Sunday, April 2, 2023
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Compiling a ranking of the most influential physicians throughout history is a perilous undertaking that has fueled animated discussions between Medscape editors and advisors. Influence is a tricky thing to gauge, after all, and depends entirely on one's viewpoint, background, location, and specialty. And "history" is a rather long timeframe. Some prickly questions were raised along the way: What constitutes influence? How do we measure it? How do we account for ethnic and gender centricity? What about complementary or alternative areas of medicine? How about those excluded from traditional historical discourse? And the list goes on.
With all of that said, in this first part of a four-part series, we've endeavored to identify the giants of medicine who we feel stand apart due to the extent of their achievements and their impact on the development of medical practice. As a starting point, we polled Medscape advisors for their suggestions, to which we added some of our own thoughts. While the result may not be entirely scientific in its methodology, we hope that you will enjoy it, and we look forward to your nominations and feedback in a Medscape-wide survey which will follow the publication of the final slideshow.
Image from Dreamstime
As a result of his extensive on-site experience during armed conflicts—most notably in the Crimean War—and groundbreaking approaches to caring for the wounded, the Russian physician and polyglot Nikolay Ivanovich Pirogov is recognized as the father of field surgery.[1] Dr Pirogov is credited with devising a new methodology for triage, introducing the use of ether as an anesthetic, furthering techniques for plaster-casting fractured bones, and establishing several surgical procedures, including the Pirogov amputation of the foot.[2] Celebrated as one of the most influential Russian physicians, several anatomical structures bear his name, including the Pirogov angle and the Pirogov triangle.
Images courtesy of Wikimedia Commons
Although he died at an age when many physicians are just starting their careers, the British anatomist and surgeon Henry Gray's legacy is enduring. His seminal text, Anatomy: Descriptive and Surgical, intended as an accessible reference tool for medical students, was first published in 1859. The 41st edition of Gray's Anatomy was published in 2015. The title even inspired the name of a popular TV drama.
Shortly following publication of the initial edition, The Lancet praised it, stating that "there is not a treatise in any language in which the relations of anatomy and surgery are so clearly and fully shown."[3]
A lecturer at St George's Hospital Medical School, Henry Gray was a native of London, where he died from smallpox.
The illustrations for Anatomy were created by anatomist, surgeon, and anatomical artist Henry Vandyke Carter (1831-1897), who long outlived his fellow Henry, spending much of his life in India.[4]
Images courtesy of National Institutes of Health and Wikimedia Commons
The publication of Helen Brooke Taussig's Congenital Malformations of the Heart in 1947 helped to establish the field of pediatric cardiology. Other highlights of Dr Taussig's distinguished career include influential work to promote hospice and palliative care, ban thalidomide, advocate the use of animals in medical research, and legalize abortion.
Dr Taussig studied at Harvard Medical School and Boston University before completing her medical degree at Johns Hopkins, an institution with which she was affiliated for most of her career.
Together with Drs Alfred Blalock and Vivien Thomas, Dr Taussig created the Blalock-Taussig-Thomas shunt to treat children born with a tetralogy of Fallot defect.
Dr Taussig was the recipient of numerous international prizes and distinctions, including the Presidential Medal of Freedom, the Albert Lasker Award, and France's Legion of Honor. She was elected to the National Academy of Sciences, and in 1960 became the first female president of the American College of Cardiology.[5]
Images from Dreamstime and courtesy of National Institutes of Health
Dr Zora Janzekovic was a pioneer in the treatment of burn victims and a proponent of tangential excision—the early excision and immediate grafting of burns to reduce morbidity and mortality. Her long medical career and innovative research, all conducted throughout the tumultuous 20th century in the Slovenian city of Maribor, helped save the lives of countless burn victims. Dr Janzekovic shaped an entire field of practice with the introduction of the gold standard of care in the treatment of deep dermal burn wounds.[6,7]
Images from Dreamstime and courtesy of Wikimedia Commons
In 1628, the English physician William Harvey became the first person to accurately describe systemic circulation in his treatise Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus. As with many original thinkers, Harvey's contributions to anatomy and physiology contradicted accepted theories of the time but his legendary powers of persuasion, intellect, and rigorous methodologies served as catalysts for future research. He achieved great fame during his lifetime and had an illustrious career, at one point serving as the "Physician Extraordinary" to King James I.[8]
Image courtesy of National Institutes of Health
Dr Virginia Apgar was the first female full professor at the Columbia University College of Physicians and Surgeons (1949) and the creator of the Apgar score (1953), the first standardized tool to evaluate the newborn.[9] An example of evidence-based medicine before the term existed, the Apgar score has been a gold standard to evaluate and guide the health of generations of newborn babies and is still in use today.[10]
In the 1930s and 1940s, Dr Apgar was also a pioneer in the nascent field of anesthesiology in the United States. In her later career, Apgar studied the association between the effects of labor, delivery, and maternal anesthetics on the baby's Apgar score and well-being, and focused on the prevention of birth defects.[11]
Images from Dreamstime and courtesy of Wikimedia Commons
Considered the father of medical genetics, Dr Victor McKusick was a "medical nomad" with broad interests and an early proponent of human genome mapping as a tool to study congenital diseases. McKusick wrote and published extensively, and is well known for his genetics studies in Amish populations.[12]
In 1966, Dr McKusick published the first edition of Mendelian Inheritance in Man (MIM)—the first catalog of all known genes and genetic disorders. The online version (OMIM®) became available in 1987 and is a continuously updated catalog of human genes and genetic disorders and traits, with a particular focus on the gene-phenotype relationship.[13]
Dr McKusick was the recipient of more than 20 honorary degrees and numerous international prizes, including the Gairdner International Award, the William Allan Award from the American Society of Human Genetics, and the Albert Lasker Award for Special Achievement in Medical Science.
Images from Dreamstime and courtesy of Wikimedia Commons
The 1997 Nobel Prize in Physiology or Medicine was awarded to Dr Stanley Prusiner for "his pioneering discovery of an entirely new genre of disease-causing agents and the elucidation of the underlying principles of their mode of action."[14] Through his work on bovine spongiform encephalopathy and Creutzfeldt-Jakob disease, Dr Prusiner was the first to propose the role of prions, a class of infectious self-reproducing pathogens primarily or solely composed of protein, in disease.[15]
Dr Prusiner is currently director of the Institute for Neurodegenerative Diseases at University of California, San Francisco. He is also the recipient of the National Medal of Science and a long list of awards.[16]
Images from Dreamstime, Ken Cedeno/AP, and courtesy of Wikimedia Commons
Stanley Dudrick's pioneering research, initially undertaken in the lab of Dr Jonathan Rhoads, led to the development of the central venous feeding technique known as intravenous hyperalimentation, or total parenteral nutrition. The new technique provided the means to nourish patients whose gastrointestinal tracts were impaired, and to this day is widely used to prevent malnutrition in patients of all ages who are unable to obtain nutrients by oral or enteral routes.[17]
Dr Dudrick is the recipient of more than 120 honors and awards and was recently named a "Living Legend" by the International Society of Small Bowel Transplantation.[18]
Image from Dreamstime and courtesy of JAMA
Dr Robert Koch, a German physician considered to be the founder of modern bacteriology, greatly advanced techniques in the laboratory and in microbiology that led to important contributions to public health. His research helped identify the causative agents for tuberculosis, cholera, and anthrax, and led to the creation of Koch's postulates—criteria designed to establish a causative relationship between a microbe and a disease, which remain central in medical microbiology.[19]
Dr Koch received the 1905 Nobel Prize in Physiology or Medicine for his "investigations and discoveries in relation to tuberculosis."[20]
Images from Dreamstime and courtesy of National Institutes of Health
In 1974, as a young oncologist at Indiana University working alongside the renowned urologic surgeon Dr John Donohoe, Dr Lawrence (Larry) Einhorn proposed a three-drug, cisplatin-based regimen for testicular cancer that achieved a cure rate approaching 100% in patients presenting with locoregional disease, while reducing the duration of therapy to 12 weeks. Dr Einhorn instituted chemotherapy as the first-line therapy for advanced testicular cancer and established a model for a curable neoplasm.[21,22] He is currently working with a multidisciplinary team of researchers at Indiana University exploring the potential role of platinum-based drugs in the treatment of lung cancer.
Images from Darron Cummings/AP and courtesy of Wikimedia Commons
Born in Boston's East End, renowned gastroenterologist Dr Joseph Kirsner was on faculty at the University of Chicago for more than 70 years. Dr Kirsner's pioneering work led to a better understanding of the role of immunology and genetics in the pathophysiology of inflammatory bowel disease. A prodigious researcher, with more than 700 published articles and 18 books, Dr Kirsner was among the first to show the link between ulcerative colitis and colon cancer, and had a far-reaching influence on gastroenterology and oncology.[23,24]
Images from Dreamstime and courtesy of National Institutes of Health
British physician John Snow is considered a founding father of modern epidemiology. His novel approach to investigating the source of an outbreak of cholera in a crowded section of Victorian London allowed it to be traced to a contaminated water pump. His research ultimately led to a better understanding of communicable disease, resulting in changes in waste and water management while laying the groundwork for the creation of epidemiology as an important component of public health. Dr Snow was also an early proponent of anesthesia and medical hygiene.[25,26]
Images from Alamy and courtesy of National Institutes of Health
In his 1817 publication An Essay on the Shaking Palsy, British physician Dr James Parkinson was the first to distinguish between "resting tremors" and "shaking tremors"[27] and describe the symptoms of paralysis agitans—the disease that would later carry his name. Affecting an estimated 1% of people over 60 years of age, Parkinson disease is one of the most common neurologic disorders.[28]
Images from Dreamstime and courtesy of National Institutes of Health
The inventor of the revolutionary "Pap" test, Dr George Papanicolaou emigrated to the United States in 1913 after growing up in Greece and undertaking part of his training in Germany. His theory that a vaginal smear could detect uterine cancer gained traction in 1943 following the publication of Diagnosis of Uterine Cancer by the Vaginal Smear,[29] which he co-wrote with Dr Herbert Traut. Dr Papanicolaou was a pioneer in cytopathology and early cancer detection, and his work has contributed to a 70% reduction in cervical cancer mortality over the past 60 years.[30]
Images from Dreamstime and courtesy of National Institutes of Health
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