Topics in the News
Measles, a childhood disease characterized by high fever, sore throat, and skin rash, was widespread in the 1920s, but was not usually fatal when patients received good care. However, in foundling hospitals half the patients might die from terminal bronchopneumonia. There was also the danger of developing blindness. Although the microorganism, or "germ," that caused measles had not been indentified, a serum made from the blood of convalescent patients was used after 1920 to provide some resistance to the disease for children who were exposed to measles. It was not completely effective in immunizing the exposed children, but those who became infected usually had a lighter case.
Before 1923 scarlet fever was a danger faced by children and adults on a daily basis. Through the work of a husband-and-wife scientific team, the germ responsible for the disease was recognized, and an inoculation was created to prevent its deadly complications. By 1924 there was still no cure for scarlet fever, but new preventive measures introduced by George and Gladys Dick removed the danger of a disease that might cause deafness, blindness, heart and kidney disease, permanent crippling, or death.
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The electrocardiograph, an instrument designed to measure the electrical currents of the heart, was invented in 1924. Willem Einthoven was responsible for this new invention, which grew out of his work regarding the nature of heart action in disease as well as in health.
Einthoven at first attempted to measure these currents by using the Lipp-mann capillary electrometer and various other instruments Einthoven built to aid his research. He found the capillary electrometer to be severely restrictive, but he was able to develop a way to correct its limitations. Still not satisfied with the available instrumentation and frustrated by the time and labor required for the current mechanisms to be effective, he searched for another means of recording the electrical currents attending the heartbeat.
A New Invention.
The string galvanometer was Einthoven's answer to the limitations of other instruments. He described his new instrument and its relation to his experiments in electrocardiography in a series of papers. These papers dealt so completely with the field that little of major importance has been added that Einthoven did not at least touch on in his original research. For example, his first paper on electrocardiography noted a case of...
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Health of Women and Children
The improvement of maternal and child hygiene, a trend throughout the 1920s, was set in motion by disturbing mortality rates. In 1921 there were 18,000 maternal deaths, or 68 maternal deaths for every 10,000 live births. The statistics for children were not any better, with 248,432 deaths recorded for children under five in 1920.
The astonishing data in the early 1920s was enough to rouse public interest and evoke changes in the state of public health and welfare. The changes were many and varied, including the establishment of divisions of child hygiene, infant welfare stations, and additional public-health nursing services. In addition, the American Child Health Organization was formed by the merging of six national organizations. The leadership of Herbert Hoover, later president of the United States, assured that the children's health movement would receive increased financial and social support.
The Sheppard-Towner Act.
One of the most significant milestones on the road to health reform for women and children was the passage of the Sheppard-Towner Act in 1921. The purpose of the act was to assist the states in setting up programs to protect the health of women and children. The act planned to meet the goals of better infant care through the...
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Diabetes mellitus, also known as "sugar disease," is a disease that killed thousands every year until the discovery of insulin in 1921. Diabetes is often seen in children, and before the treatment existed, the disease was essentially a death sentence. It is caused by a defect in the pancreas, which is then unable to produce the hormone insulin needed by muscle cells to utilize glucose. Without glucose the tissues are deprived of their main energy and are forced to produce energy from fat. High blood levels of toxic ketone bodies (acetone) result.
The diabetic shows a high level of glucose in blood and urine. Symptoms of the disease include increased thirst and hunger, increased urination, weakness, and a loss of weight. If left untreated, the acetone accumulates in the blood, brain function ceases, and the patient may slip into a coma and die.
Pancreas Defect Responsible for Disease.
Although a disease thought to be diabetes was recognized by the Egyptians as early as 1500 B.C., it was not until 1899 that the causative factor in the disease was discovered to be a defect in the pancreas. This was a major step forward because scientists were then able to produce the disease in laboratory animals. However, even with these advances, no scientist was able to isolate the...
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New Medical Machinery
Poliomyelitis was still a deadly disease in the 1920s, but victims of polio were given new hope by the invention of the iron lung in 1928. Polio, also called infantile paralysis, is a disease causing destruction of nerve cells, crippled limbs, and the wasting away of muscles. In "anterior" polio the respiratory muscles are paralyzed, often causing death within a few hours of the first respiratory distress. Due to its infectious nature, polio was a widespread and dangerous disease until the Salk vaccine was introduced in the 1950s.
Early Experiments Lead to the Iron Lung.
The invention of the iron-lung mechanical respirator allowed paralyzed polio patients to remain alive indefinitely, thus saving many lives. The iron lung was created by Philip Drinker after he observed several physiological experiments to design artificial respiration methods for use after surgery. The experiments, which were conducted by his brother Cecil and Louis Shaw, involved placing a cat inside an airtight box with his head protruding from an airtight collar. Volume changes were then measured to identify normal breathing patterns.
Philip Drinker continued to experiment similarly with paralyzed cats. He was able to keep them alive by inducing breathing artificially with the use of...
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Penicillin: A Fortunate Accident.
In September 1928 Alexander Fleming, a young physician at Saint Mary's Hospital in London, noticed an unusual finding on the culture plate he was about to discard. Several weeks earlier he had streaked the culture plate with staphylococci. A contaminant mold was growing near one edge of the plate. The unusual thing was that something was coming from the mold that was actually destroying the disease-causing bacteria in the vicinity. Fleming's colleague, Dr. C. J. La Touche, identified the mold as penicillium notatum. A derivative of the mold, which Fleming named penicillin, would become the first effective antibiotic.
Later experiments demonstrated that the mold must have been on the plate before the staphylococci rather than following it, because penicillin was effective against the organism only in the stage of active division. It had little effect on mature bacteria. Given that fact and the fact that penicillium notatum proved to be one of the most effective strains of the penicillium molds, Fleming's discovery appears to be fortunate indeed.
Fleming's Previous Work.
Fleming had worked for many years searching for an antimicrobial agent that would be effective against bacteria yet not harmful to delicate tissues. In...
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The ink-blot test devised to study personality and diagnose psychopathologic conditions was introduced in 1921 by Hermann Rorschach. Rorschach, a Swiss psychiatrist, created the test as a series of ten symmetrical ink spots that a patient would be asked to interpret. Although previous psychiatrists used the ink-blot test in free-association exercises, they used the test to study thematic content. Rorschach believed that the test could be used for more complete evaluation of a patient's condition. Through systematic analysis of factors cited by the patient, such as attention to wholes or details, color, shading, and apparent movement in human form, Rorschach could detect psychological processes or structure of the patient's personality. He also believed patterns as reported by the patient would lead to the diagnosis of certain clinical disorders. The accuracy of the Rorschach ink-blot test has been challenged by some scientists. Nevertheless, it is widely used in many countries.
Ruth Bochner, Clinical Application of the Rorschach Test (New York: Grime & Stratton, 1942).
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Hookworm, or ancylostomiasis, is a condition caused by a parasite found in tropical and subtropical climates, especially where the inhabitants do not wear shoes and where the soil is contaminated by human excrement. In the early twentieth century Dr. Charles Wardell Stiles of the United States Public Health Service found that hookworm was epidemic in the southern United States. The parasite entered the sole of the foot and made its way to the intestine, resulting in pain, diar-rhea, anemia, and listlessness. Victims sometimes experienced a craving to eat a certain type of white clay.
The Rockefeller Foundation established a sanitary commission that educated people about the problem and encouraged practical measures for permanent sanitation. In sixteen southern counties surveyed by Rockefeller workers between 1910 and 1915, the rate of hookworm infection was 59.2 percent. By 1923 the rate had fallen to 23.9 percent. Hookworm remained a problem in the South throughout the 1920s. Adequate control was made possible only by the vast social and economic changes and improvement in sanitation practices of the late 1930s and early 1940s.
Pellagra in its early stages was sometimes confused with sunburn or poison oak. A skin rash symmetrically marked the...
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Although a particularly devastating disease since the sixteenth century, syphilis in the 1920s was commonly found in a milder form. It was usually transmitted via sexual contact, but occasionally was caused by contact with objects used by someone infected with the disease. Regardless of how syphilis was transmitted, it was known that the disease was caused by a spirochete, or spiral-shaped germ, that entered the body through breaks in the skin or through the mucous membranes.
Phases of the Disease.
The primary phase of syphilis, also the most contagious phase, is during the first two to six weeks after infection when the primary lesion, or chancre, appears at the site of infection. The chancre is a single, small, painless ulcer that heals during the primary phase. Secondary syphilis appears after a latent period of six to eight weeks and is identified by flulike symptoms, including a feeling of malaise and a skin rash. After a few weeks, secondary lesions and accompanying symptoms disappear. Late or tertiary syphilis occurs after another latent period of one to twenty years and is without symptoms. The phase begins when the spirochetes have spread through the body and localized in the brain and heart. Paralysis, mental derangement, and death may result. Late syphilis develops in only about one-third of un-treated cases...
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Vitamins and Minerals
Although Albert Szent-Györgyi was awarded the Nobel Prize in 1937 for the discovery of vitamin C, it is clear that the work of scientists such as Axel Holst, Theodor Frolich, Sylvester Zilva, Charles Glen King, and Joseph L. Svirbely, led to his success. The search for vitamin C gained momentum after it was determined that scurvy was a disease caused by defective nutrition, as opposed to a germ, and that the ingestion of certain fruits and vegetables offered prevention or cure. Scurvy, which caused bleeding gums and general debility, was common among sailors who had access only to non-perishable foods. The British navy began providing lime juice for long voyages after 1795, hence the name limeys for British sailors.
Early Experiments Provide Basis for Discovery of Vitamin C.
In 1907 bacteriologist Hoist and pediatrician Frolich announced that they could produce scurvy in guinea pigs through changes in diet. They found that hay and oats, foods deficient in vitamin C, led to scurvy, while a diet of fresh fruits and vegetables did not. After World War I, Zilva obtained samples of the ingredient that seemed to prevent scurvy and determined some of its properties.
An Accidental Discovery.
Meanwhile, Szent-Györgyi spent the 1920s studying biological oxidation. He was...
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Cushing, Harvey Williams 1869-1939
A native of Cleve-land, Ohio, Harvey Williams Cushing was born 9 April 1869, the sixth son and youngest in a family of ten children. His father, grandfather, great-grandfather, and an older brother were all physicians. Harvey Cushing received his B.A. degree from Yale in 1891 and his M.D. from Harvard in 1895. He was drawn to surgery by his talent for dissecting and handling delicate tissue. He interned in surgery at Massachusetts General Hospital and took residency training at the Johns Hopkins Hospital in Baltimore. He was surgical assistant to William Stewart Halsted, one of the foremost figures in the history of American surgery. Halsted taught Cushing his slow, meticulous technique.
Cushing spent one year in Europe (1900-1901) meeting and studying with some of the best surgeons in the world. He began general surgical practice in Baltimore in the summer of 1901 and received a minor appointment at the Johns Hopkins Hospital. He gradually turned his interest...
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George and Dick, Gladys 1881-1967, 1881-1963
George and Gladys Dick, a husbandand-wife team of scientists, were able to control scarlet fever, a disease that had taken its toll on thousands. The Dicks did not find a cure for scarlet fever, but they were responsible for creating a test to determine an individual's susceptibility and for creating a way to prevent the disease.
Dr. George Francis Dick was born in Fort Wayne, Indiana, attended Indiana University, and was a graduate of the Rush Medical School in Chicago. Dick found his calling in the area of researching contagious diseases. It was during his studies in this area that George Dick met Gladys Henry. Henry earned a bachelor of science degree at the University of Nebraska and went on to receive the M.D. at Johns Hopkins in 1907. She did postgraduate work at Hopkins and at the University of Berlin. In 1911 Henry moved to Chicago, where her career and personal paths intersected with those of George Dick when both served as research pathologists at the University of Chicago. They were married in 1914.
Searching for the Germ.
George Dick soon went to work at the McCormick Institute for Contagious Diseases, while Henry was in charge of the laboratory of the Childs Memorial Hospital. Both of the doctors devoted their...
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Flexner, Abraham 1866-1959
Abraham Flexner, brother of Simon Flexner, was born in Louisville, Kentucky, and became well known as an educational reformer and an expert on medical education. In the early 1900s many medical schools existed solely for the profit of their owners, and even students without a highschool education were accepted and graduated as long as their tuition was paid. In his critical report Flexner referred to such schools as "proprietary institutions." Many of the teaching hospitals were unsanitary and lacked the necessary clinical facilities. An in-depth study by Abraham Flexner was partially responsible for bringing these practices to an end and reforming medical education in order to produce a better-educated medical community.
The education of Abraham Flexner consisted of a B.A. from Johns Hopkins University in 1886, a master's degree in psychology from Harvard University in 1906, and the study of comparative education at the University of Berlin. Throughout his schooling Flexner came to believe in the superiority of German universities and believed that the United States should restructure its educational system in like fashion. This opinion was expressed in 1908 in a book published by Flexner called The American College. The book was a wealth of information gained...
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Flexner, Simon 1863-1946
The accomplishments of Simon Flexner, pathologist and director of the Rockefeller Institute for Medical Research, were extraordinary in their diversity and impact. Flexner was the fourth of nine children born to Morris and Esther Flexner in Louisville, Kentucky. Abraham Flexner, the education specialist, was his brother. As a young man Simon Flexner was apprenticed to a druggist who sent him to the Louisville College of Pharmacy. After graduating in 1882, Flexner's interest in medicine led him to study at the University of Louisville where he earned an M.D. in 1889. This early education and Flexner's investigative nature set the stage for his remarkable career.
After medical school Flexner turned his talents to research in the fields of pathology and bacteriology. He began his work at the Johns Hopkins Hospital where he became an associate in pathology in 1892. Flexner conducted his research under the tutelage of William H. Welch,...
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Kahn, Reuben Leon 1887-1974
Reuben L. Kahn was a Russian-born American serologist and immunolgist whose primary impact was the development of a more sensitive test for syphilis. Syphilis is one of the chief venereal diseases, a group of diseases generally transferred through sexual contact. If not treated promptly, syphilis can cause paralysis, mental derangement, and death. Syphilis can also be passed to the unborn children of pregnant mothers resulting in insanity, heart disease, and paralysis in the affected child. There is no vaccine for the disease, but treatment is relatively inexpensive and simple.
The Kahn Test.
The first effective test for syphilis was developed in 1906 by August von Wassermann. The Wassermann test was welcomed as the best way to detect the disease, but the test also required a two-day incubation period, and its complexity provided many sources for error. While many physicians and scientists tried to improve the Wassermann test, none succeeded until Reuben Kahn did so in 1923. Kahn's modified syphilis test was simpler, took only a few minutes to complete, and was more accurate than any other available method for detecting syphilis. Kahn's test became the standard test for syphilis detection in the United States Navy in 1925 and was soon recognized worldwide.
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Landsteiner, Karl 1868-1943
Karl Landsteiner transformed serology from a mere collection of unrelated phenomena to a branch of chemical science. Although this achievement was one of his greatest legacies, Landsteiner's interests led him to study many different areas of medicine, and his discoveries have lasting impact.
Born in Vienna, Austria, Landsteiner studied medicine at the University of Vienna and received the M.D. degree in 1891. He spent an extensive period studying with eminent scientists in Zurich, Munich, and Vienna. This preparation contributed to his work at the Rockefeller Institute in New York beginning in 1922, which provided a significant contribution to immunological knowledge in the United States.
Blood Types Discovered.
Landsteiner's primary interests lay in the fields of immunology and serology. He found that when certain blood samples were mixed, agglutination (clumping) occurred. This area of research led to one of Landsteiner's most important discoveries, the existence of different types of blood. For a transfusion to be successful, it is necessary that the blood of the donor and that of the recipient be compatible. Neither must have present antagonistic substances or agglutinins that could dissolve or clump the cells in the blood of...
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McCollum, Elmer Verner 1879-1967
Once a widespread condition commonly found in young children, rickets has essentially been eradicated due to the pioneering efforts of Elmer McCollum, an American biochemist who dedicated his life to the study of the relationship between diet and health. He began his work in the field of biochemistry at the Connecticut Agricultural Experiment Station during his doctoral training in organic chemistry at Yale University. He earned his Ph.D. in 1907 and proceeded to develop the first white rat colony in the United States created to study the effects of nutrition. At the time he was working with the Wisconsin College of Agriculture, and although assigned to study the food and excrement of cattle, McCollum found that the use of rats circumvented the complicated methodology required when studying larger animals.
Existence of Vitamins.
McCollum's study of rats led to the realization that a fat-deficient diet resulted in growth retardation which could be reversed by feeding "an extract of egg or butter." By 1915...
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Minot, George Richards 1885-1950
George Minot's father, grandfather, and several other members of the family were all outstanding physicians in Boston, Massachusetts. After a private-school education in Boston, Minot graduated from Harvard where he received the B.A. degree in 1908 and the M.D. in 1912. In an era when postgraduate study was still unusual for physicians, he went on to intern at Massachusetts General Hospital and to take a residency at Johns Hopkins, He was especially interested in the relation of diet to disease, but he also studied problems of blood coagulation.
Study of Pernicious Anemia.
In 1915 Minot returned to Massachusetts General where his interest in blood coagulation led to a more specific study of pernicious anemia. Minot and his colleagues found that splenectomy resulted in only temporary improvement in patients with the disease.
Influence of Diabetes.
Minot began working at the Collis P. Huntington Memorial Hospital in Boston...
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Rivers, Thomas Milton 1888-1962
Life and Work.
Known for his research in the area of viral disease, Thomas Milton Rivers was also a compassionate physician and gifted administrator. Born in Jonesboro, Georgia, he graduated from Emory College in 1909 with a Bachelor of Arts degree. Immediately following graduation, Rivers was admitted to the Johns Hopkins Medical School. Although a talented student, Rivers's dream of becoming a physician was not to be soon realized. He was diagnosed with an often fatal neuromuscular degeneration and left medical school to become a laboratory assistant at a hospital in the Panama Canal Zone. By 1912 the illness had not progressed, and Rivers returned to Johns Hopkins and graduated in 1915.
An Interest in Virology Develops.
After an internship and residency in pediatrics at Johns Hopkins, Rivers spent time investigating an outbreak of pneumonia as a member of the army medical corps. This may have been the beginning of his productive career researching viral diseases. Three years of research in bacteriology...
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Steenbock, Harry 1886-1967
In the 1920s research into the effects of vitamins was extensive and carried out in laboratories throughout the world. Harry Steenbock played an important role in this field of research. Steenbock studied at the University of Wisconsin in 1907 when noted biochemist Elmer McCollum was pursuing dietary and nutritional research as a member of the faculty.
Sunlight Increases Vitamin D.
McCollum's belief that substances called vitamins were essential to life, and his discovery of vitamin D as a cure for rickets, provided a starting point for Steenbock. McCollum's research had shown that both vitamin D and sunlight were effective in the treatment of rickets, but it was not known whether these treatments were independently effective or part of a single therapeutic process. Steenboek's research would provide an answer to this question. In 1924 he was able to prove that sunlight converted chemicals in food into vitamin D. Although the conversion was not fully understood, Steenbock found that foods exposed to sunlight were effective treatments for patients suffering from rickets.
Other Nutritional Studies.
Steenbock continued research into nutrition and was able to isolate carotene, found in yellow vegetables and containing vitamin A. He...
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Whipple, George Hoyt 1878-1976
CONQUEROR OF PERNICIOUS ANEMIA
The work of George Hoyt Whipple was often ridiculed, but it saved thousands of lives and led to the understanding of organisms as intricately interconnected systems. Whipple attended the Johns Hopkins Medical School in Baltimore, Maryland, and earned his medical degree in 1905. His primary interest was in the research of blood and liver disorders, which he studied with a colleague, John H. King. Whipple and King concentrated on the study of obstructive jaundice (icterus), a disease in which liver damage results in the release of yellowish bile pigments that appear in the skin of the patient. Whipple continued his study of the disease with Charles Hooper at the University of California in San Francisco. In 1914 their research led them to consider the possibility that the liver might be involved in pernicious anemia.
Pernicious anemia is a type of anemia in which the number of red blood cells in a patient's bloodstream is severely reduced. This leads to a reduction in the level of blood hemoglobin, which transports oxygen to the cells of the body. These cells then cannot produce enough energy to create the chemical reactions needed to survive. The result is the death of the cell and often the death of the patient.
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People in the News
In 1927 the Children's Bureau of the Labor Department under the leadership of Grace Abbott announced the lowest infant mortality rate in the history of birth registration.
In 1925 Dr. John J. Abel purified and concentrated insulin, making it several times more effective than the common product then available.
New Jersey police confiscated twelve thousand fliers advertising magic powders for sale by voodoo doctor D. Alexander in August 1925.
In 1923 surgical assistant Dr. Duff S. Allen perfected the cardioscope, an instrument that made it possible to see inside a beating heart.
Edgar Allen and Edward A. Doisy in the 1920s pioneered in female sex hormone research. Their article, "An Ovarian Hormone," (JAMA, 81:819), was a mile-stone in the field.
Dr. William L. Bettison of the University of Michigan published an account of trichinosis infestation among Michigan football fans in Journal of the American Medical Association in 1926. The infestation occurred when the fans ate undercooked pork in Champaign, Illinois, before a Michigan-Illinois game in the fall of 1924.
Edwin G. Boring became director of the psychological laboratory at Harvard in 1924.
Drs. Henry I. Bowditch and Ralph D....
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John Henry Abegg, 64, Red Cross official, 4 December 1920.
Albert Abrams, 60, president of American Society for Psycho-Physical Research, 13 January 1924.
Jasper W. Babcock, 66, pellagra expert, 3 March 1922.
Robert Bell, 80, cancer expert, 20 January 1926.
Edward Hickling Bradford, 75, former dean of the Harvard Medical School, 7 May 1926.
Nathaniel E. Brill, 65, president of Medical Board of Mount Sinai Hospital and discoverer of Brill's Disease, 13 December 1926.
WiEem Einthoven, 67, heart expert and Nobel Prize winner (1924), 29 September 1928.
Joseph Goldberger, 54, who postulated dietary etiology of pellagra, 17 January 1929.
William Crawford Gorgas, 65, who helped eradicate yellow fever in Cuba and Panama Canal Zone, 3 July 1920.
Frederick Robin Green, 59, former editor of Health Magazine and secretary and executive officer of the American Medical Association, 26 April 1929.
Hugh Reed Griffin, 72, Red Cross official, 5 May 1922.
Granville Stanley Hall, 90, first president of the American Psychological Association and educator, 24 April 1924.
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The Atlas of Life and Its Opposing Forces (N.p.: World Naturalists League, 1927);
Claude Bernard, An Introduction to the Study of Experimental Medicine (New York: Macmillan, 1927);
Theodor Billroth, The Medical Sciences in the German Universities (New York: Macmillan, 1924);
Gilbert Edward Brooke, Aids to Tropical Medicine, third edition, revised (New York: Wood, 1927);
Bernard Brouwer, Anatomical, Phylogenetical and Clinical Studies on the Central Nervous System (Baltimore: Johns Hopkins University Press, 1927);
Alan Mason Chesney, Immunity in Syphilis (Baltimore: Williams & Wilkins, 1927);
David Marvel Reynolds Culbreth, A Manual of Materia Medica and Pharmacology (Philadalphia: Lea & Febiger, 1927);
Harvey Cushing, The Life of Sir William Osier (Oxford: Clarendon Press, 1925);
Cushing, The Personality of a Hospital. Ether Day Address, the Massachusetts General Hospital, October 18, 1920 (Boston: Jamaica Printing, 1921);
Charles Loomis Dana, Text-book of Nervous Diseases (New York: Wood, 1925);
Frederick Myers Dearborn, American Homeopathy in the World War (Chicago: American Institute of Homeopathy,...
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Important Events in Medicine and Health, 1920–1929
- University of Rochester scientist George Whipple cures anemia in dogs by feeding them raw liver. His work on the cause and treatment of anemia would win him the 1934 Nobel Prize in physiology or medicine.
- Phenobarbital (discovered in 1911) is introduced in the treatment of epilepsy.
- Harvey Cushing pioneers new techniques in brain surgery.
- In January, German psychologist Hermann Rorschach introduces the inkblot test for the study of personality.
- In February, James Collip isolates pure insulin.
- In May, British physician Alexander Fleming discovers an antibacterial substance, lysozyme, in saliva, mucus, and tears.
- In May, the first American birth control conference convenes in New York City.
- In July, Franklin Delano Roosevelt contracts polio. Throughout his political career he will hide his ailment from the public, doing nothing to promote public awareness of the disease.
- In July, Albert Calmette and Camille Guerin develop a tuberculosis vaccine.
- In October, Frederick Banting and Charles Best extract insulin from the pancreas and begin experiments using the substance on dogs.
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