Friday, May 9, 2008

HOW FAR WE HAVE COME

With little better to do, because of the Muhlenberg Hosital issue, I have had time to reflect upon my life time involvement in Medicine.

My father opened his practice in Plainfield in 1910-11.My brother also became a physician.I became a doctor not because I had an overwhelming desire to care for people but because I could not contemplate any other adulthood.

Someday I may expand on the Yood's Medical Careers, but not now. I wish to relate what has happened to our society over the last 80+ years. This will take several installments of various lengths. They will not be posted consecutively.

I was fortunate that my career coincided with the truly golden age of medicine. this was a time when Doctors could be patient advocates and friends, not skilled technicians subjected to the constrictions imposed by governmental agencies, third party payers, and a litigious society,

As a medical student, in 1939, when I first entered medical school, there was only one bactericidal medication available, sulfanilamide. This was a German drug that Bayer had developed from a chemical dye. A few other more effective compounds were rapidly developed. However, some like sulfathiazole had severe side effects; among them was loud ringing in the ears which could become unbearable. One could correlate the effects of that drug to today’s unlawful torture interrogation processes. Other side effects included destruction of the bodies ability to make blood cells, aplastic anemias which were incompatible with life.

Sulfadiazine was the best tolerated and most effective of the sulfas and is still used. By the time I had retired in 2001, there were multiple generations of antibiotics as well as some available anti-viral drugs,

Tuberculosis was synonymous with the sanatorium, where it was hope that the disease could be arrested by exposing patients to fresh and often cold air. Being spread by close contact especially in the presence of those who were coughing, it was a leading killer of not only the poor but the affluent.

Among the treatments were operations to remove ribs and collapse part of the chest wall and lung in an effort to close and seal the cavities that were the focus of infection.

Locally Runnells, known then as Bonnie Burns, was the local sanatorium. The ones at Lake Placid and Saranac NY were world famous. Today they are all history or converted for other uses.

Poliomyelitis was a feared disease. The worse complication was not only varying degrees of peripheral paralysis, but the involvement of the respiratory muscles including the diaphragm. When this occurred, life could only be maintained by the use of the ‘iron lung” a steel tank equipped with bellows to expand and contract the lungs. Patients lay on their back with only the head protruding through a rubber diaphragm outside the tank. If the power or pump failed they were doomed to death by asphyxiation.

Today, Polio has been eradicated almost everywhere in the world. However there are still small loci in Africa and Asia of unprotected populations and if we let our guard down this scourge like others could resurface.

Rheumatic fever and the contagions cut short many a youngster’s life. Rheumatic fever, a streptococcus infection damaged the heart valves leading to heart failure. Septicemia, including sub-acute bacterial endocarditis, a streptococcus infection which had settled on a damaged heart valve, was inevitable fatal.

By today’s standards the treatment for sub-acute bacterial endocarditis was witch craft. Intravenous injections of killed typhoid bacteria or even milk were routine in an endeavor to great an extremely high fever, 105 or better in the belief that would destroy the bacteria.

Fortunately in the early 40s Penicillin was discovered, and its potentiality against certain bacteria realized. While an intern at Syracuse University Medical Center in 1943 we were able to obtain 20,000 units of Penicillin to treat intravenously a young girl with SBE. To the best of our knowledge we cured her.

If you comprehend that today a single tablet of penicillin contains a minimum of 250.000 units, more than10 times what we had available, you can understand how great a miracle that was.

I intend this to be, if you are willing to read, the first of many periodic but intermittent postings on the change in health care in the last 60 to100years.

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