Second Session

Wednesday, October 5, 2011

“The Historical and Scientific Context: Emerging Treatment Innovations and Strategies”

Reading Assignment: Chapters 1-5

Objectives:

  1. Identify the historical developments of the 1870-1918 ear that advanced medical and scientific knowledge and education in the United States.
  2. Recount the life and impact of William H. Welch and the Johns Hopkins Medical Institutions on the advancement of medical and scientific knowledge in America.
  3. Explain why the time immediately before the 1918 Spanish flu pandemic might be characterized as the “progressive era” of American medical education and practice.
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20 Comments (+add yours?)

  1. sarah scarpace
    Sep 29, 2011 @ 17:46:52

    What do you think were the key milestones from 1800-1918 in American medical, nursing, and pharmacy education and practice that influenced the management of the Spanish flu pandemic from both the patient care and drug development perspectives?

    Reply

    • Thochaporn Tesasil
      Oct 02, 2011 @ 02:16:08

      While the discovery of the germ theory was significant, I believe that the advancement of training and education of physicians utilizing both scientific theory and evidenced-based professional training in the clinical setting with patients instead of just learning through autopsies was a key milestone in healthcare education and practice that would influence the management of the Spanish flu pandemic in America. The reform in U.S. Medical Education would form the basis not only for medical and scientific advances in health care, but create opportunities for the development of outstanding clinicians, leaders, and scientists and teachers of medicine and healthcare in America.
      Advances in medical education began when an increasing numbers of American doctors went to study in Europe, especially Germany, where the medical education was more scientifically based, and clinical and laboratory research were included as part of the curriculum and training for physicians. These physicians recognized that scientific knowledge and research with clinical practice were the building blocks and basis of medicine, and they returned to the U.S. and instituted changes in American Medical Education and Training based on the European standards. Noted physicians and scientists including Dr. William H. Welch, and William Flexner and his colleagues at the Rockefeller Foundation led the transformation of Medical and Public Health Training and Education in America (Barry, 2009). American physicians and scientists would now conduct laboratory research, and use the empirical processes to begin to work together to identify the epidemiology, disease pathology, and evidenced-based interventions needed to prevention and treatment the victims of the pandemic. These strategies would become significant in managing the pandemic.
      In nursing, in 1873, the first modern nursing school in the United States opened at Bellevue Hospital in New York City. Later, in 1889, the Johns Hopkins School of Nursing was established in consultation with Florence Nightingale and expected to be the national model for U.S. Nursing Education. Modern nursing would produce some outstanding nursing leaders, educators and clinicians and included Ms Jane A. Delano, chairperson of the American Red Cross Nursing Service, and Ms Lillian Wald, the founder of Visiting Nurses in New York City. Although the priority of care for the majority of patients needed during the great pandemic was basic nursing care focusing on hygiene, asepsis, and prevention of transmission of the virus, additional skills and leadership were critically needed to plan, access, acquire, and utilize limited resources to provide optimal care and required advanced practice and critical thinking skills. Trained nurses used the art and science of nursing to care for critically ill patients and their families in both hospital and home care settings. Additionally, US nurse scientists and nursing leaders utilized a nation-wide network to mobilize nurses and resources to respond to the patients’ and communities’ needs (Keeling, 2010). While there were major limitations and setbacks to managing this pandemic, there was some attempt to work collectively across the health professions to protect and manage this crisis in the U. S.

      Reply

  2. Sarah Botting
    Oct 01, 2011 @ 19:24:50

    America was lagging extraordinarily in the medical field compared to Europe during these times. Medical colleges had extremely low standards and the majority of their graduates would never perform an exam during their time in college. They simply listened to lectures and then learned on the job. In the 1820’s, there were calls for reform of the medical education system. “Not until 1901 did Harvard, followed soon by Penn and Columbia, join the Hopkins in requiring medical students to have a college degree (Page 82).”
    It was in 1876 that the Johns Hopkins University opened and its president wanted to create the “greatest medical school faculty in America, one to rival any in Europe (Page 44).” He did this by asking Dr. John Shaw Billings to participate in the endeavor. What he accomplished was not only a largely successful faculty list, he created one of the most important and influential contributions to medicine, a library. This library had over 80,000 volumes of literature in the first year and even today, it is known as the National Library of Medicine. This scientific library not only helped make Hopkins be as medicinally successful as it was, but it allowed scientists the access to necessary reference materials. These books and articles helped positively influence patient care and ultimately drug development. Without history of medical conditions and biological references, we would not be nearly as advanced in our society today, not to mention the minimal technology and understanding of biology, chemistry, anatomy, and physiology they had during the Spanish influenza pandemic. Reference materials for medical professionals, such as Welch, were imperative. He was constantly analyzing specimens via a microscope to figure out the deadly virus. This would not have been possible if other scientists had not shared their knowledge with others through journals, textbooks, and other primary literature.

    Reply

    • Emily Mozingo
      Oct 05, 2011 @ 16:33:22

      Sarah, I think that you discussed a very important point! I did not even consider the vital importance of establishing a library with credible, scientific sources. I think this certainly has amplified medicine as a whole and enhanced communication between health professionals. Clearly, the importance is still felt today-guidelines, therapy management, and successful research relies heavily on scientific studies which can be easily accessed.

      Reply

  3. Premjit Klaipetch
    Oct 03, 2011 @ 11:49:42

    After reading the text and articles related to the 1918 Influenza Pandemic, I was impressed with the courage, leadership and collaboration among health care providers in the United States to try to cope with this deadly pandemic crisis. Specifically, in terms of nursing I recognized the struggles that American nurses dealt with in regards to the crisis of limited and often insufficient or nonexistent resources available for caring for the ill both in hospitals and surrounding communities.
    In the hospitals, wards were full of flu patients and there was an extreme shortage of nurse. Nurses were reassigned, vacations of staff members canceled, and hours of duty extended. Student nurses were assigned full duties supervised by graduate nurses (Schoch-Spana, 2001). Since hospitals reached their maximum capacities in providing patient care, nurses and student nurses also worked in emergency hospitals established in tents, schools, and churches. In the communities, the Red Cross, in collaboration with the US Public Health Services, mobilized “Home Defense Nurses” and requested retired, private, student nurses and women with any type of remote nursing experience to report for duty. The Red Cross established emergency call and sent nurses to homes where entire families were ill with influenza and had no one care for them. Nurses provided reassurance and basic nursing practices to relieve the human suffering caused by the Spanish flu, and also educated families about personal hygiene and home sanitation (Robinson, 1990). In families where more than one member was ill or both parents were ill with the flu, nurses went into their rooms to assist and/or provide assistance with the laundry, cooking, feeding, and child care (Schoch-Spana, 2001). Motor services in cities and across the country were organized for the nurses so that they could travel from one needy area to another as well as transport food and supplies (Robinson, 1990).
    These strategies were an attempt to provide effective nursing leadership and preparation to deal with the National Health Crisis. The public health nursing infrastructure by the National Organization for Public Health Nurses (NOPHN) and the efforts of nurses in the hospital and The Red Cross Town and Country nurses (Keeling, 2010) had developed networks with other social agencies to attempt to deal with the crisis of the influenza pandemic in the USA in 1918, but did not realize the magnitude of the situation.
    References
    Keeling, A.W. (2010). “Alert to the necessities of the emergency”: U.S. nursing during the 1918 influenza pandemic. Public health reports, 125, 105 – 125.
    Robinson, K.R. (1990). The role of nursing in the influenza epidemic of 1918-1919. Nursing forum, 25 (2), 19 – 26.
    Schoch-Spana, M. (2001). “Hospital’s full-up”: The 1918 influenza pandemic. Public health reports, 116, 32-33.

    Reply

    • Sarah Botting
      Oct 05, 2011 @ 03:00:38

      You make good points. If you think about it, why would any person want to become a nurse or any other medical professional at this particular time in history? Do you think it seemed as much of a death sentence to them as the book made it out to be?

      Reply

      • Kristin Pesto
        Oct 05, 2011 @ 03:45:57

        In reply to Sarah’s questions. I was thinking about this tonight when I was rereading parts of the book. In particular, what sparked my thoughts on this was the section where Park and Williams were driving back to the lab from Upton in a “car filled with swabbings from mucosal membranes, sputum, and tissue samples of mysterious and lethal disease” (Barry, pg 274) I don’t know if faced with a mysterious widespread epidemic like this that I would have the courage to have contact with samples or let alone patients that were that sick. I believe that the healthcare professionals of that time were very courageous and selfless. I wouldn’t say it was definitely a death sentence, but I would say that they were taking a huge risk, especially when they were seeing their colleagues becoming ill around them.

      • Sarah DeRuosi
        Oct 05, 2011 @ 19:51:10

        In response to Sarah’s question about becoming a medical professional of the era, it truly does take an extreme amount of courage to tackle the extreme trouble from the influenza. Not only do I find courage as a word to describe these healthcare providers, but I would say these individuals were consistently being challenged with the uncontrollable symptoms from the ill patients. All the education and training that it took to become a nurse/physician of the time was being challenged at a whole new level. Just like many of us are taught – much of what you learn in your scope of practice is seen in real life settings/situations. Although this particular setting was one no one could predict, it causes the healthcare provider to become open-minded and experiment with various resolutions.

    • Brittany Fitzpatrick
      Oct 05, 2011 @ 21:08:33

      In response to Sarah D. I would agree with you it does take an extreme amount of courage to try to control such a quickly spreading disease. What kind of tactics do you think health care providers can take to try to remain control during such an outbreak?

      Reply

  4. Glenda B. Kelman PhD, ACNP-BC
    Oct 05, 2011 @ 03:19:07

    Sarah – You made a very interesting comment about choosing nursing or the medical profession at this particular time
    in history. If we consider the broader perspective this was the era where women were still a “silent voice” in many aspects including work force issues and as we all recall, were struggling to advocate for women’s rights and voting privileges.
    I think the author of the text describes very accurately and clearly the medical view of health care and the crisis of the influenza epidemic, but has not captured the full picture of the role and impact of nursing during this era. The comments in the text focused on the shortage of nurses or lack of nurses or use the phrase “we needed more nurses”. However, the role and presence of nursing has been developed in more detail in other references sources that we look forward to sharing in our last session.

    Reply

  5. Kristin Pesto
    Oct 05, 2011 @ 05:46:45

    In response to objectives #2 :
    When I read objective #2, a particular section from The Great Influenza came to mind. This passage seemed ironic to me since William Welch was “a man who had become arguably the single most influential scientist in the world,” (pg 36) yet Barry was describing him as “no great pioneer in his own field of medical research” and that he “did little work…to merit even membership in…the National Academy of Sciences.” I agree with the statement of him being one of the most influential scientists in the world. He had created an army of collegues and scientists through his position at Johns Hopkins and was able to exert power during the war to revolutionize American medicine. His “army” was focused on “ensuring that the best medical science be available to the military.” (Barry pg 136) This included preventing the spread of epidemic disease which was a bigger killer in war than combat wounds and probing into preventing the pneumonia suffered by those infected with measles. So although Welch may not have had a direct role in medical advances, he was a leader and brought together some of the brightest minds to advance American medicine.

    Reply

    • Brittany Fitzpatrick
      Oct 05, 2011 @ 12:27:23

      Kristin, you make some very interesting comments in regards to objective number 2. Being a great leader does not necessarily entail being the best or the brightest, but being someone who can motivate the masses. Welch did bring people together which initiated and sparked some amazing changes in American medicine. These changes lead to progress and moved us in the direction of where we are today.

      Reply

    • Emily Mozingo
      Oct 05, 2011 @ 16:44:29

      Kristin- I could not agree with you more. I found it to be a surprising that William Welch, a “Founding Father” in modern medicine, found little success in his own research. However it is important to remember what the qualities of an effective leader are; good leadership is defined as the “process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task” (http://en.wikipedia.org/wiki/Good_leader). By this definition, Welch was an effective and inspiring leader of his time. He introduced reform into the United States and it effectively spread throughout.

      Reply

    • Sarah Botting
      Oct 05, 2011 @ 20:42:19

      Kristin – Excellent point! I do not see science as just looking into a microscope at tissue samples. Science brings in every aspect of our daily lives. Welch was influential. He was not unworthy of his membership in the National Academy of Sciences.

      Reply

  6. Emily Mozingo
    Oct 05, 2011 @ 16:26:06

    I think that the most significant developments in medical and scientific knowledge were founded in the restructured medical programs with an emphasis on integrating research. Medical Doctors were expanding outside typical practice to include research; they were adopting the “scientist” role. Medical school now required prerequisites upon entrance and included two years of didactic education in basic sciences, two years of clinical training, and a minimum of 3 years of residency. This was an exciting time to be in the medical/scientific field; new information was flowing in. During this era, science was on the cusp of discovering and creating life altering/life saving vaccinations and anti serums. I think that much of this can be attributed to William H. Welch and the John Hopkins Medical Institutions. William Welch was the trailblazer for completely revitalizing medicine in the United States. Welch is responsible for integrating well established and successful practices in Europe into the United States. Welch succeeded in the reform of the Medical system; making this time a true “progressive era”.

    Reply

    • Sarah DeRuosi
      Oct 05, 2011 @ 21:06:16

      Emily, you make a very great point. The advancements in the medical programs towards a focus on research opened up a plethera of doors for medicine today. If you think about it, these scientific growths not only affected medical school programs, but it allowed for advancements in other healthcare professions such as nursing and pharmacy. The amount of patient contact, new medications, and discovery of new disease states has helped shape all scopes of practice. We are constantly challenged in every aspect of medicine, and the term “progressive era” fits perfectly…

      Reply

      • Dan Corwin
        Oct 25, 2011 @ 00:04:39

        I would also have to agree, and point out that programs were expanding to teach students more as well. Pharmacists had to be licensed and have a degree from a university after 1910. Also medical students were having more rigorous training with practical exercises and knowledge. Nursing also at this time was expanding and different programs were being initiated because of the war effort. The red cross was also helping to teach those nurses and give them practical knowledge.

  7. Suja Thomas
    Oct 05, 2011 @ 18:12:00

    1918 Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty -four weeks than AIDs has killed in twenty-four years ( Barry, 2009). It was described as the first great collision between nature and modern science. Even after World War I, medicine in US did not change. There was neither cure nor prevention that was scientifically based.The board of health instituted public campaign against coughing, sneezing, and spitting during the pandemic. Dr. Paul A. Lewis, director of the Phipps Institute of Philadelphia stated he had isolated the cause of the flu, Pfeiffer’s Bacillus which was reported as a discovery that armed the medical profession with the absolute knowledge on which to base its attack on the disease. They were wrong!
    Jacob Henle formulated the modern germ theory. In 1868 a Swiss investigator isolated deoxyribonucleic acid from a cell’s nucleus. The focus was on curing and preventing the illness and eventually medicine has discovered drugs- such as quinine, digitalis and opium- that provided benefits. In1870 even at Harvard a medical student could fail four of nine courses and still get an MD. In late 1870’s the plans for new John Hopkins Medical School was announced but opening was delayed until 1893 due to financial reasons. In 1876 John Hopkins had become a model for Modern American Research University. It was turning point in Medical Education in history. Abraham Flexner also contributed to the advancement of medical education
    With the increasing death toll and sick public, board of health closed all schools, churches, theaters, and saloons. All citizens were ordered to wear gauze masks in public. As the death toll mounted, a frantic public stripped medicines from pharmacy shelves. Students from Philadelphia College of Pharmacy and Temple University assisted in filling prescriptions. As medications disappeared, people turned to folk remedies.
    Every hospital in the city, were crowded with vehicles of every description bringing the sick, the dying, and, in most cases, the dead to the hospital. Many of the staff was sick because this was a disease of necessity (meaning care was provided for the symptoms, not the cure), the majority of work fell to nurses. Trained nurses were not enough; student nurse and lay volunteers were quickly utilized. People’s levels of anxiety, fear or phobia are high when faced with such a pandemic. Nurses were busy around the clock caring for the thousands of sick who could not reach a hospital. They described entering houses where all members of a family were dead. In some neighbourhoods they were hailed as saviours. The Society of Visiting Nurses, in its 1918 report claimed the influenza epidemic gave it purpose and resources it never would have had otherwise. As the third wave of the epidemic was waning, the Federal government urged Jean Gunn, president of Canadian National Association of Trained Nurses, along with Medical Association and United Farm Women’s Association to create a Department of Health on June6th 1919 to reform health care. In 2004, Public Health Agency of Canada was launched which focussed on promotion and protection of health of Canadians, surveillance activities, biweekly Flu watch report on Influenza and revision/update of Canadian Pandemic Influenza Plan. Nurses play a vital role in the response to outbreaks of deadly illnesses and were important to ensure they have the capacity to provide necessary services by vaccinations. Low uptake of prophylaxis may negatively impact quality of health care delivery. Nurses have a significant role to play by using their net working of colleagues and contacts throughout the community and the world to facilitate the strategies at local, national and global levels (Groft, 2006) through intersectoral planning and coordination to minimize the effects of global outbreak of Influenza.

    Reply

  8. Brittany Fitzpatrick
    Oct 06, 2011 @ 04:50:32

    We had some really great discussions tonight! I just wanted to further on one topic in particular and ask what are everyone thoughts on immunizing young children? Based on Sarah’s scientific evidence that she provided, do you feel as though there could be a link between certain immunizations and disease states?

    Reply

    • Dan Corwin
      Oct 25, 2011 @ 00:09:09

      Brittany, I don’t feel there is a strong enough correlation between immunizations and other disease states. I will say that in another book called Flu by Gina Kolata, addresses a similar issue. The author points out that in mass immunizations a certain percent of the populations will exhibit diseases just by pure chance. Some people might think this as a direct correlations, but is just mere chance they occurred so close to each other and in that order of succession. Just a side, I know we mentioned in the last session, but the research that pointed out immunizations cause autism made up his data and was striped of his medical license and the journal that published his work removed it from their journal.

      Reply

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