Wayne State University School of Medicine - Yearbook (Detroit, MI)

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DEPARTME T OF EURGLOGY m i TV I -rpg-it-4-Sl r i l l John Stirling Meyer, Chairman SITTING flelt to rightl: I. Wiederholt, H. Tellez, E. Gotham, J. Gilroy, ul.T. MCI-Ienry, MLS. Meyer, R.B. Bauer, A.D. Ericsson, D. Garwacki, G.A. Dakoske. STANDING Qleft to rightj: S. Tadjpour, D. Lustig, A. Kitamura, F. Nomura, K. Sakamoto, M. Toyoda, A. Kondo, R. Boulos, H. Kim, A. Pugcl, P.P. Miller, L. Fratila, P. Rodprasert, L. Andaya, T. Onuma, L. Lee, R. Bennett, V.N. Samuel, D. McClellan, G. Minnis. V

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- iii-... ire: The Bcttmann Archive representation of Caesarean operation. From a French translation of 15th century. Soranus of Ephesus of the second century A.D. is the authority on gynecology and obstetrics of antiquity. There were then no real additions to obstetrics until the time of Pare 1500 years later. Francois Mariceau in 1668 illustrated with exquisite copper plates the conduct of labor, version and the man- agement of placenta previa. This was a canon of the art of that time. During the 18th century care of labor passed from the midwife to the trained male obstetrician. For five genera- tions the Chambcrlens held a commanding position in English medicine. Peter the elder invented the iron tongs which were the forerunner of obstetric forceps. Forceps were regarded as a family secret until Peter Chamberlen C1560-16311 publicized their use. Cesarean section has its origin in mythology. Virgil described the delivery of Esculapius from the belly of his mother by Apollo. Abdominal cesarean sections are re- ferred to in the Talmud and are described in the living mother in the-jewish Mfiflflll written about 180 A.D. Antisepsis was employed in obstetrics before the time of Lister. The greatest single achievement of the New Vienna School was determination of the cause and prevention of puerperal fever. In 1843 the eloquent Oliver Wendell Holmes in Boston presented his classic 'fOn the Contag- iousness of Puerperal Feverf' In 1847 lgnaz Philipp Semmelweis recognized puerperal fever resulted from septicemia. With antisepsis he reduced the maternal mortality by almost 90 per cent on the first obstetric ward of the Allgemeines Krankenhaus in Vienna. This ward had such a high mortality women begged not to be taken IDIO II. i',i ' 1' 1-1 S E,- T 5-I-X1 in The Bettmann Archive Colonial childbirth scene in Pennsylvania. Both Holmes and Semmelweiss stirred up violent oppo- sition which was more effectively parried by the adept Holmes. Semmelweiss is one of medicine's martyrs. He died insane after the violent controversy arising from his observations on the cause and prevention of puerperal sepsis. Other important milestones in obstetrics are the artifi- cial induction of labor by Carl Wenzel in 1804, the study of the deformed maternal pelvis by Carl Naegele in 1839, and the use of ergot as an oxytocic by John Stearns in 1908. Sir james Young Simpson in 1847 first employed chloroform for delivery. He introduced the uterine sound and dilation of the cervix for diagnosis of cancer. Prenatal care evolved from the writings of john William Ballantyne on Diseases of the Foetusn in 1892. Modern Gynecology received its impetus from the pioneer work of Ephraim lVIcDowell and was further developed by the brilliant achievements of james Marion Sims in plastic surgery of the female genitalia. In Danville, Kentucky, in 1809, McDowell performed the first ovari- otomy on a 47-year old Mrs. Crawford who lived to be 78 years of age. He performed this operation 13 times during his lifetime with eight recoveries. Sims in 1852 described the technique for therepair of vesicovaginal fistula using the position and speculum which bear his name. The most recent important milestone in gynecology and obstetrics was erected by George Nicholas Papanicolaou. From 1928 to 1954 he established the importance of ex- foliative cytology in the diagnosis of uterine cancer and as a reflection of endocrine function. 39 t I 1. S, il i it.. ii'

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1 Q I The Beumann Archive Faradising frontal head muscle of a patient. While the recognition of epilepsy and other neurolog- ical symptoms dates back to the writings of Hippocrates, trephination of the skull is believed by archeologists to have been practiced before this time. Clinical neurology as an organized specialty really began something over 100 years ago. The German neurologist, Romberg, made the first classification of neurological diseases in his textbook published inthe early l840's. ln the 1850's, Charcot in France began clinical corre- lation of neurological diseases with autopsy findings at the Salpetrierre in France. This was a huge custodial institution in Paris with abundant clinical material having terminal neurological conditions. Later Dejerine and others in France contributed to our knowledge of diseases of the peripheral nerve and muscle while Charcot was clarifying most of the disorders of brain and spinal cord. Other contemporary pioneers of Charcot were the founders ofthe English school, Sir William Gowers and I-Iughlings Jackson, whose major contributions were in the l860's. Goweris Manual of Neurological Diseases was probably the most influential document relating to the practice of Neurology in the English language and Hughlings kIackson's writings on epilepsy and related disorders were almost clairvoyant for their clinical in- tuition. These early workers carried clinical diagnosis and anatomical localization to the ultimate. At that stage Neurology was concerned with nosology, semeiol- ogy and correlated pathology rather than treatment. Since 1900, treatment in Neurology advanced with Sir Victor I-Iorsley in England who successfully removed tumors of the spinal cord and brain and later, Harvey Cushing in the United States made his contributions to Neurosurgery. The American school began in the 1930's and its contributions continue to this day. The main contribu- tion of the American school lies in three areas: lj New methods of ancillary diagnosisg 25 Advances in methods of treatment, 3D Basic contributions in neurochemistry, neuro- pharmacology, Virology and electron microscopy. A few examples of these American contributions will be cited: The clinical application of electroencephalography in the 'l930,s advanced our treatment and diagnosis of epilepsy. The diagnostic use of acceptable methods for arteriography, pneumoencephalography, electroenceph- alography, electromyography, and nerve conduction velocity were added in the next two decades. Neurochem- istry and muscle chemistry, along with electron micro- scopy defined new diseases of brain and muscle. The biochemical background of some forms of epilepsy and mental retardation were defined. A tool for studying neuropharmacology, neurophysiology and neurochem- istry in man was made possible by the development of a reliable method of studying cerebral blood flow and metabolism in man. There was a time when the neurologist was looked upon as a dreary cataloguer of incurable diseases. This is not so today. The majority of neurological conditions can now be diagnosed early and therapy begun. The toll of human life and prolonged human disability can now be significantly decreased. In the past three years the num- ber of practicing neurologists in the United States has increased by 4O'Mn and the number of Board certified specialists by 23'MJ in the same time period.