Famous Names

Florence Nightingale

A few weeks ago, when I was composing my draft of post topics for the upcoming month, I chose to write about a well known but often under recognized figure, Florence Nightingale, as my public health figure. Little did I know just how suiting this choice would be given that May 6 is National Nurses Day. (National Nurses Week is from May 6-12). This month’s “Famous Name in Public Health” was a game changer in the structure of our health care system. It is because of her that the field of nursing became such an invaluable profession and why all of us should treat every day like Nurse’s day. So, let’s get started!

Florence Nightingale was born in 1820 to a wealthy family. In 1851, she completed her nursing training in Germany. At the time, the was not a well respected profession and her choice to pursue the career went against the norm for women of her status at the time and concerned her parents. You see, nursing was poorly paid and widely considered to be a job for the poor. There was a negative, unprofessional reputation surrounding nurses at the time. So why did Ms. Nightingale choose nursing? Her profound Christian beliefs made her feel that helping the poor and needy was her moral duty and that nursing was a call from God.

When the Crimean War broke out in 1854, Florence became one of the many nurses that tended to the soldiers. She traveled to Constantinople from London where she worked at Scutari hospital, an under equipped facility. Ms.Nightingale was in charge of the female nurses working in Turkey. She worked in aiding the sick and wounded soldiers, as well as tending to their needs. Her staff improved the sanitation and conditions of the facility. They provided food, blankets, and even wrote to the soldier’s families. It was during this time that she earned her name, “Lady of the Lamp” because she would tend to soldiers by lamplight after the medical officers had retired for the night. Her endless care and morality improved the conditions of the hospital and of the patients. Her role and active leadership made the use of nurses in military hospitals an outstanding success.

When Florence returned to England at the end of the war, in 1856, she campaigned for nursing reforms and increased sanitation in hospitals. Donations that she collected for the Nightingale Fund were used to start a nursing school at St. Thomas’ Hospital in 1860. She continued to campaign to improve health conditions in hospitals through advocacy and numerous publications. She authored more than 200 books regarding nursing, hospital planning, and facility organization, both in management and in literal floor plan designs of hospital wards. Florence used her prior education (a luxury of her family’s wealthy status) to evaluate and then revolutionize hospital systems. She set up a systematic record keeping system and found a causal link between sanitation levels and death rate. Her work was one of the first to recognize that social phenomena could be objectively measured and analyzed. She was determined to reform the health care system so the issues she encountered during the Crimean War would never impact civilians at home.

Florence Nightingale’s reform efforts were so successful that soon there were nursing schools teaching her methods around the world. She was also involved in the creation of the International Red Cross. Through her work, she transformed nursing into a respected profession and her efforts did not go unnoticed. Florence received the Royal Red Cross in 1883 and then she became the first woman to earn the Order of Merit in 1907.

Florence Nightingale passed away in 1910, but her legacy lives on.

Advertisements
Famous Names · Uncategorized

Sir Edwin Chadwick

88855

Recently, this blog has had a lot of posts about health conditions that are unequally distributed among the population, causing increased health problems among people affected by poverty. Notably, last week’s Guinea Worm post and my recent <a href="https://theartofahealthyheart.wordpress.com/2018/02/15/serving-the-medically-underserved/"Serving the Medically Underserved post. As a result, I wanted to talk about someone who has worked to lessen health disparities by being an advocate for the poor. I felt that the best way to start this conversation is to recognize that this issue is not a new problem. It’s something we have been struggling with for literally centuries. In my search for an individual fitting to this role, I found one name kept popping up on my search, Sir Edwin Chadwick. He is widely thought to be one of the most influential public health figures of the 1800s. So, without further ado, this month’s Famous Name in Public Health is, of course, Sir Edwin Chadwick!

Sir Edwin Chadwick was born in England in 1800. During his studies to become a lawyer, Sir Chadwick became interested in social and political reform while studying law in London. During this time, Sir Chadwick developed the concept of the “sanitary idea” based on science and integrated with the miasma theory. This concept proposes that diseases are caused by poisonous vapors in the air. Thus areas of the community that smell foul (mostly impoverished areas in this time period) are the causes of illness and disease among the population that lives there. Although we now know that this theory is not correct, the concept persisted for a long time because of the (yet unknown) association between bacteria and their production of malodorous scents. Around the time that Sir Chadwick’s concept of the “sanitary idea” began to grow and fuel his investigation of sick wards he took the position assistant commissioner on the poor-law commission. The following year he was appointed as the secretary of the royal commission. His work helped contribute to the future passing of the Ten Hours Act which limited “the work of women and young persons (aged 13–18) in textile mills to ten hours a day for five days in the week and eight hours on Saturday.”

Next, he worked on the Poor Laws of England. The Poor Laws were established in 1601 during the English period of depression to combat unemployment and famine. In essence, the laws classified groups of people within a each parish based on their ability to work and provide for themselves and their family. Additionally, these laws gave the local government the means to tax those able to pay and to provide relief to those in need of assistance. However, by the 1800s, these laws were in need of updating and reform. This led to the creation of the Poor Law Amendment Act. This amendment set up the Poor Law Commission to supervise local parishes, and it removed the assistance given to able bodies workers as a means to stimulate the workforce.

In 1848, he successfully campaigned for the passage of the The Public Health Act. This act is considered one of the greatest achievements in the public health history of England. This act allowed states to become the “guarantor of standards of health and environmental quality and provided resources to local units of government to make the necessary changes to achieve those standards.” This allowed things like water supply and sewage and waste management to be managed by the local government using governmental funds as a means to manage the health problems of the population (notably caused by things like the industrial revolution and urbanization). This act was incredibly controversial at the time because there was still no known link between the environment, germs and health. As a result, the act only lasted 5 years before it failed to be renewed by the government. However, this was not a loss for Sir Chadwick, as his legacy became enduring through the crating of the Public Health Act of 1875, which consolidated a lot of the legislation surrounding public health and created a uniformed administrative body to carry out the policies.

The works of Sir Chadwick extends broadly. His involvement in a variety of public health matters contributed to the eventual passing of many acts and reforms by the government. For example, beyond his investigation into child labor laws, he contributed to the Employers’ Liability Act concerning on the job injuries of adult workers. He also contributed to drainage work and matters of military sanitation to relieve troop suffering. He campaigned for the maintenance of railway systems as a public health issue. Sir Chadwick’s interests and perspectives were revolutionary and controversial at the time, but many of his arguments proved valuable and true in the future. His work helped contribute to the overall improvement in sanitation and maintenance of sanitation and living conditions for the entire population of England.

Overall, Sir Edwin Chadwick became one of the greatest social reformers in England of his time. He received knighthood in 1889 before passing away one year later on July 6, 1890.

Famous Names · Uncategorized

Dr. Elizabeth Blackwell

A tribute to my recent acceptance to medical school, this month’s Famous Names in Public Health series post centers around women’s achievements in medicine. This notable figure was the first woman to earn a medical doctorate degree in the United States. Her name is Dr. Elizabeth Blackwell.

Dr. Blackwell was born in 1821 in Bristol, England. Her family immigrated to America in 1832 and settled in Cincinnati, Ohio. Here, her father and family became advocates for the abolition of slavery and for the establishment of women’s rights. After her father passed away in 1838, her mother, sisters and herself became teachers as a means to support themselves and their family. According to Changing the Face of Medicine, Dr.Blackwell first turned to medicine because “a close friend who was dying suggested she would have been spared her worst suffering if her physician had been a woman.”

Dr. Blackwell consulted her family’s physician friends for advice and studied medicine under the guidance of 2 of these physicians for 1 year before applying to multiple medical schools on the east coast. Many schools at that time would not even entertain her application because their programs were not available to women. One school however did consider the idea- Geneva Medical College. Apparently, the faculty allowed the students (who were, of course, all male) vote on her admission because they thought it would never go through. However, the student body jokingly voted to grant her admission to the school. (It’s pretty shocking how a practical joke ultimately led to a change in history!) She graduated from the program in 1849 with her MD degree. She was the first in her class, gaining respect from faculty and classmates alike.

From there, Dr.Blackwell practiced medicine in London and Paris until 1851. When she returned to New York to practice medicine, she struggled with discrimination and had difficulty finding work. Neither hospitals were willing to hire her, nor patients willing to see her. Even a women’s department was unwilling to hire her as a practicing female physician. As a result, Dr. Blackwell opened her own small clinic in the city to treat women. In 1857, Dr. Elizabeth Blackwell, her sister; Dr. Emily Blackwell, Dr. Marie Zakrzewska, opened the New York Infirmary for Women and Children. In 1859 she became the first woman to have her name entered in the British General Medical Council’s register. Continuing this success, her New York infirmary opened a medical college for women while under her sister’s charge in 1867. Dr.Blackwell continued to practice medicine, and in 1875, she became the professor of gynecology at the London School of Medicine for Women.

Throughout her career, Dr. Blackwell campaigned for the opportunity for women to practice medicine and for their acceptance in the field. She founded the National Health Society in 1871. Accorting to The Independent, “Blackwell had set up a private practice in London in 1870, established the London School of Medicine for Women in 1874 and finally won the right for women to undertake medical degrees in Britain during 1876 following years of campaigning.” She also released numerous pamphlets, brochures and books campaigning for women in medicine and documenting her experience. He publications include Medicine as a Profession For Women in 1860, Address on the Medical Education of Women in 1864, and Pioneer Work in Opening the Medical Profession to Women, published in 1895.

Sources:

http://www.independent.co.uk/news/uk/home-news/elizabeth-blackwell-google-doodle-first-female-doctor-in-america-britain-england-a8192551.html

https://cfmedicine.nlm.nih.gov/physicians/biography_35.html

http://www.independent.co.uk/news/uk/home-news/elizabeth-blackwell-google-doodle-first-female-doctor-in-america-britain-england-a8192551.html

http://www.bristol.ac.uk/blackwell/about/elizabeth-blackwell/elizabeth-blackwell-biography/

Famous Names · Uncategorized

Dr. Souhel Najjar

Neurology is the study of the nervous system, most notably the brain. While the field has been around as far back as 2000BC, our understanding of the brain is continuing to evolve. This month’s notable figure is one among many historical members of this field of study. Dr. Souhel Najjar is a neurologist working on topics related to epilepsy, neuroinflammation-related neuropsychiatric disorders and autoimmune disorders of central nervous system. Examples of some of these conditions include anti-NMDA receptor encephalitis , temporal lobe epilepsy, and the implication of neuro-inflammation in diseases such as schizophrenia. A quick search on Google Scholar brings up pages and pages of articles listing him as one of the authors.

Dr.Najjar has an extensive educational foundation. He studied medicine at Demascus Medical School in Syria. Following this, he completed his graduate medical education via residencies in both in pathology and neurology at Albany Medical College. He also completed a fellowship in neuropathology, in addition to another fellowship in epilepsy and clinical neurophysiology at the NYU School of Medicine and NYU Hospital for Joint Diseases.

During his career, he has had multiple director positions throughout New York City. He has acted as the Director of Neurosciences and Director of Stroke at Staten Island University Hospital beginning in 2006. He has also been the Director of Epilepsy Quality Assurance and Associate Professor of Neurology at New York University School of Medicine. Dr. Najjar is currently the Chair of Neurology at Lenox Hill Hospital and Staten Island University Hospital and is Chair and Professor of Neurology at the Hofstra North Shore School of Medicine.

Outside of his pioneering research, he is well known for his work on autoimmune encephalitis diseases, which have only become recognized as their own disease family after their discovery in the early 2000s. In fact, journalist Susannah Cahalan outlined her own experience with the disease, Anti-NMDA Receptor Encephalitis, in her book titled “Brain on Fire: My Month of Madness.” A discussion between Dr.Najjar and her can be viewed at a Autoimmune Encephalitis Alliance Awareness event here. Dr.Najjar continues to act as an advocate and physician for patients within the growing field of autoimmune encephalitis and other neuro-inflammation diseases.

Famous Names · Uncategorized

Dr. Harvey Cushing

This month, for the third edition of “Famous Names in Public Health!” I will focus on the medical side of healthcare by recognizing a figure who contributed significantly to the fields of neurosurgery and epidemiology, Dr.Harvey Cushing.

Dr. Cushing graduated from Harvard Medical School in 1895 and he continued his medical training in surgery at Johns Hopkins Hospital. During the time of his training, neuroscience was a rapidly growing field of medicine making numerous advances and discoveries. Neurosurgery claimed Dr. Cushing’s professional interest as he drifted from general surgery into peripheral-nerve surgery. After this, he became more and more focused on the brain, ultimately making neurosurgery his focus for his career. In 1913, Dr. Cushing accepted a position as the surgeon in chief at Peter Bent Brigham Hospital that was associated with Harvard. He continued to practice neurosurgery even in this position. According to the article “Harvey Cushing: A Life in Surgery,” Dr. Cushing’s major interest was cerebral tumors, leading him to study and treat more than 2,000 verified tumors. These studies are documented within 5 books published between 1912 and 1938.

Throughout his years of practice, he developed the Cushing Brain Tumor registry in 1902. It is an archive “of over 2,200 case studies which includes human whole brain specimens, tumor specimens, microscopic slides, notes, journal excerpts and over 15,000 photographic negatives dating from the late 1800’s to 1936. ” What makes this collection even more unique is that Cushing was an avid bibliophile, so he meticulously recorded and documented each patient story, including the stories of the patients of the collected specimens. Today, this provides a unique history of neurosurgery’s progression throughout his career.

Most notably, Dr. Cushing made numerous contributions to science and medicine, including the control of bleeding with silver clips, the development of electro-surgery, the development of technical methods for performing surgical operations, an increased understanding of intracranial pressure, the development of the pathological classification of glioma, and the description of pituitary basophilia (also known as Cushing Syndrome). Through this work on the pituitary gland, Cushing is also considered to be one of the founders of endocrinology. Even more of his pioneering research and medical practice can be found here.

Famous Names · Uncategorized

Dr.Luc Montagnier

This month’s notable figure in public health does not stand alone in his crowning achievement- the discovery of HIV as the cause of AIDS. As a result, the other members that contributed to the discovery of the link between HIV and AIDS will also be given a nod.

Luc Montagnier was born in France in 1932 where he grew up amidst World War II and the German occupation of the country of France. He was inspired to pursue virology after learning of the discovery of the Tobacco Mosaic Virus and the subsequent research conducted on the virus. His early research in virology involved hand foot and mouth disease, which proved that viral double-stranded RNA can replicate in a similar fashion to DNA. His research then turned to oncogenic viruses, or viruses that cause cancers. He discovered that the genetic material contained within the virus is enough to have a cancerous effect. His research specifically focused on oncogenic viruses that contained RNA instead of DNA. These viruses became known as retroviruses. Dr. Montagnier’s lab began searching for retroviruses in human cancer patients.

In 1982, Dr. Montagnier became involved in HIV research in France due to the growing suspicion that the disease may be caused by a virus. Multiple virologists around the world were working to determine the composition of the HIV infectious agent. In early 1983, his lab discovered Lymphadenopathy Associated Virus (LAV), named for the virus isolated from patients displaying swollen lymph nodes in early stages of AIDS. The growth of the lymph cells in cultures utilized the technique discovered and developed by Dr. Robert Gallo. His lab’s discovery allowed researchers to grow T-cells and study the viruses that affect them, thus making LAV research possible. Dr. Montagnier, aided by the assistance of Françoise Barré-Sinoussi and Jean-Claude Chermann who both had previous research and experience with retroviruses, grew and examined LAV cells in cultures. These gentlemen recorded the RT activity in the culture and conducted valuable research in the growth and development of the samples of the new virus. In September 1983, in the midst of the AIDS outbreak, Dr.Montagnier made a presentation of his team’s scientific findings and data that linked the newly determined LAV to the disease in a causal manner. LAV would later become known at HIV. At the time this announcement was controversial because the viral data collected by Dr.Montagnier classified the virus in a different family from HTLV, the only known retrovirus of the time. However, closely followed research performed by Dr. Gallo and Dr.Jay Levy confirmed and extended the findings that the HIV virus was not part of the HTLV family. The 2008 Nobel Prize in Physiology or Medicine was awarded to Dr. Montagnier and Dr.Barré-Sinoussi for the discovery of HIV and their pioneering work in the field of virology. (There has been a controversial debate surrounding the members of the award as Dr.Gallo was notably absent from the recognition despite the use of his techniques and previous research in the discovery and testing of HIV)

Today, thanks to the research of Dr. Montagnier and other scientists, we now know that HIV stands for human immunodeficiency virus. The virus’s transmission to humans is linked to a type of chimpanzee in Central Africa. This transmission from animals established a new disease among the human population and eventually began a worldwide outbreak of HIV. The HIV virus attacks a component of the immune system, called T cells. Since it affects the immune system’s function, people with HIV are more likely to get infections and as the disease progresses, uncommon opportunistic infections and cancers can result from the body’s inability to adequately protect itself. AIDS is the most severe stage of HIV. At this level, the number of T cells is below 200 cells per cubic millimeter of blood (normal is 500 to 1,600). Unfortunately, there is no cure for HIV or for AIDS, but there is treatment available to prolong life and slow the progression of HIV. Without treatment, people with AIDS typically survive about 3 years, but people who are treated with antiretroviral therapy (ART) while in the HIV stages of the disease can live almost as long as their healthy counterparts.

For any readers interested in the complex (and slightly messy) discovery of HIV, a great dramatization of the events is displayed in the movies “And the Band Played On.

Famous Names · Uncategorized

Dr.Virginia Apgar

This month’s “Notable Figure in Public Health” is Dr.Virginia Apgar. She played an important role in the development of a medical evaluation for newborns, called the “Apgar Score,” and she contributed to the development of an NGO organization that promotes awareness and funding for research.

The life and career of Dr.Apgar includes momentous accomplishments that have contributed to the direction of the medical field more than 50 years later. Her career began as a medical student at College of Physicians and Surgeons at Columbia University during the onset of the Great Depression. Despite the economic and social challenges of the time, she continued to thrive in her education and even graduated 4th in her class in medical school in 1933. She wanted to pursue surgery, a field completely dominated by men at the time. At the encouragement of Dr.Whipple, upon seeing her drive and skill, she was encouraged to pursue anesthesiology after the completion of her surgical residency. At that time, anesthesiology was not a recognized specialty and the field was still under continuous growth and development. She eventually trained with the first anesthesiology department in the country, located at the University of Wisconsin-Madison. She returned to Columbia University College of Physicians and Surgeons as an anesthesiologist in 1938, and when the field became a recognized specialty, she was appointed as the first full time female professor at the school.

During her time as a professor, her main focus was on obstetrical anesthesia. This is the study of the affects that anesthesia given to mothers during labor has on the newborn baby. During her study in this field, Dr.Apgar developed the Apgar Score. Changing the Face of Medicine states that the Apgar Score was “the first standardized method for evaluating a newborn’s transition to life outside the womb.” The Apgar Score scoring system evaluates newborns on their heart rate, respiration, movement, irritability, and color one minute after birth and again at five minutes after birth. The Apgar scor is represented by the APGAR acronym that represents Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. This scoring method is now an established standard of evaluation for newborns around the world. The scoring method reduced infant mortality and laid the foundations of neonatology. Furthermore, Dr.Apgar and her partners were able to establish a correlation between a newborn’s Apgar Score and the mother’s delivery conditions.

In 1958, obtained her Master of Public Health degree from Johns Hopkins. Following this, she became involved in the March of Dimes organization for 15 years. In fact, the website states, “she became a pivotal figure in redirecting the March of Dimes mission in the 1960s from polio to birth defects and other infant health problems such as premature birth.” She acted as the head of the Division of Congenital Malformations. During her time with the organization, she promoted rubella immunization through the organization after a German Measles outbreak in the mid 1960s. She also worked tirelessly to reduce the stigma surrounding birth defects. She even co-authored a book with Joan Beck titled Is My Baby All Right? addressing birth defects.