Saints Cosmas and Damian and the Traditions of Faith and Charity in Medicine

Sts. Cosmas and Damian, the twin patron saints of medicine, were once among the most recognized saints in Christendom. In today’s secularized society their prominence is much less known. The saints were beheaded during the violent persecutions of Christians in the Roman Empire in the end of the 3rd century and the first years of the fourth. Their story, however, is more than miracles and martyrdom. The history of Sts. Cosmas and Damian show the connection between medicine of Classical Greece and the worship of doctor-saints in early Christendom, and the tradition of charity to the poor in medical care

America’s Original Immunization Controversy: The Tercentenary of the Boston Smallpox Epidemic of 1721

The CoVID-19 pandemic marks the 300th anniversary of the Boston smallpox epidemic of 1721, America’s first immunization controversy. Puritan minister Cotton Mather learned of inoculation for smallpox from Onesimus, a man enslaved to him. When the disease broke out in May 1721, Mather urged Boston’s physicians to inoculate all those vulnerable to the disease. Zabdiel Boylston, alone among his colleagues, decided to proceed with the procedure, igniting a heated debate that occasionally grew violent. The division between the advocates and detractors of inoculation were as deep as religion and politics. Puritan ministers supported inoculation, asserting their right to control the lives of their flock. Challenging them were a secular class of medical professionals that proclaimed primacy in medical matters. The controversy was inflamed by a nascent newspaper industry eager to profit from the fear of contagion and the passionate debate. Despite the furor and physical risk to himself and his family Boylston inoculated 282 persons, of whom only 6 died (2.1%). Of the 5759 townspeople who contracted smallpox during the epidemic, there were 844 deaths (14.7%). In America’s first effort at preventive medicine Boylston established the efficacy of inoculation, which helped support its acceptance in England, and later in the century, the adoption of Edward Jenner’s technique of vaccination in 1796

Racial Disparity, Social Determinates of Health, and Slavery During the Boston Smallpox Epidemics of the Eighteenth Century

When Benjamin Franklin published the mortality rates from smallpox during the Boston smallpox epidemic of 1752, he revealed that Blacks not only had a higher mortality rate from smallpox (12.8%, 62/485; 8.9% for whites, 452/5,059), but once inoculated, had less protection from fatal disease (mortality rate 5.0%, 7/139; 1.2% for whites, 23/1,954). His report was thus the first publication to document racial disparities in a disease and its treatment. The differential outcomes came about in the context of slavery, poverty, and war, the predecessors of the social determinates of health that we observe today. During the 1752 outbreak only 28 percent of the Boston's occupants were inoculated, a level that failed to protect the community. When the contagion returned in 1764, the town selectmen decided to provide inoculations at no cost to all that needed them. That year inoculated smallpox reached 87 percent of the total caseload. "This lowered the death rate for smallpox so markedly," wrote John Blake, historian at the National Library of Medicine, "that for the first time a smallpox year failed to stand out as one of unusual mortality." One final observation came from Franklin's data: the unexpectedly high prevalence of inoculations among Blacks (6.8% of those inoculated, 146/2,143; 8.5% of all those contracting the disease, 693/8,201). Boston's whites had made certain enslaved Blacks were inoculated, evidence the extent to which slavery was essential to the economy of colonial Boston

The Surgical Operation that Led to the Declaration of Independence and the Bill of Rights

The debate between individual rights and the limits of government has its roots in an operation in 17th century England. John Locke, the English philosopher whose concepts on the legitimacy of government are bedrocks of Western politics, was also a practicing physician who in 1668 was among a group of physicians that drained an infected hydatid cyst and thus saved the life of his political patron Anthony Ashley Cooper, the 1st Earl of Shaftesbury.Locke, who had been a classics scholar at Oxford with royalist sympathies, had by chance just joined the Cooper home as house physician and tutor the previous year. Forever grateful to his young doctor Lord Ashley nurtured Locke?s early involvement in politics. From his association with a powerful peer of the Realm Locke found himself at the very heart of English politics where he began to formulate the foundational principles of Anglo-American government

Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children

Background Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC. Methods A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8 years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint. Results Inappropriately restrained patients were older (5.1 years v. 3.6 yrs, P < .001) and weighed more (44.1 lbs v. 35.3 lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different. Discussion African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences

Pediatric surgery workforce: supply and demand

Introduction: Recent studies report a shortage of pediatric surgeons in the United States. We surveyed members of the American Pediatric Surgical Association (APSA) to estimate current workforce and demand and to provide data for workforce planning. Methods: We conducted a survey of 849 APSA members to provide workforce data on their communities as follows: the number of active, retired, or inactive APSA surgeons; non-APSA fellowship graduates; surgeons without accredited fellowship training; and the estimated demand for additional pediatric surgeons. Internet search engines identified surgeons and practices offering pediatric surgical services. The US Census Metropolitan Statistical Areas (MSAs) defined service areas with populations of 100,000 or more. Results: Of 137 MSAs with APSA members in practice, we obtained data from 113 (83%), with 247 (29%) of 849 surgeons responding. We estimate that the current pediatric surgical workforce consists of 1150 surgeons, with APSA members in active practice (60%) forming the single largest group, followed by general surgeons (21%). The percentage of active APSA surgeons was greater than the percentage of general surgeons in the 50 largest MSAs (76% vs 2%, respectively), whereas the opposite was observed in the smaller MSA ranked more than 51 in population (37% vs 46%, respectively). American Pediatric Surgical Association respondents estimated a national demand for 280 additional pediatric surgeons. Active APSA surgeons plan to delay retirement (8% of respondents) because it would leave their group or community shorthanded; 2% reported that retirement would leave the community without a pediatric surgeon. Discussion: Workforce shortage in pediatric surgery is a problem of number and distribution. Incentives to direct trainees to underserved areas are needed. General surgeons provide pediatric services in many communities. Surgical training should include additional training in pediatric surgery. © 2009 Elsevier Inc. All rights reserved

Clinical and financial characteristics of pediatric surgery practices

Pediatric surgical practices face many challenges. We wanted to define the clinical practice and financial support among different types of practices as follows: academic, private practice, and employed. Methods: This study involved an Internet survey of members of the American Pediatric Surgical Association (APSA), comparisons using χ2 and paired t test analyses. Results: The response rate was 28.7% (233/811), 145 academic, 48 private, and 40 employed. More than 90% received partial to full financial hospital support. Only 7.3% received no outside support, most frequently those in private practices (16.7%; P = .016). More than 90% had resident or fellow coverage. Nearly all practices covered newborn conditions and solid tumors, with differences in pediatric trauma, patent ductus arteriosus, and urologic condition. Transfer out of community was low but increased for specific conditions during the respondents\u27 absence, from 0.4% to 5.2% to 3.4% to 6.9% (P = .001-0.003). A minority of respondents noted that nonpediatric surgeons treated selected pediatric conditions in their communities as follows: inguinal hernia (38.4%), umbilical hernia (42.6%), abscesses (37.5%), and trauma (36.6%). Pediatric surgeons shared call within their group in 86.3%, whereas 5.6% took call alone. Many restricted call by excluding trauma (37.2%), soft tissue infections or appendectomies (21.3% for both), and older children (\u3e12 years, 23.8%). Nearly one fifth (18.9%) expressed interest in having an APSA surgeon serve as a locum tenens in their practices. Discussion: Many pediatric surgeons receive both financial and in-kind subsidies. Although they cover a wide breadth of surgical conditions, many limit the conditions that they treat to reduce call responsibilities. The workforce shortage in pediatric surgery creates call coverage problems that may affect up to 8% of US practices. © 2009 Elsevier Inc. All rights reserved