Carbolic Acid before Joseph Lister: Rail Ties, Sewage, Manure, and the Great Stink.

Before Joseph Lister's landmark Lancet publications on the use of carbolic acid wound dressings in 1867, surgeons Jules Lemaire in France and Enrico Bottini in Italy had already used carbolic acid on hundreds of patients to control suppurative wounds. After Friedlieb Runge isolated it from coal tar in 1834, a number of scientists recognized the efficacy of carbolic acid in preventing decay and neutralizing the stench of dead animals and human cadavers. Frederick Calvert, Alexander McDougall, and Angus Smith in Manchester promoted a powdered form of carbolic acid as a deodorizing agent to treat municipal sewage across the United Kingdom, most notably during London's famous "Great Stink" of 1858. Edmond Corne in France introduced his formulation, which Alfred-Armand-Louis-Marie Velpeau, Ferdinand LeBeuf, and Lemaire adapted for clinical use in 1859. Lemaire wrote extensively on carbolic acid and its surgical application in three publications from 1860 to 1862. In 1866, Bottini published his experience of 600 cases where it was used. In 1865, Lister began to use carbolic acid in open fractures after Thomas Anderson, his colleague in agricultural chemistry at the University of Glasgow, told him about its use in Carlisle sewage works. This article traces the rich history of carbolic acid from an unknown compound in coal to the cornerstone of Listerism in late-19th-century operating rooms.

The Clandestine Operations Performed on President Grover Cleveland and the Rationale for Surgical Secrecy.

The 1893 operations to remove a maxillofacial tumor from President Grover Cleveland aboard a private yacht remained a secret until long after his unrelated death from heart disease. Many historical studies have suggested that Cleveland kept his health and surgical care confidential because of the fragility of the economy during the Panic of 1893. Although that observation is true, it does not fully address the underlying reason for why the public would react poorly to news about an operation on the president. The death of Ulysses S. Grant eight years prior unearthed the denial, stigma, and fear of cancer felt by many Americans. Despite revolutionary 19th century advances in anesthesia, pathology, and surgery, the social history of "cancerphobia" ran deep.

The Rise of the Surgeon in the Seventeenth Century Virginia Colony.

Life in the early American colonies presented unique challenges to the British colonists. There was an acute need for health-care providers in the early Virginia colony at Jamestown. Many of the medical men who first arrived at Jamestown were surgeons who adapted themselves to fit the medical needs of the community. These men trained in the British system where they sat beneath physicians in a hierarchy that did not consider surgeons to be doctors. Through their service to the colonists, early surgeons earned the reputation traditionally given to physicians in Great Britain. The colonists in Virginia respected the surgeons and viewed them as doctors, which allowed surgeons to stand on equal ground with physicians as the colonies grew to eventually become the United States of America.

"Yes, I Shot the President, but His Physicians Killed Him." The Assassination of President James A. Garfield.

President James A. Garfield suffered two gunshots on July 2, 1881, but did not die until 80 days later of complications from sepsis. He might have survived had his injuries not been contaminated, either by the gunshots themselves or the interventions that followed. "Yes, I shot the president," said Charles Guiteau, Garfield's assassin, "but his physicians killed him." The drama of Garfield's struggle to survive his injuries evoked enormous national interest, a harbinger of the medical dramas and documentaries of today. D. Willard Bliss, a former Civil War surgeon, and his handpicked consultants underwent daily scrutiny by the professional community and lay press. As the President died because of his injuries, the surgeons' reputations suffered. A primary criticism was the supposed lack of antiseptic interventions in Garfield's care, especially when probing the wound with unwashed hands. Inserting a finger into the wound, however, was a basic part of examination of a gunshot wound at the time. Many American surgeons had not accepted Listerian antisepsis at the time of the event, and aseptic techniques, such as scrupulous handwashing and surgical gloves, had not yet been developed. In the context of surgical practice of the era, his surgeons followed the standards of care of the time.

Florida International University: development and accreditation of Miami's Public College of Medicine.

Anticipating pressing health care needs in the region, Florida International University (FIU) proposed the FIU College of Medicine (COM), which was approved by the Florida Board of Governors in March 2006. The FIU COM provides a program of study enabling graduates to pursue a wide spectrum of professional careers. This includes careers in general and subspecialty private practice, academic medicine, public service, health care, and public policy leadership. Irrespective of career choice, the special emphasis of the FIU COM mission is its focus on community health in a diverse metropolitan region. Clinical facilities are met through a public partner and multiple private hospital affiliations. Educational objectives are organized into five strands reflecting the breadth of medical education and running concurrently through the four-year curriculum: (1) human biology, (2) disease, illness, and injury, (3) clinical medicine, (4) professional development, and (5) medicine and society. Founding teaching faculty with expertise in the core basic sciences will not only introduce core scientific concepts during the initial seven months but reinforce these same concepts during organ system integrated courses and clerkships. The Neighborhood Health Education Learning Program is an FIU COM innovation in which each medical student is a member of a team that throughout the four-year curriculum identifies and addresses health care needs and factors affecting health outcomes. Preliminary approval of FIU COM was conferred in February 2008, with the first cohort of 40 students matriculating in August 2009.

Medical malpractice matters: medical record M & Ms.

Accurate and thorough chart documentation is extremely important not only for patient continuity of care but also for medical legal risk reduction. It is common knowledge that a large percentage of court cases involving health care practitioners rely substantially on the chart documentation to determine outcomes. In this article, the authors have outlined particular court cases that illustrate the dramatic influence medical documentation has had in case law.

From the flight deck to the operating room: an initial pilot study of the feasibility and potential impact of true interdisciplinary team training using high-fidelity simulation.

BACKGROUND: The operating room is a dynamic environment in which proper teamwork is essential. After piloting a simulation-based interdisciplinary operative team training program, we examined the impact of these sessions on the participants. METHODS: Three interdisciplinary operating room teams participated in the training model. Each team of 3 or 4 members completed the training in a virtual minimally invasive operating room using a standardized operative scenario. Upon completion of the training, participants completed a voluntary and anonymous training effectiveness questionnaire. RESULTS: All 10 participants completed the training evaluation questionnaires. Across the 3 teams, all participants felt that the training was worthwhile and would participate again. Eight participants said that the session would change their practices in the operating room. All participants felt that the session was effective in promoting team communication skills and crisis-related teamwork. Nine of the 10 felt that the training model was effective in recognizing operating room errors. CONCLUSIONS: Implementing true interdisciplinary team training with a high-fidelity simulation can be accomplished effectively. Team training has the potential for facilitating positive behavioral changes in operating room personnel that are important for adaptive team function in a crisis situation.

Gamma-guided diagnostic peritoneal lavage for detection of bowel perforation.

HYPOTHESIS: Bowel perforation can be diagnosed by detection of orally administered technetium Tc 99m sulfur colloid ((99m)Tc SC) in diagnostic peritoneal lavage (DPL) fluid using a handheld gamma-detection probe. DESIGN: A canine intestinal-injury model was used to test the hypothesis. The (99m)Tc SC (55.5 MBq) was administered in 500 mL of saline via a nasogastric tube. A DPL with 500 mL of saline was performed at 60, 90, and 120 minutes after administration of (99m)Tc SC. The radioactivity in the DPL effluent was measured using a handheld gamma probe. A DPL effluent count that was 3 SDs above the background count was considered a positive test result. Twenty animals with perforation and 5 without perforation (negative control) were studied. RESULTS: There were no false-positive gamma-DPL test results. Sensitivity improved by time up to 90 minutes. The lowest positive count in the DPL effluent measured by the gamma probe corresponded to 0.2% of the administered activity. No radioactivity was detected in blood and urine samples or liver and spleen specimens. The sensitivity, specificity, accuracy, positive predictive values, and negative predictive values at 90 minutes were 95%, 100%, 96%, 100%, and 83%, respectively. CONCLUSIONS: gamma-Guided DPL is a highly sensitive and 100% specific test in the detection of small-bowel perforation. Clinical studies are warranted to determine the patient-specific factors affecting diagnostic accuracy.