Myron Prinzmetal 1908-1987: the man behind the variant angina

Prinzmetal or variant angina refers to decrease in blood flow secondary to spontaneous spasm of the arterial wall usually without significant atherosclerotic plaques. These symptoms happen at rest and often may wake up the patient during the night. This angina is named after Myron Prinzmetal (1908-1987), who worked most of his life in Los Angeles and published 165 medical publications during his brilliant career. His interests ranged from disease of the lung, kidneys, and peripheral vascular disease to cardiac arrhythmias, circulatory shock, hypertension, and coronary syndromes. In 1959, with Dr. Rexford Kennamer and others, he published their first observations on the variant form of angina pectoris, a landmark report that was to ensure him a place in the annals of medicine. This report describes his life.     

Max Bürger--achievements in conflict-laden times--on his 100th birthday

Max Bürger (1885-1966) is one of the most outstanding German internists in our century. His special merit is the application of modern scientific methods to his special field and the founding of gerontology as a new field of research. During the time of fascism in Germany Max Bürger has retained his fidelity to an humanistic engagement of the medical profession and, in contrast to many other distinguished representatives of medicine, he didn't succumb the various corruptions for participation in misuse of authority. In spite of the hard conditions in 1945 Max Bürger decided to carry on his activities in Leipzig. Here he achieved in the following years significant results for the reconstruction of Public Health and medical university education. The underlie of these commendable decisions was a humanistic professional ethos, to whom the engagement for suffering individuals was more important than the personal prosperity.     

Think clearly,be sincere,act calmly: Adolf Kussmaul (February 22, 1822-May 28, 1902) and his relevance to medicine in the 21st century

This past year, 2002, marked the 100th anniversary of the death of Adolf Kussmaul. To rheumatologists, he is important as the author of the first case of idiopathic vasculitis, polyarteritis nodosa, which even today is the basis of our understanding of vasculitis. To general internists, his name is linked to Kussmaul's sign and Kussmaul breathing, and to gastroenterologists, he is in many ways-through the development of the gastric pump and the first gastroscope-the father of modern gastroenterology. His reputation as an excellent teacher, his compassion for his patients, and his ability as a clinician scientist led him to be regarded as a giant of 19th century medicine. Kussmaul's life and career, dedicated foremost to reducing human suffering and advancing medicine as a scientific discipline with a strong humanistic foundation, make him a role model for physicians of today.     

Gregor Johann Mendel and Modern Evolutionary Biology: Gregor Johann Mendel: From peasant to priest,pedagogue, and prelate

Gregor Mendel was an Augustinian priest in the Monastery of St. Thomas in Brünn (Brno, Czech Republic) as well as a civilian employee who taught natural history and physics in the Brünn Modern School. The monastery’s secular function was to provide teachers for the public schools across Moravia. It was a cultural, educational, and artistic center with an elite core of friar-teachers with a well-stocked library and other amenities including a gourmet kitchen. It was wealthy, with far-flung holdings yielding income from agricultural productions. Mendel had failed his tryout as a parish priest and did not complete his examination for teaching certification despite 2 y of study at the University of Vienna. In addition to his teaching and religious obligations, Mendel carried out daily meteorological and astronomical observations, cared for the monastery''s fruit orchard and beehives, and tended plants in the greenhouse and small outdoor gardens. In the years 1856 to 1863, he carried out experiments on heredity of traits in garden peas regarded as revolutionary today but not widely recognized during his lifetime and until 16 y after his death. In 1868 he was elected abbot of the monastery, a significantly elevated position in the ecclesiastical and civil hierarchy. While he had hoped to be elected, and was honored to accept, he severely underestimated its administrative responsibilities and gradually had to abandon his scientific interests. The last decade of his life was marred by an ugly dispute with civil authorities over monastery taxation.     

Tobacco research funded by the tobacco industry-an ethical conflict

What moral misgivings may arise in connection with the financing of research? Does the source of the funds for a research project matter? Tobacco exemplifies this problem well. Tobacco smoking is the largest single cause of illness and premature death in the industrialized world, but the tobacco industry is also one of its most profitable commercial undertakings. Decades of increasing scientific evidence for the harmfulness of smoking have increased the moral pressure on manufacturers. Good relations with the scientific community is a desirable way to demonstrate the legitimacy of their operations. Medical researchers should act in accordance with the classical ethical principles of medicine; autonomy, doing good, justice and doing no harm. The activities of the tobacco manufacturing companies are not in accordance with these principles. Every medical researcher or physician who uses funding from the tobacco companies cannot escape the fact of lending his or her name to the manufacture of a lethal product.     

‘I'm older and more interested in my community’: Older people's contributions to social capital

Aim: To explore and compare older people's contributions to social capital in a large rural community. Methods: Data were collected from a large representative sample (n= 1431), through a social capital questionnaire. The survey was cross‐sectional and measured frequency of participation across different age cohorts in informal social activities, group activities and community and civic activities. Results: Age and life stage pattern proved to be a factor in determining the types of activities people were involved in. While younger people were more involved in social participation that involved public places or group and sporting events, older people, particularly those in the retirement age group of 60–69 were more involved in community and civic activities. Conclusion: Older people living in non‐metropolitan areas are not only recipients of social capital. Their considerable involvement in volunteer groups, service clubs, church groups and local government demonstrates significant involvement in civic and community life.     

Civic engagement as a retirement role for aging Americans

PURPOSE: Public attention directed toward the civic engagement of retired Americans has increased considerably. The purpose of this research was to define civic engagement as a retirement role and differentiate individuals who met this role definition from other retirees. DESIGN AND METHODS: Retirees who met our definition of civic engagement were identified from a sample of 683 retired older adults living in a rural Midwestern state. Using a multinomial logistic regression analysis, we contrasted this group of engaged retirees to three other groups of retirees: (a) those who were neither working nor volunteering, (b) those who had returned to work in part-time or seasonal occupations, and (c) those who volunteered for fewer than 5 hours each week. RESULTS: The analyses indicated that individuals assigned to the group of engaged retirees were similar across 24 variables. This group of engaged retirees differed from the other groups by gender, education level, and health status; retirement motives and planning efforts; primary retirement activities; and attitudes about volunteering and returning to work. IMPLICATIONS: This research supported the contention that civic engagement could be defined as a formal retirement role, as engaged retirees differ significantly from those who volunteer less, work in noncivic roles, or do neither. Further, we resolved that associating the act of volunteering, in itself, with civic engagement may no longer be appropriate for retired older adults. The definition of civic engagement as a retirement role should also include those individuals who return to work in organizations that pursue specific civic activities.     

Bence Jones Island in Shepherd Bay,Nunavut: a little known tribute to the legendary physician and chemist’s “thé de voyage”

Henry Bence Jones is among the esteemed physicians of the mid-19^th century. Eighteen biographical medical journal articles, published between 1952 and 2021, describe his life and contributions to medicine. Unmentioned, however, is an island in the waters of Shepherd Bay in northern Canada, now Nunavut, designated Bence Jones Island, by the British explorer John Rae in 1854. Rae had sailed from Great Britain to the regions extending north of Hudson’s Bay in search of information regarding Sir John Franklin and 133 other officers and men who departed from the Kingdom of Great Britain in two ships in 1845 to search for the Northwest Passage to the Pacific Ocean; they disappeared. In anticipation of Rae’s voyage to search for evidence of Franklin’s expedition, Bence Jones provided a special preparation of tea that could be drunk cold, if necessary. It was so meaningful to the crew of Rae’s ship that it resulted in Rae naming an island near Boothia Isthmus in Shepherd Bay in recognition of this contribution to the contentment of his men under arduous conditions and in acknowledgment of Bence Jones’s professional standing, upon which we comment. Rae’s report of his voyage in 1855, cited herein, mentioned the island and showed its position on a map of the region. We have located it on a current map of the waterways and landmasses of Nunavut using Google Earth Pro by showing its position at the approximate coordinates of latitude and longitude cited by Rae.     

Integration of Alcohol and Other Drug,Trauma and Mental Health Services

SUMMARY

The Franklin County Women's Research Project is a collaboration among the Western Massachusetts Training Consortium, the Franklin Medical Center, three Women's Resource Centers located across the county, and local consumer/survivor/recovering women (CSRs). This project is unusual in two ways: (1) it is a rural site, and (2) the project was designed, implemented and evaluated by CSRs. The program model integrates services at the person level and at the system level. The Women's Resource Centers are the focal points for the individual level services integration offering women support through their peers, including AA/NA meetings, trauma recovery groups using the Addiction and Trauma Recovery Model (ATRIUM), Peer Resource Advocates, writing, art, and body awareness programs, and a variety of opportunities. The guiding principle is that women heal when they find the resources within themselves to define their lives and engage in activities and work that is meaningful to them. These Centers work in conjunction with the formal treatment systems. Services integration is accomplished through the Services Integration Committee comprised of the mental health, AOD and domestic violence providers, the Community Coordination Council comprised of a wider network of service and support providers, and through the activities of the Trauma Liaison, an employee of Franklin Medical Center who chairs the committees and provides consultation on women with trauma histories.     

The History of James Parkinson and His Disease

Summary: James Parkinson was born over 200 years ago. Although he is remembered in medicine for his monograph on The Shaking Palsy, his interests were broadly divided between social reform, the natural sciences and the teaching and practice of medicine. Born to the great literary era of Samuel Johnson, Goldsmith and Burke, Parkinson knew an upper class sense of excellence in art, literature, knowledge and good taste which was being compared to the achievements of the Roman Empire. Against this historical background James Parkinson was a general practitioner, a surgeon, a social reformer and a pamphleteer. His medical writings include Observations on the Nature and Cure of Government, The Chemical Pocket-Book¹, and the renowned case report of perforation of the appendix². He was a foundation member of the Geological Society of London and his publication Organic Remains of a Former World³ records his studies on geology and fossil research. Medical Admonitions⁴ and The Villagers' Friend⁵ were especially prepared for the laity since he felt a compelling need to promote knowledge of the prevention and treatment of disease to all men.     

Berolina iubilans: Berlin physicians as Halle doctoral candidates (IV). Johann Ulrich Bilguer (1720-1796), Halle doctoral candidate of 1761

The physician Johann Ulrich Bilguer (1720-1796) born in Chur in Graubünden obtained high posts in military medicine in Prussian services. He had particular merits in the organization of military hospitals. With his doctoral thesis on indication and contraindication of amputations submitted in Halle in 1761 he became the "Father of the conservative surgery" as he was called. During his stay in Berlin for many years Bilguer wrote a number of treatises, in which he expressed his opinion to many medical scientific problems and again to questions of an improved treatment of patients.     

General internal medicine and technologically less developed countries

OBJECTIVE: To assess the international health activities of departments of medicine, divisions of general medicine, and general medicine faculty and the interest among departments of medicine in joint international health ventures. DESIGN: 15-item, mailed questionnaire. PARTICIPANTS: 100 chiefs of divisions of general medicine associated with training programs in internal medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Completed questionnaires were returned by 87 division chiefs representing 1,355 general medicine faculty. 49% of division had faculty with six weeks' experience in less developed countries. 8.5% of general medicine faculty had six weeks' experience in less developed countries. 7.6% of general medicine faculty were interested in spending extended time in less developed countries. 19% of departments had formal collaborations with schools in less developed countries. 45% of departments were interested in affiliations with U.S. institutions for the purpose of joint international health ventures. CONCLUSIONS: The international health interests of current general medicine faculty may not be satisfied. Departmental and divisional encouragement of international interests would increase the number of U.S. general internists participating in less developed countries. The authors discuss the potential for greater involvement of general medicine faculty in international health.     

Zur aktuellen Struktur der internistischen Rheumatologie an deutschen Hochschulen

The teaching of rheumatology requires competent rheumatological structures in German university hospitals. In 2002, the nationwide 'RISA' survey on the extent and quality of rheumatological training in Germany brought a variety of deficits to light. In the same year, a new law regulating the licensing process to practise medicine came into force. Since this law aimed at a more practise-based training of medical students, hopes were high that the conditions for the rheumatological education of students would improve over time. Therefore, our survey was repeated four years later, supplemented by a questionnaire covering scientific activities in rheumatology at university hospitals. In addition, another survey, known as the Rhesus study, was started in 2007 to analyse the size and capacity of rheumatological departments and units at German medical faculties. The results show that rheumatology represents one of the smallest subjects of internal medicine in Germany. Several German university hospitals do not include a rheumatological department at all. Since 2002, no significant progress has been made with regard to the extent of training for medical students in rheumatology, and the new licensing law has not yet shown beneficial effects in this respect. The current data represent only a snap-shot. The development of rheumatology requires cautious observation to prevent this important area of medicine from being sacrificed to economic interests or structural changes.     

Current research and development of integrated traditional Chinese and Western Medicine in gastroenterology

Traditional Chinese medicine (TCM) is one of China’s scientific treasures. We are very fortunate to apply modern scientific knowledge and methodology towards reorganizing our inherited TCM and to then promote the integration of TCM and Western medicine (TCM-WM). Over the 45 years, many remarkable achievements have been made in this regard and we are looking forward to the next achievements in the coming century; however, many challenges remain to the establishment of TCM-WM as a trusted and oft used approach for improving human health.     

Factors Predicting Civic Engagement among Older Adult Nursing Home Residents

This study examined civic engagement participation among older adult nursing home residents and determined resident characteristics that predict group membership, resident council participation, informal volunteering, and voting. Residents (N = 139) answered questions from standardized surveys during in-person interviews. The most common civic engagement activity was membership in social/community groups. Logistic regression results showed that emotional well-being and social support predict group membership and resident council participation. Age and activities of daily living predict volunteering. Study findings suggest that community groups could utilize residents in their efforts, and that future research should determine supports and adaptations for increasing civic engagement among residents.     

Edkins and a century of acid suppression

In 1905, John Edkins (1863-1940) undertook the studies of gastrin that have subsequently formed the basis for a century of investigation into the physiological basis of acid secretion and led to the elucidation of a variety of acid-suppressive pharmacological agents that have revolutionized the management of acid peptic disease. Although his name is known to few, his contributions to the physiology of gastric secretion and his study of spiral organisms in the stomach were prescient and to this day remain models of insightful and rigorous research. As a mentor, his educational impact was exemplified by the fact that he was the first to teach physiology to women in the United Kingdom. Gastrin has evolved from an initially unaccepted phenomenon, to be recognized as an important hormone and a fundamental component of regulatory biology as well as a clinically relevant biomarker of disease. Its critical role in the modulation of acid secretion has become a sine qua non and has been extended to include a broad regulatory proliferative role in the mucosa of the gastrointestinal tract. The pivotal role of gastrin in gastric physiology, biology and clinical medicine is now well accepted and reflects the fundamental contributions that Edkins made to the identification of the agent and the elucidation of its function. As a result of the delineation of the neural and hormonal regulatory mechanisms of acid secretion, the scientific basis of acid peptic disease has become apparent. The identification of histamine receptors and proton pumps has led to the discovery of novel pharmacotherapeutic agents capable of producing acid suppression of such efficacy that surgery has become virtually obsolete in the treatment of the disease process. A century after the initial observations by Edkins of gastrin, the identification of Helicobacter pylori and the ability to eradicate it, as well as the use of the proton pump inhibitor class of drugs, have revolutionized the management of gastroduodenal ulceration and gastroesophageal reflux disease. Both patients and physicians owe a great debt to Edkins, whose seminal observations regarding gastrin initiated an era of gastrointestinal scientific, clinical and pharmacological advance that has culminated in the ability to treat and cure acid peptic disease.     

The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals.

The oral traditions of medicine and public health have it that malnutrition is an important risk factor for the development of tuberculosis (TB). Malnutrition profoundly affects cell-mediated immunity (CMI), and CMI is the principle host defense against TB. It makes biological sense. Although most health professionals readily accept this principle, much of this belief is based on uncontrolled observations such as disaster situations or on backwards logic from the cachexia common among TB patients. In fact, the evidence in humans is surprisingly thin from the perspective of scientific rigor. And few data, if any, quantify the extent of the relative or attributable risk of TB due to malnutrition. Moreover, until recently, data from experimental animals were based on animal models that were largely not relevant to human TB infection and disease. This article reviews the scientific data supporting the contention that malnutrition is an important risk factor for TB concentrating on observations in humans and on experimental animal studies based on a highly relevant animal model. If it is true, malnutrition may account for a greater population attributable risk of TB than HIV infection, and certainly a much more correctable one.     

Associations between Political/Civic Participation and HIV Drug Injection Risk

Background: Participating in civic activities has been found to be related to positive health outcomes. Objective: This study examines associations between injection drug use health variables (sharing paraphernalia, using shooting galleries) and political/civic engagement (identifying with any political party, attention paid to politics and being registered to vote). Methods: Participants (N = 162) were recruited at 6 New York City (NYC) methadone programs as part of an HIV intervention (86% male). Results: In the bivariate analysis, being registered to vote and political party identification were related to lower paraphernalia sharing; higher levels of attention paid to politics were associated with lower shooting gallery use. In the multivariate analysis, political party identification was associated with lower paraphernalia sharing and higher levels of attention paid to politics was related to lower shooting gallery use. Conclusions: Findings suggest that maintaining connections with mainstream civic activities can be related to reduced health risks, including HIV risk behaviors. Scientific Significance: This study contributes to understanding the relationships between involvement in civic/political participation and health, an area in which few studies have been conducted.     

An association for patient-oriented research.

Physician-scientists, who study the pathogenesis of disease by using both bedside observations and modern laboratory techniques, are decreasing in number. Ideally, in any profession, some members are devoted to developing its scholarly basis; in contrast, technologists perform activities derived from the work of scientists or scholars. Therefore, the decreasing number of physician-scientists may cause medicine to become a technology rather than a profession. This atrophy in patient-oriented research is caused in part by the current state of laboratory science: Discoveries that are not generated from clinical observations often elucidate many aspects of disease. Furthermore, economic necessities have impelled research-oriented physicians to choose between delivery of health care and performance of basic laboratory science. This paper discusses the continuing need for detailed observation of human disease as a driving force in the development of biomedical science, which combines clinical and laboratory observations. To further the development of this field, the Association for Patient-Oriented Research has been founded. This association will be a new forum in which physician-scientists can present their work and encourage other physicians to join in the research endeavor.