Riva Rocci

The cuff sphygmomanometer was invented by Italian physician Scipione Riva-Rocci in 1896. (Scipione Riva-Rocci (7 August 1863 — 15 March 1937) was an Italian internist and pediatrician who was a native of Almese. He earned his medical degree in 1888 from the University of Turin, and from 1900 until 1928 was director of the hospital in Varese.)This simple device caught the eye of US surgeon Harvey Cushing, who believed he could use it in the measurement of BP, which would be useful in his ongoing studies of cerebral perfusion. Cushing introduced this instrument at Johns Hopkins Hospital. Early supporters of this new method of BP measurements were Theodore Janeway in New York City and George Crile in Cleveland, OH. After only 2 years of experience on the wards of Johns Hopkins Hospital, Cushing and his surgical house officers set out to promote wider use of the cuff. This was the foundation for the use of BP measurements in epidemiologic studies and for controlled clinical trails of antihypertensive agents, which have so dramatically reduced the socioeconomic impact of heart attack and stroke in the last 25 years. Contrast the history of spirometry with that of the development and widespread application of the sphygmomanometer, invented 50 years after the spirometer.

John Hutchinson’s Mysterious Machine

John Hutchinson, a surgeon, recognized that the volume of air that can be exhaled from fully inflated lungs is a powerful indicator of longevity. He invented the spirometer to measure what he called the vital capacity, ie, the capacity to live. Much later, the concept of the timed vital capacity, which became known as the FEV1, was added. Together, these two numbers, vital capacity and FEV1, are useful in identifying patients at risk of many diseases, including COPD, lung cancer, heart attack, stroke, and all-cause mortality. This article cites some of the rich history of the development of spirometry, and explores some of the barriers to the widespread application of simple spirometry in the offices of primary care physicians.

John Hutchinson, a surgeon, invented a calibrated bell, inverted in water, in order to be able to capture and measure the volume of exhaled air from fully inflated lungs. He coined the term vital capacity, ie, the capacity for life, because he realized that compromise of this crucial measurement was predictive of premature mortality. His exacting observations taught him that in normal subjects, the vital capacity was directly related to the height, and inversely related to the age of the individual. Weight had only a minor effect on the vital capacity, but he observed that vital capacity became mildly reduced following a large meal.1 In his first article published in 1846, he reported on measurement of 2,130 individuals, including deceased patients .Hutchinson would go to the morgue immediately following death, insert into the trachea the equivalent of an endotracheal tube with a stopcock, and inflate the corpse with a bellows until no more air could enter. He then released the flow of air into his spirometer by opening the stopcock. The lungs and thorax emptied through elastic recoil. Of course, this was not the full FVC, but something very close to it. The lungs emptied to their minimum volume, a function of the residual volume. In this era, tuberculosis was rampant in Europe. Hutchinson recognized that fibrotic complications from tuberculosis resulted in a reduced vital capacity and early death. Similar observations were made in heart failure and in coal miners.2

Hutchinson was a handsome young man . He had a keen ear for music and became a master violinist. Hutchinson became a consultant to the insurance industry of London. He believed that the vital capacity should be used in actuarial predictions for persons selling life insurance. Hutchinson’s invention was initially acclaimed:
…we have no hesitation in recording our deliberate opinion, that it forms one of the most valuable contributions to physiologic science that we have met with for some time. In all future investigations into the phenomena of the respiratory process, the name of Mr. Hutchinson must receive honorable notice.2

Hutchinson’s instrument was not widely accepted in London, or anywhere else, and still remains absent from most physicians’ offices and clinics. This may be one of the reasons why John Hutchinson was frustrated when he left his wife and three children and emigrated to Melbourne, Australia at 41 years of age.

He may have been in search of gold, since a gold strike had just been made in Australia. Another speculation is that he had tuberculosis and sought the cure of a prolonged ocean voyage with abundance of fresh air and sunshine, which was a common method of seeking the cure for tuberculosis in that era.2 Other speculations over alcohol abuse were made.2 After he reached Australia, he abandoned all further use of his spirometer. Toward the end of his life he moved to Fiji, where he died at 50 years of age, probably a victim of murder.2 His autopsy showed no signs of tuberculosis, nor did it explain his demise.5 No evidence of liver disease was found at autopsy.2

A statue was erected to the memory of John Hutchinson by the Thoracic Society of Australia and the British Thoracic Association in 1990 . It can be viewed by visitors to Fiji.

For details read the full article John Hutchinson’s Mysterious Machine Revisited*
Thomas L. Petty, MD, Master FCCP in the CHEST Journal
http://chestjournal.chestpubs.org/content/121/5_suppl/219S.full
CHEST May 2002 vol. 121 no. 5 suppl 219S-223S

Mitral valve

Mitre is the liturgical headdress and part of the insignia of a Christian bishop. In the Western church it is a tall pointed hat with peaks in front and back, worn at all solemn functions

The mitral valve is named so because of its similarity in shape to the mitre. Andreas Vesalius, the father of anatomy, noted the striking similarity between the two while performing anatomic dissections in the sixteenth century.

The bishop in the board game chess is represented by a stylized Western mitre.

Flexner Report

The 1910 report that revolutionized medical education and established current system of education.

The Flexner Report is a book-length study of medical education in the United States and Canada, written by the professional educator Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath.

The Report (also called Carnegie Foundation Bulletin Number Four) called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to the protocols of mainstream science in their teaching and research. Many American medical schools fell short of the standard advocated in the Report, and subsequent to its publication, nearly half of such schools merged or were closed outright. The Report also concluded that there were too many medical schools in the USA, and that too many doctors were being trained. A repercussion of the Flexner Report resulting from the closure or consolidation of university training, was reversion of American universities to male-only admittance programs to accommodate a smaller admission pool. Universities had begun opening and expanding female admissions as part of women's and co-educational facilities only in the mid-to-latter part of the 19th century with the founding of co-educational Oberlin College in 1833 and private colleges such as Vassar College and Pembroke College.

William Chester Minor

William Chester Minor, also known as W. C. Minors was an American surgeon who made many scholarly contributions to the Oxford English Dictionary while confined to a lunatic asylum.

William Chester Minor ( June 1834 - March 26 1920) was born on the island of Ceylon, the son of Congregationalist Church missionaries from New England. He is known to have been fascinated as a teenager by the young Ceylonese girls and to have had lascivious thoughts which plagued his conscience. At 14 he was sent back to the United States by steamship, finishing his education as a surgeon at Yale in New Haven, Connecticut in 1863.
He was accepted by the Union Army as a surgeon and saw service at the Battle of the Wilderness in May, 1864. This was a battle that was notable for the horrible casualties suffered. He was ordered as a surgeon to brand an Irish deserter, a member of the Fenian Brotherhood, on the face. Paranoid delusions about the Fenians, Irish revolutionaries, were part of his later madness.

After the end of the American Civil War Minor saw duty in New York City. He was strongly attracted to the fleshpots of the city and devoted much of his off-duty time spending time with prostitutes. By 1867, his bizarre behavior had come to the attention of the Army and he was transferred to a remote post in the Florida Panhandle. By 1868 his disease had progressed to the point that he was admitted to St. Elizabeth's Hospital, a lunatic asylum in Washington, DC. After eighteen months he showed no improvement. He was allowed to resign his commission and take retirement pay.

In 1871 he went to London, England settling in the slum of Lambeth where once again he took up a dissolute life. Haunted by his paranoia he shot a man he believed had broken into his room. He was judged innocent by reason of insanity and incarcerated in the aslyum at Broadmoor in the village of Crowthorne, Berkshire. As he had his army pension and was not judged dangerous, he was given rather nice quarters and was able to buy and read books.

It was probably through his correspondence with the London booksellers that he heard of the call for volunteers from what was to become the Oxford English Dictionary. He devoted the remainder of his life to that work.

He was one of the most effective of the volunteers, systematically reading through his library, and compiling lists of the occurrence of words. He kept current with the words needed in the volume currently being worked on, and as his lists grew was able to supply quotations on demand for a particular word. Eventually he became well acquainted with the editor of the OED, Dr. James Murray, who visited him at the asylum and befriended him. In time Minor's condition grew worse; his health failed and he was permitted to return to the United States and St. Elizabeth's. Psychiatry had progressed in the meantime and Dr. Minor was diagnosed as suffering from dementia praecox or schizophrenia. He died in 1920 in New Haven, Connecticut.

The 2009 Nobel Prize in Physiology or Medicine

<

Uvea

The uvea is the middle portion of the eye. The term derives from the Latin word for grape, since anatomists once thought that the peeling of the outside of the eye left a grape-like structure beneath