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