It was 108 years ago today that...

Karel Raška (17 November 1909 – 21 November 1987) born in the South Bohemian town Strašín, in what is now Czech Republic. He was a physician and epidemiologist, who headed the successful international effort during the 1960s to eradicate smallpox. Raska was a Director of the WHO Division of Communicable Disease Control since 1963. His new concept of eliminating the disease was adopted by the WHO in 1967 and eventually led to the eradication of smallpox in 1977.[1] Raška was also a strong promoter of the concept of disease surveillance, which was adopted by WHO in 1968 and has since become a standard practice in epidemiology.[2]

D.A. Henderson commented:

“Dr Raška’s studies in the epidemiology of hepatitis in Czechoslovakia were known to and respected by all epidemiologists concerned with this major infectious disease problem. No other country or area in the world has documented so thoroughly its experience with hepatitis. The surveillance programme in the United States was cut with a different fabric. Its construction for a variety of reasons differs from that of Czechoslovakia. Comparisons of data have to be interpreted cautiously”.

In those days, Czech studies were far superior and extensive than those in the USA. And Raška had a major influence on them.[3]  Raska received the Edward Jenner Medal awarded by the Royal Society of Medicine.

A tough deal

The recognition by the Royal Society of Medicine and WHO notwithstanding, Raska faced a tough deal back home. Walter Holland, describes the following about Raska in the Central European Journal of Public Health:

"Raška lived in challenging times. Czechoslovakia became an independent republic in 1918, after the First World War. Thus his early years were spent in a country beginning to establish its identity in the face of great uncertainty and turmoil. This culminated with invasion by Germany, Poland and Hungary of the borderlands in 1938 and full occupation by Hitler’s Germany in 1939. The war years were not pleasant for any Czech, and he participated in resistance activities. His involvement in the control of an epidemic typhus outbreak in Terezin is particularly poignant.
For the rest of his life, he worked under the communist regime. This was the time of the Cold War between East and West. There were major differences in policies and paranoia about contacts of individuals from the East with those in the West, particularly the United States and the United Kingdom. Those from Russian dominated regimes who had contacts in the West were viewed with some suspicion in their own country. Persons from the East were also treated with reserve by the West. Every WHO office had an individual from an Eastern country responsible for reporting on the behaviour and contacts of his Eastern colleagues. Only those considered “reliable” were allowed, to a small degree, to collaborate with individuals from the West. Those who did so, showed remarkable courage.

Raška was a good example of a scientist who had the courage to appreciate that medical science had no boundaries and could only advance through collaboration; infectious agents have no ideological principles and do not recognise state boundaries. He suffered the consequences of this behaviour, when he returned to Czechoslovakia, after his service with WHO in the early 1970s. It is particularly unfortunate that his enormous achievements in the control of infectious disease over a long period were not acknowledged in his own country and many of his former colleagues and pupils abandoned him and his achievements."  [3]

And he is not the only one. Look what Vladimir Zikmund writes in the same journal:

"Raška publicly criticized the invasion both at home and abroad and after he returned permanently to Czechoslovakia, he was completely deprived of all positions in public health by the Minister of Health, Prokopec. Raška became an exile in his own country for the rest of his life. It is a pity that Karel Raška was barred from educating medical students and future generations of epidemiologists. His lectures had been informative because he stated concrete cases of fighting infectious diseases. Raška was also not allowed to publish at home. The main hygienist during the period in question wrote a letter to the editor of journal Vesmír that Raška’s scientific capacity had declined and that there was no reason to publish his work. Even citing his work was discouraged. Unfortunately, some authors respected this banishment of Raška all too much." [2]

 

Raška's legacy

Fortunately, this politically orchestrated isolation that tried to make the world forget about this public health hero, failed.  Raska was a founding member of the International Epidemiological Association (IEA), and key members considered his contribution:

".....inestimable. He brought to the IEA, the views of a highly experienced Infectious Disease Epidemiologist working in Eastern Europe. His support for the Association, from his part of the world, demonstrated that the aims and objectives of the Association could transcend boundaries and Ideologies."

Raska was greatly appreciated by many leaders in public health, among which was Alexander Langmuir. In his "Appreciation of Raska", that was published in the International Journal of Epidemiology the year after his death, Langmuir writes:

"From our first meeting we related warmly to each other. Behind a somewhat stiff, even brusque exterior, my first impression was a warm personality, great enthusiasm for scientific ideas, and a mission to achieve. He deeply believed that the principles of what he termed epidemiological surveillance should be applied worldwide."

D.A. Henderson, director of the active phase of the smallpox eradication program, added:

"Karel made two further important contributions to epidemiology. The first was his enormously successful efforts as a professor, to recruit and to train young Czech physicians in the subject. It was apparent to all of us that of the countries of Europe, Czechoslovakia was one of the strongest in epidemiology and contributed a number of first-rate epidemiologists to WHO programmes. Almost all of these were trained by Karel.
The second was regarding the smallpox eradication: he [Karel] played an important role [....] without which the programme could not have succeeded"

In his article in 1988, Henderson summarized his view on Raska's contribution to smallpox eradication as follows:

“Raška played an important role in gaining acceptance of a number of vital administrative and policy matters without which the program could not have succeeded”.

Imagine how many lives are saved each year, as a legacy of Raska's efforts: the World Health Organization estimates that in 1967 still 15 million people contracted the disease and that two million died in that year. [4]

Karel Raska is one of the people, we owe a debt of gratitude. So let's celebrate his birthday on 17 November.

References

1. Karel Raska, from Wikipedia, the free encyclopedia, accessed 12 December 2014
2. "Karel Raška and Smallpox". Central European Journal of Public Health. March 2010. Retrieved 2010-11-17.
3. "Karel Raška — The Development of Modern Epidemiology. The role of the IEA.". Central European Journal of Public Health. March 2010. Retrieved 2010-11-17
4. "Smallpox". WHO Factsheet. Archived from the original on 2007-09-21
5. AD Langmuir. An Appreciation of Karel Raska. International Journal of Epidemiology, Volume 17, Issue 3, 1 September 1988, Pages 491–492, https://doi.org/10.1093/ije/17.3.491

No, we are not talking of St. Martin of Tours, the former Bishop of Tours, whose name we celebrate on November 11. This post is about the other Saint Martin, patron Saint of Public Health Workers.

What is said about St. Martin de Torres?

St. Martin de Porres was born in Lima, Peru on December 9, 1579. Martin was the illegitimate son to a Spanish gentlemen and a freed slave from Panama, of African or possibly Native American descent. At a young age, Martin's father abandoned him, his mother and his younger sister, leaving Martin to grow up in deep poverty. After spending just two years in primary school, Martin was placed with a barber/surgeon where he would learn to cut hair and the medical arts.

As Martin grew older, he experienced a great deal of ridicule for being of mixed-race. In Peru, by law, all descendants of African or Indians were not allowed to become full members of religious orders. Martin, who spent long hours in prayer, found his only way into the community he longed for was to ask the Dominicans of Holy Rosary Priory in Lima to accept him as a volunteer who performed the most menial tasks in the monastery. In return, he would be allowed to wear the habit and live within the religious community. When Martin was 15, he asked for admission into the Dominican Convent of the Rosary in Lima and was received as a servant boy and eventually was moved up to the church officer in charge of distributing money to deserving poor.[1]

Life in the convent

During his time in the Convent, Martin took on his old trades of barbering and healing. He also worked in the kitchen, did laundry and cleaned. After eight more years with the Holy Rosary, Martin was granted the privilege to take his vows as a member of the Third Order of Saint Dominic by the prior Juan de Lorenzana who decided to disregard the law restricting Martin based on race. However, not all of the members in the Holy Rosary were as open-minded as Lorenzana; Martin was called horrible names and mocked for being illegitimate and descending from slaves.

Martin grew to become a Dominican lay brother in 1603 at the age of 24. Ten years later, after he had been presented with the religious habit of a lay brother, Martin was assigned to the infirmary where he would remain in charge until his death. He became known for encompassing the virtues need to carefully and patiently care for the sick, even in the most difficult situations.[1]

Epidemic response with compassion

During an epidemic in Lima, many of the friars in the Convent of the Rosary became very ill. Locked away in a distant section of the convent, they were kept away from the professed. However, on more than one occasion, Martin passed through the locked doors to care for the sick. However, he became disciplined for not following the rules of the Convent, but after replying, "Forgive my error, and please instruct me, for I did not know that the precept of obedience took precedence over that of charity," he was given full liberty to follow his heart in mercy.

In January of 1639, when Martin was 60-years-old, he became very ill with chills, fevers and tremors causing him agonizing pain. He would experience almost a year full of illness until he passed away on November 3, 1639.

He has become the patron saint of people of mixed race, innkeepers, barbers, public health workers and more. His feast day is November 3.

 

 

Reference:

1. From: 'Catholic Online - Saints and Angels - St Martin de Porres', Accessed 3 November 2017

 

What makes 28 October 2017 special?

It is exactly 103 years ago when Jonas Salk was born; an American medical researcher and virologist, who discovered and developed one of the first successful polio vaccines. [1]

It is also 105 years ago, to the day, that Richard Doll was born; a British physiologist who became an epidemiologist, turning the subject into a rigorous science. He was a pioneer in research linking smoking to health problems. [2]

Why celebrate together?

Especially in this day and age, it seems appropriate to celebrate the giants on whose shoulders we stand when it comes to safe and effective vaccines, as well as reliable and convincing epidemiology evidence.

In 1950, Richard Doll undertook with Austin Bradford Hill a study of lung cancer patients in 20 London hospitals, at first under the belief that it was due to the new material tarmac, or motor car fumes, but rapidly discovering that tobacco smoking was the only factor they had in common. Doll himself stopped smoking as a result of his findings, published in the British Medical Journal in 1950, which concluded:

"The risk of developing the disease increases in proportion to the amount smoked. It may be 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers."

In 1947, Jonas Salk accepted an appointment to the University of Pittsburgh School of Medicine. In 1948, he undertook a project funded by the National Foundation for Infantile Paralysis to determine the number of different types of polio virus. Salk saw an opportunity to extend this project towards developing a vaccine against polio, and, together with the skilled research team he assembled, devoted himself to this work for the next seven years. The field trial set up to test the Salk vaccine was, according to O'Neill,

"the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers."

Over 1,800,000 school children took part in the trial. When news of the vaccine's success was made public on April 12, 1955, Salk was hailed as a "miracle worker" and the day almost became a national holiday. Around the world, an immediate rush to vaccinate began, with countries including Canada, Sweden, Denmark, Norway, West Germany, the Netherlands, Switzerland, and Belgium planning to begin polio immunization campaigns using Salk's vaccine. [1]

 

Recognition

In 1966 Doll was elected to the Royal Society. The citation stated:[2]

Doll is distinguished for his researches in epidemiology, and particularly the epidemiology of cancer where in the last 10 years he has played a prominent part in (a) elucidating the causes of lung cancer in industry (asbestos, nickel & coal tar workers) & more generally, in relation to cigarette smoking, and (b) in the investigation of leukaemia particularly in relation to radiation, where using the mortality of patients treated with radiotherapy he has reached a quantitative estimate of the leukaemogenic effects of such radiation. In clinical medicine he has made carefully controlled trials of treatments for gastric ulcer. He has been awarded the United Nations prize for outstanding research into the causes & control of cancer & the Bisset Hawkins medal of the Royal College of Physicians for his contributions to preventative medicine.

1977, Jonas Salk was awarded the Presidential Medal of Freedom from President Jimmy Carter, with the following statement accompanying the medal: [1]

"Because of Doctor Jonas E. Salk, our country is free from the cruel epidemics of poliomyelitis that once struck almost yearly. Because of his tireless work, untold hundreds of thousands who might have been crippled are sound in body today. These are Doctor Salk's true honors, and there is no way to add to them. This Medal of Freedom can only express our gratitude, and our deepest thanks."2014,

On the 100th anniversary of Salk's birth, a Google Doodle was created to honor the physician and medical researcher. The doodle shows happy and healthy children and adults playing and going about their lives with two children hold up a sign saying:[3]

"Thank you, Dr. Salk!"

 

References:

1. Jonas Salk, in: Wikipedia, accessed 28 October 2017
2. Richard Doll, in: Wikipedia, accessed 28 October 2017
3. Www.google.com

It was 196 years ago when..

Rudolf Ludwig Carl Virchow (13 October 1821 – 5 September 1902) was born in Schievelbein in eastern Pomerania, Prussia (now Świdwin in Poland). He was the only child of Carl Christian Siegfried Virchow (1785–1865) and Johanna Maria née Hesse (1785–1857). His father was a farmer and the city treasurer. Academically brilliant, he always topped in his classes and was fluent in German, Latin, Greek, Hebrew, English, Arabic, French, Italian, and Dutch. He progressed to the gymnasium in Köslin (now Koszalin in Poland) in 1835 with the goal to become a pastor. He graduated in 1839 upon a thesis titled A Life Full of Work and Toil is not a Burden but a Benediction. However, he chose to start studying medicine mainly because he considered his voice too weak for preaching.[1] His uncle was a high-ranking officer, which may have helped him gain admission into the most prestigious medical school of the time-a military medical school in Berlin with a selective acceptance policy.[2]

The pope of medicine

It was from that medical school that Virchow would further develop into a physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician, known for his advancement of public health. He is known as "the father of modern pathology" because his work helped to discredit humourism, bringing more science to medicine. He is also known as the founder of social medicine and veterinary pathology, and to his colleagues, the "Pope of medicine".[1]

At the early age of 27 he was appointed to a government commission to investigate a typhus epidemic in Upper Silesia (1847-1848). At that time, typhus, typhoid, and recurrent fever were not yet clearly separated diagnostic entities. The study came at an explosive time in European and especially German history, and his report on the aetiology of the epidemic, expressed in radically antiestablishment social and political terms typified the professional radicalism of the period. [2]

"The logical answer to the question as to how conditions similar to those unfolded before our eyes in Upper Silesia can be prevented in the future is, therefore, very easy and simple: education, with its daughters, liberty and prosperity."

The ravages of the epidemic must have made a lasting impression on young Virchow, shaping not only his character, but also his professional perspective. He wrote in his report:

"A devastating epidemic and a terrible famine simultaneously ravaged a poor, ignorant and apathetic population. In a single year 10% of the population died in the Pless district, 6.48% of starvation combined with the epidemic, and, according to official figures, 1.3% solely of starvation. In 8 months, in the district of Rybnik, 14.3% of the population were affected by typhus, of whom 20.46% died. . . . At the beginning of the year, 3% of the population of both districts were orphans. . . ." [3]

Even though he was not particularly successful in combating the epidemic, his 190-paged Report on the Typhus Epidemic in Upper Silesia in 1848 became a turning point in politics and public health in Germany. From it, he coined a well known aphorism:

"Medicine is a social science, and politics is nothing else but medicine on a large scale".

He returned to Berlin on 10 March 1848, and only eight days later, a revolution broke out against the government in which he played an active part. To fight political injustice he helped finding Die medicinische Reform (Medical Reform), a weekly newspaper for promoting social medicine, in July of that year. The newspaper ran under the banners "medicine is a social science" and "the physician is the natural attorney of the poor". Political pressures forced him terminate the publication in June 1849 and became expelled from his official position. After five years, Charité invited him back to direct its newly built Institute for Pathology, and simultaneously becoming the first Chair of Pathological Anatomy and Physiology at Berlin University. The campus of Charité is now named Campus Virchow Klinikum.

Virchow was the first to precisely describe and give names of diseases such as leukemia, chordoma, ochronosis, embolism, and thrombosis. He coined scientific terms, chromatin, agenesis, parenchyma, osteoid, amyloid degeneration, and spina bifida. His description of the transmission cycle of a roundworm Trichinella spiralis established the importance of meat inspection, which was started in Berlin. He developed the first systematic method of autopsy involving surgery of all body parts and microscopic examination. A number of medical terms are named after him, including Virchow's node, Virchow–Robin spaces, Virchow–Seckel syndrome, and Virchow's triad. He was the first to use hair analysis in criminal investigation, and recognised its limitations. His laborious analyses of the hair, skin, and eye colour of school children made him criticise the Aryan race concept as a myth.

He was an ardent anti-evolutionist. He referred to Charles Darwin as an "ignoramus" and his own student Ernst Haeckel, the leading advocate of Darwinism in Germany, as a "fool". He discredited the original specimen of Neanderthal man as nothing but that of a deformed human, and not an ancestral species. He was an agnostic. [1]

Anti-germ theory of diseases

Virchow did not believe in the germ theory of diseases, as advocated by Louis Pasteur and Robert Koch. He proposed that diseases came from abnormal activities inside the cells, not from outside pathogens. He believed that epidemics were social in origin, and the way to combat epidemics was political, not medical. He regarded germ theory as hindrance to prevention and cure. He considered social factors such as poverty as major cause of diseases. He even attacked Koch's and Ignaz Semmelweis' policy of hand-washing as an antiseptic practice. He postulated that germs were only using infected organs as habitats, but they were not the cause, and stated,

"If I could live my life over again, I would devote it to proving that germs seek their natural habitat: diseased tissue, rather than being the cause of diseased tissue".Virchow said. [1]

In hindsight, he may be glad that he did not embark on such path.

Death

Virchow broke his thigh bone on 4 January 1902, jumping off a running streetcar while exiting the electric tramway. Although he anticipated full recovery, the fractured femur never healed, and restricted his physical activity. His health gradually deteriorated and he died of heart failure after eight months, on 5 September 1902, in Berlin. A state funeral was held on 9 September in the Assembly Room of the Magistracy in the Berlin Town Hall, which was decorated with laurels, palms and flowers. He was buried in the Alter St.-Matthäus-Kirchhof in Schöneberg, Berlin. His tomb was shared by his wife on 21 February 1913. [1]

"At his death Germany would complain of having lost four great men in one: her leading pathologist, her leading anthropologist, her leading sanitarian, and her leading liberal."
Erwin Ackerknecht [2]

References:

1. Rudolf Virchow, in: Wikipedia, accessed 13 October 2017
2. Silver GA. Virchow, the heroic model in medicine: health policy by accolade. American Journal of Public Health. 1987;77(1):82-88.
3. Virchow RC. Report on the Typhus Epidemic in Upper Silesia. American Journal of Public Health. 2006;96(12):2102-2105.

It was 107 years ago today..

..when Alexander Duncan Langmuir was born in Santa Monica, California. He spent his youth in New Jersey. His uncle, Irving Langmuir won the Nobel Prize in Chemistry in 1932. At Harvard College, Alex Langmuir received his AB (cum laude) in 1931 and his MD in 1935 from Cornell University Medical College.[3]

From 1942 to 1946, he served as an epidemiologist with the Armed Forces Epidemiologic Board’s Commission on Acute Respiratory Diseases, stimulating his lifelong interest in influenza. In 1946, Langmuir returned to Johns Hopkins University as an associate professor of epidemiology. By 1949 he was attracted to the challenge of becoming the first chief epidemiologist of the newly established Communicable Disease Center (now the Centers for Disease Control and Prevention [CDC]) in Atlanta, Georgia, a position he held for over 20 years.[3]

He wrote extensively on all phases of epidemiology on a global basis and was recognized internationally as a leading contributor in epidemiology. Langmuir was a visiting professor at the Johns Hopkins School of Hygiene and Public Health from 1988 until his death in 1993.[1]

In 1951, following the start of the Korean War, Langmuir established the EIS program as an early warning system against biologic warfare. EIS officers then and now are physicians, veterinarians, nurses, and health scientists who serve 2-year assignments. In an obituary written for the New York Times, Lawrence Altman said Langmuir “taught what he called ‘shoe leather epidemiology,’ stressing that investigators go into the field to collect their own data and view directly the locale of the public health problem they were investigating.” Langmuir said:

“Each epidemic aid call was an adventure and a training experience, even the false alarms.”

He stressed that field epidemiology should be taught in the field, not in the classroom. Admission into the EIS program was highly selective. Langmuir believed that when competent persons were thrust into challenging circumstances with supportive supervision, excellent results were certain. He regarded the EIS officers as members of his extended family, backing them firmly when they found themselves in difficulty and joining them for the roasts of CDC leaders during the officers’ annual skit night—often at his own expense.

In 1955, Langmuir and his young staff achieved early recognition due to the “Cutter Incident.” The new inactivated (Salk) polio vaccine was causing cases of polio. Surgeon General Leonard Scheele asked Langmuir to develop a surveillance system to determine the extent of the problem. Langmuir deployed his staff, and within days they determined that the cases were caused by vaccine from a single manufacturer: Cutter Laboratories.

“Langmuir was able to predict with great accuracy the expected size of the epidemic and the number of secondary cases that would occur,”
(William Foege, former CDC director).

Langmuir's vision of surveillance

The idea of effective national disease surveillance captured Alex Langmuir’s imagination throughout his career. He believed that surveillance is the foundation for evidence-based public health action. Langmuir preached the importance of the systematic collection of pertinent data, the consolidation and analysis of these data into useful information, and the dissemination of the results to all who need to know so that they can take action. His goal was to use surveillance systems to define populations at risk for disease, determine interventions, and monitor their impact. Langmuir and his staff developed novel national surveillance programs for an array of communicable diseases and for chronic diseases, injuries, and reproductive health. Indeed, he considered the population explosion to be the most serious epidemic of all. [3]

Altman described Langmuir as “a tall man who could command immediate attention when he stood to speak to audiences in his deep voice. He thrived on controversy and took pride in overcoming local political pressures to crusade for preventive medicine and other measures to safeguard public health.” Philip Brachman, who succeeded Langmuir as EIS director, described Langmuir as “visionary, clairvoyant, tenacious, well prepared, scientifically honest, and optimistic.” Langmuir enjoyed being a civil servant and working to benefit the public. “His concerns were to control and prevent disease by applying the principles of epidemiology to the identification of causes and solutions,” Brachman wrote. Foege described Langmuir as someone with a public health message who arrived at the right time and place in history to be able to broadly disseminate his message. [3]

In 1979, when Alex Langmuir was interviewed by D.A. Henderson about being recruited to work at CDC in 1949, Langmuir said,

“As I looked it over and saw the vision, there was no question, [former CDC director] Justin Andrews took me to the mountain and showed me the Promised Land.”

At CDC, Alex Langmuir changed the way epidemiology is used in public health practice, first in the United States and then throughout the world. In the 65 years since Langmuir’s arrival at CDC, his disciples—EIS and field epidemiology training program officers—have played pivotal roles in combating the root causes of major public health problems. In addition, EIS inspired Field Epidemiology Training Programmes (FETP) all around the world. At present, 69 FETP's worldwide train field epidemiologists after the example that Langmuir set. Millions of persons live longer and healthier lives because of the accomplishments of Langmuir and his progeny in controlling and preventing disease.

This is Alex Langmuir’s grand legacy. [3]

References:

1. Alexander Langmuir, in: Wikipedia, accessed on 12 september 2017
2. Alexander Langmuir, in: Heroes of Public Health. Johns Hopkins School website. Accessed on 12 September 2017
3. Schultz MG, Schaffner W. Alexander Duncan Langmuir. Emerging Infectious Diseases. 2015;21(9):1635-1637. doi:10.3201/eid2109.141445.

It was 393 years ago when....

Thomas Sydenham was born on 10 September 1624 at Wynford Eagle in Dorset. He was an English physician and the author of Observationes Medicae which became a standard textbook of medicine for two centuries. This earned him the predicate 'The English Hippocrates'. Among his many achievements was the discovery of a disease, Sydenham's Chorea, also known as St Vitus Dance. [1]

Much to describe on infectious diseases.

His first book, Methodus curandi febres (The Method of Curing Fevers), was published in 1666; a second edition, with an additional chapter on the plague, in 1668; and a third edition, further enlarged and bearing the better-known title of Observationes mediciae (Observations of Medicine), in 1676. His next publication was in 1680 in the form of two Epistolae responsoriae (Letters & Replies), the one, "On Epidemics," addressed to Robert Brady, Regius Professor of Physic at Cambridge, and the other "On the Lues venerea," (On Venereal Diseases) to Henry Paman, public orator at Cambridge and Gresham Professor of Physic in London.

In 1679, Sydenham gave Whooping cough the name pertussis, meaning a 'violent cough of any type'.

In 1682 he published another Dissertatio epistolaris (Dissertation on the Letters), on the treatment of confluent smallpox and on hysteria, addressed to Dr William Cole of Worcester. The Tractatus de podagra et hydrope (The Management of Arthritis and Dropsy) came out in 1683, and the Schedula monitoria de novae febris ingressu (The Schedule of Symptoms of the Newly Arrived Fever) in 1686. [1]

Dance, Dance, Dance
All night long
(Steve Miller Band)

Among other things Sydenham is credited with the first diagnosis of scarlatina and with the modern definition, of chorea, also known as St Vitus Dance.

Sydenham's chorea (SC) or chorea minor (historically referred to as St Vitus's dance) is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham's chorea results from childhood infection with Group A beta-haemolytic Streptococcus and is reported to occur in 20–30% of patients with acute rheumatic fever (ARF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of rheumatic fever. Sydenham's chorea is more common in females than males and most patients are children, below 18 years of age. Adult onset of Sydenham's chorea is comparatively rare and the majority of the adult cases are associated with exacerbation of chorea following childhood Sydenham's chorea.

The disorder is a result of an autoimmune response that occurs following infection by group A β-hemolytic streptococci that destroys cells in the corpus striatum of the basal ganglia. Molecular mimicry to streptococcal antigens leading to an autoantibody production against the basal ganglia has long been thought to be the main mechanism by which chorea occurs in this condition. [2]

 

Death

Hardly anything is known of Sydenham's personal history in London. He died at his house in Pall Mall on 29 December 1689, aged 65. He is buried in St James's Churchyard, Piccadilly, where a mural slab was put up by the College of Physicians in 1810.

A memorial stone dedicated to Thomas can be found halfway up the staircase of St James's Church, Pall Mall. It was put there by the now defunct 'Sydenham Society’. [1]

 

References

1. Thomas Sydenham, in: Wikipedia, accessed 8 September 2017
2. Sydenham's Chorea, in: Wikipedia, accessed 8 September 2017

It was 89 years ago today ...

Donald Ainslie Henderson was born in Lakewood, Ohio on September 7, 1928, of Scots-Canadian immigrant parents. Henderson was an American physician, educator, and epidemiologist who directed a 10-year international effort (1967–77) that eradicated smallpox throughout the world and launched international childhood vaccination programs. From 1977 to 1990, he was Dean of the Johns Hopkins School of Public Health. Later, he played a leading role in instigating national programs for public health preparedness and response following biological attacks and national disasters. At the time of his death, he was Professor and Dean Emeritus of the Johns Hopkins Bloomberg School of Public Health, and Professor of Medicine and Public Health at the University of Pittsburgh, as well as Distinguished Scholar at the UPMC Center for Health Security. [1]

Eradication of smallpox.

Henderson served as Chief of the CDC virus disease surveillance programs from 1960 to 1965, working closely with the inspirational epidemiologist Dr. Alexander Langmuir. During this period, he and his unit developed a proposal for a United States Agency for International Development (USAID) program to eliminate smallpox and control measles during a 5-year period in 18 contiguous countries in western and central Africa.

The USAID initiative provided an important impetus to a World Health Organization (WHO) program to eradicate smallpox throughout the world within a 10-year period. In 1966, Henderson moved to Geneva to become director of the campaign. At that time, smallpox was occurring widely throughout Brazil and in 30 countries in Africa and South Asia. More than 10 million cases and 2 million deaths were occurring annually. Vaccination brought some control, but the key strategy was "surveillance-containment". This technique entailed rapid reporting of cases from all health units and prompt vaccination of household members and close contacts of confirmed cases. WHO staff and advisors from some 73 countries worked closely with national staff. The last case occurred in Somalia on October 26, 1977, only 10 years after the program began. Three years later, the World Health Assembly recommended that smallpox vaccination could cease. Smallpox is the first human disease ever to be eradicated. [1]

 

Not without a fight

What seems such an obvious effort now, looking back, was far from obvious at the time. Eradicating the virus from the planet was not merely an epidemiological and microbiological activity. It was mainly about overcoming huge political resistance. At that level, public health might as well be called 'political health'.

On 15 August 1975, the Indian government hosted a lavish party. It had good reason to celebrate: not only was it marking 28 years of independence from British rule, but the prime minister, Indira Gandhi, had declared the date “Independence from Smallpox Day”. For decades, India was considered the endemic home of the disease, accounting for some 60% of globally reported cases. Yet in the space of just one year, infections had fallen from 188,000 to zero, thanks to a combination of disease surveillance, vaccination and publicity.

Yet as Donald Henderson left the celebrations in order to catch a flight to Bangladesh, he received word that the borders were closed. The Bangladeshi military had staged a coup; the president and his family were dead.

It was a pivotal moment in the global effort to eradicate smallpox, a disease that had until recently killed some 2 million people each year. To get this far, Henderson and his team had overcome political resistance, ineffective vaccine stocks, floods, famine and civil war.[2]

They had stopped cars in the streets of the former Yugoslavia to vaccinate people, and gone house to house in remote regions of India to nip outbreaks in the bud. Now, eight years into the campaign, Bangladesh was the final refuge for Variola major, the most infectious form of the virus, and the country was threatening to fall apart.

Fearing that a tide of refugees might trigger fresh outbreaks, or even reimport the disease to India, Henderson deployed large numbers of health workers to the border to step up surveillance, and vaccinate as required. Fortunately, the predicted influx never arrived. A few weeks later, the borders reopened and WHO’s teams went back to work. In November 1975, Bangladesh reported its final case of smallpox and, two years later, the world’s last case was identified in Ali Maow Maalin – a Somali cook from the port city of Merca. The world was finally declared smallpox-free in 1979.[2]

 

“If the Nobel prize in medicine was not so focused on basic science, Henderson and the smallpox team would surely have shared it,”

Chris Beyrer, , Desmond Tutu professor of public health and human rights at the Johns Hopkins Bloomberg School of Public Health in Baltimore

Donald Henderson died in Baltimore, USA, on August 19, 2016

 

References

1. Donald Henderson, in: Wikipedia, accessed 7 September 2017
2. Obituary, the Guardian, 20 August 2016.

It was 136 years ago today...

that Alexander Fleming was born, on August 6, 1881, in Ayrshire, Scotland. He was the third of the four children of farmer Hugh Fleming (1816–1888) and his wife Grace Stirling Morton.

After working in a shipping office for four years, the twenty-year-old Fleming inherited some money from an uncle, John Fleming. His elder brother, Tom, was already a physician and suggested to him that he should follow the same career, and so in 1903, the younger Alexander enrolled at St Mary's Hospital Medical School in Paddington; he qualified with an MBBS degree from the school with distinction in 1906. Het joined the research department at St Mary's, where he became assistant bacteriologist to Sir Almroth Wright, a pioneer in vaccine therapy and immunology.

In 1908, he gained a BSc degree with Gold Medal in Bacteriology, and became a lecturer at St Mary's until 1914. Fleming served throughout World War I as a captain in the Royal Army Medical Corps, and was Mentioned in Dispatches. He and many of his colleagues worked in battlefield hospitals at the Western Front in France. In 1918 he returned to St Mary's Hospital, where he was elected Professor of Bacteriology of the University of London in 1928.

Work before penicillin

During World War I, Fleming witnessed the death of many soldiers from sepsis resulting from infected wounds. Antiseptics, which were used at the time to treat infected wounds, often worsened the injuries. In an article he submitted for the medical journal The Lancet during World War I, Fleming described an ingenious experiment, which he was able to conduct as a result of his own glass blowing skills, in which he explained why antiseptics were killing more soldiers than infection itself during World War I. Antiseptics worked well on the surface, but deep wounds tended to shelter anaerobic bacteria from the antiseptic agent, and antiseptics seemed to remove beneficial agents produced that protected the patients in these cases at least as well as they removed bacteria, and did nothing to remove the bacteria that were out of reach. Sir Almroth Wright strongly supported Fleming's findings, but despite this, most army physicians over the course of the war continued to use antiseptics even in cases where this worsened the condition of the patients.

At St Mary’s Hospital Fleming continued his investigations into antibacterial substances. Testing the nasal secretions from a patient with a heavy cold, he found that nasal mucus had an inhibitory effect on bacterial growth. This was the first recorded discovery of lysozyme, an enzyme present in many secretions including tears, saliva, skin, hair and nails as well as mucus. Although he was able to obtain larger amounts of lysozyme from egg whites, the enzyme was only effective against small counts of harmless bacteria, and therefore had little therapeutic potential.

Accidental discovery

When I woke up just after dawn on September 28, 1928, I certainly didn't plan to revolutionise all medicine by discovering the world's first antibiotic, or bacteria killer. But I suppose that was exactly what I did.

— Alexander Fleming

By 1927, Fleming had been investigating the properties of staphylococci. He was already well-known from his earlier work, and had developed a reputation as a brilliant researcher, but his laboratory was often untidy. On 3 September 1928, Fleming returned to his laboratory having spent August on holiday with his family. Before leaving, he had stacked all his cultures of staphylococci on a bench in a corner of his laboratory. On returning, Fleming noticed that one culture was contaminated with a fungus, and that the colonies of staphylococci immediately surrounding the fungus had been destroyed, whereas other staphylococci colonies farther away were normal, famously remarking "That's funny".

Fleming grew the mould in a pure culture and found that it produced a substance that killed a number of disease-causing bacteria. He identified the mould as being from the Penicillium genus, and, after some months of calling it "mould juice", named the substance it released penicillin on 7 March 1929.

He investigated its positive anti-bacterial effect on many organisms, and noticed that it affected bacteria such as staphylococci and many other Gram-positive pathogens that cause scarlet fever, pneumonia, meningitis and diphtheria, but not typhoid fever or paratyphoid fever, which are caused by Gram-negative bacteria, for which he was seeking a cure at the time. It also affected Neisseria gonorrhoeae, which causes gonorrhoea although this bacterium is Gram-negative.

Not much attention...

Fleming published his discovery in 1929, in the British Journal of Experimental Pathology, but little attention was paid to his article. Fleming continued his investigations, and found that cultivating penicillium was quite difficult, and that after having grown the mould, it was even more difficult to isolate the antibiotic agent. Fleming's impression was that because of the problem of producing it in quantity, and because its action appeared to be rather slow, penicillin would not be important in treating infection. Fleming also became convinced that penicillin would not last long enough in the human body (in vivo) to kill bacteria effectively. Many clinical tests were inconclusive, probably because it had been used as a surface antiseptic.

In the 1930s, Fleming’s trials occasionally showed more promise, and he continued, until 1940, to try to interest a chemist skilled enough to further refine usable penicillin. Fleming finally abandoned penicillin, and not long after he did, Howard Florey and Ernst Boris Chain at the Radcliffe Infirmary in Oxford took up researching and mass-producing it, with funds from the U.S. and British governments. They started mass production after the bombing of Pearl Harbor. By D-Day in 1944, enough penicillin had been produced to treat all the wounded in the Allied forces.

Fleming was said to be "a reticent and rather taciturn man, with great independence of mind and strength of character". He was a keen observant of nature and everything around him, always ready to devise and test new methods for studying germs in the lab. He accepted the many honors that were bestowed upon him with modesty. It seemed that simple tributes touched him most, such as the letter of some poor person who had benefitted from penicillin.

Fleming died on 11 March 1955, at his home in London of a heart attack. He was buried in St Paul's Cathedral

References:

1. Alexander Fleming, in: Wikipedia, accessed 6 August 2017
2. Robert Cruickshank, Obituary of Alexander Fleming. In: Nature, nr 4459, April 16,1955, P663

 

Fanny Hesse (Born Angelina Fanny Elishemius, June 22, 1850 – December 1, 1934) is best known for her work in microbiology alongside her husband, Walther Hesse. Together they were instrumental in developing Agar as a medium for culturing microorganisms. She was born in 1850 in New York City to Gottfried Elishemius, a wealthy import merchant, and his wife, Cecile Elise. Fanny met her husband and research partner Walther Hesse in 1872 while in Germany. They were engaged in 1873 and married in 1874 in Geneva.[1]

In 1881, she worked for her husband as a technician in the laboratory of German physician and microbiologist Robert Koch. Hesse, working unpaid, would make drawings for her husband's publications.[1] At the time, Koch was desperately searching for a suitable medium to grow bacterial cultures. He originally used potato slices, yet not all bacteria would grow on that surface. Then he used gelatin broths, yet during warm weather, these would liquefy and become all gooey. Besides, several bacteria used enzymes to break down the gelatin.[2]

One day in 1881, while eating lunch, Walter asked Fanny about the jellies and puddings that she made and how they managed to stay gelled even in warm weather. Fannie told him about how she learned about the seaweed product, agar-agar, from a Dutch neighbor of hers while she was growing up in New York City. Her neighbor had emigrated from Indonesia, where it was the local custom to use agar in their cooking. Fannie suggested that they try this out in their laboratory. The rest is history. Agar turned out to be an ideal gelling agent that stayed firm even in the incubator and could not be digested by any bacterial enzymes. Walter Hesse notified Koch of this new technique, who immediately added agar to his nutrient broths. [2]

Lab work can be a lot like cooking. You have to follow directions to measure, mix, and heat different chemicals to the right temperature to get the desired result.[3]

This led to Koch using agar to cultivate the bacteria that cause tuberculosis.  While Koch, in an 1882 paper on tuberculosis bacilli, mentioned he used agar instead of gelatin, he did not credit Fanny or Walther Hesse or mention why he made the switch. Fanny Hesse's suggestion never resulted in financial benefit for the Hesse family.[1]

References:

1. Fanny Hesse, in Wikipedia. Accessed 8 March 2017.
2. Jay Hardy, in 'Agar and the quest to isolate pure cultures'.
3. Angeline Fanny Hesse - the woman who made microbiology possible. In: Rejected Princesses, accessed on March 8, 2017.

It was 106 years ago today when William Haenszel was born in Rochester, New York.

William Manning Haenszel (June 19, 1910 – March 13, 1998) was an American epidemiologist who developed the first national system to track cancer cases and their possible causes (Surveillance, Epidemiology, and End Results or SEER). He was an elected fellow of the American Statistical Association, the American Public Health Association, and the American Association For the Advancement of Science. He worked at the National Cancer Institute from 1952 to 1976, when he became a Professor of Epidemiology at the University of Illinois. With Nathan Mantel, he co-authored the Mantel-Haenszel statistical test for omitted variables.[1]

In the 1970's, when the Nixon Administration declared a ''war on cancer,'' William Haenszel, as chief of biometry -- the statistical analysis of biological data -- set out to record individual cases, to track them from diagnosis to death, and to synthesize the data at the N.C.I., in Bethesda, Md., to learn about potential causes. SEER -- which he started in 1973 -- is probably the largest registry for any one disease in the world, said Dr. Earl S. Pollack, who was chief of biometry at the institute after Haenszel. [2]

"Mr. Haenszel provided the intellectual foundation for what epidemiologists do on a day-to-day basis in the study of causes of disease,''

''We can make the right inferences today because of his insights.''

Dr. Jack H. Goldberg

Haenszel was widely known for migrant studies in the 1950's and 1960's. In one project, he showed that the high stomach cancer rates in Japan were no longer found in the Japanese who migrated to Hawaii. He identified the role of diet as a possible cause of stomach cancer. In a 1959 paper, written with Nathan Mantel, also of the cancer institute, Mr. Haenszel described what is now known as the Mantel-Haenszel Method for analysis to assess the relationship between exposure to a hazard and disease rates. [2]

Dealing with things that are not there

The Cochran-Mantel-Haenszel method is a technique that generates an estimate of an association between an exposure and an outcome after adjusting for or taking into account confounding. The method is used with a dichotomous outcome variable and a dichotomous risk factor. We stratify the data into two or more levels of the confounding factor (as we did in the example above). In essence, we create a series of two-by-two tables showing the association between the risk factor and outcome at two or more levels of the confounding factor, and we then compute a weighted average of the risk ratios or odds ratios across the strata (i.e., across subgroups or levels of the confounder).[3]

References

1. William M. Haenszel, in: Wikipedia.
2. Obituary William Haenszel, New York Times, 22 March 1998.
3. The Cochran-Mantel-Haenszel Method, in: Confounding and Effect Measure Modification

Florence Nightingale, (12 May 1820 – 13 August 1910) was an English social reformer and statistician, and the founder of modern nursing.

She came to prominence while serving as a manager of nurses trained by her during the Crimean War, where she organised the tending to wounded soldiers. She gave nursing a highly favourable reputation and became an icon of Victorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night.

As a young woman, Nightingale was described as attractive, slender and graceful. While her demeanour was often severe, she was said to be very charming and possess a radiant smile. Her most persistent suitor was the politician and poet Richard Monckton Milnes, but after a nine-year courtship she rejected him, convinced that marriage would interfere with her ability to follow her calling to nursing.

In 1860, Nightingale laid the foundation of professional nursing with the establishment of her nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world, now part of King's College London. In recognition of her pioneering work in nursing, the Nightingale Pledge taken by new nurses, and the Florence Nightingale Medal, the highest international distinction a nurse can achieve, were named in her honour, and the annual International Nurses Day is celebrated around the world on her birthday. Her social reforms include improving healthcare for all sections of British society, advocating better hunger relief in India, helping to abolish prostitution laws that were over-harsh to women, and expanding the acceptable forms of female participation in the workforce.

Nightingale was a prodigious and versatile writer. In her lifetime, much of her published work was concerned with spreading medical knowledge. Some of her tracts were written in simple English so that they could easily be understood by those with poor literary skills. She also helped popularise the graphical presentation of statistical data. Much of her writing, including her extensive work on religion and mysticism, has only been published posthumously.[1]

Statistics and sanitary reform

Florence Nightingale exhibited a gift for mathematics from an early age and excelled in the subject under the tutelage of her father.  Indeed, Nightingale is described as "a true pioneer in the graphical representation of statistics", and is credited with developing a form of the pie chart now known as the polar area diagram, or occasionally the Nightingale rose diagram, equivalent to a modern circular histogram, to illustrate seasonal sources of patient mortality in the military field hospital she managed. Nightingale called a compilation of such diagrams a "coxcomb", but later that term would frequently be used for the individual diagrams. She made extensive use of coxcombs to present reports on the nature and magnitude of the conditions of medical care in the Crimean War to Members of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports. In 1859, Nightingale was elected the first female member of the Royal Statistical Society. She later became an honorary member of the American Statistical Association.

Her attention turned to the health of the British army in India and she demonstrated that bad drainage, contaminated water, overcrowding and poor ventilation were causing the high death rate. She concluded that the health of the army and the people of India had to go hand in hand and so campaigned to improve the sanitary conditions of the country as a whole.

Nightingale made a comprehensive statistical study of sanitation in Indian rural life and was the leading figure in the introduction of improved medical care and public health service in India. In 1858 and 1859, she successfully lobbied for the establishment of a Royal Commission into the Indian situation. Two years later, she provided a report to the commission, which completed its own study in 1863. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".

At the same time she combined with the retired sanitary reformer Edwin Chadwick to persuade Stansfeld to devolve powers to enforce the law to Local Authorities, eliminating central control by medical technocrats. Her Crimean War statistics had convinced her that non-medical approaches were more effective given the state of knowledge at the time. Historians now believe that both drainage and devolved enforcement played a crucial role in increasing average national life expectancy by 20 years between 1871 and the mid-1930s during which time medical science made no impact on the most fatal epidemic diseases.

Artwork

If you want to enjoy artwork of Florence Nightingale, then feel welcome to visit the Facebook page of Saint Roch's Corner, and browse through the album 'Nurses at Work'.

References

1. Florence Nightingale, in: Wikipedia. Accessed 11 May 2017.
2. Hugh Small. A brief history of Florence Nightingale and her Real Legacy: a Public Health Revolution, Amazon.

Pierre-Simon, marquis de Laplace (23 March 1749 – 5 March 1827) was an influential French scholar whose work was important to the development of mathematics, statistics, physics and astronomy. He summarized and extended the work of his predecessors in his five-volume Mécanique Céleste (Celestial Mechanics) (1799–1825). This work translated the geometric study of classical mechanics to one based on calculus, opening up a broader range of problems. In statistics, the Bayesian interpretation of probability was developed mainly by Laplace.

 

Laplace is remembered as one of the greatest scientists of all time. Sometimes referred to as the French Newton or Newton of France, he has been described as possessing a phenomenal natural mathematical faculty superior to that of any of his contemporaries.

 

In 1812, Laplace issued his Théorie analytique des probabilités in which he laid down many fundamental results in statistics. The first half of this treatise was concerned with probability methods and problems, the second half with statistical methods and applications. Laplace's proofs are not always rigorous according to the standards of a later day, and his perspective slides back and forth between the Bayesian and non-Bayesian views with an ease that makes some of his investigations difficult to follow, but his conclusions remain basically sound even in those few situations where his analysis goes astray. In 1819, he published a popular account of his work on probability.[1]

 

The theory of probability, in essence, is nothing more than common sense, reduced to a calculation.

 

Pierre Laplace realized that certain error was inherent in all calculations. Instead of ignoring the error, he chose to quantify it, and the field of statistics was born. He even demonstrated that there was a mathematical distribution to the likelihood of error observed in given experiments. His student, Karl Peason, then took Laplace one step further and showed that not only there is a probability to the likelihood of error, but even our own measurements are probabilities. Pearson's revolutionary work laid the basis for modern statistics. After that, the early twentieth century geneticist Ronald Fisher introduced randomization and p-values, followed by A.Bradford-Hill, who applied there concepts to medical illnesses and founded clinical epidemiology.[2]

 

Laplace died in Paris in 1827. His brain was removed by his physician, François Magendie, and kept for many years, eventually being displayed in a roving anatomical museum in Britain. It was reportedly smaller than the average brain. Laplace was buried at Père Lachaise in Paris but in 1888 his remains were moved to Saint Julien de Mailloc in the canton of Orbec and reinterred on the family estate. [1]

 

References:

1. Pierre-Simon Laplace, in Wikipedia, accessed on 22 March 2017.
2. A Clinician's Guide to Statistics and Epidemiology in Mental Health. By S. Nassir Ghaemi

It was 151 years ago today.....

August Paul von Wassermann (21 February 1866 – 16 March 1925) was a German bacteriologist and hygienist.

Born in Bamberg, with Jewish origins, he studied at several universities throughout Germany, receiving his medical doctorate in 1888 from the University of Strassburg. [1] On September 1, 1891, he entered the newly established Institute for Infectious Diseases, headed by Koch, as an unpaid assistant in both the scientific and clinical divisions, working under Bernhard Proskauer. In February 1893 he became a temporary assistant assigned to problems related to cholera, and from February 1895 to June 1896 he was inspecting physician at the Institute’s antitoxin control station for diphteria, which was transferred in 1896 to the Institute for Serum Research and Testing in the Berlin suburb of Steglitz. Wassermann then returned to the institute itself as an unpaid assistant.

Some felt that Wassermann carried on his investigations as a hobby, and he certainly did not need to earn a living. He was small in stature but, contrary to assertion, he was not stooped or hunch-backed, and he had bright blue (not dark) eyes. He always dressed with extreme elegance.

He was an impulsive man and a superb speaker, expressing his conclusions openly without scientific inhibitions. It was said that his theoretical knowledge was rather weak and that his practical application was not at all that good either, but that he relied on a number of technicians to do his biddings in the laboratory. These were dubbed his scientific coolies. He had an outstanding capacity to render complicated theoretical problems comprehensible to the uninitiated. [2]

In 1906 he became director of the division for experimental therapy and serum research at the institute, followed by a directorship of the department of experimental therapy at the Kaiser-Wilhelm-Gesellschaft for the Advancement of Science in Berlin-Dahlem (1913).

Wassermann developed a complement fixation test for the diagnosis of syphilis in 1906, just one year after the causative organism, Spirochaeta pallida, had been identified by Fritz Schaudinn and Erich Hoffmann. The so-called "Wassermann test" allowed for early detection of the disease (despite its nonspecific symptoms), and thus prevention of transmission. He attributed the development of the test to earlier findings of Jules Bordet and Octave Gengou (complement fixation reaction) and to a hypothesis introduced by Paul Ehrlich in his interpretation of antibody formation.

The Wassermann test remains a staple of syphilis detection and prevention in some areas, although it has often been replaced by more modern alternatives. With Wilhelm Kolle, he published the six-volume Handbuch der Pathogenen Mikroorganismen (Handbook of Pathogenic Microorganisms). [1]

With Rudolf Kraus (1868-1932), Wassermann was co-founder of the Free Association for Microbiology, and he served as president of the Academy for knowledge of Judaism. Although occasionally sarcastic, he was always helpful and kind, even under different conditions. He once characterized himself as a "laboratory worker.” His many honours included orders and decorations from Prussia, Belgium, Japan, Romania, Spain, and Turkey.

In 1921 Wassermann was the first recipient of the Aronson Foundation Prize. However, he was never appointed to a chair at the prestigious Berlin faculty, and was never awarded the Nobel Prize, to which he is said to have been a candidate. In 1895 he married Alice von Taussig of Vienna; they had two sons. [2]

References

1. August von Wassermann in Wikipedia, accessed 20 February 2017.
2. August Paul von Wasserman, in Whonameedit.

It was 103 years ago today:

Viktor Mikhailovich Zhdanov  was born in the village of Shtepino (Ukraine). Zhdanov (13 February 1914 – 1987) was a  virologist and instrumental in the effort to eradicate smallpox globally.

After graduating from Kharkiv Medical Institute in 1936, he spent the next decade working as an army doctor, where he became interested in epidemiology; this work would directly lead to his doctoral thesis on Hepatitis A.

In 1946, Zhdanov was invited to become Chief of the Epidemiology Department of the I. I. Mechnikoff Institute of Epidemiology and Microbiology in Kharkiv, becoming its director two years later. His work in virus classification saw him admitted to the International Committee on Taxonomy of Viruses as a life member.

 

 

Alice Bukrinskaya, the D.I. Ivanovsky Institute of Virology, Moscow, U.S.S.R,  [3] would say this about him after he died:

Zhdanov was a scientist of keen and inquisitive mind and extraordinary flexibility of thought, a declared enemy of dogmatism and bureaucracy. He was an amiable, warm and charming person, highly appreciative of the other's talent, a reliable, humorous and attentive friend.

In 1958, Zhdanov, as Deputy Minister of Health for the Soviet Union, called on the World Health Assembly to undertake a global initiative to eradicate smallpox. The proposal (Resolution WHA11.54) was accepted in 1959. Zhdanov left the Ministry of Health in 1961, and focused on scientific research for the rest of his career. This work included studying influenza, hepatitis, and in the 1980s, HIV.

In addition to his accomplishments in the field of public health, Zhdanov chaired the Soviet Union's Interagency Science and Technology Council on Molecular Biology and Genetics, which among its many functions directed the Soviet biological weapons program.

Despite Zhdanov's relative obscurity, some have argued that Zhdanov has done "more good for humanity" than any other human in history.[1]

To provide a rapid means of disseminating new findings in virology, Zhdanov founded the journal Problems in Virology in 1956; he remained its editor and an active contributor until his death.
Zhdanov's years in health administration were marked by constant struggles with party officials on the Central Committee, who neither understood nor supported his initiatives and succeeded in blocking many of them. Unsatisfied and disillusioned with administrative work, Zhdanov left the Ministry of Health in 1961 to devote himself to scientific research. Because of his belief in the value of international cooperation, Zhdanov maintained close working associations with scientists in the West, even during the Corld War. Joint influenza research projects were done with Walter Dowdle, Robert Webster, Edward Kilbourne, and Nancy Cox; joint viral oncogenesis research projects were done with John Moloney and Fred Rapp; joint viral hepatitis research projects were done with Daniel Bradley and James Maynard, to mention but a few. [3]

References:

1. Viktor  Zhdanov, in Wikipedia. Accessed 13 February 2017
2. World Health Assembly Resolution WHA11.54
3. In memory of Victor Zhdanov. Archives of Virology 1991, Volume 121, Issue 1-4, pp 237-240

It was 120 years ago, today

John Franklin Enders (February 10, 1897 – September 8, 1985) was an American biomedical scientist and Nobel laureate. Enders has been called

"The Father of Modern Vaccines."

In 1949, Enders, Thomas Huckle Weller, and Frederick Chapman Robbins reported successful in vitro culture of an animal virus—poliovirus. The three received the 1954 Nobel Prize in Physiology or Medicine "for their discovery of the ability of polioviruses to grow in cultures of various types of tissue".

Meanwhile, Jonas Salk applied the Enders-Weller-Robbins technique to produce large quantities of poliovirus, and then developed a polio vaccine in 1952. Upon the 1954 polio vaccine field trial, whose success Salk announced on the radio, Salk became a public hero but failed to credit the many other researchers that his effort rode upon, and was somewhat shunned by America's scientific establishment.

In 1954, Enders and Peebles isolated measlesvirus from an 11-year-old boy, David Edmonston. Enders began development of measles vaccine, using the 'Edmonston-B Strain' of the virus, leading up to the 'Enders-Edmonston Strain' for the vaccine. In October 1960, an Enders team began trials on 1,500 mentally retarded children in New York City and on 4,000 children in Nigeria.

On 17 September 1961, New York Times announced the measles vaccine effective. Refusing credit for only himself, Enders stressed the collaborative nature of the effort. In 1963, Pfizer introduced a deactivated measles vaccine, and Merck & Co introduced an attenuated measles vaccine.

References

1. John Franklin Enders, in Wikipedia. Accessed on 10 February 2017
2. Measles History, at CDC website, accessed 10 February 2017

Kiyoshi Shiga (February 7, 1871 – January 25, 1957) was a Japanese physician and bacteriologist.

Shiga was born in Sendai, Miyagi Prefecture, though his original family name was Satō. He graduated from the Medical School of Tokyo Imperial University in 1896 and went to work at the Institute for the Study of Infectious Diseases under Dr. Kitasato Shibasaburō. Shiga became famous for the discovery of Shigella dysenteriae, the bacillus causing dysentery, in 1897, during a severe epidemic in which more than 90,000 cases were reported, with a mortality rate approaching 30%.[1] The bacterium Shigella was thus named after him, as well as the shiga toxin, which is produced by the bacterium.

When attending the trecentenary celebration at Harvard [2], 1936, he opened his speech with:

Many thousands still suffer from this disease every year, and the light of hope that once burned so brightly has faded as a dream of a summer night. This sacred fire must not burn out

After the discovery of Shigella, Shiga worked with Paul Ehrlich in Germany from 1901 to 1905. After returning to Japan, he resumed the study of infectious diseases with Dr. Kitasato. He became a professor at Keio University in 1920.

From 1929 to 1931, Shiga was the president of Keijō Imperial University in Keijo (Seoul) and was senior medical advisor to the Japanese Governor-General of Korea. Shiga was a recipient of the Order of Culture in 1944. He was also awarded the Order of the Sacred Treasure, 1st class, on his death in 1957.

Shigellosis

The causative agent of human shigellosis, Shigella causes disease in primates, but not in other mammals. It is only naturally found in humans and gorillas. During infection, it typically causes dysentery.

Shigella is one of the leading bacterial causes of diarrhea worldwide, causing an estimated 80-165 million cases. The number of deaths it causes each year is estimated at between 74,000 and 600,000 deaths. It is in the top four pathogens that cause moderate-to-severe diarrhea in African and South Asian children.

References

1. Kiyoshi Shiga on Wikipedia. Accessed on 6 February 2017. 
2. Rofa AF, Ueno-Olsen H, Oiwa R, Yoshikawa M (1999), "Dr. Kiyoshi Shiga: discoverer of the dysentery bacillus", Clinical Infectious Diseases, 29 (5): 1303–1306, doi:10.1086/313437
3. Shigellosis on Wikipedia. Accessed on 6 February 2017

Jaume Ferran i Clua (Corbera d'Ebre, 1851 – Barcelona 1929) was a Spanish bacteriologist and sanitarian, contemporary of Koch, and said by his fellows to have made some of the discoveries attributed to Koch. As early as 1885, he wrote on immunization against cholera. In 1893, his work on this subject was translated into French with the title L'Inoculation préventive contre le Cholera.

Tuberculosis is another disease in which Ferran was always deeply interested.

As the son of the village doctor, he graduated in Medicine at the University of Barcelona.  There he became interested in bacteriology. In 1884, the Royal Academy of Medicine recognized his report on 'bacterial parasitism' and the Barcelona municipality sent him to Marseilles to study the epidemic of cholera. Convinced of its bacterial etiology, newly discovered by Koch, Ferran prepared attenuated cultures  of the vibrio bacillus, which was used to develop the first cholera vaccine.
During the outbreak of epidemic cholera in 1885, Ferrán was called to Valencia , to organise mass inoculation of the population. In spite of the success obtained, a controversy was unleashed; some believed that the Ferranian method was dangerous, and subsequently, the Government prohibited vaccination.

Later, he carried out research on the immunology of abdominal typhus and diphtheria and proposed a supra-intensive method for anti-rabies vaccination.

 

On the historic Lazareto in the middle of the port of Mahon at Menorca, Spain, you may find an expressive bronze statue of a man who breaks away from chains. Engraved on the four sides of the stone plinth are the names of four eminent men of medicine and medical science, of microbiology, of bacteriology and of immunology: Louis Pasteur, (France), Juan Carlos Finlay (Cuban), Sir Alexander Fleming, (Scottish) and Edward Jenner (English). It is an appreciation to pioneers who have furthered our knowledge about infectious diseases, in an era that still relied on quarantine islands such as the Lazareto of Mahon.

References:

1. Jaume Ferran i Clua, in Wikipedia. https://en.wikipedia.org/wiki/Jaume_Ferran_i_Clua. accessed 31 january 2017.
2. Discover Lazareto, Menorca's Historic Treasure. http://menorca-live.com/discover-lazareto-menorcas-historic-treasure/

 

Baron Kitasato Shibasaburō (January 29, 1853 – June 13, 1931) was a Japanese physician and bacteriologist during the prewar period. [1] He is remembered as the co-discoverer of the infectious agent of bubonic plague in Hong Kong in 1894, almost simultaneously with Alexandre Yersin. [3,4]

Kitasato was nominated for the Nobel Prize in Physiology or Medicine in 1901.  Kitasato and Emil von Behring working together in Berlin in 1890 announced the discovery of diphtheria antitoxin serum, Von Behring was awarded the 1901 Nobel Prize because of this work, but Kitasato was not.

Kitasato was born in Okuni village, Higo Province, (present-day Oguni Town, Kumamoto Prefecture, Kyūshū). He studied under Dr. Robert Koch in the University of Berlin from 1885 to 1891. In 1889, he was the first person to grow the Tetanus bacillus in pure culture, and in 1890 cooperated with Emil von Behring in developing a serum therapy for tetanus using this pure culture. He also worked on antitoxins for diphtheria and anthrax. Kitasato and Behring demonstrated the value of antitoxin in preventing disease by producing a passive immunity to tetanus in an animal that received graded injections of blood serum from another animal infected with the disease.

 

After returning to Japan in 1891 he founded the Institute for Study of Infectious Diseases with the assistance of Fukuzawa Yukichi. One of his early assistants was August von Wassermann. Kitasato demonstrated how dead cultures can be used in vaccination. He also studied the mode of infection in tuberculosis.

He traveled to Hong Kong in 1894 at the request of the Japanese government during an outbreak of the bubonic plague, and identified a bacterium that he concluded was causing the disease. Yersin, working separately, found the same organism several days later. Because Kitasato's initial reports were vague and somewhat contradictory, some scientific historians give Yersin sole credit for the discovery, while others advise dual credit, however, a thorough analysis of the morphology of the organism discovered by Kitasato by microbiologists determined that although his samples likely became contaminated later, leading to the conflicting reports from his laboratory, there is "little doubt that Kitasato did isolate, study, and reasonably characterize the plague bacillus" in Hong Kong and "should not be denied this credit".[2]

Four years later, Kitasato and his student Shiga Kiyoshi were able to isolate and describe the organism that caused dysentery.

When the Institute for Infectious Diseases was incorporated into Tokyo Imperial University in 1914, he resigned in protest and founded the Kitasato Institute (the forerunner of Kitasato University), which he headed for the rest of his life.

In September 1921 Kitasato founded, together with several medical scientists, the Sekisen Ken-onki Corporation with the intention of manufacturing the most reliable clinical thermometer possible. The company was later renamed Terumo Corporation.

Kitasato also was the first dean of Medicine at Keio University, first president of the Japan Medical Association, and served on the House of Peers. He was ennobled with the title of danshaku (baron) in the kazoku peerage system in February 1924.

Kitasato died of an Intracranial hemorrhage at his home in Azabu, Tokyo on June 13, 1931. His grave is at the Aoyama Cemetery in Tokyo.

 

References:

1. Kitasato Shibasaburō in Wikipedia. https://en.wikipedia.org/wiki/Kitasato Shibasaburō. Accessed 25 January 2017.
2. Bibel, DJ; Chen, TH (September 1976). "Diagnosis of plaque: an analysis of the Yersin-Kitasato controversy.". Bacteriological Reviews. 40 (3): 633–651, quote p. 646. PMC 413974. Freely accessible. PMID 10879.
3. E.G. Pryor. The Great plague of Hongkong. 
4. Medical report on the epidemic of bubonic plague 1894. 

Today it is 216 years ago that Edwin Chadwick was born in Manchester.
Sir Edwin Chadwick (24 January 1800 – 6 July 1890) was an English social reformer who is noted for his work to reform the Poor Laws and to improve sanitation and public health. He was born in 1800 at Longsight, Manchester, to James Chadwick. His mother died when he was still a young child, yet to be named. His father, James Chadwick, tutored the scientist John Dalton in music and botany and was considered an advanced liberal politician, thus exposing young Edwin to political and social ideas. [1]

At 18, he decided to pursue a career in law and undertook an apprenticeship at an attorney's office. In 1823, he enrolled in law school at The Temple in London. On 26 November 1830 he was called to the bar, becoming a barrister, also known as a court lawyer.

Called to the bar without independent means, he sought to support himself by literary work such as his work on Applied Science and its Place in Democracy, and his essays in the Westminster Review, mainly on different methods of applying scientific knowledge to the practice of government. He became friends with two of the leading philosophers of the day, John Stuart Mill and Jeremy Bentham. Bentham engaged him as a literary assistant and left him a large legacy. He also became acquaintances with Thomas Southwood Smith, Neil Arnott, and James Kay-Shuttleworth, all doctors.

From his exposure to social reform and under the influence of his friends, he began to devote his efforts to sanitary reform. While still officially working with the Poor Law, Chadwick took up the question of sanitation in conjunction with Dr Thomas Southwood Smith. Their joint efforts produced a salutary improvement in the public health. His report on The Sanitary Condition of the Labouring Population (1842) was researched and published at his own expense. A supplementary report was also published in 1843. The formation of the Health of Towns Association and the creation of various city-based branches followed rapidly. The national and local movements contributed to the passing of the Public Health Act 1848. [1]

By 1848 Chadwick had become Sanitary Commissioner of London, and was very influential in the city's approach towards cholera. He believed that filth in rivers was less dangerous than filth in sewers. As Commissioner, he had the power to have sewers regularly flushed into the River Thames. This policy inadvertently contributed to the spread of cholera by water purveyors which had their intakes in the polluted areas of the river. Contrary to Dr. John Snow, he was a strong believer in the theory that epidemics were generated spontaneously from dirt, and that basic sanitation rather than specific avoidance of cholera germs would control the disease. He rejected with scorn as mere hypothesis Snow's germ theory, as described in Snow's 1855 book. [2]

While others had come to accept the germ theory, Chadwick remained a committed sanitarian to the end, telling a newspaper reporter shortly before his death in 1890:

"I cannot tell you how strongly I believe in soap and water as a preventive of epidemics" (Weekly Dispatch, July 13, 1890).

It is interesting to observe that this strong position on use of soap and water, is not at all in conflict with the germ theory. In addition, his work on mapping disease in Bethnal Green Parish resembles the later work of Snow on mapping cholera mortality a lot. It seems that the two men had a strong passion for improving public health in common, and were mainly divided over the theories of causation.

In January 1884, he was appointed as the first president of the Association of Public Sanitary Inspectors, now the Chartered Institute of Environmental Health. Its head office, in Waterloo, London, is named Chadwick Court, in his honour.

In recognition of his public service, he was knighted in 1889. He served in his post until his death, at 90, in 1890, at East Sheen, Surrey.

 

References:

1. Edwin Chadwick in Wikipedia. Accessed 23 January 2017
2. A brief history of Chadwick during the Snow Era. University of California Los Angeles (UCLA), department of epidemiology. Accessed 23 January 2017

Anyone who uses statistics, or who is involved in study design, should know who Gertrude Cox was. To be clear: she did not give her name to Cox regression (proportional hazards model). That was Sir David Cox, from Birmingham; 'the other famous Cox-statistician'.

Born January 13, 1900, in Dayton, Iowa, Gertrude M. Cox reflected the upbringing of the times and location. It is said she was "instilled with ethics, moral courage, and determination". Her professional efforts succeeded to make statistics practical for those working in agricultural and biological research. This achievement, together with her strong organizing skills, made her successfully bridge the gap between theoreticians and research workers.

After a bachelor studies in mathematics, she received a master's degree in statistics from Iowa State College in 1931. She then studied psychological statistics and was a graduate assistant at the University of California, Berkeley. In 1933 she returned to Iowa to assist George Snedecor by heading the newly created Statistical Laboratory. Cox answered Snedecor’s call to work as a consultant and manage his Iowa State Statistics Lab of “computers” for the statistical consulting projects.

"Computers", as they referred to them, were the women hired to compute sums of squares and standard deviations on big, cumbersome Merchant and Monroe desk calculators. Because of their attention to detail, women were often sought for this task.

Cox was made a research assistant professor in 1939. During this period she began her research on experimental design. During this period she compiled a series of notes on standard designs, that eventually led to the book 'Experimental Designs', cowritten by William G. Cochran and published in 1950.

Her appointment in 1940 to organize and head a Department of Experimental Statistics in the School of Agriculture at North Carolina State College in Raleigh, seemed to be the result of a footnote in a letter from Snedecor to North Carolina State College, in which he recommended five men. He added,

"Of course if you would consider a woman for this position I would recommend Gertrude Cox of my staff."

In January 1941, the department was established with Cox as the first female full professor and first female department head at North Carolina State College, a propitious choice that changed the course of statistics in North Carolina.

Her skill as an administrator was unsurpassed. She employed outstanding faculty and staff and left them to their teaching and research while she raised funds. In addition to her administrative duties, Cox continued to teach, drawing on her many years of consulting to produce practical real-life examples designed to illustrate experimental designs, all of which were flawlessly computed before the age of computers.

She held many positions that were of great influence on the field of statistics. Among many examples, she was the first woman to be elected president (1956) of the American Statistical Association (founded in 1839).

In addition to her professional achievements, Cox was known for the personal interest she took in relatives, friends, and wives and children of faculty and staff. The memory books in the Department of Statistics at North Carolina State University hold many remembrances of her tenure there, from newspaper clippings of awards to the department to wedding invitations for staff and Christmas cards sent and received.

Cox died of leukemia October 17, 1978.

References

1. Gertrude M. Cox. Statisticians in History Website. Accessed 12 January 2017
2. The life and times of Gertrude May Cox, by Helena Hoen on Blogspot. Accessed 12 January 2017.

Adelard (752-827) was the grandson of Charles Martel, nephew of King Pepin and first cousin to Charlemagne. He became a monk, at the age of 20, at Corbie in Picardy in 773. Eventually he was chosen abbot, and became Charlemagne's counselor. He was forced by the king to quit the monastery and work for him as chief minister for his son Pepin. He was accused of supporting a rival power (Bernard) against Emperor Louis the Debonair and was banished to a monastery on the island of Heri. Five years later he was recalled to the king's court (821). He later retired to the Abbey at Corbie and died January 2 after an illness. Miracles were reported after his death. When Adelard first became monk at Corby in Picardy (in 773), his first assignment was gardener of the monastery. He did his job humbly and piously, praying throughout the day. His great virtues eventually helped him become Abbot. [1]

Saint Adelard was canonized by Pope John XIX in 1026.

 

With the above description in mind, it will not be much of a surprise that Adelard became the patron saint of gardeners. In addition, he became known as the patron of sufferers of fevers and typhus. [2]

 

 

In this case it will be important to know that for a long time, the diagnose 'typhus' was used for all types of severe febrile illness. The Greek term [typhos] (smoke, mist, fog) was employed by Hippocrates to define a confused state of the intellect, with a tendency to stupor (stupor attonitus); and in this sense it is aptly applied to typhus fever with its slow cerebration and drowsy stupor. Boissier de Sauvages first (in 1760) called this fever "typhus," and the name was adopted by Cullen of Edinburgh in 1769. Previous to the time of de Sauvages typhus was known as "Pestilential" or "Putrid Fever," or by some name suggested by the eruption, or expressive of the locality in which it appeared, as "Camp," "Jail," "Hospital," or "Ship Fever". [3]

 

In modern medicine, typhus refers to a group of infectious diseases that are caused by rickettsial organisms and that result in an acute febrile illness. Arthropod vectors transmit the etiologic agents to humans. The principle diseases of this group are epidemic or louse-borne typhus (Typhus exanthematicus, classic typhus fever; caused by Rickettsia prowazekii) and its recrudescent form known as Brill-Zinsser disease, murine typhus (flea-borne typhus fever, Shop typhus; caused by Rickettsia typhi -Rickettsia mooseri-; R. felis), and scrub typhus (mite-borne typhus fever, Tsutsugamushi disease; caused by Orientia tsutsugamushi). [4]

 

References

1. Adelard of Corbie. Catholic Online Website. http://www.catholic.org/saints/saint.php?saint_id=252. Accessed 2 January 2017.
2. January 2, St. Adelard of Corbie - Patron saint of gardeners and sufferers of typhus. 365rosaries website. https://365rosaries.blogspot.nl/2013/01/january-2-2013-saint-adelard-of-corbie.html. Accessed 2 January 2017.
3. Typhus. Online etymology dictionary. http://www.etymonline.com/index.php?term=typhus. Accessed 2 January 2017.
4. David L. Heymann (ed). Control of Communicable Diseases Manual, 18th edition. Pages 630-6

Pierre Paul Émile Roux (17 December 1853, Confolens, Charente – 3 November 1933, Paris) was a French physician, bacteriologist and immunologist. Roux was one of the closest collaborators of Louis Pasteur (1822–1895), a co-founder of the Pasteur Institute, and responsible for the Institute's production of the anti-diphtheria serum, the first effective therapy for this disease.[1]

When the Institut Pasteur was created in 1888, Roux was placed in charge of instruction in microbiology. At the same time, he became director of the Service de Microbie Technique and began his most important original work. There, confirmed the pathological role of the diphtheria bacillus, and perhaps most important, he demonstrated with A. E. J. Yersin that the pathogenic power of this bacillus depends not merely on its presence but, rather, on a poison, or toxin, that it produces.

“snake venoms themselves are not as deadly.”

Roux said about this toxin.[2] Would his parents have been aware that the initials of their son (PPE) would become a key concept in communicable disease control?

References:

1. Emile Roux, from Wikipedia, the free encyclopedia, accessed 17 december 2016
2. Medicine Biographies-Emile Roux, Encyclopedia.com, accessed 17 december 2017

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Margaret Mead (December 16, 1901 – November 15, 1978) was an American cultural anthropologist who featured frequently as an author and speaker in the mass media during the 1960s and 1970s. She earned her bachelor's degree at Barnard College in New York City and her M.A. and Ph.D. degrees from Columbia University.

Mead was a respected and often controversial academic who popularized the insights of anthropology in modern American and Western culture. Her reports detailing the attitudes towards sex in South Pacific and Southeast Asian traditional cultures influenced the 1960s sexual revolution. She was a proponent of broadening sexual mores within a context of traditional Western religious life. [1]

When Margaret Mead died in 1978, she was the most famous anthropologist in the world. Indeed, it was through her work that many people learned about anthropology and its holistic vision of the human species. [2] And as such, she contributed a wealth of knowledge and insights to public health.

One of her quotes:

As the traveler who has once been from home is wiser than he who has never left his own doorstep, so a knowledge of one other culture should sharpen our ability to scrutinize more steadily, to appreciate more lovingly, our own.

December 16, the birthday of Margaret Mead, is a day to remember her.

References:

1. Margaret Mead, from Wikipedia, the Free Encyclopedia, accessed on 15 December 2016
2. Institute for Intercultural Studies: Margaret Mead, an anthropology of human freedom. Biography.

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