Who was James Lind, and what exactly did he achieve

Lessons for Cardiovascular Clinical Investigators: The Tumultuous 2,500-Year Journey of Physicians Who Ignited Our Fire

Whereas medical practice stems from Hippocrates, cardiovascular science originates with Aristotle. The Hippocratic philosophy was championed by Galen (129-216 CE), whose advocacy of a tripartite soul found favor in the early Christian Church. In contrast, Aristotle's works were banned as heresy by ecclesiastical authority, only to survive and prosper in the Islamic Golden Age (775-1258 CE). Galen theorized that the circulation consisted of separate venous and arterial systems. Blood was produced in the liver and traveled centrifugally through veins. When arriving in the right ventricle, venous blood passed through tiny pores in the ventricular septum into the left ventricle, where it became aerated by air passing from the lungs through the pulmonary veins to the left side of the heart. Following arrival at distal sites, arterial blood disappeared, being consumed by the tissues, requiring that the liver needed to continually synthesize new blood. The heart was viewed as a sucking organ, and the peripheral pulse was deemed to result from changes in arterial tone, rather than cardiac systole. Galen's framework remained undisputed and dominated medical thought for 1,300 years, but the reintroduction of Aristotelian principles from the Islamic world into Europe (through the efforts of the Toledo School of Translators) were nurtured by the academic freedom and iconoclastic environment uniquely cultivated at the University of Padua, made possible by Venetian rebellion against papal authority. At Padua, the work of Andreas Vesalius, Realdo Colombo, Hieronymus Fabricius ab Acquapendente, and William Harvey (1543-1628) methodically destroyed Galen's model, leading to the modern concept of a closed-ended circulation. Yet, due to political forces, Harvey was ridiculed, as was James Lind, who performed the first prospective controlled trial, involving citrus fruits for scurvy (1747); it took nearly 50 years for his work to be accepted. Even the work of William Withering (1785), the father of cardiovascular pharmacology, was tarnished by professional jealously and the marketing campaign of a pharmaceutical company. Today's cardiovascular investigators should understand that major advances are routinely derided by the medical establishment for political or personal reasons; and it may take decades or centuries for important work to be accepted.

Bitesize Epidemiology for General Awareness of All Students - I

This is the first part of a two-part series article. Recently, we have been in the middle of a difficult time due to the Covid-19 pandemic. Pandemics or global epidemics are not new to humankind; they have occurred many times in history. The discourse of epidemiology describes mainly the causal factors which need to be mitigated to prevent or combat the effects of epidemics. In epidemiology, we are not concerned for a person, but rather every individual globally, to make life healthier for all. In this article, we will discuss the basics of epidemiological practice that scientists have used for centuries to prevent epidemics with great results. Overall, we plan for better global health aided by epidemiology.

Nutritional deficiency presenting as acute pain, fatigue and bruising in a college health clinic

A previously healthy university student presents to Health Services with sudden onset of pain, fatigue, bruising, and a rapidly progressive anemia. There was not any previous significant health history. The case discussion will emphasize the critical overlap of physical and mental health assessments in identifying the cause and cure of a potentially life-threatening health crisis for a young adult student.

Science based public policies: Lessons from Covid19 on the use of randomized trials

The current SARS-CoV-2 pandemic gave rise to a spirit of methodological anarchy in some fronts of biomedical research, embraced by some under the excuses of urgency and time restraints. This movement, however, comes at the same time when social sciences begin to recognize the value and soundness of the clinical research rationale - the need for randomization, of fair comparisons between intervention groups, the humility of acknowledging ignorance and accepting uncertainty, these last two imperatives usually subsumed under the principle of “equipoise”.

The assessment of Perkins' patent metallic "tractors": Abandonment of an 18th-century therapeutic fad following trials using sham instruments

From 1799 to 1801, with the instigation of John Haygarth, physicians in England evaluated the claims of Elisha and Benjamin Perkins that their patented "metallic tractors" could cure a wide variety of disorders. Previous therapies were typically judged based on experience and authority, whereas Perkinism was evaluated using a series of clinical trials of varying methodological sophistication, most employing sham instruments (all but those involving infants or horses), with a variety of trial designs, inconsistent use of contemporary controls, and different approaches to blinding subjects to the treatment administered. Haygarth and his colleagues collectively demonstrated that tractors and sham instruments produced equivalent effects in adults, and, by inference, that the tractors had no special therapeutic properties. Other trials using only genuine tractors demonstrated no effects in infants and horses, subjects who could not reasonably be influenced by suggestion and the imagination. These collective results provided strong support for the rival hypothesis that the observed effects were due to suggestion and the imagination of the subjects. Despite fallacy-laden counterattacks and counterarguments from Benjamin Perkins and his supporters, the trials eroded support for this therapy and led to abandonment of the "Metallic Practice" as a treatment in Britain and elsewhere.

Five centuries of medical contributions from the Royal Navy

Royal Naval ships' companies, isolated by hundreds of miles of sea with contacts to the outside world tightly regulated, provided perfect environments to study the epidemiology of disease. In 1747, James Lind organised one of the earliest clinical trials, demonstrating that scurvy could be treated by lemon juice. A century later, Alexander Bryson proved the value of careful epidemiological data collection and observation of infectious diseases encountered on the West Africa station. In the 20th century, Royal Navy physicians were at the cutting edge of vaccine research and antibiotic production. Nuclear submarines placed naval physicians at the forefront of nuclear medicine and environmental safety. The development of new aircraft carriers has driven a renewed interest in aviation medicine. This article reviews the contributions that Royal Navy physicians have made to medicine over the centuries, detailing some of the better known as well as some almost forgotten, but still remarkable, achievements.

James Lancaster's prevention of scurvy

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