Justin Barr

A Short History of Dapsone, or an Alternative Model of Drug Development

From 1936 until 1996, the drug dapsone treated a diverse array of diseases, including tuberculosis, leprosy, malaria, and AIDS-related pneumonia. This article explores how dapsone transformed from a cure for one disease into a treatment for a totally different malady. This process of reinvention in the clinic represents an alternative model of drug development that the historical literature, focused on success in the laboratory, has largely ignored. The core of the paper discusses the reinvention of dapsone as an antimalarial in the Vietnam War through trials led by Robert J. T. Joy, a physician and military officer. As a case study, it offers a fresh perspective on the clinic-as-laboratory approach that other scholars have addressed in a civilian context. Viewing the randomized clinical trial (RCT) through a military prism will demonstrate how a combat environment combined with the regimentation of the armed forces affected the standard methodology of the RCT.

Vascular Surgery in World War II: The Shift to Repairing Arteries.

Vascular surgery in World War II has long been defined by DeBakey and Simeones classic 1946 article describing arterial repair as exceedingly rare. They argued ligation was and should be the standard surgical response to arterial trauma in war. We returned to and analyzed the original records of World War II military medical units housed in the National Archives and other repositories in addition to consulting published accounts to determine the American practice of vascular surgery in World War II. This research demonstrates a clear shift from ligation to arterial repair occurring among American military surgeons in the last 6 months of the war in the European Theater of Operations. These conclusions not only highlight the role of war as a catalyst for surgical change but also point to the dangers of inaccurate history in stymieing such advances.

Development and Evolution of Self-Retaining Retractors in Surgery: The Example of the Bookwalter Retractor

One of America’s prodigious inventors, scientists, and founding fathers, Benjamin Franklin, suggested that “without continual growth and progress, such words as improvement, achievement, and success have no meaning.” He believed that scientific contributions should be used to increase efficiency and improve the human condition, sentiments that continue to motivate innovators. By inventing a universally applicable, self-retaining, table-fixed retractor, John Bookwalter markedly advanced a field that had seen dozens of ephemeral designs during the preceding 70 years. He aspired to improve the safety and efficacy of abdominal and pelvic surgery and enhance the learning environment for students and trainees. Subsequent modifications to the post, rings, and ratchets made the device easier and more flexible to use, thereby broadening its acceptance. As it became the most common self-retaining retractor in the United States, the Bookwalter helped transform the practice of surgery. Its history is interwoven into that of the last two generations of surgeons and epitomizes innovation in response to need; its future, however, in a profession increasingly dominated by minimally invasive techniques, remains less certain.

The anatomist Andreas Vesalius at 500 years old

December 31, 2014 marked 500 years since the birth of Andreas Vesalius. Praised by contemporaries and lauded by generations since as the most important anatomist in western history, he fundamentally reshaped the discipline, made numerous anatomical discoveries, and most importantly, advanced the trajectory of modern medicine by rejecting textual dependence in favor of personal observation. This article, commemorating Andreas Vesalius and his accomplishments on the 500th anniversary of his birth, will first provide a brief biography of the man. It then discusses his role as the “Father of Anatomy” and his influence in transforming the study of the human body. Finally, it highlights Vesalius’ specific contributions to vascular anatomy and physiology.