LECTURE 13 Romanian medicine in the second half of the 19th century up to present time

1. LECTURE 13Romanian medicine in the second half of the 19th century up to present time

2. Romanian medicine in the 20th century • Outstanding personalities of the Romanian medicine in the 19th and 20th century

3. Romanian medicine in the 20th century • We can divide the Romanian medicine of the 20th century into three stages: • The beginnings of organizing the medical support and the dependence of the foreign schools of medicine (1800-1857); • The creation of the Romanian medical school (1858-1886); • The debut of creativity of the Romanian medicine and the registration in the world’s values.

4. Outstanding personalities of the Romanian medicine in the 19th and 20th century • Nicolae Kretzulescu • Carol Davila • Victor Babes • Ion Cantacuzino • Gheorghe Marinescu • Dimitrie Gerota • Nicolae Paulescu • Constantin Levaditi • Constantin I. Parhon • Iuliu Hatieganu • Ana Aslan • George Emil Palade • Nicolae Cajal

5. Nicolae Creţulescu or Kretzulescu (1812-1900) • was a Romanian politician and physician. He served three terms as Prime Minister of Romania: from 1862 to 1863, again from 1865 to 1866, and finally in 1867. He was elected to the Romanian Academy. • Born in Bucharest, he studied medicine in Paris, having Gustave Flaubert as a colleague. As a physician, his notable work was the translation of Jean Cruveilhier's manual of anatomy.

6. Carol Davila (1828 – 24 August 1884) • was a prestigious Romanian physician of Italian ancestry. • Davila studied medicine at the University of Paris, graduating in February 1853. In March 1853, he arrived in Romania. He was the organizer of the military medical service for the Romanian Army and of the country's public health system. Davila, together with Nicolae Kretzulescu, inaugurated medical training in Romania in 1857, by founding the National School of Medicine and Pharmacy. • It was due to his many activities that several scientific associations appeared in Romania: the Medical Society (1857), the Red Cross (1876), the Natural Sciences Society (1876). With his assistance, two medical journals entered print: the Medical Register (1862) and the Medical Gazette (1865). During the Independence War (1877-1878) he was the head of the Army's sanitary service. • Davila is also credited with the invention of the Davila tincture for the treatment of cholera, an opioid-based oral solution in use for symptomatic management of diarrhea.

7. Victor Babeş (4 July 1854 – 19 October 1926) • was a Romanian physician, biologist, and one of the earliest bacteriologists. He made early and significant contributions to the study of rabies, leprosy, diphtheria, tuberculosis, and other infectious diseases. • The Babeş-Bolyai University in Cluj-Napoca and the University of Medicine and Pharmacy "Victor Babes" Timisoara bears his name. • Born in Vienna (at the time, the capital of the Austrian Empire) to an ethnic Romanian family from the Banat, he studied in Budapest, then in Vienna, where he received his doctorate in Science. Attracted by the discoveries of Louis Pasteur, he left for Paris, and worked first in Pasteur's laboratory, and then with Victor André Cornil. • In 1885 he discovered a parasitic sporozoan of the ticks, named Babesia, and which causes a rare and severe disease called babesiosis. In the same year, he published the first treatise of bacteriology in the world, Bacteria and their role in the histopathology of infectious diseases, which he co-authored with Cornil.

8. Babeş' scientific endeavours were wide-ranging. He was the first to demonstrate the presence of tuberculous bacilli in the urine of infected patients. He also discovered cellular inclusions in rabies-infected nerve cells. Of diagnostic value, they were to be named after him (Babeş-Negri bodies). • Babeş was one of the founders of serum therapy, and was the first to introduce rabies vaccination to Romania. His work also had a strong influence upon veterinary medicine, especially concerning prophylaxis and serum medication. • He became a professor of Pathology and Bacteriology at the Carol Davila University of Medicine and Pharmacy in Bucharest. He was also a member of the Romanian Academy (in 1893), of the Paris Académie Nationale de Médecine, and an officer of the French Légion d'honneur. • His nephew, Aurel Babeş, was also a physician, who discovered a screening test for cervical cancer.

9. Ioan C. Cantacuzino or Ion Cantacuzino (November 25, 1863 – January 14, 1934) • was a renowned Romanian physician and bacteriologist, a professor at the Romanian School of Medicine and Pharmacy and a member of the Romanian Academy. He was the founder of the fields of microbiology and experimental medicine in Romania, and creator of the Ioan Cantacuzino Institute. • In 1901, Cantacuzino was assigned a teaching position in Bucharest, where he became a major influence on a generation of scientists. His discoveries were relevant in the treatment of cholera, epidemic typhus, tuberculosis, and scarlet fever. • As a disciple of Mechnikov, he devoted part of his research to expanding on the latter's field of interest (phagocytes, the body's means of defence against pathogens, as well as the issue of immunity and invertebrates). He invented the notion of contact immunity. • During the Second Balkan War, Cantacuzino was appointed head of the staff combatting the cholera epidemic in the ranks of the Romanian Army stationed in Dobruja; he was assigned to the same position during the Romanian campaign in World War I, in the fight against typhus.

10. Gheorghe Marinescu (February 28, 1863, Bucharest – May 15, 1938, Bucharest) • was a Romanian neurologist, founder of the Romanian School of Neurology. • After the attendance of Medicine at the Bucharest University, Marinescu received most of his medical education as preparator at the laboratory of histology at the Brâncoveanu Hospital and as assistant at the Bacteriological Institute under Victor Babeş, and with Babes already early published several works on myelitis transversa, hysterical muteness, dilatation of the pupil in pneumonia • After qualification, on the recommendation of Babes the government sent him with a grant to Paris to undertake postgraduate training in neurology under Jean-Martin Charcot at the Salpêtrière Hospital, where he met Pierre Marie, Joseph Babinski and Fulgence Raymond. He later worked with Carl Weigert in Frankfurt and then with Emil du Bois-Reymond in Berlin. On the assignment of Pierre Marie he lectured on the pathological anatomy of acromegaly at the Berlin International Congress in 1890.

11. After nine years abroad Marinescu returned in 1897 to Bucharest where he received his doctorate. At Bucharest a new professorial department had been created for him at the Pantelimon Hospital. Shortly thereafter, in 1897, a chair of Clinical Neurology was created in the University of Bucharest, at the Colentina Hospital. He remained in this post for the next 41 years and is regarded as the founder of the Romanian School of Neurology. • He had a wide range of research interests, including pathological anatomy and experimental neuropathology. • Daily contact with scores of the infirm and his astuteness made him put use every one of the latest methods as they became available: the roentgen ray, with which he investigated bone changes in acromegaly, the film camera, for the study of body movements in health and disease. The results of these studies appeared in the monography Le Tonus des Muscles striés (1937) with Nicolae Ionescu-Siseşti, Oskar Sager and Arthur Kreindler, with a preface by Sir Charles Sherrington.

12. Early in his career he published with the bacteriologist Victor Babeş and the French pathologist Paul Oscar Blocq a much needed atlas on the pathological histology of the nervous system. His description with Blocq of a case of parkinsonian tremor due to tumour in the substantia nigra, in 1893, was the basis for Édouard Brissaud's theory that parkinsonism occurs as a consequence of damage to the substantia nigra. With Paul Blocq he was the first to describe senile plaques and with Romanian neurologist confirmed in 1913 Hideyo Noguchi's discovery of Treponema pallidum in the brain in patients with general paresis. His monumental work La Cellule Nerveuse, with a preface by Santiago Ramon y Cajal, appeared in 1909.

13. Dimitrie D. Gerota (17 July 1867 – 3 March 1939) • Romanian anatomist, physician, radiologist, urologist, and an associated member of the Romanian Academy from 1916. • Considered to be the first Romanian radiologist, Gerota initiated academic radiology education in that country. In 1898, he wrote the book '"The Röntgen Rays or the X-Rays". Some years later, he had to abandon radiology because of radiodermatitis of the hand, which required amputation. • In 1909, he established a sanatorium, where he practiced surgery, and carried out charitable work. From 1913, he was a professor of surgical anatomy and experimental surgery at the University of Bucharest. • Gerota researched the anatomy and physiology of the bladder and appendix, and developed a method for injecting lymphatic vessels known in textbooks as the "Gerota method".

14. The renal fascia is sometimes called Gerota's fascia or Gerota's capsule after him. Also, the Albarran-Ormond syndrome (an inflammatory retroperitoneal fibrosis, named after urologists Joaquín Albarrán and John Kelso Ormond) is also known as Gerota’s syndrome or Gerota’s fasciitis. • He was a famed surgeon and the founder of a large Bucharest emergency-care hospital, now named the "Prof. Dr. Dimitrie Gerota Military Hospital", as well as a museum of anatomical-surgical casts of his creation.

15. Nicolae Paulescu (October 30, 1869 – July 17, 1931) • was a Romanian physiologist, professor of medicine, and the discoverer of insulin (which he termed pancreatine). • In 1897 he graduated with a Doctor of Medicine degree in Paris, and was immediately appointed as assistant surgeon at the Notre-Dame du Perpétuel-Secours Hospital. In 1900, Paulescu returned to Romania, where he remained until his death (1931) as Head of the Physiology Department of the University of Bucharest Medical School, as well as a Professor of Clinical Medicine at the St. Vincent de Paul Hospital in Bucharest. • In 1916, he succeeded in developing an aqueous pancreatic extract which, when injected into a diabetic dog, proved to have a normalizing effect on blood sugar levels. After a gap during World War I, he resumed his research and succeeded in isolating the antidiabetic pancreatic hormone (pancreine).

16. From April 24 to June 23, 1921, Paulescu published four papers at the Romanian Section of the Society of Biology in Paris: • The effect of the pancreatic extract injected into a diabetic animal by way of the blood. • The influence of the time elapsed from the intravenous pancreatic injection into a diabetic animal. • The effect of the pancreatic extract injected into a normal animal by way of the blood. • An extensive paper on this subject - Research on the Role of the Pancreas in Food Assimilation - was submitted by Paulescu on June 22 to the Archives Internationales de Physiologie in Liège, Belgium, and was published in the August 1921 issue of this journal. • Eight months after Paulescu's works were published, doctor Frederick Grant Banting and biochemist John James Richard Macleod from the University of Toronto, Canada, published their paper on the successful use of a pancreatic extract for normalizing blood sugar (glucose) levels (glycemia) in diabetic dogs.

17. Paulescu supporters think that their paper is a mere confirmatory paper, saying that the paper made direct references to Paulescu's article but misquoted that. • While Paulescu had patented his technique in Romania, no clinical use resulted from his work. The work published by Banting, Best, Collip and McLeod represented the injection of purified insulin extract into a diabetic individual ameliorating symptoms of the disease. Not surprisingly, Banting and Macleod received the 1923 Nobel Prize in Physiology or Medicine for the discovery of insulin. International recognition for Paulescu's contribution to the discovery of insulin came only years later. • Ian Murray, a professor of physiology at the Anderson College of Medicine in Glasgow, Scotland, the head of the department of Metabolic Diseases at a leading Glasgow hospital, vice-president of the British Association of Diabetes, and a founding member of the International Diabetes Federation, wrote in an article for a 1971 issue of the Journal of the History of Medicine and Allied Sciences

18. "Insufficient recognition has been given to Paulesco, the distinguished Roumanian scientist, who at the time when the Toronto team were commencing their research had already succeeded in extracting the antidiabetic hormone of the pancreas and proving its efficacy in reducing the hyperglycaemia in diabetic dogs.“

19. Constantin Levaditi (1874—September 5, 1953) • was a Romanian physician and microbiologist, a major figure in virology and immunology (especially in the study of poliomyelitis and syphilis). • He studied at the Carol Davila University of Medicine and Pharmacy, where he studied under Victor Babeş; In 1900, he was accepted by Ilya Ilyich Mechnikov to work in his team at the Pasteur Institute in Paris. Sometime after, Pierre Paul Émile Roux awarded him an independent laboratory within the Institute. • With Karl Landsteiner, he discovered in 1909 the presence of the polio virus in tissues other than nervous. He expanded on these studies during a polomyelitis outbreak in Sweden, working with Scandinavian researchers (among them Karl Oskar Medin); • He was able to isolate the poliovirus on tissue explant and made precious observations on its characteristics. Together with , he authored the first monograph dedicated to the disease, La Poliomyélite aiguë épidémique (1913). • His work was the basis for the development of vaccinea (by Jonas Salk and Albert Sabin. • In his studies of syphilis, Levaditi introduced new techniques in serology, and recommended bismuth in its treatment.

20. Constantin Ion Parhon (October 15, 1874—August 9, 1969) • was a Romanian neuropsychiatrist and endocrinologist. • In 1909, he co-authored with the first book on endocrinology, Secreţiile Interne ("Internal Secretions"). Later on, he published a Handbook of Endocrinology, co-written with M. Goldstein and (3 volumes, 1945-1949). Parhon published over 400 titles, and was known for his encyclopaedic knowledge. Besides the afore-mentioned works, some of his other well-known works are Old Age and Its Treatment (1948), The Age Biology (1955), and Selected Works (5 volumes, 1954-1962). Iuliu Haţieganu (1885-1972) • was an eminent Romanian clinician, physician. He was the brother of politician Emil Haţieganu. • He is especially famed for his research into tuberculosis.

21. Ana Aslan (born 1 January 1897, at Brăila - death 20 May 1988, at Bucharest) • was a Romanian biologist and physician. She is considered to be a founding figure of gerontology and geriatrics in Romania. In 1952, under the leadership of Prof. Dr. Ana Aslan, the Geriatric Institute in Bucharest was founded. This Institute was the first of its kind in Romania and was recognized by the World Health Organization. • The Gerovital H3 concept was introduced for the first time in 1957, in Verona, Italy, on the occasion of the 4th International Gerontology Congress. Many scientists from the USA, Germany, England, Japan, Italy, Austria and Romania have studied and confirmed the effects of the Gerovital H3 treatment suggested by Prof. Dr. Ana Aslan. In the 60’s the Gerovital H3 treatment became a scientific certitude (which, readers should note, is an oxymoron, though certainly pedantic enough to appear credible to consumers), a high value anti-aging treatment.

22. Notables such as French President Charles De Gaulle, U.S. President John F. Kennedy, West German Chancellor Konrad Adenauer, Chinese Chairman Mao Zedong, and Vietnamese Chairman Ho Chi Minh have traveled to Romania to benefit this anti-aging therapy. • Other well-known people, including actresses Marlene Dietrich, Lillian Gish, the Gabor sisters, actors Charlie Chaplin and Kirk Douglas, and artist Salvador Dalí have also followed the same path.They traveled to Bucharest, where Dr. Aslan did her research with Gerovital H3. Once discovered by these celebrities, Gerovital itself has become famous and is now used in over twenty countries around the world for its renowned anti-aging properties. • Ana Aslan’s research activity received many international distinctions.

23. George Emil Palade (November 19, 1912 – October 7, 2008) • was a Romanian cell biologist. In 1974, he shared the Nobel Prize in Physiology or Medicine with Albert Claude and Christian de Duve, for discovering the vacuole. • Palade also received the U.S. National Medal of Science in Biological Sciences for "pioneering discoveries of a host of fundamental, highly organized structures in living cells..." in 1986,(National Medal of Science), and was previously elected a Member of the National Academy of Science in 1961. • In 1952, Palade became a naturalized citizen of the United States. He was a Professor at the Rockefeller Institute (1958-1973), Yale University Medical School (1973-1990), and University of California, San Diego (1990-2008). • At the Rockefeller Institute for Medical Research, Palade used electron microscopy to study the internal organization of such cell structures as mitochondria, chloroplasts, the Golgi apparatus, and others.

24. His most important discovery was made while using an experimental strategy known as a pulse-chase analysis. In the experiment Palade and his colleagues were able to confirm an existing hypothesis that a secretory pathway exists and that the Rough ER and the Golgi apparatus function together. • He focused on Weibel-Palade bodies (a storage organelle unique to the endothelium, containing von Willebrand factor and various proteins) which he described together with the Swiss anatomist Ewald R. Weibel.

25. Nicolae Cajal (October 1, 1919, Bucharest- March 7, 2004) • was a Romanian Jewish physician, academic, politician, and philanthropist. He was President of the Jewish Communities' Federation of Romania from 1994 to his death. • Cajal held a Ph.D. in virology and chaired the Ştefan S. Nicolau Virology Research Center in Bucharest for years. He was a member of the Romanian Academy, the Romanian Medical Sciences Academy, the British Royal Society of Medicine, and the New York Academy of Sciences. From 1966, he was an expert for the World Health Organization. • Nicolae Cajal was an active member in civil society, involved in improving awareness of war crimes carried in World War II Romania and of the genocide in Transnistria and other occupied areas (see Romania during World War II).

26. Daily contact with scores of the infirm and his astuteness made him put use every one of the latest methods as they became available: the roentgen ray, with which he investigated bone changes in acromegaly, the film camera, for the study of body movements in health and disease. The results of these studies appeared in the monography Le Tonus des Muscles striés (1937) with Nicolae Ionescu-Siseşti, Oskar Sager and Arthur Kreindler, with a preface by Sir Charles Sherrington. • Early in his career he published with the bacteriologist Victor Babeş and the French pathologist Paul Oscar Blocq a much needed atlas on the pathological histology of the nervous system. His description with Blocq of a case of parkinsonian tremor due to tumour in the substantia nigra, in 1893, was the basis for Édouard Brissaud's theory that parkinsonism occurs as a consequence of damage to the substantia nigra. With Paul Blocq he was the first to describe senile plaques and with Romanian neurologist confirmed in 1913 Hideyo Noguchi's discovery of Treponema pallidum in the brain in patients with general paresis. His monumental work La Cellule Nerveuse, with a preface by Santiago Ramon y Cajal, appeared in 1909.