced by President Bill Clinton in June 2000, with publication following in February 2001. Final high-accuracy sequence published in April 2003. The project, which cost over 3 billion dollars, was facilitated, inter alia, by new technology that allowed researchers to clone large chunks of human DNA in yeast (14-15, Doudna & Sternberg, 14-15).

U.S. Senate Appropriations Committee establishes Office of Alternative Medicine within NIH with funding of $2 million; In 1998, Congress upgraded its status to the National Center for Complementary and Alternative Medicine (Whorton, 294-295).

FDA’s Antiviral Advisory Committee endorses use of CD4 counts (T-cell counts) as surrogate marker for demonstrating efficacy of nucleotide analogues in treatment of AIDS. In July, Committee recommended licensing of DDL, and in 1992, it gave “conditional approval” to DDC when used in conjunction with AZT (Epstein, 276-280).

Philip Green and his team at Stanford Research Institute assemble first working model of a telepresence surgery system, which they licensed to Intuitive Surgical, Inc. in 1995. The latter firm added EndoWrist and “improved the three-dimensional video imaging, navigation, and registration of the video image to the spatial frame in which the robot operates.” A haptic (touch, tactile) interface was added to the system by Kenneth Salisbury of MIT Artificial Intelligence Laboratory (Lenoir, 30-31).

Medicare begins using William Hsiao’s research-based relative value scale (RERVs) to scientifically determine what each physician service was worth. It led to a new currency termed “Relative value units” (RVUs), based on work/time spent for a visit or intervention; overhead insured in performing the service; cost of training needed to perform the service; and the malpractice expense involved. It was adopted by private insurers as well (Rosenthal, 61). But the scientific objectivity of the scale was turned on its head when Congress assigned annual adjustments to the scale to the AMA, which in turn assigned the updates to the value of codes to a committee (i.e., the Relative Value Scale Update Committee) that met three times yearly and was composed entirely of physicians with vested financial interests in Medicare remuneration to their respective specialties. “Allow the AMA to determine doctors’ payments is akin to letting the American Petroleum Institute decide what BP and Shell and ExxonMobil can charge us not just for gas but, somehow, for wind and solar power as well” (63).

FDA severely restricts availability of silicone gel-filled breast implants (Haiken,230-232).

Establishment of the Cochrane Centre, based in Oxford and part of Britain’s National Health Service. Cochrane Collaboration was launched in 1993 in Oxford; it now has 49 international review groups, each with a coordinating editor supported by an editorial team that conducted systematic reviews of specific medical topics. Reviews are updated and posted on the Web and also supplied on CD as The Cochrane Library, a database of systematic reviews and controlled trial registers (J. Daly, 167). There are also 14 Cochrane Centres with national or regional responsibilities for coordinating Cochrane initiatives (168). Whereas emphasis at McMaster University was on incorporating evidence from trials into clinical practice, the Cochrane emphasis was on systematic reviews of trials, which provided more reliable evidence for practice (171).

WHO listed no less than 10 countries in which TB was dramatically increasing; It was subsequently realized that the AIDS virus was the most important trigger for this new global threat. The very immune cells destroyed by the HIV virus are the cells that enable the body to fight TB, so the virus could trigger TB among the 1.7 billion people in developing nations (as of 1992) who, unbeknownst to them, harbored the TB germ in little healed cicatrices in the lungs. (F. Ryan, 395-398, 401, 417).

National Blue Cross/Blue Shield Board allows member plans to become for-profit insurers, enabling them to go to the stock market and borrow money against massive indebtedness incurred by the 90s, when the Blues alone were left to cover the sickest patients denied coverage by Aetna, Cigna, et al. (Rosenthal, 18).

Study shows that Merck’s simvastatin (Zocor) not only reduced risk of coronary heart disease but also saved lives (La Berge, 158).

Oregon, via referendum, approves Death with Dignity Act that allows physicians to prescribe, but not to administer, lethal doses of drugs for patients who had less than six months to live, who had been deemed mentally competent, and who chose death voluntarily in front of witnesses. After Oregonians approved the PAS referendum a second time, the law went into effect in October 1997 (Wailoo II; Lavi, 164ff.). “. . . a central component of the Oregon act – which has its roots deep in the nineteenth century – is the role played by the accompanying physician at the deathbed. . . . [attending physicians are the vehicle of patient’s informed consent] which should not be understood naively as offering all available information to patients . . . informed consent is a means by which the patient’s autonomy is structured within the regulatory regime of modern medicine.” Patient’s decision is also structured via an “elaborated array of safeguards,” which “creates a process through which the desires of the patient will be constructed and not simply discovered (e.g., introducing both the family and the therapist, whose advice can be rejected but who cannot be ignored (Lavi, 167-168).

Discovery of AIDS retrovirus (HTLV-III [human T-cell leukemia virus]) simultaneously by research groups at Pasteur Institute and National Cancer Institute in Bethesda (Desowitz, 181-184). Publication of DSM-IV: “. . . the psychiatric tradition and sociopolitical considerations seem to have played the major roles in shaping this document. . . Very different symptoms are included under the rubric of ‘schizophrenia’ mainly because they have always been grouped together, rather than because of any new scientific evidence that they share a common etiology. In fact, schizophrenia seems to be a ‘catch-all’ disorder for any serious thought disorder, as long as a number of specific factors such as age, brain damage, toxins, generalized dementia, or an overriding mood disorder can be ruled out” (Valenstein, 158-163; quoted at 161).

Bird viral flu scale in Hong Kong cut short by massive epidemiological effort, which identified chickens as source of the H5N1 flu virus, transmitted to humans in “wet market” in business/hotel district where the chickens were slaughtered on the spot for their purchasers. The flu-infested chickens came from Southern China, which shipped 80,000-100,000 birds to Hong Kong daily. More than 1.2 million chickens were killed to avoid a “chicken Ebola,” with the story representing “a triumph of epidemiology” (Kolata, chap 8, quoting CDC’s Nancy Cox at 241).

Publication of experiments of Benedetti with placebo, naloxone, etc. show that “Placebo treatment can dramatically reduce pain compared to no treatment, but only if the subjects know it is happening. It is not the placebo itself that reduces the pain . . . It is the knowledge of the placebo that does the trick” (Moerman, 106). Benedetti then showed, with active medication as a constant, that “subjects who were given open injections by a clinician needed less medication to get pain relief than did the secretly medicated patients” (108).

Via Federal Drug Administration Modernization Act. FDA relaxes restrictions on promotion of pharmaceuticals, allowing direct to consumer (DTC) advertising via guidelines for product-specific prescription drug broadcast advertisements that permitted (1) product claim advertisements; (2) reminder advertisements; and (3) so-called help-seeking advertisements that told consumers about unspecified treatment possibilities for diseases or conditions. FDA’s “Draft Guidance for Industry: Consumer-Directed Broadcast Advertisements” spelled out ways drug firms could meet the “brief summary requirements” in broadcast ads by referring consumers to a toll-free phone number, print ads, a website, and/or their pharmacists or physicians for complete info about a drug’s risks and benefits (Donohue, 685). Broadcast DTCA ads “focus on chronic problems affecting relatively healthy people, with large potential treatment populations and long-term usage, including drugs for allergy, anxiety, obesity, arthritis, erectile dysfunction, and high cholesterol. About 20 prescription drugs make up 60 per cent of the pharmaceutical company spending on DTCA (Hollon, 2005)” (Conrad & Leiter I, 832). Act also eases limitations on manufacturers re advertising off-label use of their products to physicians (Conrad & Leiter II, 161, 166). DTCA advertising rose from $1.3 billion in 1998 to $3.3 billion in 2005 (Donohue, 685-686).

Bratman proposes term "orthorexia nervosa" to describe people whose obsession with eating only healthy foods leads to extreme diets that result in malnutrition and compromise daily functioning. But orthorexia has received scant attention in the North American literature and lacks formal diagnostic status (Bratman, 1997; Dunn & Bratman).

Hirokawa and associates at University of Tokyo, looking at kinesins (molecular motors that transport molecules around cells) in mice, discovered monocilia that, unlike ordinary cilia (microscopic hair-like structures extending from the ends of cells), turned clockwise like propellers, creating a current flow that pumps signaling molecules secreted by the node from right to left – a molecular biological explanation of the origins of left-right asymmetry (McManus, 116-117).

Fourteen years after loosing a hand, New Zealander Clint Hallan recipient of first-hand transplant in Lyon, with surgical team led by Michael Dubernaud. But he psychologically rejected the new right hand and had it amputated in 2001. In 2016, 18-year-old Indian woman received grafts of two new hands from 21-year-old male donor. In 2019, she reported that her new hands had since begun to exhibit female features (Chaddock, 251-252).

FDA approves Celgene’s application to market thalidomide (Thalomid) in U.S. for treatment of ENL (leprosy). “Some observers have noted the FDA’s deft political move in the thalidomide case: the FDA showed its sensitivity to the needs of patients, while taking responsibility for the outcomes of a minute number of leprosy cases and avoiding responsibility for the estimated thousands of off-label prescriptions [e.g., for AIDs/HIV “wasting disease”] (Timmermans & Berg, ch 6, quoted at p. 188). “Instead of a horror drug of the past, thalidomide appeared through the scientific work as any other chemical compound with known toxicological parameters, and . . . this picture proved less alarming than some other drugs currently approved by the FDA and widely available by prescription (e.g., Accutane). . . Thalidomide is the most regulated drug in U.S. History” via the standardized S.T.E.P.S. program (190- 191). The designers of the program preserved and enhanced the professional autonomy of the key actors: “Physicians’ off-label prescription prerogatives were left untouched, and pharmacists were given desired counseling responsibilities. The federal regulators were satisfied that the proposed drug system set a new precedent for restricted distribution” (192). “By marking women’s reproductive behavior as the most important safety valve, the designers [of the program] perpetuated a distorted view of women as untrustworthy decision makers and delegated control to physicians and pharmacists.”

Maryland becomes first of 28 states to adopt contraception mandates requiring contraceptive coverage by insurers (Starr, 288). Re the Affordable Care Act, Obama’s compromise with critics in early 2012 was to guarantee employees of religiously affiliated institutions contraceptive coverage paid not by the employers but by the insurers, for whom employees’ access to contraception would cut insurers’ overall costs (290-291).

Publication by Michael Ackerman (Mayo Clinic) of first use of postmortem genetic testing to help establish cause of sudden death, i.e., identifying the molecular cause of electrical disease by sequencing parts of four genes. Then, in 2016, two groups of Australian researchers showed that among young people who died suddenly in Australia and New Zealand, a relevant genetic variant was found in almost a third of cases (Ashley, 45)/

U.S. Congress passes Drug Addiction Treatment Act.

Geneticists have now characterized about 1,000 genes out of an estimated 10,000 that cause single-gene-inherited diseases (Rutherford, 156).

Exegen (Watertown, MA) introduces clinical temporal artery thermometer that used dual scanners to record ambient environment and skin temperature, recording over 1000 readings per second. After 3000 readings, an internal “heat balance” algorithm determines the arterial temperature, which is displayed on an LED screen. It also released a home version of the device for $30 (Schuman).

Michael DeBakey, age 97, suffers an aortic dissection, and, despite urgings of wife and family, declines surgery. However, hospital’s ethics committee allowed the operation DeBakey himself had invented to proceed. It was successful, and several months later, he was frequently seen in the hospital gym doing his rehab workout. He returned to work and lived two more years, dying a few months before his 100th birthday (Morris, loc 1482ff.).

Genetic Information Nondiscrimination Act forbids insurers from limiting coverage or altering premiums on the basis of genetic information. The law prevents insurers from requiring policy holders to undergo genetic testing but could still make testing a requirement for treatment (Cornetta & Brown, 2-3).

Death of Senator Edward Kennedy on 25 August reignites progressive commitment to health care reform after summer of right-wing demagoguery (“death panels,” loss of Medicare benefits) against the Affordable Care Act. Obama read letter from Kennedy in his 9 September health care address to Congress: “What we face is above all a moral issue; at stake are not just the details of policy but fundamental principles of social justice and the character of our country” (Starr, 220-222).

Passage of Patient Protection and Affordable Care Act – Mechanics of Passage: In Senate, Majority Leader Harry Reid made these concessions: he killed public option and Medicare buy-in for 55–64-year-olds to retain vote of Joseph Lieberman; he gave Nelson special treatment for Nebraska on Medicaid (“Cornhusker kickback,” which never made it into law). Affordable Care Act thereby passed in Senate on straight party lines, 60-40, on 24 December 2010 (228-230). On 21 March 2011, House of Representatives passed Senate bill, 219 to 212, with no Republication support. On 25 March 2011, House and Senate enacted the follow-up reconciliation measure putting the bill into Law. The reconciliation measure (to which a majority of Senators had agreed in advance) made the Senate bill more progressive by raising affordability subsidies for low-income people buying subsidiaries through the exchanges; eliminating special provision for Nebraska; and increasing support for states’ expansion of Medicaid (233).

Affordable Care Act (U.S.): Compromise Nature of: “This is the puzzle of the Affordable Care Act. It calls for major changes, but it is also notable for what it leaves unchanged. . . the law does not substantially alter how medical care is organized, and it may not change the long-term trajectory of health spending. . . The Affordable Care Act was not socialized medicine; it was an effort to fill in the holes of the existing insurance system with a minimum of disruption to established institutions and the protected public. But much of the protected public could never be won over to a program that they perceive as primarily benefiting the poor and minorities. . . .”(Starr, 239, 276). . . . As originally written, the law “extends eligibility for Medicaid to all citizens with incomes under or near the federal poverty line and subsidizes private insurance for both citizens and legal immigrants earning up to four times the poverty level. According to projects by the Congressional Budget Office at the time the law passed, it would extend coverage to about 32 million people, roughly half through Medicaid and half through added private insurance, raising the insured shared of the population to about 94 percent (240). “But the legislation he [Obama] signed as president does not actually establish a general right to health care or to health insurance. Instead, it creates a series of individual rights in relation to private insurance – for example, a right against arbitrary rescissions and unreasonable limits of coverage. It also creates a right to federally subsidized coverage for people who otherwise would not be able to afford it. And to make the system workable, it calls for what the law itself terms ‘shared responsibility,’ referring primarily to obligations of individuals and employers to pay for insurance” (248).

Affordable Care Act: “Mandate” provision of: Regarding the minimum level of health coverage mandated by the Act (= “bronze” level plan with a high-deductible), “The law also provides exemptions from the mandate on a number of grounds, including financial hardship. . . . For fear of a backlash, Congress was unwilling to back up the mandate with sanctions. If people without insurance fail to pay the fines they owe, the Affordable Care Act does not authorize criminal penalties, the garnishing of wages, or liens against property. . . . The mandate’s central purpose is to deter people from opportunistically dipping into the insurance funds when they are sick and refusing to contribute when they are healthy, but there are other ways to bring about that result” (Starr, 251).

Affordable Care Act: Provision reining in of nonprofit hospitals: One provision, which elicited fierce hospital protests, began requiring IRS to collect each hospital’s quantitative enumeration of charitable activities and their value  Schedule H (Form 990), where hospitals now list how much money-losing care they dispensed, and how they calculated that number. They must also list and value activities to better their communities. “Recent research shows that many are providing nowhere near the amount of charity care and community benefit that would justify the value of their tax exemption” (Rosenthal, 50).

Horizon Pharma releases Duexis, a combination of ibuprofen and famotidine (Pepcid). The two drugs, purchased separately at Costco, cost $9 monthly; Duexis, covered by five patents, cost $1,600 monthly. Deploying 160 sales reps. Horizon’s gross annual sales quickly rose to 85.5 million. Via a “pay-for-delay” settlement, Horizon paid generic manufacturer Par not to produce a generic version of Duexis until 2023. “Patient outrage over the high price of patient patent plays was the last business barrier drugmakers had to resolve  “co-pay coupons” “so that the manufactures can continue to submit bills for the full price of the drug to insurers. A direct payment by the drug company could be considered a kind of bribe, so foundations with noble-sounding missions . . . were often created to cut the checks” (Rosenthal, 112-115).

Jennifer Doudna and colleagues at Berkeley demonstrate that CRISPR-Cas9 (clustered repeated sequences), with which bacteria cells destroy viruses, can be modified in laboratory to destroy genes other than the bacteriophages (bacteria-eating viruses) targeted by the immune systems of specific bacteria. The critical experiment, devised by Martin Jimek and Doudna, targeted a jellyfish gene (green fluorescent protein [ GFP]), incubating them with Cas9 and the jellyfish DNA in a DNA-cleavage assay. The experiment was successful, as all the GFP DNA was sliced apart at the intended site. “How incredible that bacteria had found a way to program a warrior protein to seek and destroy viral DNA! And how miraculous, how fortunate, that we could repurpose this fundamental property for an entirely different use.” Their seminal paper was published in Science on 28 June 2012 The paper concluded “with a brief but significant nod to uses of CRISPR outside of bacteria, including in other cell types”(Doudna & Sternberg, 80-85, quoted at 84, 85).

Outbreak of Ebola (a Filovirus, like Marburg virus; hemorrhagic fever) in southeast Guinea, then by February 2014 to Liberia and Sierra Leone (=Upper West Africa), especially where the three countries intersect (the Kissi Triangle). Initially misdiagnosed as cholera, it was an epidemic spread by caregivers: almost 1,000 healthcare workers from the three countries became infected, half of whom died: “The epidemic was fueled and sustained within this three-country region by everyday acts of caregiving, the mundane yet sacred obligations people felt to nurse the sick and bury the dead – without the PPE, or personal protective equipment, that such duties often required. . . . Like COVID-19, Ebola is a zoonosis, meaning it’s caused by a pathogen that jumps from animals to humans. . . . a ‘spillover event’. . . . [Western commentators] invoked a host of exotic practices and beliefs held to be common in this part of the world. But variations of these practices (eating game, having babies, nursing the sick, respecting and transmitting traditions about last rites and burial) are encountered across the world, and Ebola’s putative natural host or hosts also have a wide distribution zone. . . . [All such cultural explanations] didn’t throw much light on the particulars of the disease’s catastrophic spread across Upper West Africa.” International relief efforts (WHO, MSF, etc.) adopted a contain-over-care paradigm that antagonized local populations (who expected hands-on supportive care from outside providers), which led to nonreports of illness, destruction of health care facilities (ETOs, etc.), and drove the infection underground (Farmer, Preface, ch 1).

U.S. Department of Justice reaches a settlement of $3 billion with GlaxoSmithKline for various “misdeeds” regarding the anti-nausea drug Zofran, including promoting it to pregnant women with morning sickness, for which it was not approved, illegal efforts to keep competing nausea drugs off the market, and pay=for-delay deals to keep generic Zofran and much cheaper anti-nausea drugs (e.g., generic Compazine) off the market (for which it was sued by South Korea) (Rosenthal, 121).

On 9 April, in response to a lawsuit by the WSJ, Medicare for the first time released data showing how much it had paid to every individual doctor. “Thousands of physicians made more than $1 million each from Medicare in 2012 and dozens more than $10 million” (Rosenthal, 84).

FDA grants patent to Vanda for Hetlios (tasimeltonin), a new molecule functionally equivalent to melatonin (i.e., it bonds with melatonin receptors), for treatment of Non-24, an obscure sleep disorder among the totally blind, whose inability to perceive light throws off circadian rhythm. A boutique drug company, Vanda based its application on “fungible surrogate endpoints,” such as shrinking the study population to 62 patients, and then focusing only on the 25% of nights when subjects’ sleep time was lowest. In this manner, it relied on “surrogate measurements” to prove efficacy and get “expedited approval” from the FDA. The result: Hetlios proved less effective than melatonin and cost over $200 a day, whereas melatonin was an OTC drug that cost $6 for a bottle of 100 pills (Rosenthal, 101-105).

During Napa conference, which, like the Asilomar conference of 1975, advocated “a path forward rather than putting on the brakes”), word reached attendees of experiments on non-viable human embryos underway in China.” In the end, attendees agreed that while use of CRISPR tools for non-inheritable gene editing was a good thing, called for a temporary halt on germline editing in humans at least until the safety and social issues could be further understood” (Issacson, 288).

In December, first International Summit on Human Gene Editing in Washington, reaching a conclusion almost identical to that of Napa meeting at beginning of year, viz., that “Human genome editing should be strongly discouraged until stringent conditions were met, but the words ‘moratorium’ and ‘ban’ were avoided” (Isaacson, 292).

U.S. Congress passes Comprehensive Addiction and Recovery Act (CARA), among whose unwitting consequences was investigation of any mother whose newborn showed traces of any drug, legal or illegal. This meant that mothers taking legally prescribed drugs during pregnancy (e.g., suboxone, for addiction) were investigated and sometimes lost their infants for simply following doctors’ orders and taking a prescription med during pregnancy.

Ignoring international guidelines, e.g., of the National Academy of Sciences), a 34-year-old publicity-obsessed Chinese researcher, He Jiankui used a CRISPR gene edit to take out the receptor gene for HIV (CCR5) in healthy human embryos. Two twin girls who had received the gene edit were born normally in early November, though it came to light that unwanted off-target gene edits had been made and that both embryos had been mosaics (i.e., had begun cell division before the gene edit), so that some of the resulting cells in the babies were unedited. The international uproar was played out at the Hong Kong conference (Issacson,310-311, 315ff.). Doudna “was appalled at what Jiankui had done, because it was premature and unnecessary as a medical procedure and a grandstanding act that could spark a backlash against all gene-editing.” Yet, the conference statement she issued with Baltimore, et al., sought to steer “a middle course,” as she “wanted to pave the way to making it safer to do so. . . . So the statement that Doudna, Baltimore, and the other organizers crafted was very restrained” (323-324).

In July, in first clinical trial for CRISPR-Cas 9 gene editing, sickle cell patient Victoria Gray had stem cells extracted from her blood (ex vivo) and reinjected (in vivo) following gene editing using CRISPR-Cas 9. The gene editing activated a gene that produced a type of healthy blood cell normally formed only during the fetal stage of life, enabling Gray to begin producing her own good blood. “It was an amazing milestone: CRISPR had apparently cured a genetic disease in humans.” The trial was led by CRISPR Therapeutics, founded by Emmanuel Charpentier (Isaacson, 245-247).

On 31 December, World Health Organization China Office is informed of several cases of a pneumonia of unknown etiology in Wuhan. Symptoms include shortness of breath and fever = emergence of Covid-19 virus in China.

On 3 January, China informs WHO of having identified over 40 cases of pneumonia of unknown etiology, and on 7 January Chinese public health officials identify a novel coronavirus as the causative agent of the outbreak. The Center for Disease Control (CDC) thereupon established incident management structure to guide their response to novel coronavirus reported by the Chinese. It followed the preparedness plan devised for Middle East Respiratory Syndrome Coronavirus (MERS-CoV). On 9 January, China reports first officially certified death from coronavirus, and Chinese researchers publicly post the full genetic sequence of the virus (Issacson, 404). On 11 January, World Health Organization (WHO) reports, via tweets, that it has received genetic sequence of the coronavirus, to become publicly available in near future.

On 20 January CDC reports first laboratory-confirmed case of Novel Coronavirus in U.S. from samples taken on 18 January in Washington state. On same day it activates its Emergency Operations Center (EOC) to respond to emerging outbreak.

On 11 March, following more than 118,000 reported cases of Covid-19 in 114 countries and 4,291 reported deaths, WHO declares Covid-19 a pandemic. On March 13, Trump Administration declares nationwide emergency in U.S. and issues travel ban on non-U.S. citizens traveling from 26 European countries. On March 14, CDC issues “no sail order” for all cruise ships, directing them to cease activity in all waters over which the U.S. had jurisdiction. On March 16, “Clara-Bot,” a Covid-19 symptom checker, becomes available on CDC website.

In March and April, U.S. President Donald Trump offers medieval intuitions about effective Covid-19 treatment: “We ought to give it [hydroxychloroquine] a try . . . feel good about it. That’s all it is, just a feeling, you know, smart guy. I feel good about it” (20 March); “I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning? Because you see it gets in the lungs, and it does a tremendous number on the lungs. So, it would be interesting to check that” (23 April); “So, supposing we hit the body with a tremendous —  whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body?” (23 April). (Stepansky IV).

On 11 December Pfizer-BioNTech COVID-19 vaccine (Comirnaty) becomes available under FDA’s Emergency Use Authorization (EUA) to individuals 16 years of age and older, with authorization extended to 12–15-year-olds on 10 May 2021. On December 18, the Moderna COVID‑19 vaccine (Spikevax®) was likewise authorized by the FDA under an EUA for individuals 18 years and older.

In June, in Dobbs v. Jackson Women's Health Organization, the U.S. Supreme Court, by 6-3 vote, overturned the Roe v. Wade decision of January 1973, which held that women's right to abortion was rooted in the language of the Constitution and Bill of Rights: the unduly restrictive state regulation of abortion was thereby unconstitutional. The Dobbs decision, by a 6-3 vote, held that abortion was not a constitutional right, thereby eliminating women’s freedom to end unwanted pregnancies, and throwing the regulation of abortion back to the states.

In September, replacement of original Pfizer and Moderna Covid-19 vaccines with “bivalent” vaccines, which targeted both the original SARS-CoV-2 virus and Omnicron variants BA.4 and BA.5 (Katella).

On 8 December, FDA approves first medical application of CRISPR/Cas9 gene-editing technology in the U.S. Casgevy, (exagamglogene autotemcel), an ex vivo, exogamous (i.e., using the patient’s own blood) application of CRISPR/Cas9, was approved for treatment of sickle-cell disease in patients 12 years and older. On the same day, the FDA also approved Lyfgenia, another cell-based gene therapy (i.e., genetic modification of the patient’s blood stem cells) for patients 12 years and older with sickle cell disease (FDA News Release, 8 December 2023). The UK’s announcement preceded the FDA’s by several weeks, when the Medicines and Health Care Agency gave the green light for the use of Casgevy as a treatment for sickle cell disease and transfusion-dependent β-thalassemia. “The UK’s decision to endorse Casgevy in sickle cell disease was based on an impressive ability to eliminate severe vaso-occlusive crises — painful inflammatory attacks, often requiring hospitalization — in 28 out of 29 trial participants eligible for evaluation. It remains to be seen whether the therapy will also reduce stroke and organ damage in the long term and, crucially, extend life expectancy” (Sheridan).