Topics in the News
A Critical Study.
Medical care had always been trusted as competent and adequate, but a study published in 1962 by Dr. Ray Trussell from Columbia University questioned that trust. He examined the medical charts of Teamsters Union members and their families who were admitted to New York hospitals.
Trussell deemed the care of about half the patients to be good or excellent, but he judged that one-fourth of the admissions received poor medical service. Patients fared better in nonprofit hospitals, especially those associated with medical schools, where faculty members supervised physicians in training. One out of five hospital admissions he considered unnecessary, and many hysterectomies, or surgical removals of women's uteruses, he thought were being done without good reason.
Concern over Costs.
The study was sponsored by both the Teamsters members and their management, who paid the bills for medical care. They were concerned about quickly rising costs, but 80 percent of the patients them-selves thought they received excellent care.
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A Changing Tradition
Before World War II about 40 percent of doctors' visits were made by the physicians going to patients' homes. By 1960 the number of house calls had dropped to 10 percent; by 1970 they were rare occurrences. The reasons for this drop varied. Mainly, physicians considered house calls an inefficient use of their time. It was increasingly difficult for a doctor to do an adequate exam in a patient's home because all the proper equipment and drugs that had been developed and might be needed were impossible to carry. In large cities physicians were sometimes attacked for the drugs they carried.
The Public's Perspective.
The public saw the change of tradition differently, and most were not pleased. They were accustomed to having the caring doctor at the bed-side when someone was ill. Now doctors were charging more and making people come to them.
"The House-Call Habit," Time, 78 (15 September 1961): 62.
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A New Group of Interns.
In 1948 Congress voted to let foreign medical-school graduates come to the United States for further training, inadvertently establishing a two-tier system of medical practice. American graduates generally took their internship and residency at prestigious university-based hospitals. The foreign graduates went mostly to fourteen hundred smaller community and veterans' hospitals, where they staffed emergency rooms and treated the poor who could not pay for care.
The Educational Council for Foreign Medical Graduates (ECFMG), an agency developed by the American Medical Association (AMA) with legal backing from the government, was created to regulate the placement of these interns. This agency required special seven-hour tests in English and general medicine for the fifteen thousand foreign-trained doctors. The grueling and deliberately tricky tests were meant to fail 50 percent, causing some eight thousand foreigners to lose their visas. The exams were first given in November 1960. About twenty-five hundred foreign doctors failed and faced having their visas revoked by 31 December.
There was an outcry from the hospitals where these physicians worked. Who would care for charity patients if foreign doctors were forced to leave? Public...
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Government Health Programs
Johnson's Health-Care Program.
President Lyndon B. Johnson's Great Society program proposed far-reaching legislation on health care, the backbone of which was the Medicare program. Medicare was enacted in a bill signed in 1965 that extended social-security insurance to cover medical expenses for all citizens over 65 years of age. The program, which went into effect on 1 July 1966, was voluntary, but estimates were that 85-95 percent of those eligible would participate. Funding came from increased payroll taxes.
The Design of Medicare.
Medicare has had two different parts since its inception. Part A covers hospitalization, outpatient diagnostic services, home-nursing ser-vices, and nursing-home care. Part B can be added voluntarily to cover doctor's fees and drug costs as well as other incidentals; it cost three dollars per month in 1966. The program was designed to be managed by Blue Cross or a similar organization that would pay hospitals and physicians and bill the government.
The Benefits of Medicare.
Hospital stays of up to ninety days were covered, but the patient was required to pay the first forty dollars, plus ten dollars per day for each day over sixty days. Nursing-home care for patients who had been hospitalized was available for one hundred days at a cost to the patient...
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Heart Surgery: the Artificial Heart
Heart donors are scarce, and recipients often do not have the luxury of time. To facilitate the process of heart transplantation, there was a concerted effort during the 1960s to develop an artificial heart for temporary use in bridging the time gap between a patient's need and the availability of a donor or as an assisting device for people whose hearts are not fully functional. Early experiments involved the use of a plastic banana-shaped device with internal valves to assist the blood in its movement from one heart chamber to another. A large pump outside the body provided the force. Dr. Michael E. DeBakey used such a device, which he called an intrathoracic pump, on a forty-two-year-old patient in 1963, but the patient died four days later, and there was some indication that the pump had caused blood clots.
An Improved Model.
Dr. Adrian Kantrowitz of Brooklyn's Maimonides Hospital codeveloped the heart booster produced by the Avco-Everett Research Laboratory near Boston, where his physicist brother, Dr. Arthur Kantrowitz, was director. Their device, a banana-shaped booster without valves, attacked the common problem of blood clots experienced with early heart pumps. The Kantrowitz device was meant to be implanted permanently in patients with severe heart failure. It could be placed in the chest cavity and attached...
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Heart Surgery: Coronary Artery Bypasses
Two developments led to a revolution in the field of cardiovascular surgery during the middle of the decade. The first was cardiac catheterization to penetrate interior walls of the coronary arteries. This technique was pioneered by Dr. F. Mason Sones of the Cleveland Clinic in 1959. The second new method was revascularization, developed by Dr. Arthur M. Vineberg in Montreal and refined at the Cleveland Clinic by Vineberg and Dr. Donald Effer. Vineberg used a shunt to direct the flow of blood from the nonessential left internal mammary artery to the heart, bypassing diseased arteries. By the end of 1966 he had performed the surgery eighty-seven times with only three deaths due to the operation. Forty of his patients had returned to work.
A Multiple-Graft Procedure.
The mammary-artery graft worked well but was useful only if one coronary artery needed repair. The heart is served by three main artery branches, and frequently more than one artery or artery branch required a shunt to provide the necessary supply of blood to the heart. The procedure that eventually allowed multiple grafts was the coronary-artery bypass graft (CABG), in which veins from patients' legs were used to repair the coronary arteries. Vineberg, Effer, Dr. C. Walton Lilledi at the University of Minnesota, and DeBakey in Houston all worked on similar...
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Heart Surgery: Endarterectomy
Cholesterol and various fats some-times reach excessive levels in the bloodstream. One of the body's responses is to deposit some of the greasy mix on the inside walls of arteries. These deposits build up over time to form large plaques on the vessel walls, a condition known as atherosclerosis. If the buildup gets thick enough, the artery can be blocked off completely, but before this happens a very thin and irregular section of blood flow can lead to blockage by blood clots. When the flow of blood is severely restricted, the cells served by the artery die. When coronary arteries are affected, the result may be a heart attack.
Cleaning the Arteries.
The technique of endarterectomy, the reaming out of arteries, was developed to re-move the plaques and reopen clogged vessels. Drs. Philip Sawyer, Martin Kaplitt, and Sol Sobel of the Kings County Hospital in Brooklyn developed gas endarterectomy for use on blocked arteries in the leg, abdomen, and neck. A needle was inserted in the artery, and a jet of carbon dioxide (CO2) was injected at a pressure of eight pounds per square inch. This tore away the lining of the artery as well as the plaques. The vessel could then be opened to remove the plaques. The technique had been successful on about seventy patients when the doctors began to try it on coronary arteries. The...
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Heart Surgery: Resuscitation
A Cure That Kills.
Imagine the following scene. In early-twentieth-century America, a middle-aged man leaving the theater clutches his chest, then he drops to the ground. The cry goes out, "Is there a doctor in the house?" Up walks a physician. He proceeds to cut open the man's chest and squeeze the heart into activity again. All cheer as the victim, momentarily revived, is rushed to the hospital. He dies a few days later. Scenes such as this were played out repeatedly as Good Samaritan physicians applied what was then state-of-the-art medicine. A few patients' lives were saved by this routine; it was better than no treatment at all, but the cure was nearly as deadly as the illness.
In 1960 Dr. W. B. Kouwenhoven, a Ph.D. in electrical engineering at Johns Hopkins University, started advertising a new technique for cardiac resuscitation. Calling it the hand-pump, or closed-chest, massage, he developed the technique in collaboration with a group of Johns Hopkins physicians. Kouwenhoven claimed that even nonphysicians could learn the method, and early results showed that it was very effective.
The Technique.The hand-pump method does not require cutting open the chest at all. Instead the hands
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New Methods: Cryosurgery
Cutting with Cold.
Cryosurgery is surgery by freezing. Normal surgery involves cutting through tissue to reach and remove abnormal masses. In routine procedures it is usually necessary to remove some normal tissue at the edges of the surgical field. The body heals after surgery by scarring both internal and external tissues. Cryosurgery may involve an initial incision with a knife to reach an area of interest, but the main difference is the use of a precise freezing probe. A medium such as liquid nitrogen is pumped into the probe, causing it to freeze at low temperatures; the probe is then used to kill tissue it contacts but not surrounding cells. The body heals by dissolving the dead tissue. Some scarring generally occurs, but it is not as severe as that caused by surgery using a knife. Between 1960 and 1965 cryosurgery progressed in several specialty medical applications from a novelty to a commonly used surgical technique.
A Delicate Operation.
Dr. Irving S. Cooper, a neurologist at New York's Saint Barnabas Hospital, was a pioneer in using cryosurgery. An example was his treatment of nine-year-old Steve Schiavo, who suffered from dystonia, a crippling condition caused by a brain tumor and characterized by tremors, muscle deformities, and loss of muscle control. Schiavo could no longer walk, and his arms had constant tremors. When...
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New Methods: Home Dialysis
Kidney failure is devastating because the kidneys cease to cleanse the body of poisons that come from the digestion of food and the normal breakdown of proteins in the body. Without treatment a person with kidney failure will live for about three weeks before dying of uremia (named for a poison that builds up in the blood). Dialysis involves taking blood from the patient with kidney failure and removing the poisons by passing the blood over a membrane which has fluid on its other side. The fluid contains water, salts, sugars, and other small molecules found in normal blood. The dialysis process was designed to be used with an artificial kidney. The patient went to the hospital twice a week for four to six hours at a time. The equipment was expensive, and the medical personnel who ran it required special training. By 1964 there were one hundred patients in the United States routinely being dialyzed twice a week at a cost of about $10,000 a year each.
Patients who required hospitalization two days a week found it difficult to keep a job so that they could pay the cost of dialysis, or at least qualify for group health insurance that paid for it. The answer was home dialysis, a refined procedure that significantly reduced the cost and the time required.
How It Works....
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New Methods: Portable Ekg
Heart activity is measured by the electrocardiogram, or EKG (the K is from the original German spelling), which measures cardiac electrical activity with an array of suction cups and disks placed on the patient's chest and limbs. At the beginning of the decade the EKG machine was a bulky and sensitive piece of equipment that was used strictly in hospital settings or in the offices of specialists. In 1964 the Public Health Service began local testing in the Washington, D.C., area for a more convenient method of obtaining an EKG. A nurse could go to the patient's home in Alexandria, Virginia, with a nine-pound box, place four electrodes on the patient's chest, phone George Washington University Medical School, put the phone's mouthpiece on a receptacle attached to the box, and record the results on a university computer.
Less Bulky System.
Honeywell made Cardioview, the box for this function, that took advantage of all the new technology in electronics to miniaturize the system. Bell Telephone Company made the Bell Dataphone, the receptacle that allowed the EKG to be transmitted over the phone. The university computer allowed doctors to read the EKG directly with an oscilloscope, a kind of television screen, or to record the results on a paper readout of the EKG.
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Organ Transplants and Limb Reimplantation
Transplant Surgery and the Immune System.
Between 1960 and 1969 numerous advances were made in the field of transplant surgery. In early 1960 the only major transplants performed were those of kidneys from one identical twin to another; surgeons had not yet learned how to suppress the body's natural tendency to reject tissue that is not its own. Each person's body has a unique chemical coding that is basic to the immune system. Body cells are protected by a complex system of protein that rejects foreign matter, including bacteria and viruses. Any matter that is not similar to the body's tissue is rejected (with the exception of some invaders, such as cold viruses). This system of protection also causes the body to reject organ implants from someone else's body.
Advances in the Field.
Several developments during the 1960s revolutionized the field of transplantation. A major discovery was that certain anticancer drugs sup-press the immune system and can be used to delay or prevent rejection—at a price. The immune system constantly destroys the early cancers that form in the body as well as the microscopic intruders that occasionally get inside the body. Too much suppression of this system allows foreign bacteria and viruses to kill the patient; too little fails to keep the body from rejecting a transplanted organ, or graft. Another major...
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The Polio Sugar Cube
Is It Safe?
In 1960 a medical debate raged over the polio vaccine. In 1954 Dr. Jonas Salk had produced a killed-virus vaccine that was administered by injection and was 90 percent effective. The vaccine seemed relatively safe and cheap. Then in 1955 Dr. Albert B. Sabin of the University of Cincinnati produced a live-virus vaccine that was placed on a sugar cube and eaten, rather than injected. Researchers, physicians, and patients were wary. Researchers suspected that the attenuated, or weakened, virus might gain the strength to cause polio once it was introduced into the human body. Physicians felt the Salk vaccine had been proven, and it was not worth the risk to switch to an oral vaccine simply for the sake of convenience. Patients were suspicious of a process of preventing polio by eating the live polio virus.
A Cautious Success.
The live-virus vaccine was tested as an oral medication on children between six-months and one-year old in Houston, Texas, and on children under five in New Haven, Connecticut. In Cleveland, Ohio, newborn babies were given an eyedropper full of vaccine without the sugar cube. Large-scale testing was done outside the United States. In the Soviet Union the Sabin vaccine was given to twelve million people. By the middle of 1960 U.S. Surgeon General Le Roy Burney gave results of two years of testing on one...
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"Routine Illness": Measles
A Serious Disease.
Measles was considered a routine childhood illness in 1960. Most children contracted the disease; this was considered a good thing because an adult's infection was thought to be much more serious. Many people did not realize how dangerous measles could be for children, though. Of four million cases in America each year, four hundred—mostly children—ended in death. One out of every four thousand children with measles recovered but was mentally retarded. This "simple" childhood illness was not at all simple.
The Enders Vaccine.
In the late 1950s Dr. John Enders isolated the measles virus. In 1961 he and his colleagues at Harvard University introduced a live-virus vaccine. To reduce side effects, which included fever and rashes, the vaccine was injected in a mixture of gamma globulin. Early tests on children showed the. vaccine gave nearly 100 percent immunity.
Live-Virus versus Killed-Virus Vaccine.
In 1963 two vaccines were approved for general use. The Merck, Sharpe, and Dohme live-virus vaccine was grown in eggs. It was injected in a mixture of gamma globulin, like the original Enders vaccine from which it was developed. Chas Pfizer and Company was approved to distribute a killed-virus vaccine, but it required three doses injected at monthly intervals. Its...
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The Rubella Epidemic
Between 1963 and 1965 a rubella (German measles) epidemic swept the nation. It caused thirty thousand miscarriages; another twenty thousand pregnant women who contracted the disease gave birth to babies who suffered severe deformities, including blindness, deafness, limb defects, heart defects, and mental retardation. Infection in the first half of pregnancy meant a 50 percent chance that the baby would be affected. Later infections, in the second half of pregnancy, were less devastating (only 20 percent of babies were affected).
Identifying the Virus.
Isolating the virus was the first step to developing a vaccine. Three different groups succeeded in identifying the rubella virus at about the same time: Drs. Paul Parkman and Edward L. Buescher at Walter Reed Army Institute for Research; Drs. Thomas Weiler and Franklin Neva at Harvard; and Drs. John L. Sever and Gilbert M. Schiff at the National Institute of Health (NIH). Dr. Parkman moved to the NIH and worked with Dr. Harry M. Meyer on finding a way to curb the growth of the virus. Together they were first to develop a test that determined a person's immunity to rubella. Their hemagglutination-inhibition test produced results in three hours instead of the three weeks required by the old testing method.
Which Vaccine Would Work?...
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Sex in the 1960s: Abortion
An Illegal Act.
In 1960 abortion was illegal in every state in the union. In forty-five states an exception was made if the mother's life were in danger from the preg-nancy. For the rich there was a way out: a women could go to certain doctors at certain hospitals and claim she would kill herself if forced to carry the pregnancy. Thus her life was in danger, and an abortion was permitted. Other women were having abortions illegally. Some were performed by surgeons in sterile environments for a large fee, but most were done by amateurs using dangerous methods.
Several states considered further exceptions. Before the end of the decade Colorado passed a law allowing legal abortion in the case of rape or incest, raising fear among conservative watchdogs that the exceptions provided a means of legal abortion for any woman willing to claim she had been raped. One married woman had to prove her husband was sterile before she was allowed an abortion for a pregnancy as a result of rape.
During the 1960s major changes occurred in the way the public viewed pregnancy that brought changes in abortion law during the 1970s. There was a growing concern about birth defects and advances in physicians' abilities to predict them during pregnancy. The thalidomide tragedy (see...
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Sex in the 1960s: Artificial Insemination
Artificial insemination involves placing sperm near a woman's cervix (the part of the uterus at the top of the vagina) by instrumental means. The physician injects the sperm of the husband into a proxy parent when he is not the cause of the couple's infertility or, in other cases, the sperm of a donor, or proxy parent. It was estimated in 1960 that one thousand to twelve hundred babies per year were artificially conceived by proxy, for a total of about fifty thousand children in the United States since the procedure was introduced.
As reliable methods were developed to freeze sperm for storage, artificial insemination attracted more interest, and the issues related to the process posed more perplexing problems. A geneticist suggested that men freeze sperm samples before exposure to radio-activity (which can cause sterility), for example, which seemed a valid precautionary measure. More controversial were the possibilities that long-dead men whose sperm had been frozen could still father children or that genetically attractive men—chosen for their intelligence, athletic ability, or looks—could participate in sperm markets to sell their genetic qualities to women shopping for a means of mateless conception.
Legal issues arose as...
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Sex in the 1960s: The Birth-Control Pill
Success in the Laboratory.
The birth-control pill, developed in the 1950s, contains the female hormones estrogen and progesterone. Finding a cheap source of progesterone was an early stumbling block to development of the pill, until researchers found that the hormone could be extracted from Mexican yams. Once a pill was produced and found to be safe in lab animals, it was tested on a human volunteer population in Puerto Rico. Results were astounding. Pregnancy prevention reached a level of nearly 100 percent, and most failures were due to forgetfulness—patients had to take the pill regularly, or it did not work.
The Public Gets the Pill.
In May 1960 the FDA approved distribution of the first oral contraceptive to the general population by prescription. The first pill, called Enovid, was marketed by the G. D. Searle Company of Chicago. It cost the consumer about ten dollars a month. The effects were reversible—fertility returned soon after women stopped taking the pill. The only common physical side effect was nausea.
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Sex in the 1960s: Fertility Drugs
Two effective drugs to combat infertility in women by stimulating the ovaries to prepare and release eggs were developed in Europe in the 1960s prior to the development of the American fertility drug clomiphene. Swedish scientists used pituitary glands obtained from autopsies to produce the fertility hormone gonadotropin. Injections were given monthly to infertile women for ten to fifteen days. A more popular drug was the Italian-made Pergonal, made from the urine of postmenopausal women. It took three gallons of urine to make one injection of Pergonal. Cutter Laboratories of Berkeley, California, was licensed to sell the drug in America. Clomiphene was more popular than the European drugs because it could be taken orally.
Results May Vary.
One of the early reports of Pergonal's effects was from Columbia-Presbyterian Medical Center in New York. Of twenty-one infertile women given the drug, fifteen became pregnant. Among the first seven who delivered, three had single babies, three had twins, and one had quadruplets. Gonadotropin and clomiphene had similar effects. Prospective patients were undeterred by the risk of multiple births, however. It was several years before physicians learned how to use these drugs effectively without having to advise would-be parents to buy nursery supplies in bulk.
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Sex in the 1960s: Giving Birth
Less Painful Deliveries.
After World War II the process of giving birth changed. Increasingly, a woman went to the hospital for delivery instead of staying home. Through most of labor she inhaled pain-reducing anesthesia agents. Near the end of labor the woman was given general anesthesia to put her to sleep. Since she could not push the baby out, a physician used forceps, large steel spoons, around the baby's head to pull it out. This system served several purposes: pregnant women experienced less pain during labor; the hospital staff appreciated caring for less noisy patients; and physicians controlled the whole birthing process. At this time, it was thought that the baby was not greatly affected by drugs given to the mother.
Reaction against Anesthesia.
Changes began after it was learned that babies seemed to be exposed to drugs the mothers took during pregnancy. Studies showed that babies exposed to high levels of anesthesia during labor had significant problems. A few hospitals introduced natural childbirth, using a technique popularized by French obstetrician Fernand Lamaze, in which mothers learned special breathing methods to control pain and were provided with practical information about the childbirth process.
Public versus Professional Perspectives.
Saint Mary's Hospital...
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Sex in the 1960s: Lippes Loop
Evolution of the IUD.
Ancient history relates the tale of Arabs putting stones into the uterus of a camel to prevent the camel from getting pregnant. The first recorded modern medical use of similar devices in people was during the 1920s, when Ernest Grafenberg of Germany placed rings of silk, and later silver, within the uterus of his female patients to prevent pregnancy. The procedure caused excessive bleeding and infections, and Grafenberg was forced to give up on the devices when he moved his practice to the United States. The Japanese and Israelis subsequently used such methods for birth control with greater success. The intrauterine device (IUD) gained wider acceptance in the early 1960s, when American medical researchers used new materials to develop new products. The new IUDs were made of plastic, nylon, or stainless steel. After insertion by a physician, they could be left for years. Pregnancy prevention with IUDs was almost as effective as the new birth-control pills. Most women who wanted to become pregnant could do so within a few months after having their device removed.
An Inexpensive Method.
IUDs cost about two cents to manufacture, and physicians charged to insert them. Since there was only a one-time cost, IUDs were cheaper than the oral contraceptive pills, and users did not have to remember anything to get effective...
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Sex in the 1960s: The Male Pill
A Pill for Men?
As new methods of contraception developed during the 1960s, the time-honored method of male condom use decreased. Because new contraceptives were primarily for women, birth control became a feminine imperative and responsibility. This attitude was challenged by the development of an effective male birth-control pill. One social and one medical problem led to the abandonment of the technique.
The male pill was developed from research on diamines, protein compounds to combat amoebic intestinal infections. During animal testing it was discovered that diamines arrested maturation of the sperm in males, making them sterile. Dr. Carl Heller of the Pacific Northwest Research Foundation decided to shift the focus of his research to contraception. He tested the diamines on thirty-nine male convicts at the Oregon State Penitentiary. By taking a pill daily, they stopped producing sperm, he found. There was no effect on libido (sex drive) or the ejaculation process. When the men stopped taking the pills, their sperm counts quickly re-turned to normal. The female birth control pill (Enovid) cost three to four dollars a month to manufacture, but the diamine male contraceptive cost under one dollar a month. Dr. Heller's elation at the discovery of a cheap, effective method of birth control was dampened when he extended his...
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Solid Proof: Cancer Spreads
In 1960 a virus was proven to cause a cancer in chickens. It was the first time a virus was found definitely to cause a cancer and the first time a cancer was shown to be contagious. The proof of this finding was affirmed by using Robert Koch's postulates, a set of sensible procedures which eliminate the possibility that there is more than one cause for an effect. First the agent must be isolated from affected individuals and then grown in pure cultures. Next normal individuals exposed to the cultured agent must contract the disease the agent is assumed to cause. Finally the same agent must be isolated from the exposed individuals who contracted the illness.
Researching Sarcoma Cause.
Dr. B. R. Burmester of the U.S. Department of Agriculture Regional Poultry Laboratory in East Lansing, Michigan, applied Koch's postulates to the Rous sarcoma virus, assumed to cause a certain type of cancer called sarcoma. Burmester isolated the virus in chickens with sarcoma, cultured it, and injected healthy chickens. Of the forty-five he injected, thirty-five chickens developed sarcomas. From these Burmester isolated the same virus. By Koch's postulates, then, Burmester determined that the virus caused the sarcoma.
The Cancer Connected with Contagious Virus.
He continued his...
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Smoking and Cancer
The Government Examines Smoking.
While scientists and physicians were generally convinced of the link between cancer and cigarettes by the early 1960s, the government was not. Political pressure from congressmen representing states where tobacco was grown delayed a Public Health Service report on the subject. In 1962 President John F. Kennedy asked U.S. Surgeon General Luther L. Terry to resolve the matter. Terry appointed a committee of ten, including three cigarette smokers, one cigar smoker, and one pipe smoker to review the findings of others rather than conduct their own research. Over a period of nearly two years committee members pored over eight thousand articles in the National Medical Library in Bethesda, Maryland. During the course of the inquiry Terry, who smoked cigarettes when the study started, switched to a pipe.
The report of the surgeon general was presented in the auditorium of the old State Department building on a Saturday morning, when the stock exchanges were closed, so that the findings would not have an immediate effect on tobacco company prices. The 387-page, 150,000-word report had disastrous news about the dangers of smoking. The committee found that cigarette smoking increased the rate of death and caused serious illnesses such as heart disease and emphysema. Findings were based on the number of...
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Sugar by Any Other Name? People concerned about the health effects of sugar had two alternatives in the mid 1960s, saccharin and cyclamates. Saccharin, the older of the two, is intensely sweet but may leave a bitter after-taste. Cyclamates, the other substitute, are also intensely sweet—thirty times as sweet as sugar and they leave no aftertaste. The positive qualities cannot outweigh the negative, however, Cyclamates can kill.
Dr. Jacqueline Verrett, a researcher at the Food and Drug Administration (FDA), experimented with chicken embryos and cyclamates in 1966. She found that the chemical caused birth defects in 15 percent of the chicks exposed. She also showed that cyclamates caused chromosome breaks in rats which were fed high doses of the substance and cancer in other animals. In metabolizing the cyclamates many people's bodies formed cyclohexylamines, breakdown products known to cause bladder cancer in rats. Verrett reported her findings to FDA Commissioner Dr. Herbert Ley, Jr. Along with officials at Abbott Labs (which produced cyclamates), Ley proclaimed the product was safe. A public argument with full press coverage ensued.
A Review and a Ban.
Over five million pounds of cyclamates were used each year in America in 1963, and twenty-one million pounds were expected to be...
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Thalidomide: Global Tragedy
Thalidomide was developed in the United States as a possible antiseizure drug, but when it was found to have no antiseizure properties, rights were sold to a West German drug company (Chemie Gruenenthal) that continued testing. Chemie Gruenenthal found that thalidomide was a reasonably effective sedative with an unusual property: there was no fatal dosage. As a sedative, the drug could be prescribed to potentially suicidal patients without risk of overdose. After testing with what seems to have been rigged results, thalidomide was approved for distribution in West Germany. Subsequently, it became apparent that it relieved nausea, or morning sickness, in many women during early pregnancy. This discovery led to a tragedy affecting thousands of lives.
Chemie Gruenenthal marketed thalidomide successfully, both in its pure form and in multiple-drug combinations, for a wide variety of ailments. As thalidomide use spread quickly throughout Europe, physicians began noting an increase in a rare type of birth defect called phocomelia (literally, "seal limbs"), in which a baby's limbs do not fully form; the baby might be born without an arm, for instance, its hand coming directly out of its shoulder. Heart defects, kidney problems, and deafness also increased in newborns. Some obstetricians wrote to Chemie...
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Triparanol and Chloramphenicol
Problems with Triparanol.
In the same decade that thalidomide deformed thousands of babies around the world, more drugs were learned to have unexpected side effects. One was the Merrell's MER/29, or triparanol, marketed to lower blood cholesterol. The drug was found to cause baldness and blindness from an unusual form of cataracts. The FDA learned that these cataracts had been noted in animal studies required for approval of the drug, but Merrell failed to mention the finding to the FDA in the approval request. The FDA brought charges against Merrell, the parent company (Richardson-Merrell, Incorporated), and three former executives.
Antibiotic Risks of Chloramphenicol.
Another drug with unexpected side effects was chloramphenicol, known by the trade name Chloromycetin (Parke, Davis and Company), an antibiotic particularly useful against some rare and tropical diseases and lifesaving against certain types of meningitis. When confined to the treatment of life-threatening infections, the risks of chloramphenicol are worth taking. Chloromycetin was introduced in 1949 with the hype given any new drug. Doctors prescribed it for minor bacterial infections, such as bronchitis and acne, and even as a placebo for viral infections such as colds—even though it was known that antibiotics have no effect on viruses. By 1952 some patients taking...
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Cooley, Dr. Denton A. 1920-
The New Specialization.
After the development of the heart-lung machine in the mid 1950s, which made open-heart surgery possible, a new group of heart-surgery specialists emerged to meet the demand for new techniques. Dr. Denton A. Cooley was among the first such specialists, and he quickly rose to become one of its foremost practitioners.
Education and Early Inspiration.
Cooley studied at the University of Texas at Austin and received his M.D. at Johns Hopkins University, where he then served as an intern and as a resident and worked under respected heart surgeon Dr. Alfred Blalock. In November 1944 he assisted Blalock in the first blue-baby operation, which corrected a heart defect that prevented the infant from receiving enough oxygen. This experience in particular inspired Cooley to pursue a specialization as a heart surgeon.
A Growing Reputation.
In 1954 Cooley returned to his native Houston to join the faculty of the Baylor University College of Medicine, where heart surgeon Dr. Michael E. DeBakey was already...
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Cooper, Dr. Irving S. 1922-1985
NEUROLOGIST, PIONEER OF CRYOSURGICAL TECHNIQUES
A Remarkable Man and a Great Brain Surgeon.
Praised by British writer and scientist C. P. Snow as "one of the most remarkable men alive" and "professionally one of the great brain surgeons of the world," during the 1960s Dr. Irving S. Cooper built on his already-impressive reputation from the early 1950s in treating victims of Parkinson's disease by expanding his procedures to a new field: cryosurgery. His advances led to international acclaim and to no small amount of professional jealousy and personal attacks.
Education and Early Career.
Cooper earned his M.D. at George Washington University and his Ph.D. at the University of Minnesota, then worked as a fellow at the Mayo Clinic (1948-1951) before joining the faculty at New York University Medical School and the surgical staff at Saint Barnabas Hospital in the Bronx. Brilliant and compassionate, as a surgeon he devoted himself to helping people with debilitating, seemingly hopeless neurological disorders such as Parkinson's disease, which afflicts its aging victims with uncontrollable tremors. He made a name for himself as a young surgeon in the early 1950s with his discovery that by cutting off the blood supply to small portions of the brain related to Parkinson's disease—thus destroying the tissues—the...
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Debakey, Dr. Michael E. 1908
Pioneering Heart Surgeon.
During the 1960s tremendous advances were made in the area of cardiovascular surgery, and Dr. Michael E. DeBakey led many of them. His work in arterial grafting and replacement and in artificial-heart devices, along with subsequent developments for which he paved the way, has saved the lives of thousands of patients. He has also been a highly visible promoter of public service for the medical profession and a prolific scholar.
Education and Early Successes.
The son of a Lebanese immigrant who settled in Cajun territory to be with other French speakers, DeBakey grew up in Lake Charles, Louisiana, and studied at Tulane University in New Orleans, where he received his M.D. He spent most of the 1930s occupied with his studies, internships, and residencies, but in 1932 he developed a pump that became a stepping-stone to the heart-lung machines later used in open-heart surgery, and in 1936 he and Dr. Alton Ochsner were among the first to point out a connection between cigarette smoking and lung cancer. He taught at Tulane from the late 1930s to the late 1940s, interrupted only by military service from 1942 to 1946 in the office of the surgeon general. In 1948 he joined the faculty of the Baylor University College of Medicine in Houston, Texas, where he made his most noteworthy...
(The entire section is 620 words.)
Harlow, Harry F. 1905-1981
Harry Harlow was born in Fairfield, Iowa, on 31 October 1905. His Ph.D. was in experimental psychology, and he taught for forty-four years (1930-1974) at the University of Wisconsin. His experimental work with animals changed thinking about animal development and learning. His work had practical applications in education and in the developmental aspects of human infancy and childhood.
New Theories of Animal Behavior.
Harlow was the first to show that mammals all tend to learn in similar ways, first by trial and error, then by insightful learning, in which they develop strategies, predict what will happen next, and begin to think abstractly. His work in social and developmental psychology continued with a study of motivation. It was generally thought that animal behavior was motivated by biological drives, such as the need for food or sex. Harlow showed otherwise in brilliant experiments. While much animal behavior is motivated by biological drives, it is also driven by abstract motivation. Animals' behavior can result from an urge to explore and manipulate their environment.
Experiments with Baby Monkeys.
The best-known works by Harlow involved his infant monkey experiments. Monkey babies were separated from their mothers...
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Kelsey, Dr. Frances Oldham 1914-
A Singular Contribution.
Pharmacologist Dr. Frances Oldham Kelsey is credited with single-handedly preventing an outbreak of drug-related birth defects by denying approval for the distribution of thalidomide in the United States. She did so in spite of pressure and attacks claiming that she was keeping a beneficial product from potential users.
Kelsey was born on Vancouver Island, British Columbia, and studied at McGill University in Montreal before attending the University of Chicago, where she earned a Ph.D. in pharmacology in 1938. She taught there and in South Dakota, where she earned her M.D. in 1950. She became an American citizen in 1956. In 1960 she moved with her husband to Washington, D.C., where she joined the Department of Health, Education, and Welfare's Food and Drug Administration (FDA)....
(The entire section is 568 words.)
Terry, Dr. Luther L. 1911-1985
MEDICAL RESEARCHER, TEACHER, US. SURGEON GENERAL
The First Surgeon General's Warning.
Since the mid 1960s cigarette packs and advertisements have come with warnings from the office of the U.S. surgeon general that cigarettes may be hazardous to one's health. The surgeon general who first stated this on behalf of the federal government was Dr. LutherL. Terry, who held the position from 1961 to 1965.
Education and Early Career.
Born in Red Level, Alabama, Terry studied at Birmingham-Southern College before earning his M.D. at the Tulane University School of Medicine in 1935. He taught and practiced in the South and Midwest and served four years with the United States Public Health Service, then in 1950 he joined the National Heart Institute, where he specialized in hyper-tension studies. He became assistant director of the National Heart Institute in 1958. President John P. Kennedy appointed Terry as surgeon general in 1961.
Researchers had long indicated a link between cigarette smoking and various health problems. Terry headed a ten-member panel that studied published reports and scholarship on the effects of smoking. The panel reached a consensus, which Terry presented on 11 January 1964. In its report the panel concluded that a strong connection...
(The entire section is 326 words.)
People in the News
Dr. Malcolm S. Artenstein of the Walter Reed Institute of Research developed a meningitis vaccine in 1969.
Harvard Medical School dean Dr. George Berry retired in 1965. He stressed the need for scientific research as a tool to understand better the patient as a person.
Fully implantable heart pacemakers with batteries were developed by Dr. William A. Chardack of the Buffalo, New York, Veterans' Hospital in 1961.
Dr. Thomas D. Cronin of Houston introduced the Silastic breast implant to America in 1963. It felt like normal breast tissue.
In 1961 Dr. John Enders and colleagues announced a live-virus measles vaccine.
In 1964 Dr. Vincent Freda and Dr. John Gorman at Columbia-Presbyterian Hospital in New York collaborated with Dr. William Pollack of the Ortho (Pharmaceutical Company) Research Foundation to produce Rh Immune Globulin, better known by the trade name, RhoGAM.
At the White House Conference on Children and Youth in March-April 1960 Dr. Stanley M. Garn of Antioch College reported on obesity in teenagers. Increased caloric intake and decreased exercise were to blame.
University of Colorado Medical Center physician Dr. Joseph H. Holmes reported on the painless, portable...
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NOBEL PRIZE WINNERS IN MEDICINE OR PHYSIOLOGY
Sir Frank McFarlane Burnet (Australia) and Peter B. Medawar (Great Britain)
Georg von Bekesy (United States)
James Dewey Watson (United States), Maurice H. F. Wilkins (Great Britain), and Francis Harry C. Crick (Great Britain)
Alan Lloyd Hodgkin (Great Britain), Andrew Fielding Huxley (Great Britain), and Sir John Carew Eccles (Australia)
Konrad e. Bloch (United States) and Feodor Lynen (Germany)
François Jacob (France), André Lwoff (France), and Jacques Monod (France)
Charles Huggins (United States) and Peyton Rous (United States)
Ragnar Granit (Sweden), Haidan Keffer Hartline (United States), and George Wald (United States)
Robert W. Holley (United States), H. Gobind Khorana (United States),...
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Franz Gabriel Alexander, 73, Hungarian-born psychoanalyst, pioneered psychosomatic medicine in the United States, 8 March 1964.
W. Wayne Babcock, 90, physician, involved in the development of spinal anesthesia and introduced a variety of surgical techniques including the use of steel-wire sutures, 23 February 1963.
Louis Hopewell Bauer, 75, cardiologist, pioneered aviation medicine and served as secretary-general of the World Medical Association (1948-1961), 2 February 1964.
Alfred Blalock, 65, surgeon in chief of Johns Hopkins Hospital, codeveloped blue-baby surgery as well as the hand-pump cardiac-resuscitation method, 15 September 1964.
Paul Earle Carlson, 36, missionary doctor, killed by Congolese rebels in Stanleyville, Congo, 24 November 1964.
Frank P. Corrigan, 86, surgeon, diplomat, and first U.S. ambassador to Venezuela, helped prove the feasibility of blood transfusion, 21 January 1968.
Thomas Dooley, 34, physician, established medical missions in Laos and was a founder of the Medico organization, 18 January 1961.
Thomas Francis, Jr., 69, virologist, developed an anti-influenza vaccine and directed field testing of the Salk polio vaccine, 1 October 1969.
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Franklin Bicknell, Chemicals in Food and in Farm Products (New York: Emerson, 1961);
Marguerite Clark, Medicine Today: A Report on a Decade of Progress (New York: Funk & Wagnalls, 1960);
John H. Heller, Of Mice, Men, and Molecules (New York: Scribners, 1960);
Brian Inglis, The Case for Unorthodox Medicine (New York: Putnam, 1965);
Dr. Fritz Kahn, The Human Body (New York: Random House, 1965);
Henry B. Lent, Man Alive in Outer Space (New York: Macmillan, 1961);
Benjamin F. Miller and Ruth Goode, Man and His Body: The Wonders of the Human Mechanism (New York: Simon & Schuster, 1960);
Peter S. Nagan, ed., Medical Almanac 1961-62 (New York: Saunders, 1961);
Charles Singer and E. Ashworth Underwood, A Short History of Medicine (New York: Oxford University Press, 1962);
Norman Burke Taylor and Allen Ellsworth Taylor, The Putnam Medical Dictionary (New York: Putnam, 1961).
Orlando A. Battista, Toward the Conquest of Cancer (New York: Chilton, 1961).
Health Insurance and Government Programs...
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Important Events in Medicine and Health, 1960–1969
- The percentage of babies delivered by cesarean section doubles in twenty years to between 5 and 6 percent.
- U.S. Department of Agriculture poultry scientist B.R. Burmeister demonstrates that a virus causes a type of cancer in chickens. His work implies that viruses may likewise cause cancer in humans.
- Laborer Billy Smith has a severed leg reimplanted, but with only temporary success.
- Debate continues over the effectiveness of inactive-versus active-virus polio vaccines.
- On January 1, physicians visit only 10 percent of patients in their homes. The other 90 percent come to the physician's office for treatment.
- On January 1, abortion is illegal in all 50 states, though 45 permit abortion when pregnancy endangers the mother's life.
- In February, Dr. Frank L. Horsfall Jr. becomes director of the prestigious Memorial Sloan-Kettering Cancer Center in New York.
- In April, a breast implant is made from silicone gel in a plastic bag.
- In May, the Food and Drug Administration approves Enovid, an oral contraceptive pill, for use in the United States.
- In July, Harvard University physician and Nobel laureate John F. Enders' measles vaccine shows promise in early tests.
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