Saturday, February 4, 2023
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The father of cognitive therapy, Dr Aaron Temkin Beck is considered one of history's most influential psychotherapists and a pioneer in the field of mental health.[1]
Dr Beck's early work on psychoanalytic theories of depression led to his development of cognitive therapy,[2] a new theoretical and clinical orientation, "based on the theory that maladaptive thoughts are the causes of psychological symptoms such as anxiety and depression, which in turn cause or exacerbate physical symptoms."[3] Through this empirical framework, Dr Beck conducted extensive research on the psychopathology of depression, suicide, anxiety disorders, panic disorders, alcoholism, drug abuse, personality disorders, and schizophrenia, and developed cognitive therapy for these disorders—helping to establish theories that are widely used in the treatment of clinical depression.[2]
Dr Beck has published over 600 scholarly articles and 25 books and is the recipient of a long list of awards, including the 2006 Albert Lasker Clinical Medical Research Award "for the development of cognitive therapy, which has transformed the understanding and treatment of many psychiatric conditions, including depression, suicidal behavior, generalized anxiety, panic attacks, and eating disorders."[4]
Originally from Providence, Rhode Island, Dr Beck attended Yale Medical School and completed residencies in pathology, neurology, and psychiatry. He joined the Department of Psychiatry of the University of Pennsylvania in 1954 and has remained affiliated with the institution for most of his long career.[2]
Beyond his influence in the realm of psychiatry, Dr Beck made important contributions to public health, founding the Beck Initiative in collaboration with the Department of Mental Health/Mental Retardation Services in Philadelphia. He was also the first recipient of the Kennedy Community Health Award from the Kennedy Forum.[5]
Image from Dreamstime, courtesy of Beck Institute for Cognitive Behavior Therapy
Considered the founder of clinical auscultation, the French physician Dr René Théophile Hyacinthe Laënnec was also the inventor of the stethoscope and was responsible for coining many clinical terms that are still in use today. He classified several pulmonary conditions (including pneumonia and emphysema) and was the first person to describe cirrhosis and bronchiectasis.[6]
With the period following the French Revolution as a turbulent backdrop, Dr Laënnec dedicated himself to his studies, gaining a reputation for brilliance first in Nantes and later during his pathology training in Paris. He had the good fortune of learning from the best-known French teachers of the time and won awards in both medicine and surgery.[6]
In 1816, Dr Laënnec created the first tube to magnify sound—the prototype of the stethoscope—by rolling up a sheet of paper to listen to a patient's chest. He modified his designs over the subsequent years, and by mid-century the stethoscope had become a standard tool for all physicians.[7]
Dr Laënnec's De l'auscultation mediate, a classic of modern medicine, published in 1819, was the first text to minutely describe the audible sounds of thoracic diseases, such as rales, bronchial breathing, bubbling, and metallic tinkle.[8]
Dr Laënnec is considered one of the first masters of clinical examination, whose research and inventions shone a guiding light on clinical practice.[6,9]
Images from Dreamstime, National Institutes of Health
The German physician Dr Paul Ehrlich was the joint recipient of the 1908 Nobel Prize in Physiology or Medicine (with Dr Ilya Ilyich Mechnikov) in recognition of his work on immunity.[10]
Dr Ehrlich is perhaps best known for his immunologic studies which he first undertook as an assistant to Dr Robert Koch (who was honored as #41 in our Top 50 list) at the Institute for Infectious Diseases in Berlin.[11] Dr Ehrlich was influential before this period, however, for his work on dyes and staining. His research on the staining of granules in blood cells provided the groundwork for seminal findings in hematology, ultimately providing the knowledge and tools to diagnose several blood diseases. In bacteriology, Dr Ehrlich also contributed to the understanding that led to the Gram method of staining bacteria.[11]
Dr Ehrlich contributed important work on hemolysins and on the toxin/antitoxin reaction, which eventually allowed him to create the framework used for the future standardization of sera, leading to the side-chain theory of immunity.[12]
In the field of chemotherapy, Dr Ehrlich's concept of "magic bullets"—chemical substances designed to be attracted to pathogenic organisms—is considered the original conceptual framework and precursor to modern pharmaceutical research.[11,12]
Dr Ehrlich was also the founding director of the Paul-Ehrlich-Institut which is the modern-day German Federal Institute for Vaccines and Biomedicines.[13]
Images from Dreamstime, courtesy of National Institutes of Health
Dr Jonas Salk is celebrated for having created the first polio vaccine.[14]
Contrary to accepted theories at the time, Dr Salk believed that he could design an effective vaccine from killed virus that would not cause disease to propagate. His theory was borne out by subsequent clinical testing. The new vaccine caused the incidence rate of the disease in the United States to drop from 45,000 cases per year in the early 1950s to 910 cases in 1962.[15]
Dr Salk was born and raised in New York City. He completed his medical studies at New York University and worked on a research fellowship to develop a vaccine for influenza at the University of Michigan before being appointed as director of the Virus Research Laboratory at the University of Pittsburgh School of Medicine. In Pittsburgh, Dr Salk set out to work on a vaccine for paralytic poliomyelitis, an incurable disease that spread fear throughout the United States and beyond.[15] The discovery of the vaccine shot Dr Salk to immediate international stardom.[16]
Just 5 years after creating the polio vaccine, Dr Salk began work on "a collaborative environment where researchers could explore the basic principles of life and contemplate the wider implications of their discoveries for the future of humanity." [17] With support from the March of Dimes, the Salk Institute for Biological Studies was established, with a mission "to dare to make dreams into reality…[to] explore the very foundations of life, seeking new realities in neuroscience, genetics, immunology and more."[18]
At the end of his life, Dr Salk was actively involved in AIDS research.[19]
Images from Dreamstime, courtesy of National Institutes of Health
Dr Harvey Cushing, in a nutshell, invented the approaches, techniques, and philosophy of modern neurosurgery, becoming one of the first Americans to lead in any field of surgery.[20] Furthermore, owing to his interest in the pituitary gland, Dr Cushing was one of the founders of endocrinology. He was also a well-read, accomplished writer who won a Pulitzer Prize for The Life of Sir William Osler, his two-volume book on his lifelong friend and colleague.[21]
Dr Cushing grew up in a well-educated family of physicians in Cleveland, before completing his studies at Yale, Harvard, and Johns Hopkins—where he studied with the father of American surgery, Dr William Halstead.[20,22] As was typical at the time, Dr Cushing started his career as a general surgeon before becoming interested in the surgery of the nervous system, which led him to specialize in the brain.
Dr Cushing's methods and extraordinarily meticulous documentation of cases and procedures led to the Cushing Brain Tumor registry—an important training reference, housed at the Cushing Center at the Yale School of Medicine, that includes over 2200 cases and 15,000 photographic illustrations documenting brain and tumor specimens.[22,23]
Through Dr Cushing's pioneering work, the risks associated with brain surgery were considerably reduced and the mortality rate dropped to approximately 10%.[24]
Images from Dreamstime, courtesy of National Institutes of Health
Considered the father of scientific psychiatry, the German psychiatrist Dr Emil Kraepelin studied the links between brain biology and mental illnesses,[25] and through clinical observation believed that "specific combinations of symptoms in relation to the course of psychiatric illnesses allow one to identify a particular disorder."[26]
Dr Kraepelin is known for proposing the differentiation between dementia praecox (which he believed to be a "biological illness caused by anatomical or toxic processes") and manic depression ("an episodic disorder, which does not lead to permanently impaired brain function"), considering them the two root forms of psychosis.[26]
First published in 1883, Dr Kraepelin's Compendium of Psychiatry argued that observation and experimentation should guide the study of psychiatry, just like other medical sciences. Although it fell out of favor in the mid-20th century, Dr Kraepelin's pioneering work played an influential role in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.[26,27]
Dr Kraepelin studied medicine and experimental biology, writing his thesis on the relationship between psychiatry and experimental biology in 1878.[25] He researched the effects of coffee, morphine, and alcohol on the nervous system, adopting and furthering early psychological laboratory techniques.
Through his studies on the effects of psychiatric drugs, Dr Kraepelin is considered one of the founders of pharmacopsychotherapy. He also contributed to the field of psychiatric genetics[25] and was one of the initiators of cross-cultural psychiatry.[28]
Images from Dreamstime, courtesy of National Institutes of Health
The scholarly writings of the Greek physician Claudius Galen helped shape the practice of medicine for 1500 years and were among the last contributions to Western medicine before the Middle Ages.[29] He is credited with the creation of an empirical approach to medicine, rooted in original experimentation on animal models. An avid dissector and a prolific publisher of medical treatises, Galen had a thirst for anatomy and physiology, as well as an inherent curiosity that led to the discovery that arteries carry blood and that urine forms in the kidneys.[30]
Born in Pergamum (in modern-day Turkey) to well-to-do Greek-speaking parents, Galen studied medicine throughout the Mediterranean and Near East[29] and achieved such clinical renown that he was appointed physician to the Roman emperors Marcus Aurelius, Commodus, and Septimius Severus.[30]
Galen was influential in classifying structures of the brain, identifying seven pairs of cranial nerves and describing cervical, brachial, and lumbar sacral plexuses.[31] His work also contributed to the early understanding of fundamental genitourinary principles.[32]
Images from Dreamstime, courtesy of National Institutes of Health
"Trust yourself. You know more than you think you do." is the opening sentence of Dr Benjamin Spock's Common Sense Book of Baby and Child Care, which was published in 1946 and rapidly became a runaway parenting and cultural phenomenon—and, with over 50 million books sold in 42 languages, one of the best-selling books in history.[33,34]
In writing his book, Dr Spock sought to encourage a more permissive approach to child-rearing, different from existing orthodoxy grounded in strict routines and schedules and a sparing use of affection. With his gentle method, Dr Spock wished to encourage parental instinct and the use of common sense. From a theoretical standpoint, Dr Spock implemented some of the ideas of Sigmund Freud and the philosopher John Dewey.[34]
The oldest of six children, Benjamin Spock grew up in New Haven and attended Yale University where, as a member of the rowing team, he won a gold medal at the Paris Olympics in 1924.[33,34] Dr Spock graduated from Columbia University's College of Physicians and Surgeons and went on to specialize in pediatrics, combining these studies with psychiatry. As a clinician, he earned a reputation for caring about his patients' (and their parents') feelings and being approachable. He chose to wear ordinary business suits rather than the more intimidating white doctor's coat.[34]
Dr Spock wrote several other books on childcare and rearing, including Dr Spock Talks with Mothers (1961), Raising Children in a Difficult Time (1974), and Dr Spock on Parenting (1988). His work touched a nerve in the postwar era, radically altered the path of child-rearing in the Western world,[33] and continues to influence the care of children well into the 21st century.[35,36]
Images courtesy of National Institutes of Health, Pocket Books
Born in Virginia and raised in Missouri and Kansas, Andrew Taylor Still, the founder of osteopathic medicine, received his medical training in the typical frontiersman style: by independent study of available texts and interning with a physician, his father.[37] His life and practice were also keenly influenced by a period he spent with the Shawnee Indians in Kansas.[38]
In the early part of his career, Dr Still travelled widely to visit patients and practiced many of the techniques of the times, including bleeding, blistering, and purging. However, after the carnage of the Civil War and the added trauma of the death of a number of close relatives, Dr Still began to question his medical knowledge and search for new solutions.[37]
Still's new "manipulative" methodology was grounded in the correction of anatomical anomalies or "deviations" that he believed hindered the "nerve force" in the body. Dr Still's "osteopathic medicine" was "founded on the philosophy that all body systems are interrelated and dependent upon one another for good health."[39] As such, Still became convinced that most diseases could be treated without drugs.
Dr Still probably drew inspiration for his theories from several philosophies and practices in circulation at the time—such as magnetic healing, bone-setting, Grahamism, eclecticism, homeopathy, and hydropathy—as well as from his personal interests in philosophy, religion, and social and intellectual movements. His approach was also the result of his advanced knowledge of anatomy[37] and, perhaps, the nature-centered belief system of the Shawnee Indians.[38]
Ridiculed at the start and rejected by traditional medical practitioners—despite gaining traction with patients—Dr Still was eventually able to establish the American School of Osteopathy (ASO) in Kirksville, Missouri, in 1892. The school flourished, becoming the cornerstone from which osteopathy spread around the nation and the world.
There are currently over 74,000 doctors of osteopathy practicing in a wide range of medical specialties in the United States. Accredited professional DOs practice in more than 65 countries.[39]
Images from Corbis, courtesy of Wikimedia Commons
Scotland-born physician Dr Alexander Fleming is celebrated for his discovery of penicillin and for his earlier research on lysozyme—an enzyme found in body fluids—that was crucial to our understanding of how the body fights infection.[40]
In 1928, while examining a culture plate of Staphylococcus aureus, Fleming noticed that mold (Penicillium notatum) had inhibited the growth of bacteria. This observation led to important future studies; collaborations with other researchers; and a well-known chain of events that culminated in the availability of antibiotics and to Dr Fleming winning the 1945 Nobel Prize for Medicine, along with Ernst Boris Chain and Sir Howard Walter Florey.[41,42]
The seventh of eight children, Dr Fleming began his medical training in 1901 at the University of London's St Mary's Hospital Medical School, where he earned the gold medal as top medical student (1908).[40] After considering a specialization in surgery, Fleming opted for further studies in bacteriology with Sir Almroth Edward Wright, and was influenced by the pioneering work of Paul Ehrlich (#18).[43]
The availability of penicillin, starting in the 1940s, kicked off the era of antibiotics, arguably one of the most influential advances in therapeutic medicine.[44]
Images from Dreamstime, courtesy of National Institutes of Health
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