Moses Maimonides

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Moses Maimonides

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Michael E. DeBakey (1908–2008)

Michael E. DeBakey, Surgeon, Scientist, Innovator, and Administrator (1908–2008)

Hines, George L. MD

Author Information

Division of Vascular Surgery, NYU Winthrop Hospital, Mineola, New York

The author has no conflicts of interest to report.

I was recently giving a talk to third-year medical students about aortic dissections. During this talk, I discussed the contribution of Dr. Michael DeBakey to the field of aortic dissection. I assumed that every medical student would know about him, probably the preeminent cardiovascular surgeon of the 20th century. I was stunned when none of the students had even heard of Dr. DeBakey.

I think it is important to be aware of the contributions of our predecessors, and no one has made a greater contribution than Dr. DeBakey. My disclosure in this review is that I never personally worked with him, but one of my closest associates spent 2 years as a fellow at Baylor and maintained a lifelong friendship with his mentor. The only time I personally saw Dr. DeBakey was when he was in his early 90s and he was giving a talk at the New York Academy of Medicine. He took the steps to the podium 2 at a time in his cowboy boots and gave a 45-minute talk that was probably one of the most articulate lectures I ever heard.

Michael DeBakey was born in Lake Charles, Louisiana, in 1908. His parents were Lebanese immigrants who apparently instilled in their son the concepts of hard work and a desire to excel. He attended college and medical school at Tulane. He began a surgical residency at Charity Hospital in New Orleans. While there, he met 2 surgeons who greatly influenced his later professional life: Dr. Rudolph Matas, who had developed endoaneurysmorrhaphy for the treatment of abdominal aortic aneurysm, and Dr. Alton Ochsner. Both of these doctors were surgical greats of their era. While a resident, Dr. DeBakey did research involving many general surgical issues including peptic ulcer disease and subphrenic abscess. He also developed a roller pump to aid in blood transfusions. This roller pump concept was later to become an integral part of the heart-lung machine.1/.../

René Théophile Hyacinthe Laënnec (1781-1826)

René Laënnec

FRENCH PHYSICIAN

WRITTEN BY: 

• Kara Rogers
• Ariel Roguin

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René Laennec

French physician

Alternative Title: René-Théophile-Hyacinthe Laënnec

René Laënnec, in full René-Théophile-Hyacinthe Laënnec, (born February 17, 1781, Quimper, Brittany, France—died August 13, 1826, Kerlouanec), French physician who invented the stethoscopeand perfected the art of auditory examination of the chest cavity.

When Laënnec was five years old, his mother, Michelle Félicité Guesdon, died from tuberculosis, leaving Laënnec and his brother, Michaud, in the incompetent care of their father, Théophile-Marie Laënnec, who worked as a civil servant and had a reputation for reckless spending. In 1793, during the French Revolution, Laënnec went to live with his uncle, Guillaume-François Laënnec, in the port city of Nantes, located in the Pays de la Loire region of western France. Laënnec’s uncle was the dean of medicine at the University of Nantes. Although the region was in the midst of counterrevolutionary revolts, the young Laënnec settled into his academic training and, under his uncle’s direction, began his medical studies. His first experience working in a hospital setting was at the Hôtel-Dieu of Nantes, where he learned to apply surgical dressings and to care for patients. In 1800 Laënnec went to Paris and entered the École Pratique, studying anatomy and dissection in the laboratory of surgeon and pathologist Guillaume Dupuytren. Dupuytren was a bright and ambitious academic who became known for his many surgical accomplishments and for his work in alleviating permanent tissuecontracture in the palm, a condition later named Dupuytren contracture. While Dupuytren undoubtedly influenced Laënnec’s studies, Laënnec also received instruction from other well-known French anatomists and physicians, including Gaspard Laurent Bayle, who studied tuberculosis and cancer; Marie-François-Xavier Bichat, who helped establish histology, the study of tissues; and Jean-Nicolas Corvisart des Marets, who used chest percussion to assess heart function and who served as personal physician to Napoleon I.

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Laënnec’s original stethoscope design consisted of a hollow tube of wood that was 3.5 cm (1.4 inches) in diameter and 25 cm (10 inches) long and was monoaural, transmitting sound to one ear. It could be easily disassembled and reassembled, and it used a special plug to facilitate the transmission of sounds from the patient’s heart and lungs. His instrument replaced the practice of immediate auscultation, in which the physician laid his ear on the chest of the patient to listen to chest sounds. The awkwardness that this method created in the case of women patients compelled Laënnec to find a better way to listen to the chest. His wooden monoaural stethoscope was replaced by models using rubber tubing at the end of the 19th century. Other advancements include the development of binaural stethoscopes, capable of transmitting sounds to both ears of the physician.

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In 1819 Laënnec published De l’auscultation médiate (“On Mediate Auscultation”), the first discourse on a variety of heart and lung sounds heard through the stethoscope. The first English translation of De l’auscultation médiate was published in London in 1821. Laënnec’s treatise aroused intense interest, and physicians from throughout Europe came to Paris to learn about Laënnec’s diagnostic tool. He became an internationally renowned lecturer. 

Julian Tudor Hart (March 9, 1927 - July 1, 2018)

Julian Tudor Hart

Geoff Watts

Published: 28 July 2018

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DOI: https://doi.org/10.1016/S0140-6736(18)31660-X

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Radical general practitioner. He was born in London, UK, on March 9, 1927, and died from complications of a bowel perforation in Swansea, UK, on July 1, 2018, aged 91 years.

A visionary general practitioner (GP) who spent his career practising what he preached, Julian Tudor Hart is best known as the author of the inverse care law: “The availability of good medical care tends to vary inversely with the need for it in the population served.” Like Karl Marx, his guiding inspiration, Tudor Hart believed that it was not enough to interpret the world in various ways; the point was to change it. That his law was intended as more than a neutral observation becomes clear when you read the less quoted sentences that follow it in his celebrated 1971 Lancet paper. The law, he wrote, “operates more completely where medical care is most exposed to market forces, and less so where such exposure in reduced. The market distribution of medical care is a primitive and historically outdated social form.”

Tudor Hart's urge to change the world found expression in his professional life. “He was the first GP to measure the blood pressure of all his patients”, says Professor Graham Watt, Honorary Senior Research Fellow in Glasgow University's Institute of Health & Wellbeing. “At the time, hypertension was often thought of as a condition that had to be managed by hospital specialists”, adds Sir Andy Haines, Professor of Environmental Change and Public Health at the London School of Hygiene & Tropical Medicine. “Julian was a major force in ensuring that it became embedded in primary care.” His endeavours paid off. “When in 1990 he published the results of 25 years of what he'd been doing compared to a neighbouring practice”, says Watt, “he showed that mortality was down by about 30%”. This, Watt believes, was attributable to a number of interventions besides blood pressure measurements. “The main thing, I think, was that he was providing unconditional personalised continuity of care for all his patients”, says Watt. Tudor Hart was above all a committed family doctor.

Tudor Hart studied medicine at St George's Hospital Medical School in London, UK, qualifying in 1952 and spending 5 years as a GP in an impoverished area of west London. “[The epidemiologist] Richard Doll, who was a patient of Julian's…suggested that his personality, which was described as being somewhat obsessional, might be suited to research”, explains Watt. Tudor Hart left general practice to study epidemiology with Doll, then joined Archie Cochrane to work on pneumoconiosis at the Medical Research Council (MRC) Epidemiology Unit in Llandough, Wales. In 1961, dissatisfied with diagnosing illness but not treating it, Tudor Hart joined a general practice in the south Wales coal mining village of Glyncorrwg. With the support of the MRC, and the indispensable help of his wife Mary, a researcher, he transformed it into a research practice. “By going to the back of beyond he was able to develop in microcosm a lot of ideas, and had the freedom to do it”, says Watt who, like Haines, spent a period as one of Tudor Hart's research fellows. The understanding in the practice was that in return for a level of medical care unlikely to be matched elsewhere, the patients would constitute a group of research participants. As Watt comments, although it was mutually beneficial, a modern research ethics committee might criticise this relationship.

Haines describes Tudor Hart as one of the great thinkers about health care and an inspiration, even to those who didn't share his politics: “He spoke to a wider group of people…because he was able to talk so cogently about the importance of social justice. He was a powerful advocate of a more equitable health system.” Tudor Hart was often outspoken. “He was not afraid of tackling powerful interests”, Haines adds. He was critical of many in his profession—and of himself. “He's the only person I know who's published a series of 500 case reports of deaths in his own practice.”

Tudor Hart was embedded in his community. According to Watt, “Glyncorrwg was the kind of community Julian wanted to belong to, and the only way he could imagine belonging to it was as a doctor”. In this his career resembled that of his father Alexander, also a lifelong socialist and a GP in a Welsh colliery village. His mother Alison Macbeth was also a doctor. Besides his wife Mary, Tudor Hart leaves their children Robin, Rachel, and Ben, also a GP, as well as Penny and Alison, daughters from his first marriage to Joyce. “Julian believed in science”, says Watt. “He had incredible mental energy and he wasn't just producing evidence, but using it to inform his practice.”

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Slide de uma aula inaugural do Curso de PG Epidemiologia que dei em 2007

Dr. Julian Tudo Hart, General Practitioner de Gales, hoje aposentado (agora falecido), autor do primeiro estudo epidemiológico sobre pressão arterial numa comunidade inteira, a população que tinha sob sua guarda, e não somente HA mas diversas outras variáveis que ele anotava com muito cuidado em seu dia a dia. Ele também é responsável pela lei inversa da assistência ao observar que aqueles que mais necessitam, recebem pior qualidade de assistência.

Conversando com ele em Bogotá, no início dos anos 80 ele me falou de uma hipótese que já vi formulada posteriormente: “a hipertensão é uma resposta daqueles que têm equipamento para tanto, à uma depressão larvada”. Isto coincide com a constatação de uma depressão generalizada no mundo dito civilizado, coincidente com a transição demográfica – urbana – industrial – capitalista - consumista.

Uma das bases para esta teoria está nos mediadores químicos envolvidos na sua fisiopatogenia que são os mesmos envolvidos com estresse, com cocaína e outras drogas, com tabagismo, e com violência.
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Student BMJ‏Verified account @StudentBMJ

"Although the #NHS helped to counteract the inverse care law, it did not abolish it." @MichaelMarmot on the continued relevance of the inverse care law https://www.bmj.com/content/362/bmj.k3216 …

9:12 AM - 31 Jul 2018