Venita Jay

The Extraordinary Career of Dr Purkinje

F every student of histopathology, the name Purkinje immediately invokes images of neurons in the cerebellum and subendocardial fibers in the heart. Their famous discoverer, Jan Evangelista Purkinje, with his astounding range of interests spanning histology, physiology, pharmacology, visual phenomena, and fingerprints, left an indelible mark on medicine. In his innovations and original thinking, Purkinje was clearly ahead of his time and far ahead of his contemporaries, who failed to fully appreciate him. This was further compounded by the fact that several noted scientific works of this passionate Czech nationalist were published in his native tongue and remained in relative obscurity for almost a century. In addition, Purkinje was an unassuming scientist who did not publicize or champion his own revolutionary ideas and innovations, which were at the forefront of medicine. For Purkinje, it was not a question of personal gain or glory— it was enough that scientific progress was made. Purkinje (1787–1869), Czech patriot, philosopher, and scientist, was born December 17, 1787, in Libochovice, Bohemia. His name is correctly spelled Purkyně in Czech, but in his publications, he opted for the use of the form Purkinje, which is its phonetic approximation in German. With the death of his father when Purkinje was only 6 years old, his family faced difficult times. The second decade of Purkinje’s life was spent studying in monasteries of the Piarist Order, but he would not take his final vows to become a priest. Although Czech was his native language, Purkinje’s linguistic talents extended to an extraordinary number of European languages. After leaving the Piarist Order in 1807, Purkinje arrived in Prague, initially devoting himself to philosophy, mathematics, literature, and poetry (he created some of his own poetic compositions in Czech). Then he turned to physics and biological sciences. Purkinje’s medical studies began in 1813 in Prague. He was influenced by J. W. Goethe’s vision theory, and his inaugural dissertation was on subjective visual phenom-

The legacy of Armauer Hansen.

Dr Gerhard Henrik Armauer Hansen. Illustration by Venita Jay, MD, FRCPC. L has been known to humankind from ancient times. This age-old scourge appeared in Europe several hundred years before the common era. The medieval treatment of lepers remains one of the darkest incidents of man’s inhumanity to man. The extreme disfigurement caused by this disease led to segregation of afflicted persons who were regarded as social outcasts and made to live in special dwellings. With spread of the disease during the Middle Ages, numerous leprosy hospitals (leprosaria) were established. Lepers had to announce their presence with bells or clappers and wear distinctive attire. People afflicted with this dreaded scourge were dealt with as if they were no longer alive. It took the persistence and dedication of a visionary Norwegian to uncover the mystery of leprosy. In discovering the causative organism of leprosy, Gerhard Henrik Armauer Hansen touched millions of lives. Because of Hansen’s work, leprosy became one of the first communicable diseases wherein a specific causative organism was demonstrated. Hansen (1841–1912) was born in Bergen, Norway, on July 29, 1841, the eighth in a family of 15 children. During harsh times in the 1840s, his father Claus Hansen, a merchant, took on additional work to make ends meet but was eventually forced into bankruptcy. Because of the family’s difficult financial situation, Armauer Hansen put himself through the University of Christiania (now Oslo) by working as a tutor. He took courses in physics and zoology and had an enduring interest in botany and athletics. During his medical school years at the University of Christiania, Hansen was not afraid to contradict his teachers. He was offered a position at the university as a substitute prosector in anatomy. As a prosector, Hansen quickly gained the respect of his students, who were his age. Hansen graduated with honors in medicine in 1866 and completed an internship at the National Hospital in Christiania. Thereafter, he served as a physician in a small fishing community in Lofoten, Norway. In the winter of 1868, Hansen returned to Bergen to pursue a line of research that was to make him a household name in medicine. It is not precisely determined when leprosy first made its appearance in Norway, but it likely entered Norway

The Legacy of Harvey Cushing

Dr Harvey Cushing. Illustration by Venita Jay, MD, FRCPC. I is a formidable task for any biographer to record all of the achievements of Harvey William Cushing, commonly known as the Father of American Neurosurgery. Regarded as the leading neurosurgeon of the 20th century, Cushing was a tireless investigator, dedicated teacher, prolific writer, gifted artist, and ardent bibliophile. His name is known to every medical student and is immortalized in the well-known Cushing syndrome, Cushing disease, Cushing reflex, and Cushing ulcer. Cushing also left a lasting legacy in pathology with his work on the pituitary gland and brain tumors. Cushing launched neurosurgery as a distinct discipline and firmly established it as a separate specialty. Every phase of Cushing’s career has been the subject of intense scrutiny, with extensive biographies detailing his college days at Yale, medical training at Harvard, surgical residency at Johns Hopkins, and the years at Peter Bent Brigham and Yale. There are also several well-known biographies of Cushing, including those written by John F. Fulton, Elizabeth H. Thomson, and Justin F. Denzel. Born on April 8, 1869, in Cleveland, Ohio, Cushing was the youngest of 10 children, 7 of whom survived to maturity. His great-grandfather, grandfather, father, and older brother Ned were physicians. Cushing attended Yale College in New Haven, Conn, and graduated from that institution in 1891. While at Yale, Russell Chittenden encouraged in Cushing an interest in physiological chemistry. Cushing greatly admired his father and his brother Ned. He followed in the family tradition and embarked on a medial career, joining Harvard Medical School in Boston, Mass. Cushing attended Harvard from 1891 to 1896 and received his medical degree in 1895. He completed his internship at Massachusetts General Hospital. During his medical school years, Cushing was a keen and observant student, who was able to recognize the importance of new developments. Ether anesthesia had come into vogue, and medical students were called upon to administer it. One patient anesthetized by Cushing died, which disturbed Cushing so much that he wanted to quit medicine. Brooding over the tragedy and hoping that such deaths could be prevented if vital signs were monitored, he embarked on a new venture with fellow student Ernest Amory Codman. Together, they developed a record of an-

The legacy of Robert Koch.

Robert Koch. Illustration by Venita Jay, MD, FRCPC. N in the history of bacteriology did so much happen so quickly as in the last quarter of the 19th century. On the evening of March 24, 1882, an epoch-making lecture was delivered to a stunned audience at the University of Berlin’s Physiological Institute. On the demonstration table lay more than 200 microscopic preparations, test tubes and plates with cultures, a microscope, and other accompaniments of a serious bacteriologist. The presenter of this monumental work was Robert Koch, who rose from humble beginnings as a country doctor to the pinnacle of scientific achievement. Three weeks later, Koch’s work was published under the title ‘‘The Etiology of Tuberculosis’’ in the Berliner Klinische Wochenschrift. On April 22, 1882, an English summary of this momentous work appeared as a letter in the London Times, and news spread across the Atlantic to New York and soon to the entire world. It is a formidable task for any historian to recount each of Koch’s remarkable achievements. It can be said that history has seen but a few individuals whose extraordinary genius allowed them to leave such an immeasurable impact on human life. The list of Koch’s scientific achievements is exhaustive, but he is most revered for his discovery of the causative organism of tuberculosis. During his career, Koch forever changed the face of medicine and firmly established the science of bacteriology. His work had far-reaching impact globally in the field of infectious disease and public health. His discovery of the tubercle bacillus was a starting point for a worldwide campaign against an age-old scourge of the human race. Heinrich Hermann Robert Koch was born December 11, 1843, in Clausthal in Hanover (later a part of Germany). The son of a mining engineer, he was the third child in a family of 13, of whom 11 survived to adulthood. His uncle, Eduard Biewend, would leave a tremendous impact on the young Koch, encouraging an interest in nature, insect collection, and most of all, introducing him to the nascent field of photography. Koch’s enduring interest in photography would become greatly enhanced with his bacteriologic research in later life. Koch was a bright youngster and could read by age 5. He studied medicine at Gottingen University, graduating in 1866. As a student, he was influenced profoundly by Jacob Henle, who was a proponent of contagium animatum,

Richard Bright—Physician Extraordinaire

Richard Bright. Illustration by Venita Jay, MD, FRCPC. T their favorite teacher, Richard Bright, the students at Guy’s Hospital offered not only their deepest respect but also their affection. One of the great men of Guy’s, Bright’s medical contributions were far reaching and his love for medicine and pathology all consuming. He is rightfully regarded as one of the founding fathers of nephrology, with his name immortalized in the eponym Bright’s disease. There were other facets to this handsome scholar of medicine; Bright was also an accomplished artist, naturalist, linguist, geologist, traveler, and botanist. It has been said, ‘‘He wrote as no man had ever written before and as all who followed him were to attempt to write.’’ Bright’s extraordinary gift of observation was complemented by his detailed and exquisite illustrations. Born in Bristol, England, in 1789, Bright came from a wealthy intellectual family, which afforded him an excellent education and enabled him to travel. As a youth, he attended private school and later went to Edinburgh University. While at Edinburgh, Bright learned that the famous geologist Sir George Steuart Mackenzie was planning an expedition to Iceland. Bright and his friend Henry Holland accompanied Sir Mackenzie on this mission to study the volcanic geology of Iceland. When Mackenzie’s book, Travels in Iceland in the Summer of 1810, was published, it contained Bright’s sketches of the local flora and fauna, as well as shepherds and fishermen. As evidenced by his sketches, Bright’s remarkable skills of observation and artistic talent were fully utilized on this trip. The sojourn to Iceland profoundly affected the young Bright, who nearly lost his life on a couple of occasions during stormy moments, including a narrow escape from shipwreck. After his Icelandic adventure, Bright embarked on his medical studies at Guy’s Hospital in October 1810. He was profoundly affected by William Babington, who taught chemistry to medical students. Bright got his training at Guy’s and in Edinburgh and graduated in 1813 with a thesis on Erysipelas, in which he stressed the contagious nature of this disease. After graduation, Bright was off again on another excursion in 1814. This took him through Holland, Belgium,

The legacy of Karl Rokitansky.

Karl Rokitansky. Illustration by Venita Jay, MD, FRCPC. B the middle of the 19th century, Vienna flourished as a European center of excellence in medical teaching. This fame is attributable to the New Vienna School, one of the founders of which was the eminent pathologist, Karl Rokitansky. At the Institute of Pathological Anatomy, the coming of Rokitansky marked the beginning of a new era in the history of pathology. Karl Rokitansky (1804–1878) was born in Konigsgratz, Bohemia. He studied medicine in Prague and Vienna, graduating in 1828. Shortly thereafter, he became an assistant in Pathological Anatomy to Wagner at the Vienna School. As a student, Rokitansky was profoundly influenced by the French school of medicine and by the concepts of comparative anatomy and embryology put forth by Johann Friedrich Meckel. Rokitansky became professor of pathological anatomy at the Vienna School and remained there until 4 years prior to his death. Rokitansky was an astute observer who recorded all he saw with admirable clarity and thoroughness. Stressing what the naked eye could see helped him lay the foundations of pathological anatomy, following the initiatives of the preeminent anatomist, Giovanni Morgagni. It was not enough to simply get a good anatomical exposition; Rokitansky stressed the importance of correlating symptomatology and disease with anatomical appearances. At the completion of a postmortem examination, he worked backward to determine what could have led to the observed pathology. His writings were masterful and won him praise for their clarity and vitality. At the Pathology Institute of the Allgemeines Krankenhaus, a new hospital regulation had increased the availability of bodies for postmortem examination. It is believed that Rokitansky probably had access to between 1500 and 1800 cadavers annually. Great diagnosticians like Skoda performed their studies on living patients and later checked their observations with gross findings in Rokitansky’s postmortem room. By the time Rokitansky retired, after having spent an active career in Vienna, he had performed more than 30 000 postmortem examinations and had several thousands more available for his review. Rokitansky’s record of scientific publications was astounding. His Handbuch der pathologischen Anatomie, published

Pierre Paul Broca

Pierre Paul Broca. Illustration by Venita Jay, MD, FRCPC. T 19th century French surgeon Pierre Paul Broca left an indelible mark in medicine with his observations on aphasia, language dominance, and cerebral localization. Broca is also remembered for his contributions to anthropology, which include valuable studies of human skulls and the founding of the Societe d’Anthropologie. Broca (1824–1880) was born at Sainte-Foy-la-Grande near Bordeaux, France, on July 28, 1824. He was educated in Bordeaux and Paris, and received his medical degree in 1848. Broca’s remarkable career would revolve around 2 lasting interests—medicine and anthropology. He excelled in both, as a professor of surgery at the Bicetre in Paris and as a noted anthropologist dealing with a plethora of subjects, including the Cro-Magnon man and Neolithic trephination. Broca also founded the world’s first anthropological society and his own school and institute of anthropology. The first cortical localization that became widely accepted linked fluent, articulate speech to the frontal lobes. Cortical localization of speech was a much-debated issue in the early and mid-19th century, and many scientists had presented data for and against this theory before Broca’s epoch presentation in 1861. In the early part of the 19th century, Franz Joseph Gall addressed the issue of localization of speech to a specific area of the brain. Gall placed the faculty of memory of words in the frontal lobes, based primarily on his observation of skull shape. Jean Baptiste Bouillaud also believed in the localization of speech to the frontal region. In 1836, Marc Dax suggested that speech disturbances were due to lesions of the left hemisphere, but his hypothesis remained unknown for 30 years until his son, Gustave Dax, presented his father’s work in 1863 and published it in 1865. Broca’s concepts on speech localization were initially based on the study of a single patient, Monsieur Leborgne, who was affected by epilepsy and who had lost the ability to speak. Leborgne was able to comprehend and communicate by gestures, but his speech was limited to the monosyllable ‘‘tan,’’ and he thus came to be nicknamed ‘‘Tan.’’ Tan also had right hemiparesis. On April 11, 1861, Tan was admitted to Broca’s surgical service for cellulitis of the right leg. He was examined also by Ernest Auburtin,

Baron Guillaume Dupuytren.

Guillaume Dupuytren. Illustration by Venita Jay, MD, FRCPC. R from grinding poverty and struggles in early life to become France’s leading surgeon and millionaire, Baron Guillaume Dupuytren (1777–1835) remains one of the most enigmatic figures in surgical history. Although he was not liked by many of his contemporaries, even his bitter adversaries acknowledged that Dupuytren was the ablest surgeon of his time in France. His name remains eponymous with the Dupuytren contracture, yet the medical contributions of this great surgeon were indeed farreaching. With a solid foundation in anatomy and pathology, Dupuytren was the outstanding surgical innovator of his day in Europe, the latter part of his working life becoming known as ‘‘the age of Dupuytren.’’ Dupuytren lived during a period of tremendous upheaval in France. At the time of his birth, Louis XVI was still in power, and as a youth, Dupuytren would witness a radical political upheaval in the coming of the French Revolution. Dupuytren was born to an advocate of limited means in Pierre-Buffiere, near Limoges in central France. Stimulated by the tumultuous times brought on by the French Revolution, Dupuytren was seriously contemplating a military career. However, there were other surgeons in the family, and Dupuytren bowed to his father’s wishes that he too pursue a career in surgery. Dupuytren started his medical training in Limoges and later went to Paris. His early struggles in Paris as a medical student left an indelible mark on his character. Dupuytren’s inner strength, determination, and industry carried him through these years of extreme poverty and struggle. It has even been said that he had to use cadaveric fat to make oil for his study lamp. Being a young man of great determination, Dupuytren persisted in his efforts and became prosector of anatomy in charge of autopsies at the Hotel Dieu in 1795. In 1801, he was appointed chief of anatomic studies. This opportunity furthered his interest in pathology and physiology. Within the first year, his group of prosectors had completed summaries on more than 1000 autopsies, carefully documenting every congenital and acquired lesion and cataloging the abnormalities. So competent was Dupuytren in his teaching that he started his own course in pathological anatomy, with Gaspard Bayle and Rene Laennec

The sign of Babinski.

Dr Joseph Babinski. Illustration by Venita Jay, MD, FRCPC. F every student of medicine, the name Babinski immediately invokes the image of an upgoing toe. But the contributions of Joseph Francois Felix Babinski to neurology and neurosurgery were indeed more far-reaching—his legacy marked an exemplary chapter in Parisian medicine. Babinski was Jean Martin Charcot’s favorite pupil. While the turbulent political scene of the mid-19th century did not affect Charcot, who was busy establishing the world’s leading center of neurology in Paris, Babinski’s parents were violently uprooted from their native Poland when an uprising against the Russian domination failed. Babinski’s parents eventually settled in Paris, where they had 2 sons, Henri and Joseph. The brothers would remain inseparable to the end. Joseph Babinski (1857–1932) was brought up in modest circumstances in Paris. He studied medicine and graduated from the University of Paris in 1885. Prior to graduation, he was appointed an intern at the Hopitaux de Paris in 1879. Working under the famous neurologist Edme Vulpian aroused Babinski’s interest in neurology. He served as chef de clinique to Charcot at the Salpetriere. Babinski obtained his doctorate with a meticulous thesis on the topography of lesions and their correlation with symptomatology in multiple sclerosis. When Babinski appeared for the highly competitive examination of Professeur agrege, he was not deemed successful due to an unfortunate and regrettable estrangement between Charles Bouchard, who conducted the examinations, and Charcot. Bouchard passed one of his own students and eliminated Babinski, who was Charcot’s pupil. Thus Babinski, who was viewed by many as Charcot’s successor, could not take up an academic appointment at the university. Instead, he served as head of the neurological clinic of the Pitie hospital in Paris from 1890 to 1927. In one sense, being spared the burden of academia and hours of systematic teaching allowed Babinski to become one of Paris’ exemplary clinicians who could devote time to his 2 passions: clinical neurology and research. Before he devoted his life to neurology, Babinski excelled in general medicine. He made several noteworthy contributions in medicine, including work on typhoid fe-

Gregor Johann Mendel

Gregor Mendel. Illustration by Venita Jay, MD, FRCPC. O August 6, 1847, Gregor Johann Mendel was ordained as a priest in Brunn, Moravia. Luckily for medicine, Mendel’s personality and psychosomatic disposition rendered him unsuitable for practical pastoral duties. It was 18 years later that the results of his famous experiments with the garden pea were presented to the Brunn Natural History Society. In the following year, the landmark work, ‘‘Experiments on Plant Hybrids,’’ was published. Even the enigmatic Mendel, who elucidated the fundamental principles of genetics, was perhaps unaware of the monumental nature of his work. Upon his death in 1884, no one had yet recognized him as the founder of a new and powerful science; the belated discovery of this cloistered monk would come years later. Born Johann Mendel in July 1822, in Heizendorf, Silesia (then in Austria), Mendel hailed from a humble family of peasants devoted to farming and gardening. Johann Schreiber, a priest from a Moravian parish, recognized the immense talent in the young Mendel and encouraged the family, which was under dire financial circumstances, to send Mendel for higher education. Schreiber was an expert fruit grower with a special interest in natural history and would have a lasting influence on Mendel. It was with all of Mendel’s strength and endurance and the support of his family that he was able to complete his 2-year course of philosophical studies. When Mendel’s father died, the financial hardship facing his family became more severe. Mendel tried private tutoring, but with his perpetual struggle to make ends meet, he could see no satisfactory worldly existence compatible with his intellectual ideals. He thus turned to theology as a vocational choice, and joined the Augustinian Monastery in Brno (Brunn) in 1843. At the time, Brunn was a thriving cultural center in Moravia. The abbot of this monastery, Franz Cyrill Napp, was an enigmatic figure. An ardent linguist proficient in ancient Oriental languages, Napp had many other passions, including horticulture, viniculture, and fruit growing. Many exotic plants were grown in Napp’s monastery. It was in this monastery that the young Mendel stepped in, taking the name Gregor. There was intense interest in animal and plant breeding