No Canadian heroes? Here’s one.

Canada's full-bore pursuit of gold at the Olympics the country is hosting in Vancouver, B.C., has attracted much comment, mostly about how out-of-character overt ambition supposedly is for Canadians.

Writing in the New York Times last week, Charles McGrath quoted the Canadian writer George Woodcock on the subject: “Canadians do not like heroes, and so they do not have them. They do not even have great men in the accepted sense of the word.”

Here's one for the books, then -- William Osler, the so-called "father of modern medicine," a great man if ever there was one, born in Bond Head, Ont., in 1849.

William Osler

Dr. William Osler

Osler received his medical degree from McGill University in Montreal in 1872 but, critically, then went abroad to study in London, Berlin and Vienna before returning to join the McGill faculty. By 1883, he was one of two Canadian fellows of the British Royal College of Physicians. The next year, he accepted a post as professor of clinical medicine at the University of Pennsylvania in Philadelphia.

It was as a founding faculty member of Johns Hopkins School of Medicine in Baltimore, where he went in 1888, that Osler had the opportunity to put the innovations he had seen in Europe to work.

Osler insisted that the patient could teach medical students nearly everything they needed to know -- that the study of medicine was properly conducted at the bedside -- and that hands-on laboratory research must also be part of medical training.  He also introduced the German model of post-graduate training, a one-year internship followed by several years of full-time residency.

These innovations began a profound change in American medical education, which up to this point had been largely a matter of learning from lectures.

Osler was able to implement his ideas because he was an excellent doctor. In 1905 he moved to England to take up a prestigious post as professor of medicine at the University of Oxford. His book, The Principles and Practice of Medicine, was a major work in medicine for nearly half a century.

Osler died in England in 1919, of the Spanish flu.

Canadians might say that Osler's absconding to the United States and England rules him out as a national hero, but it says something when a boy from Bond Head can hit the heights of world medicine.

Speaking of medical detective stories…

Who doesn't love them? Aren't curiosity and a desire to improve the human condition two of the most interesting traits a person can display?

Paul de Kruif's 1926 book, Microbe Hunters, is an  early, influential collection of some great medical detective stories, 12 important successes in the field of microbiology, which were achieved by extraordinary medical detective work.

Microbe Hunters dramatizes the journeys, among others, of  Anton van Leeuwenhoek, the first microbiologist; Sir David Bruce, who traced African sleeping sickness to the tsetse; and Walter Reed, who led the team that discovered that yellow fever is caused by mosquitoes.

Medical historian William Summers was one of many dazzled as a teen-ager by the book, which he says "inspired a generation or more of budding young microbiologists."

Microbe Hunters has sold millions of copies and is still in print, but from a modern perspective, the book is flawed -- De Kruif presents detailed conversations between historical figures, for example.

Even when it was written, the book had its detractors, Summers writes. Ronald Ross, a researcher who won the Nobel Prize in 1902 for identifying the parasite that causes malaria, describing its life cycle and explaining how it comes to infect human beings, successfully sued to prevent publication in the United Kingdom of the chapter about his work.

But De Kruif was one of the most successful medical science writers of his time, and when readers take up a book like Richard Preston's The Hot Zone, about the Ebola virus, they are reading an account profoundly influenced by Microbe Hunters.

The conquest of infectious disease is important to obstetrics.  Infection was the leading cause of maternal mortality until well into the 20th century -- and it still is in many parts of the world.

A medical detective story

One of the studies presented at the annual meeting of the Society of Maternal Fetal Medicine last week was an intriguing medical detective story.

Researchers at the University of Washington in Seattle noticed that their state had a high incidence of a devastating birth defect called gastroschisis, in which organs, especially the intestines, develop outside the abdomen. The defect has a 90 percent survival rate but requires extensive interventions at and after birth.

The incidence of gastroschisis has doubled and in some places quadrupled in the past 30 years, according to the study. The researchers -- Sarah Waller, Kathleen Paul, Suzanne Peterson, and Jane Hitti, all MDs -- wondered if it might have an environmental cause.

A Washington farm

Rural areas in Washington were the hardest hit

Using the state's birth-certificate data base, they determined that the highest incidence of gastroschisis was in the agricultural eastern part of the state.  They matched cases of the defect with a history of agricultural spraying provided by the U. S. Geological Survey. Three possible culprits emerged -- atrazine, nitrates, and 2,4-dichlorophenoxyacetic acid, chemicals commonly used in agriculture.

The researchers looked at all 805 babies born with gastroschisis in Washington between 1987 and 2006 (with a control group of 3,616), and then they calculated how close the babies' mothers lived to water sources with high levels of the three chemicals.

An association between gastroschisis and atrazine, a common herbicide, emerged in the study. The closer mothers lived to a water source with high levels of atrazine, the more likely they were to have a baby with gastroschisis.

The researchers also found that the incidence of gastroschisis increased with babies conceived in the spring, when spraying is especially prevalent. No association was found with the two other chemicals.

This elegant study will be the basis of more study, no doubt, the first steps down the road toward protecting babies from a possible environmental hazard.

The Pregnancy Meeting

The Society for Maternal Fetal Medicine held its annual conference in Chicago last week, and I went to a few sessions. The physicians, who specialize in the health of mothers and their babies, spent up to six days in meetings, so I got a canape-size serving compared to theirs.

Research teams from all over the country, and from other countries as well, reported on their investigations into conditions that jeopardize mothers' and babies' health in pregnancy.  Several important findings came out of the meeting. Here are just a few:

* A simple new urine test with a cool name, the "Congo Red Dot Test," appears to be able to predict and diagnose preeclampsia, a condition that can kill mothers and babies, cause birth defects, and is a major contributor to pre-term birth. A research team from the Yale University School of Medicine found that the test accurately predicted preeclampsia in 347 women in their study. Preeclampsia symptoms include hypertension and protein in the urine. The condition affects 5 to 10 percent of pregnancies. It is commonly treated by delivering the baby.

* One of every three pre-term births is caused by a "silent" infection inside the uterus. Now it appears some women and babies are genetically more susceptible to inflammatory infections, according to a study led by Roberto Romero MD, Chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development. The study won an award from the March of Dimes, a nonprofit group that works to prevent birth defects, premature birth and infant mortality.

At the SMFM meeting, the Yale U. School of Medicine also presented the results of a couple of other investigations that might lead to a decrease in preterm births as well.

A health consumer’s BFF

Health consumer, meet your first best friend, Johannes Gutenberg.

Johannes Gutenberg

Johannes Gutenberg

Of all the instruments and processes medical researchers have invented, none has been more important to the advancement of medicine than the printing press, which Gutenberg developed in the mid-15th century, publishing 180 copies of his celebrated Bible around 1455.

A former goldsmith, Gutenberg developed moveable type that could be made of wood or metal, and adapted a wine press to imprint the image on the paper.

Soon, scholars and scientists all over Europe were exchanging ideas. Relatively few people could read at the time, and books were expensive, but that ability to convey information to more than a small group at a time resulted in an explosion of understanding of how the world works.

For the record, the Chinese invented moveable type hundreds of years before Gutenberg did.