Single Episode of Binge Drinking Linked to Gut Leakage and Immune System Effects

 

Binge drinking is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08g/dL or above. For a typical adult, this pattern corresponds to consuming five or more drinks for men, or four or more drinks for women, in about two hours. Some individuals will reach a 0.08g/dL BAC sooner depending on body weight. Binge drinking is known to pose health and safety risks, including car crashes and injuries. Over the long term, binge drinking can damage the liver and other organs.

 

According to an article publish online in PLOS ONE, a single alcohol binge can cause bacteria to leak from the gut and increase levels of bacterial toxins in the blood. These increased levels of these bacterial toxins, called endotoxins, were shown to affect the immune system, with the body producing more immune cells involved in fever, inflammation, and tissue destruction.

 

For the study, 11 men and 14 women were given enough alcohol to raise their blood alcohol levels to at least .08 g/dL within an hour. Blood samples were taken every 30 minutes for four hours after the binge and again 24 hours later. Results showed that the alcohol binge resulted in a rapid increase in endotoxin levels in the blood and evidence of bacterial DNA, showing that bacteria had permeated the gut. Endotoxins are toxins contained in the cell wall of certain bacteria that are released when the cell is destroyed. Compared to men, women had higher blood alcohol levels and circulating endotoxin levels. According to the authors, it was found that a single alcohol binge can elicit an immune response, potentially impacting the health of an otherwise healthy individual, and that the study results suggest that an alcohol binge is more dangerous than previously thought.

 

Earlier studies have tied chronic alcohol use to increased gut permeability, wherein potentially harmful products can travel through the intestinal wall and be carried to other parts of the body. Greater gut permeability and increased endotoxin levels have been linked to many of the health issues related to chronic drinking, including alcoholic liver disease.

Treatment of Chagas Disease

 

Chagas disease, also known as American trypanosomiasis, is a tropical parasitic disease caused by the protozoan Trypanosoma cruzi and spread mostly by insects known as Triatominae or kissing bugs. Chagas disease is endemic throughout much of Mexico, Central America, and South America where an estimated 8 million people are infected. The triatominae are known by a number of local names, including: vinchuca in Argentina, Bolivia, Chile and Paraguay, barbeiro (the barber) in Brazil, pito in Colombia, chinche in Central America, and chipo in Venezuela. The disease may also be spread through blood transfusion, organ transplantation, eating food contaminated with the parasites, and from a mother to her fetus. The symptoms change over the course of the infection. In the early stage, symptoms are typically either not present or mild and may include: fever, swollen lymph nodes, headaches, or local swelling at the site of the bite. After 8-12 weeks, individuals enter the chronic phase of disease and in 60-70% it never produces further symptoms. However, the other 30-40% of people develop further symptoms 10 to 30 years after the initial infection. This includes enlargement of the ventricles of the heart in 20 to 30% leading to heart failure. An enlarged esophagus or an enlarged colon may also occur in 10% of people.

 

By applying published seroprevalence figures to immigrant populations, CDC estimates that more than 300,000 persons with Trypanosoma cruzi infection live in the United States. Most people with Chagas disease in the United States acquired their infections in endemic countries. Although there are triatomine bugs in the U.S., only rare vectorborne cases of Chagas disease have been documented.

 

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Rhodnius prolixus

 

Current therapeutic options for Chagas’ disease are limited to benznidazole and nifurtimox, which have been associated with low cure rates in the chronic stage of the disease and which have considerable toxicity. Posaconazole has shown trypanocidal activity in murine models.

 

According to an article published in the New England Journal of Medicine (2014; 370:1899-1908), a prospective, randomized clinical trial was performed to assess the efficacy and safety of posaconazole as compared with the efficacy and safety of benznidazole in adults with chronic Trypanosoma cruzi infection. The study randomly assigned patients to receive posaconazole at a dose of 400 mg twice daily (high-dose posaconazole), posaconazole at a dose of 100 mg twice daily (low-dose posaconazole), or benznidazole at a dose of 150 mg twice daily; all the study drugs were administered for 60 days. Antiparasitic activity was assessed by testing for the presence of T. cruzi DNA, using real-time polymerase-chain-reaction (rt-PCR) assays, during the treatment period and 10 months after the end of treatment. Posaconazole absorption was assessed on day 14.

 

The intention-to-treat population included 78 patients. During the treatment period, all the patients tested negative for T. cruzi DNA on rt-PCR assay beyond day 14, except for 2 patients in the low-dose posaconazole group who tested positive on day 60. During the follow-up period, 92% of the patients receiving low-dose posaconazole and 81% receiving high-dose posaconazole, as compared with 38% receiving benznidazole, tested positive for T. cruzi DNA on rt-PCR assay (P<0.01). In the per-protocol analysis, 90% of the patients receiving low-dose posaconazole and 80% of those receiving high-dose posaconazole, as compared with 6% receiving benznidazole, tested positive on rt-PCR assay (P<0.001). In the benznidazole group, treatment was discontinued in 5 patients because of severe cutaneous reactions; in the posaconazole groups, 4 patients had aminotransferase levels that were more than 3 times the upper limit of the normal range, but there were no discontinuations of treatment.

 

According to the authors, posaconazole showed antitrypanosomal activity in patients with chronic Chagas’ disease. However, significantly more patients in the posaconazole groups than in the benznidazole group had treatment failure during follow-up.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area.

 

FDA Allows Marketing of First Prosthetic Arm That Translates Signals From Person’s Muscles to Perform Complex Tasks

 

The FDA has allowed marketing of the DEKA Arm System, the first prosthetic arm that can perform multiple, simultaneous powered movements controlled by electrical signals from electromyogram (EMG) electrodes. EMG electrodes detect electrical activity caused by the contraction of muscles close to where the prosthesis is attached. The electrodes send the electrical signals to a computer processor in the prosthesis that translates them to a specific movement or movements. The EMG electrodes in the DEKA Arm System convert electrical signals into up to 10 powered movements, and it is the same shape and weight as an adult arm. In addition to the EMG electrodes, the DEKA Arm System contains a combination of mechanisms including switches, movement sensors, and force sensors that cause the prosthesis to move.

 

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From the DEKA Website

 

The FDA reviewed clinical information relating to the device, including a 4-site Department of Veterans Affairs study in which 36 DEKA Arm System study participants provided data on how the arm performed in common household and self-care tasks. The study found that approximately 90% of study participants were able to perform activities with the DEKA Arm System that they were not able to perform with their current prosthesis, such as using keys and locks, preparing food, feeding oneself, using zippers, and brushing and combing hair. The DEKA Arm System can be configured for people with limb loss occurring at the shoulder joint, mid-upper arm, or mid-lower arm. It cannot be configured for limb loss at the elbow or wrist joint.

 

Data reviewed by the FDA also included testing of software and electrical and battery systems, mitigations to prevent or stop unintended movements of the arm and hand mechanisms, durability testing (such as ability to withstand exposure to common environmental factors such as dust and light rain), and impact testing.

 

The FDA reviewed the DEKA Arm System through its de novo classification process, a regulatory pathway for some novel low- to moderate-risk medical devices that are first-of-a-kind.

 

The DEKA Arm System is manufactured by DEKA Integrated Solutions in Manchester, N.H.

Chocolate Avocado Delight with Strawberries and Amaretto

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Chocolate Avocado Delight ©Joyce Hays, Target Health Inc.

 

Ingredients

1 ripe avocado

1/4 cup cocoa powder

1/4 cup raw agave nectar

1/4 cup almond milk

1 teaspoon vanilla extract

1 pint fresh sweet strawberries

Amaretto (optional)

 

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All the ingredients ©Joyce Hays, Target Health Inc.

 

Directions

1. Put all ingredients into a food processer and puree until smooth.

2. Pour the mixture into a bowl and chill for 2-3 hours or overnight.

3. Wash the strawberries and dry on paper towel.

4. Cut small strawberries in half and large ones in quarters or slice all of them.

 

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Soaking the strawberries in Amaretto ©Joyce Hays, Target Health Inc.

 

1. Put strawberries in a bowl and pour some of the Amaretto over them and let them soak it up.

2. When you take the mousse out of the fridge, cut the strawberries in half and put some in the bottom of each individual glass dessert dish. Cover strawberries with chocolate plus more. Add a few more strawberries, then cover with more chocolate.

3. Add a dollop of cool whip on each serving and a strawberry on top of that.

4. Enjoy!

 

The avocado is a climacteric fruit (the banana is another), which means it matures on the tree, but ripens off the tree. Persea americana, or the avocado, is believed to have originated in the state of Puebla, Mexico,though fossil evidence suggests that millions of years ago similar species were much more widespread, occurring as far north as California at a time when the climate of that region was more hospitable to them. The native, undomesticated variety is known as a criollo, and is small, with dark black skin, and contains a large seed.It likely coevolved with extinct megafauna.The oldest evidence of avocado use was found in a cave located in Coxcatlan, Puebla, Mexico, that dates to around 10,000 BCE.

 

Avocados are an incredibly versatile fruit, well known as the main ingredient inguacamole and one of my favorite things to put in a salad. Besides having a delicious nutty flavor, they’re loaded with healthy fats and nutrients. But did you know it’s a fruit and not a veggie? In fact, it’s a berry.

 

A fruit is “the matured ovary of a flower,“ according to University of California Agriculture & Natural Resources. Fruits consist of a tough outer layer (the skin or rind), a middle layer we typically think of as the flesh of the fruit and a casing around a seed (or seeds). Avocado is further classified as a fleshy as opposed to a dry fruit, and a berry rather than a drupe, which has tough pits or stones, like peaches. An avocado also has more potassium than a banana. A single avocado has 975 milligrams of potassium, while a banana, well-known for being loaded with potassium, delivers just half that, with 487 milligrams per large fruit.

 

Buy your avocados ahead of time (like, for this week’s recipe) and ripen them at home with a banana or an apple. Bananas and apples release ethylene gas, a naturally-occurring plant hormone. If you store your unripe avocados in a brown bag with an apple or a banana, the gases trapped in the bag will help your avocado ripen faster.

 

Besides containing potassium, it makes sense to use an avocado in desserts because one avocado has four grams of protein, among the highest amount coming from a fruit. Plus this is good quality protein. They don’t contain every single amino acid, required in the body’s protein-building process, but they do have all 18 of the important ones. Plus, all of that protein is available for the body to use, while some of the protein you might get from meat sources is not.

 

As you see from this week’s recipe, you can swap avocados for butter. How healthy is that if you’re watching your cholesterol.

 

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©Joyce Hays, Target Health Inc.

 

I’ve been experimenting with this recipe and it’s delicious with Amaretto strawberries and without. Just a matter of taste.

 

On individual plates or small bowls, you could also spoon out the cut Amaretto strawberries, then serve the chocolate-avocado as a sauce, over the berries, topping with cool whip, whipped cream or vanilla ice cream. As a sauce, this would also be wonderful over the flourless almond cake I came up with, in one issue of the ON TARGET newsletter, sent out around the Easter/Passover holidays.

 

No wine photo. Not drinking wine this weekend, because my lover and best friend is off on the hunt.

 

So, until next week.

 

Bon Appetit !

Using Risk-Based and Central Monitoring in Place of Source Document Verification (SDV)

 

In order to support the transformation of how the pharmaceutical industry manages the performance of clinical trials, in 2013, the Food and Drug Administration (FDA) issued its Final Guidance for Industry: Oversight of Clinical Investigations – A Risk-Based Approach to Monitoring, and a Guidance for Industry: Electronic Source Data in Clinical Investigations.  These guidances are consistent with the European Medicines Agency (EMA) Reflection Paper on Risk Based Quality Management in Clinical Trials andExpectations for Electronic Source Data and Data Transcribed to Electronic Data Collection Tools in Clinical Trials.

 

Target Health is pleased to announce that since 2012, it has been performing both risk-based and central monitoring tied in with direct data entry using Target e*CTR® (eClinical Trial Record; eSource) fully integrated with Target e*CRF®. If you want to see some profound metrics, take a look at a recent publication in Applied Clinical Trials, entitled “Time to Change the Clinical Trial Monitoring Paradigm – Results from a Multicenter Clinical Trial Using a Quality by Design Methodology, Risk-Based Monitoring and Real-Time Direct Data Entry.” The article is posted on our website.

 

We reduced onsite monitoring by at least 50%, had very low query rates and database changes as a result of SDV was in the 1% range. We now spend our time looking at data in real time and making sure the sites understand and are following the protocol. The new definition of quality is:

 

1. The absence of errors that matter

2. Are the data fit for purpose

 

and not whether a transcribed blood pressure of 120/80 was precisely transcribed from 121/80. Of course with direct data entry, “the data are the data“ so there is no checking needed.

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Springtime in NY – Park Avenue Cherry Trees ©Target Health

 

ON TARGET is the newsletter of Target Health Inc., a NYC-based contract research organization (eCRO), providing strategic planning, regulatory affairs, clinical research, data management, biostatistics, medical writing and software services, including the paperless clinical trial, to the pharmaceutical and device industries.

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

 

Joyce Hays, Founder and Chief Editor of On Target

Jules Mitchel, Editor

 

How to Survive a Hospital Shooting

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The emergency room at Bronx-Lebanon Hospital was home to a shootout (Photo: CBS 2)

 

According to one study, although metal detectors allowed security officers to confiscate more 1) ___, the number of assaults did not decrease.

 

A 50-year-old man loaded bullets and shot his mom’s surgeon in the stomach, then fired twice more — into his mother’s skull and then his own. The shooter and his mother both died, and locked down the Johns Hopkins Hospital for over 3 hours. That attack and suicide in September 2010 planted the seed for hospital shooting research and a day-long symposium last month, April 2014, at Johns Hopkins about how staff should prepare and react to 2) ___ in hospitals. An expert panel at the symposium plans to issue national guidance this fall of 2014.

 

This was not an isolated incident. In a 2012 Annals of Emergency Medicine study, it was reported that of the 154 hospital shootings from 2000 to 2011 across 40 states, roughly 30% occur in 3) ___ departments. “In 4) ___emergencies, caregivers are charged and trained and expected to enter that room and take care of the situation,“ said Mike Thiel, director of security for Children’s Hospital of Wisconsin. “That has consequences because you can’t turn off those natural behaviors.“

 

People usually flee when they hear gunshots. But in November, 2013, two nurses at the Children’s Hospital of Wisconsin in Milwaukee sprinted toward the sound of 5) ___ fired. They peered around the corner. That’s when they saw the man running at them with a gun. Only then the nurses turned and fled. Then the gunman screamed, “I can’t see, I can’t see,“ and the nurses — driven by an instinct to help — returned to the scene, pressed the door button, and inadvertently allowed the suspect to escape from the police officer who had him cornered and restrained with pepper 6) ___.

 

Another big takeaway from the Wisconsin incident was the need to clearly let staff know that alerts and announcements during the incident were not just a practice drill,“ Thiel said. He had noted during the event that some staff and people in the hospital did not recognize the severity of the issue. And if that was the case, they might have missed their first opportunity to react quickly. It turns out healthcare workers have to be trained to react differently to gun violence, according to an American Journal of Disaster Medicine study about how to prepare staff for active shooters in the ED. Perhaps it’s obvious, but it’s important that each department have a plan in place so that people know how to respond swiftly and effectively, Thiel said. Not everyone will know how to react, but there must be some staff trained to respond correctly. “Sometimes people won’t react until someone takes charge,“ Thiel said. Everyone needs to know who is in charge in the situation. And those plans must include which medical teams will be the first 7) ___ for casualties. “People have to want to be there,“ said Howard S. Gwon, senior director of emergency management for Johns Hopkins Medicine. That’s the main prerequisite for first responders. But Gwon, also known as “the master of disaster“ around Hopkins says he also always asks volunteers: “Has your significant other given permission?“ That’s just one question that healthcare providers need to wrestle with when it comes to hospital shooters. The other one is: What is the priority in cases of violent patients?

 

It’s an answer to that question that Catherine A. Marco, MD, a professor of emergency medicine at Wright State University, learned her first day as a resident in the emergency department in 1988. A violent patient thrashed around, biting nurses in one of the bays. When Marco rushed to help restrain the patient, the attending physician stopped her. He said her job was to observe the situation until security restrained the patient enough so she could assess the medical condition. There’s no consensus among ethicists about how physicians should weigh personal safety in these situations, said Marco, who has chaired the American College of Emergency Physician’s ethics committee. She said healthcare providers need to remember the goal to provide the “most good for the most people.“ “If you can’t protect yourself, you can’t protect others,“ Marco added. “When push comes to shove, protect 8) ___.“ Thiel, the director of security at the Wisconsin hospital said, “Self-preservation is not abandonment, if you get shot you’ll be unable to provide care.“ Self-preservation means having a plan and knowing how hospital administrators plan to communicate during emergencies — email, text, website, intercom — and stay tuned, in silent mode.

 

Can Shootings Be Prevented?

On the whole, hospital shootings are less likely than death by lightning, and victims are rarely physicians or other healthcare providers, said Gabe Kelen, MD, chair of emergency medicine at Johns Hopkins University, who authored the 2012 active shooter study. And there’s very little in the way of prevention. What about metal detectors? Robert McNamara, MD, chair of emergency medicine at Temple University, surveyed people in one emergency department and found that 75% already felt safe. McNamara, past president of the American Academy of Emergency Medicine, found metal detectors would help people feel even safer. But a 1999 study published in the Annals of Emergency Medicine found that while metal detectors allowed security officers to confiscate more guns, the number of assaults did not decrease. What’s more, patients found other ways to elude the metal 9) ___ — for example, they slipped guns into the hospital through ambulances.

 

The other complication with metal detectors is that additional staff — armed with guns — must staff the stations. Kelen said 18% of gun incidents on hospital property happened after someone grabbed the security person’s firearm. That number jumps to 50% in emergency department shootings.

 

Could profiling help? All presenters largely agreed that there’s no single profile that can help healthcare providers and security people identify possible shooters. Roughly 30% of the shooters had a grudge. In the ED, shooters tended to be younger — 35% were between 18 and 29 years old, according to Kelen’s 2012 study. In many cases, the shooters were under custody of armed security. Special agent Erin L. Sheridan, a member of a behavioral analysis unit from the FBI National Center for the Analysis of Violent Crimes Task Force, said even checklists of threatening behaviors have limited value. 10) ___ rarely give direct threats, especially in targeted violence that is more emotionally charged and less premeditated. Kelen said about the only practical intervention besides planning is for physicians and providers to take care of patients by de-escalating potential problems in the emergency department and “keep the flow going.“ And when prevention fails, here’s how experts recommend you protect yourself, colleagues, and your 11) ___.

 

In an active shooter situation, there are three “zones“ — hot, warm and cold, said Matthew Levy, DO, senior medical officer at the Johns Hopkins center of law enforcement medicine. The hot zone means there’s a direct threat to your life. Weigh three reactions in the hot zone: Run, hide, or fight, said George Economas, senior director of security at Johns Hopkins Medical Institution. Economas gave five questions to help quickly assess the situation:

 

1. How close is the shooter?

2. Is there time to get everyone out safely?

3. Can the area be secured?

4. Should we shelter in place?

5. Should I prepare to defend myself and protect my patients?

 

If the shooter is nearby, but you have a way to move everyone safely, evacuate and call 911. Tell them where you are, the number, description, and location of the shooters. If you can, include description of weapons and details for wounded. When you don’t have enough cover to move, it’s time to hide. “Shooters are drawn to movement,“ said Sheridan. Once you’ve identified a place to hide, push heavy furniture or patient beds with lockable wheels to block doors that don’t lock. Turn off the lights and move away from windows and doors. Hide in cabinets, closets, or anything that blocks you from view of the shooter. Turn your phones, nurse call systems, and pagers to silent. Call 911 and quietly provide as much information as you can, and leave the phone line open. Arm yourself in case you must confront the shooter. The last option is when you’re cornered. Experts like Economas say there is evidence that you must fight and commit fully to disabling the shooter. A 2013 active shooter study conducted by J. Pete Blair, PhD, director of research at the Advanced Law Enforcement Rapid Response Training at Texas State University, provides evidence that when given no other choice, fighting back is often the way people restrain assailants. Economas recommends working as a team and throwing anything to distract, disorient or incapacitate: staplers, keys, tape dispensers, etc. If there’s a fire extinguisher within reach, spray it at the shooter.

 

In the cold zone, there’s no threat to safety, so stay put for instructions from those in charge. In all cases, stay put even after shooting stops — wait for the police to announce an “all clear.“ Once police arrive, stay calm, move slowly, put down anything you held, and keep hands visible to avoid adding confusion to the tense situation. It’s in the warm zone where there’s still a potential threat, but healthcare providers must make the calculated risk to provide care. Levy, who was the on-scene medical director at the Columbia Mall shooting in January 2014, said the main priorities are to stabilize bleeds and extract the injured. In order to do this safely, it’s important to identify safe passageways between hot zones and 12) ___ zones.

 

Levy used the acronym MARCHED to describe the level of tactical emergency casualty care given in a warm zone:

 

1. Massive hemorrhage control

2. Airway management (basic)

3. Respiration (bag-valve mask ventilation)

4. Circulation risk (CPR, needle decompression)

5. Hypothermia

6. Head injury

7. Everything else, decon etc.

8. Documentation (what was done).

 

One way to prepare is to equip code carts with some additional supplies like dressings, tourniquets, and chest seals, said Levy. And while there’s no way to predict or prevent these shootings, Gwon, who oversees preparedness at Hopkins health system, said their adult trauma team volunteered as first responders in their active shooter plans. So when Cohen, the Hopkins orthopedic surgeon, was shot in the stomach, they stabilized him in the ED and then moved him to surgery quickly. “Used to be ‘If the scene ain’t safe, I’m not going in,’“ Levy said. “That ship has sailed, we need to figure out how to get in there and stabilize patients.“ As if to punctuate the issue, just 4 days after the symposium, a man walked into a Hopkins hospital emergency department bathroom and shot himself to death. Sources :Annals of Emergency Medicine, Kelen GD, et al “Hospital-based shootings in the United States: 2000 to 2011“ Ann Emerg Med; DOI: 10.1016/j.annemergmed.2012.08.012; MedPageToday.com

 

ANSWERS: 1) guns; 2) gunfire; 3) emergency; 4) medical; 5) shots; 6) spray; 7) responders; 8) yourself; 9) detectors; 10) Shooters; 11) patients; 12) warm

 

George Emory Goodfellow MD (1855-1910)

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Editor’s note: We allowed this article to be longer than usual, because the life of Dr. George E. Goodfellow is such a vividly active one. Also, through this true and raw story, you get a real glimpse of the colorful narrative of American history when the West was truly wild and this particular physician seems to have thrived on it.Arizona became a separate territory just before the Civil War and when silver was discovered at Tombstone, Arizona, in 1877, nearly 7,000 people came to the territory. By the 1880’s the Arizona territory was bustling with fortune seekers from all around the world.  It wasn’t until 1912, that Arizona became the 48th state of the United States and no longer a completely lawless frontier.

 

Until the 1880s, the standard practice for treating a gunshot wound called for physicians to insert their unsterilized fingers into the wound to probe and locate the path of the bullet. Surgically opening abdominal cavities to repair gunshot wounds, Germ theory, and Dr. Joseph Lister’s technique for “antisepsis surgery“ using dilute carbolic acid, which had been first demonstrated in 1865, had not yet been accepted as standard practice by prevailing medical authorities. For example, 16 doctors attended to James A. Garfield and most probed the wound with their fingers or dirty instruments. Historians agree that massive infection was a significant factor in President Garfield’s death.

 

At almost the same time, in Tombstone, Arizona Territory on July 13, 1881, Dr. George E. Goodfellow performed the first laparotomy to treat an abdominal gunshot wound. Dr. Goodfellow was a physician and naturalist in the American Old West. As a physician, he treated many gunshot wounds to both lawmen and outlaws. He was also the first surgeon to perform a perineal prostatectomy to remove an enlarged prostate. He pioneered the use of spinal anesthesia and sterile techniques in treating gunshot wounds and is regarded as the first civilian trauma surgeon.

 

Goodfellow was a pugnacious, “brilliant and versatile“ physician with wide-ranging interests. During his life he not only practiced medicine, he studied earthquakes and published the first surface rupture map of an earthquake in North America, interviewed Geronimo, conducted research into the venom of Gila monsters, and played a role in brokering a peace settlement in the Spanish-American War. He was also a skilled boxer and in his first year at the United States Naval Academy, he became the Academy boxing champion, but was dismissed for kicking and beating the first African-American to attend the institution. In 1889, he got into a fight with another man and stabbed him, but was found to have acted in self-defense.

 

Goodfellow treated Virgil Earp and Morgan Earp after they were wounded in the Gunfight at the O.K. Corral. His testimony later helped absolve the Earps and Doc Holliday of murder charges when they shot and killed three outlaw Cowboys and supported their contention that they acted lawfully. He treated Virgil again when he was maimed in an ambush and rushed to Morgan’s side when he was mortally wounded by an assassin. Goodfellow left Tombstone in 1889 and established a successful practice in Tucson before moving to San Francisco in 1899. He lost his practice and all of his personal belongings in the 1906 San Francisco Earthquake and returned to the Southwest where he became the Chief Surgeon for the Southern Pacific Railroad in Mexico. He fell ill during 1910 and died later that year in Los Angeles.

 

Goodfellow was born on December 23, 1855 in Downieville, California, then one of the largest cities in the state. His parents also had two daughters, Kitty and Bessie. His father became a mining engineer and maintained an interest in medicine. Goodfellow grew up around California Gold Rush mining camps and developed a deep interest in both mining and medicine. He was then accepted to the University of California at Berkeley where he studied Civil Engineering for one year before he applied to U.S. Naval Academy.

 

Goodfellow declined a Congressional appointment to West Point and instead accepted an appointment from Nevada congressional representative C. W. Kendall to the United States Naval Academy, arriving there in June 1872. Goodfellow became the boxing champion at the Academy. Like many of his fellow cadets, he took exception to the presence of the Academy’s first black cadet, John H. Conyers. While marching, Goodfellow and another Cadet began kicking and punching Conyers, who had been shunned constantly and brutally harassed since his arrival. News of the incident and the constant hazing experienced by Conyers leaked to the newspapers, and a three-man board was convened to investigate the attacks. Goodfellow denied any wrongdoing and Conyers claimed he could not identify any of his attackers. The board nonetheless concluded that “His persecutors are left then without any excuse or palliation except the inadmissible one of prejudice.“ The review board believed the Academy needed to give Conyers a fair chance at succeeding on his own merits, and recommended that strong measures should be taken. In the end Goodfellow and two others were dismissed from the Academy.

 

Goodfellow eventually attended Wooster University Medical School and on February 23, 1876, he graduated with honors. Goodfellow briefly opened a medical practice in Oakland. Goodfellow was soon invited by his father Milton to join him in Yavapai County, Arizona Territory, where he was a mining executive for Peck, Mine and Mill. Goodfellow worked as the company physician for the next two years in Prescott until he secured permission to serve with Custer’s 7th Cavalry but his orders to join the unit were delayed and he missed the Battle of Little Big Horn on June 25-26, 1876. Instead, he joined the U.S. Army as acting assistant surgeon at Ft. Whipple in Prescott. In 1879 he became for a brief period the contract surgeon at Ft. Lowell near Tucson.Medical practice in Tombstone

 

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George E. Goodfellow practiced in Tombstone, Arizona for 11 years.

 

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Goodfellow arrived in Tombstone in 1880 as the town was booming during its silver mining peak.

 

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Dr. Goodfellow’s office was on the second floor of the Crystal Palace Saloon, seen here in 1885.

 

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The Crystal Palace Hotel, restored in 2010

 

In 1880 Goodfellow decided to open his own medical practice. On September 15, 1880, he canceled his Army contract and he and his wife relocated to the silver boom town of Tombstone, Arizona Territory. There were already 12 doctors in the town of 2,000 residents, but only he and three others had medical school diplomas. The town was less than a year old and its population had exploded from about 100 residents in March 1879 when it consisted mostly of wooden shacks and tents. By the fall of 1879 more than a thousand hardy miners and merchants lived in a canvas and matchstick camp built on top of the richest silver strike in the United States. On September 9, 1880, the richly appointed Grand Hotel was opened, adorned with fine oil paintings, thick Brussels carpets, toilet stands, elegant chandeliers, silk-covered furniture, walnut furniture, and a kitchen with hot and cold running water.

 

At age 25, Goodfellow opened an office on the second floor of the Crystal Palace Saloon, one of the most luxurious saloons in the West. It was also the location of offices for other notable officials including County Coroner Dr. H. M. Mathews, Deputy U.S. Marshal Virgil Earp, attorney George W. Berry, Cochise County Sheriff Johnny Behan, and Justice of the Peace Wells Spicer. When he wasn’t busy tending to patients, he walked down the outside stairs to the saloon below, where he spent many hours drinking, playing Faro, and betting on horse races, foot races, wrestling and boxing matches. He got along well with the hardscrabble miners, the elite of Tombstone, and characters like the notoriously drunk lawyer Allen English.

 

Goodfellow lost his office when the saloon and most of downtown Tombstone burned to the ground during a large fire on May 26, 1882. The building was quickly rebuilt and the Crystal Palace earned a reputation for its gambling, entertainment, food and the best brands of wines, liquors, and cigars available 24 hours a day. Goodfellow cared for the indigent and was reimbursed by the county at the rate of from $8,000 to $12,000 per year.

 

The mine and business owners, miners, townspeople and city lawmen including brothers Virgil, Morgan, and Wyatt Earp were largely Republicans from the Northern states. There was also the fundamental conflict over resources and land, of traditional, Southern-style, “small government“ agrarianism of the rural Cowboys contrasted to Northern-style industrial capitalism. The Tombstone Daily Journal asked in March 1881 how a hundred outlaws could terrorize the best system of government in the world, asking, “Cannot the marshal summon a posse and throw the ruffians out?“ Goodfellow later described Tombstone as the “condensation of wickedness.“

 

Authority on gunshot wounds

On July 2, 1881, President James Garfield was shot by Charles J. Guiteau. One bullet was thought later to have possibly lodged near his liver but could not be found. Standard medical practice at the time called for physicians to insert their unsterilized fingers into the wound to probe and locate the path of the bullet. Surgically opening abdominal cavities to repair gunshot wounds, Germ theory, and Dr. Joseph Lister’s technique for “antisepsis surgery“ using dilute carbolic acid, which had been first demonstrated in 1865, had not yet been accepted as standard practice by prevailing medical authorities. Sixteen doctors attended to Garfield and most probed the wound with their fingers or dirty instruments. Historians agree that massive infection was a significant factor in President Garfield’s death. On July 4, two days after the President was shot, a miner outside Tombstone was shot with a 32-caliber Colt revolver in the abdomen. Goodfellow was able to treat the man nine days later, on July 13, 1881, when he performed the first laparotomy to treat a bullet wound. Goodfellow noted that the abdomen showed symptoms of a serious infection, including distension from gas, tumefaction, redness and tenderness. The man’s intestines were covered with a large amount of “purulent stinking lymph.“ The patient small and large intestine were perforated by six holes, wounds very similar to President Garfield’s injury. Goodfellow followed Lister’s recommended procedure for sterilizing everything: his hands, instruments, sponges, and the area around the wound. He successfully repaired the miner’s wounds and the miner, unlike the President, survived. A laparotomy is still the standard procedure for treating abdominal gunshot wounds today.

 

Goodfellow traveled many hours to treat cowboys miles from Tombstone and performed surgery under primitive conditions. He traveled to Bisbee, 30 miles (48 km) from Tombstone, in January 1889 to treat a patient struck in the abdomen by a bullet from a 44 Colt. At midnight, he operated on the patient stretched out on a billiard table. Goodfellow removed a .45-calibre bullet, washed out the cavity with two gallons of hot water, folded the intestines back into position, stitched the wound closed with silk thread, and ordered the patient to take to a hard bed for recovery. He wrote about the operation: “I was entirely alone having no skilled assistant of any sort, therefore was compelled to depend for aid upon willing friends who were present – these consisting mostly of hard-handed miners just from their work on account of the fight. The anesthetic was administered by a barber, lamps held, hot water brought and other assistance rendered by others.“ The man lived for 18 hours after surgery, long enough to write out his will, but died of shock.

 

Medical authority on abdominal wounds

During his career, Goodfellow published 13 articles about abdominal bullet wounds based on treatments and techniques he developed while practicing medicine in Tombstone. His articles were laced with colorful commentary describing his medical practice in the primitive west. He wrote, “In the spring of 1881, I was a few feet distant from a couple of individuals [Luke Short and Charlie Storms] who were quarreling. They began shooting. The first shot took effect, as was afterward ascertained, in the left breast of one of them, who, after being shot, and while staggering back some 12 feet, cocked and fired his pistol twice, his second shot going into the air, for by that time he was on his back.“ He included a description of the bullet wounds he most often treated: “The .44 and .45 caliber Colt revolver, .45-60 and .44-40 Winchester rifles and carbines were the toys with which our festive or obstreperous citizens delight themselves.“ The .45 caliber Colt Peacemaker round contained 40 grains of black powder that shot a thumb-sized, 250 grain slug at the relatively slow velocity of 910 feet per second. But the large bullet could smash through a 3.75 inches (95 mm) pine board at 50 yards (46 m). The nearly half-inch lead slug used at the time did considerably more damage than modern steel-jacketed bullets. Goodfellow saw the effect of these large caliber weapons up close and was very familiar with their powerful impact. In an article “Cases of Gunshot Wound of the Abdomen Treated by Operation“ in the Southern California Practitioner of 1889 he wrote, “the maxim is, shoot for the guts; knowing death is certain, yet sufficiently lingering and agonizing to afford a plenary sense of gratification to the victor in the contest.“ His article described five patients with penetrating abdominal wounds, four of whom survived, and the laparotomies he completed on all of them. He wrote, “it is inexcusable and criminal to neglect to operate upon a case of gunshot wound in the abdominal cavity.“

 

Goodfellow learned that the caliber of the bullet determined whether a medical procedure was needed. If the bullet was .32-caliber or larger, it “inflicted enough damage to necessitate immediate operation.“ He noted, “Given a gunshot wound of the abdominal cavity with one of the above caliber balls [.44 and .45], if the cavity be not opened within an hour, the patient by reason of hemorrhage is beyond any chance of recovery.“ W. W. Whitmore wrote in an October 9, 1932, article in the Arizona Daily Star that Goodfellow “presumably had a greater practice in gunshot wounds of the abdomen than any other man in civil life in the country.“

 

Conceived of bulletproof fabrics

 

 

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On February 25, 1881, Faro dealer Luke Short and professional gambler and gunfighter Charlie Storms got into an argument. Storms had successfully defended himself several times with his pistol. Bat Masterson initially defused a confrontation between the two men, but Storms returned, yanked Short off the sidewalk, and pulled his cut-off Colt .45 pistol. Examining Storms afterward, Goodfellow found that he had been shot in the heart, but was surprised to see “not a drop of blood“ exiting the wound. He discovered that the bullet had ripped through the man’s clothes and into a folded silk handkerchief in his breast pocket. He extracted the intact bullet from the wound with the silk wrapped around it. He found two thicknesses of silk wrapped around the bullet and two tears where it had struck the vertebral column. Another case that attracted his attention was an incident when Assistant City Marshal Billy Breakenridge shot Billy Grounds from 30 feet (9.1m) with a shotgun, killing him. Goodfellow examined Billy and found that two buckshot grains had penetrated Billy’s thick Mexican felt hat band embroidered with silver wire. These two buckshot and two others penetrated his head and flattened against the posterior wall of the skull, and others penetrated the face and chest. He also noted that one of the grains had passed through two heavy wool shirts and a blanket-lined canvas coat and vest before coming to rest deep in his chest. But Goodfellow was fascinated to find in the folds of a Chinese silk handkerchief around Grounds’ neck two shotgun pellets but no holes. In a third instance, he described a man who was shot through the right side of the neck, narrowly missing his carotid artery. A portion of the silk neckerchief was carried into the wound by the bullet, preventing a more serious injury, but the scarf was undamaged. To Goodfellow, the protection offered by the silk was remarkable. He noted that the bullet that struck Storms would ordinarily have passed through the body. The second case of the buckshot best illustrated the protection afforded by silk.

 

In 1887, Goodfellow documented these cases in an article titled “Notes on the Impenetrability of Silk to Bullets“ for the Southern California Practitioner. He experimented with designs for bullet-resistant clothing made of multiple layers of silk. By 1900, gangsters were wearing $800 silk vests to protect themselves.

 

Other medical firsts

Goodfellow was an innovative physician who was forced to experiment with differing methods than those utilized by physicians in more civilized eastern practices. He pioneered the idea of treating tuberculosis patients by exposing them to Arizona’s dry climate. Goodfellow performed the first appendectomy in the Arizona Territory. During 1891 at St. Mary’s Hospital in Tucson, he performed what many consider to be the first perineal prostatectomy, an operation he developed to treat bladder problems by removing the enlarged prostate. He traveled extensively across the United States for several years, training other physicians to perform the procedure. Among these was Dr. Hugh Young, a well-known and respected urology professor at Johns Hopkins University. Goodfellow completed 78 operations and only two patients died, a remarkable level of success for the time period. He was among the first surgeons anywhere, let alone on the frontier of the United States, who used spinal anesthetic, which he improvised by crushing cocaine crystals in spinal fluid and reinjecting the mixture into the patient’s spine.

 

Personal reputation

Along with being an extremely talented and innovative surgeon, Goodfellow developed a reputation as hard-drinking, irascible ladies-man. He kept company with some of the courtesans who frequented the Crystal Palace saloon. He was also known to be a vocal supporter of the Earps, town business owners, and miners, but that did not keep the rural Cowboys from seeking his services during the eleven years his office was located in Tombstone. He delivered babies, set miners’ broken bones, treated gunshot wounds to cowboys and lawmen alike, and provided medical care to anyone in need. Tombstone had a large number of silver mines during its peak production period, and Goodfellow entered smoke-filled mining shafts on more than one occasion to help treat trapped and injured miners. The Tombstone Epitaph said Goodfellow had “both skill and nerve, both of which were brought into requisition on Contention Hill“ when he personally rescued unconscious miners in late May 1886.

 

During the Tombstone fire on June 1881, George W. Parsons was helping to tear down a balcony to prevent the fire from spreading when he was struck by the falling wood. Parson’s upper lip and nose were pierced by a splinter of wood, severely flattening and deforming his nose. Goodfellow devised a wire framework and in a series of treatments successfully restored Parson’s nose to his pre-injury profile. He refused payment because Parsons had been hurt as he was assisting others.

 

Interest in Gila Monsters

 

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Goodfellow proved the venomous Gila Monster didn’t kill people as was commonly thought.

 

In addition to his medical practice and related studies, Goodfellow published articles about rattlesnake and Gila monster bites in the Scientific American and the Southern California Practitioner. He was among the first to research the actual effects of Gila monster venom when the lizard was widely feared for its deadly bite. The Scientific American reported in 1890 that “The breath is very fetid, and its odor can be detected at some little distance from the lizard. It is supposed that this is one way in which the monster catches the insects and small animals which form a part of its food supply – the foul gas overcoming them.“ Goodfellow offered to pay local residents $5 for Gila monster specimens. He bought several and collected more on his own. In 1891 he purposefully provoked one of his captive lizards into biting him on his finger. The bite made him ill and he spent the next five days in bed, but he completely recovered. When Scientific American ran another ill-founded report on the lizard’s ability to kill people, he wrote in reply and described his own studies and personal experience. He wrote that he knew several people who had been bitten by Gila monsters but had not died from the bite.

 

While Goodfellow lived in Tombstone, he was a founder in 1880 of the plush Tombstone Club located on the second floor of the Ritchie Building. The rooms were furnished with reading tables and chairs. The 60 male members had access to more than 70 publications. He also helped organize the Tombstone Scientific Society. He was active in other community affairs, and invested in the Huachuca Water Company, which in 1881 built a 23 miles (37 km)-long pipeline from the Huachuca Mountains to Tombstone, along with a community swimming pool.

 

Goodfellow treated a number of notorious outlaw cowboys in Tombstone, Arizona during the 1880s. Curly Bill Brocius was drunk when he got into an argument with Lincoln County War veteran Jim Wallace, who had insulted Brocius’ friend and ally, Tombstone Deputy Marshal Billy Breakenridge. Brocius took offense and even though Wallace apologized, Brocius threatened to kill him. When Wallace left, Curly Bill followed him and Wallace shot him though the cheek and neck. Goodfellow treated Brocious, who recovered after several weeks. Marshal Breakenridge arrested Wallace but the court ruled he acted in self-defense.

 

Goodfellow was noted for his wry humor. A gambler named McIntire was shot and killed during an argument over a card game. Goodfellow performed an autopsy on the man and wrote in his report that he had done “the necessary assessment work and found the body full of lead, but too badly punctured to hold whiskey.“

 

Treats O.K. Corral lawmen

 

 

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Goodfellow treated Deputy U.S. Marshal Virgil Earp both after the Gunfight at the

O.K.  Corral and after his left arm was shattered in ambushed one month later.

 

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Goodfellow tended to Assistant Deputy U.S. Marshal Morgan Earp after the Gunfight

at the O.K. Corral and again when he was mortally wounded by an assassin.

 

During the Gunfight at the O.K. Corral on October 26, 1881, Deputy U.S. Marshal Virgil Earp was shot through the calf and Assistant Deputy U.S. Marshal Morgan Earp was shot across both shoulder blades. Doc Holliday was grazed by a bullet. Goodfellow treated both Earps’s wounds. Cowboy Billy Clanton, who had been mortally wounded in the shootout, asked someone to remove his boots before he died, Goodfellow was present and obliged. After the gunfight, Ike Clanton filed murder charges against the Earps and Doc Holliday. Goodfellow reviewed Dr. H. M. Mathew’s autopsy reports on the three outlaw Cowboys the Earps and Holiday had killed: Billy Clanton and brothers Tom and Frank McLaury. Goodfellow’s testimony about the nature of Billy Claiborne’s wounds during the hearing supported the defendants’ version of events, that Billy’s arm could not have been positioned holding his coats open by the lapels or raised in the air, as witnesses loyal to the Cowboys testified. Goodfellow’s testimony was helpful in exonerating the Earps and the judge ruled that the lawmen had acted in self-defense. Goodfellow treated Virgil Earp again two months later on December 28, 1881 after he was ambushed. At about 11:30 p.m. that night, three men hid in the upper story of an unfinished building across Allen Street from the Cosmopolitan Hotel where the Earps were staying for mutual support and protection. They shot him from behind as he walked from the Oriental Saloon to his room. They struck him in the back and left arm with three loads of double-barreled buckshot from about 60 feet (18 m). Goodfellow advised Virgil that the arm ought to be amputated, but Virgil refused. Goodfellow operated on Virgil in the Cosmopolitan Hotel using the medical tools he had in his bag, and asked George Parsons and another fellow to fetch some supplies from the hospital. He removed more than 3 inches (76 mm) of shattered humerus bone from Virgil’s left arm, leaving him permanently crippled.

 

The next victim of the feud between the Cowboys and the Earps was Morgan Earp. At 10:50 p.m. on March 18, 1882, Morgan was playing a round of billiards at the Campbell & Hatch Billiard Parlor against owner Bob Hatch. Dan Tipton, Sherman McMaster, and Wyatt watched, having also received death threats that same day. An unknown assailant shot Morgan through a glass-windowed, locked door that opened onto a dark alley between Allen and Fremont Streets. Morgan was struck in the back on the left of his spine and the bullet exited the front of his body near his gall bladder before lodging in the thigh of mining foreman George A. B. Berry. Morgan was mortally wounded and could not stand even with assistance. They laid him on a nearby lounge where he died within the hour. Drs. Matthews, Millar, and Goodfellow all examined Morgan. Even Goodfellow, recognized in the United States as the nation’s leading expert at treating abdominal gunshot wounds, concluded that Morgan’s wounds were fatal. As County Coroner, Goodfellow conducted Morgan Earp’s autopsy. He found that the bullet, “entering the body just to the left of the spinal column in the region of the left kidney emerging on the right side of the body in the region of the gall bladder. It certainly injured the great vessels of the body causing hemorrhage which undoubtedly causes death. It also injured the spinal column. It passed through the left kidney and also through the loin.“ The bullet passed through Morgan Earp and struck Berry in the thigh. Berry recovered from his wound.

 

Coroner for John Heat

 

 

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Tombstone citizens lynched John Heath (also spelled “Heith“) on February 22, 1884.
As Coroner, Goodfellow ruled he died of “strangulation, self-inflicted or otherwise.“

 

On the morning of December 8, 1883, a group of outlaw Cowboys including Daniel “Big Dan“ Dowd, Comer W. “Red“ Sample, Daniel “York“ Kelly, William E. “Billy“ Delaney, and James “Tex“ Howard robbed the Goldwater & Castaneda Mercantile which was rumored to be holding the$7,000 payroll for the Copper Queen Mine. But the payroll had not yet arrived, and they decided to steal whatever they could take from the safe and the employees and customers. They stole between $900 and $3,000 along with a gold watch and jewelry. As two of the robbers left the store, the three men outside began shooting passersby, killing four people, including a pregnant woman and her unborn child. John Heath (sometimes spelled Heith) had been a cattle rustler in Texas, but since arriving in Arizona he had served briefly as a Cochise County deputy sheriff and had also opened a saloon. When the five bandits were caught, they quickly implicated Heath as the man who had planned the hold-up. He was arrested and tried separately from the other five, who were convicted of first-degree murder and sentenced to hang. Heath was convicted of second-degree murder and conspiracy to commit robbery, and the judge reluctantly could only sentence him to a life term at the Yuma Territorial Prison. The citizens of Tombstone were outraged and broke into the jail, forcibly removing Heath and stringing him up from a nearby telegraph pole. Heath’s last words were: “I have faced death too many times to be disturbed when it actually comes. Don’t mutilate my body or shoot me full of holes!“ Goodfellow, who was present at Heath’s hanging, was County Coroner and responsible for determining the exact cause of death. His wry conclusion reflected the popular sentiment of the town. He ruled that Heath died from “emphysema of the lungs which might have been, and probably was, caused by strangulation, self-inflicted or otherwise, as in accordance with the medical evidence.“

 

In 1886, Goodfellow reportedly rode with the U.S. Army who were attempting to recapture Geronimo after he left the San Carlos Reservation against Army orders. During his escape, he and his warriors killed “fourteen Americans dead in the United States and between 500 and 600 Mexicans dead south of the border.“

 

Apache, befriended Geronimo

 

 

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Goodfellow on El Rosillo, a gift from Mexican President Porfirio Diaz.

 

When the Bavispe earthquake struck Sonora, Mexico, on May 3, 1887, it destroyed most of the adobe houses in Bavispe and killed 42 of the town’s 700 residents. Goodfellow spoke excellent Spanish and he loaded his wagon with medical supplies and rode 90 miles (140 km) to aid survivors. The townspeople named him El Doctor Santo (The Sainted Doctor), and in recognition of his humanitarian contributions, Mexican President Porfirio Diaz presented him with a silver medal that had belonged to Emperor Maximilian and a horse named El Rosillo. Goodfellow was fascinated by the earth movement and studied the earthquake’s effects. He noted that it was very difficult to pin down the time of the earthquake due to the absence of time pieces or a nearby railroad, and the primitive living standards of the area’s residents.

 

Goodfellow returned twice more, the second time in July with Tombstone photographer Camillus Sidney Fly, to study and record the effects of the earthquake. He traveled over 700 miles (1,100 km) through the Sierra Madre mountains recording his observations, mostly on foot. The United States Geological Service praised his “remarkable and creditable“ report, describing it as “systematic, conscientious, and thorough.“ On August 12, 1888, he wrote a letter following up on his initial report in the top U.S. scientific journal Science. It included the first surface rupture map of an earthquake in North America and photographs of the rupture scarp by C.S. Fly. The earthquake was at the time the “longest recorded normal-fault surface rupture in historic time.“ It was later described as an “outstanding study“ and a “pioneering achievement.“ Goodfellow developed a relationship with Mexican politician Ramon Corral and hosted him in 1904 when he visited San Francisco.

 

 

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John C. Handy MD

 

Dr. John C. Handy of Tucson abused his wife and repeatedly threatened to kill her lawyer Francis J. Heney. At noon on September 24, 1891, Goodfellow’s good friend and colleague Dr. John Handy was shot on the streets of Tucson. Goodfellow unsuccessfully tried to repair 18 perforations of his intestines. Handy had divorced his wife and now he was trying to evict her from the home the court had granted her. When she hired attorney Francis J. Heney, Handy repeatedly threatened to kill him. Handy’s finger-trigger didn’t keep up with his hair-trigger temper. He assaulted the attorney on the street that afternoon and Heney shot him in self-defense. Goodfellow rode 24 miles (39 km) by horseback to Benson, Arizona where he caught a locomotive and caboose, set aside just for him, to Tucson. In an effort to save Handy, he took over the engine from the engineer and drove the train at high speed, and covered the 46 miles (74 km) in record time. Goodfellow arrived in Tucson at 8:15 pm. Handy had been attended by Doctors Michael Spencer, John Trail Green, and Hiram W. Fenner until Goodfellow arrived and began operating on Handy at about 10:00 pm. Goodfellow was too late and Handy died at 1:15 a.m., before Goodfellow could complete the surgery. After Handy’s death, Goodfellow was invited to take over his Tucson practice, and he and his daughter Edith relocated there. Goodfellow purchased the old Orndorff Hotel located near present-day City Hall and used it as a hospital. He also practiced at St. Mary’s Hospital in Tucson. He concurrently worked as a surgeon for the Southern Pacific Railroad from 1891-1896, where he became head surgeon. He was appointed by Governor Louis C. Hughes in 1893 as the Arizona Territorial Health Officer, a position he held until 1896. In 1896 he was living in Los Angeles and was listed in the 1897 Los Angeles City Directory.

 

Further military service

Goodfellow returned to Tucson in 1898 and later that year he became the personal physician to his friend General William “Pecos Bill“ Shafter during the Spanish-American War. Appointed as a Major, he was in charge of the General’s field hospital. Shafter relied on Goodfellow’s excellent knowledge of Spanish to help negotiate the final surrender after the Battle of San Juan Hill. Goodfellow attributed part his success to a bottle of “ol’ barleycorn“ he kept handy in his medical kit which he properly prescribed to himself and Spanish General Jose Toral, lending a more convivial atmosphere to the conference. Goodfellow was recognized with a commendation for his service that cited his “especially meritorious services professional and military“.

 

Practice in San Francisco

In late 1899 he moved to San Francisco and established his practice at 771 Sutter St. On January 19, 1900, he was appointed as the surgeon for the Sante Fe Railroad headquartered in San Francisco. He was an active member of the Bohemian Club and attended their summer camp on the Russian River regularly. On February 15, 1900, Wells Fargo Express Agent Jeff Milton, a friend of Goodfellow, arrived on board a train in Fairbank, near Benson, Arizona. Former lawman-turned-outlaw Burt Alvord and five other robbers attempted to rob an arriving train of its cash. Milton was seriously wounded in the left arm and the railroad dispatched a special engine and boxcar to transport Milton from Benson to Tucson for treatment. In Tucson, the shattered bone was tied together with piano wire. When the wound wouldn’t heal, Milton was sent to San Francisco where he could be seen by experts at the Southern Pacific Hospital there. They wanted to amputate his arm at the elbow, but he refused and got a ride to Dr. Goodfellow’s office. Goodfellow successfully cleaned and treated Milton’s wound but told him he would never be able to use the arm again. Milton’s arm healed but was of little use and noticeably shorter than his right arm.

 

In April 1906, at the time of the 1906 San Francisco earthquake, Goodfellow was living at the St. Francis Hotel. He lost all of his records and personal manuscripts in the hotel and his office to the earthquake and subsequent fire. His finances were ruined and Goodfellow returned to the Southern Pacific Railroad where he was Chief Surgeon in Guaymas, Mexico from 1907 to 1910.

 

Goodfellow fell ill in the summer of 1910 with an illness which he had reportedly been exposed to during the Spanish-American War. He sought treatment from his sister Mary’s husband, Dr. Charles W. Fish, in Los Angeles. Over the next six months his health gradually declined, and soon he could no longer practice medicine. He was hospitalized for several weeks at the end of 1910 at Angelus Hospital in Los Angeles. Goodfellow declared he didn’t want to live any longer and on December

 

First American MERS Patient

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An American healthcare worker, apparently infected with the Middle East coronavirus (MERS-CoV) while working in Saudi Arabia, is improving in an Indiana hospital. At a briefing, staff at the Community Hospital in Munster, Indiana, said the patient is improving daily, is eating well, and is off oxygen. The hospital has started the discharge process and they expect him to be going home soon.

 

The healthcare workers who looked after the patient before the diagnosis have been taken “offline“ and are now in home isolation, have no indication of illness and are being monitored daily. The incubation period of the virus is not known with certainty, but is thought to be between 2 and 14 days. Most cases appear within about 5 days.

 

After the diagnosis, the hospital used full contact precautions when dealing with the patient and there is no sign so far of any secondary cases. The hospital believes that they have been able to contain the exposure at this point.

 

The report comes as Saudi Arabia registered 36 cases of MERS on Friday, Saturday, and Sunday, almost half the total for the week. The latest cases bring the Saudi totals since the virus was first recognized in 2012 to 414 cases and 115 deaths.

 

Cases elsewhere have almost universally shown an epidemiological link to the Middle East kingdom, including the case in Indiana, the first in the U.S., the CDC reported Friday. The patient, who has not been named, left the Saudi Arabian capital of Riyadh April 24, and flew first to London and then to Chicago. After taking a bus to Indiana, the patient developed respiratory symptoms April 27, including cough, shortness of breath, and fever, and was admitted to hospital the following day. In Saudi Arabia, the health ministry reported six deaths over the 3 days, three of them among people previously reported to have the virus. The ministry reported 18 cases on Friday, 15 on Saturday, and three on Sunday, including:

 

A total of 13 cases in the capital, Riyadh

12 cases in Jeddah

8 cases in Mecca

3 cases in Medina

 

The ministry said 10 people remain without symptoms, 10 are in stable condition, 13 are being treated in intensive care units, and three have died. Also, three people reported earlier to be infected have died, the ministry said. On the other hand, the ministry said that five people previously reported to be infected have now cleared the virus and have been discharged from the hospital. Saudi officials have not previously reported recoveries on a regular basis. Source: MedPageToday.com

 

ONCOLOGY

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New Cancer Immunotherapy Method Could Be Effective Against a Wide Range of Cancers

 

All malignant tumors harbor genetic alterations, some of which may lead to the production of mutant proteins that are capable of triggering an antitumor immune response. Research has shown that human melanoma tumors often contain mutation-reactive immune cells called tumor-infiltrating lymphocytes, or TILs. The presence of these cells may help explain the effectiveness of adoptive cell therapy (ACT) and other forms of immunotherapy in the treatment of melanoma. In ACT, a patient’s own TILs are collected, and those with the best antitumor activity are grown in the laboratory to produce large populations that are infused into the patient. However, prior to this work it had not been clear whether the human immune system could mount an effective response against mutant proteins produced by epithelial cell cancers. These cells comprise more than 80% of all cancers. It was also not known whether such a response could be used to develop personalized immunotherapies for these cancers.

 

According to an article published online in the journal Science (9 May 2014), a new method for using immunotherapy to specifically attack tumor cells that have mutations unique to a patient’s cancer has been developed. The research has demonstrated that the human immune system can mount a response against mutant proteins expressed by cancers that arise in epithelial cells which can line the internal and external surfaces (such as the skin) of the body. These cells give rise to many types of common cancers, such as those that develop in the digestive tract, lung, pancreas, bladder and other areas of the body. The research also provides evidence that this immune response can be harnessed for therapeutic benefit in patients.

 

For this study, the researchers set out to determine whether TILs from patients with metastatic gastrointestinal cancers could recognize patient-specific mutations. To do this, TILs were analyzed from a patient with bile duct cancer that had metastasized to the lung and liver and had not been responsive to standard chemotherapy. The patient, a 43-year-old woman, was enrolled in an NIH trial of ACT for patients with gastrointestinal cancers (Clinical trial number NCT01174121). At first, whole-exome sequencing was performed, in which the protein-coding regions of DNA are analyzed to identify mutations that the patient’s immune cells might recognize. Further testing showed that some of the patient’s TILs recognized a mutation in a protein called ERBB2-interacting protein (ERBB2IP). The patient then underwent adoptive cell transfer of 42.4 billion TILs, approximately 25% of which were ERBB2IP mutation-reactive T lymphocytes, which are primarily responsible for activating other cells to aid cellular immunity, followed by treatment with four doses of the anticancer drug interleukin-2 to enhance T-cell proliferation and function.

 

Following transfer of the TILs, the patient’s metastatic lung and liver tumors stabilized. When the patient’s disease eventually progressed, after about 13 months, she was re-treated with ACT in which 95% of the transferred cells were mutation-reactive T cells, and she experienced tumor regression that was ongoing as of the last follow up (six months after the second T-cell infusion). These results provide evidence that a T-cell response against a mutant protein can be harnessed to mediate regression of a metastatic epithelial cell cancer.

 

According to the authors, given that a major hurdle for the success of immunotherapies for gastrointestinal and other cancers is the apparent low frequency of tumor-reactive T cells, the strategies reported here could be used to generate a T-cell adoptive cell therapy for patients with common cancers.

 

Longevity Gene May Boost Brain Power

 

As people live longer the effects of aging on the brain will become a greater health issue. This is especially true for dementias, a collection of brain disorders that can cause memory problems, impaired language skills and other symptoms. With the number of dementia cases worldwide estimated to double every 20 years from 35.6 million people in 2010 to 65.7 million in 2030 and 115.4 million in 2050, the need for treatments is growing.

 

According to an article published online in Cell Reports (8 May 2014), it has been found that people who have a variant of a longevity gene, called KLOTHO, have improved brain skills such as thinking, learning and memory regardless of their age, gender, or whether they have a genetic risk factor for Alzheimer’s disease. Increasing KLOTHO gene levels in mice made them smarter, possibly by increasing the strength of connections between nerve cells in the brain.

 

Klotho is the name of a Greek mythological goddess of fate, “who spins the thread of life.“ People who have one copy of a variant, or form, of the KLOTHO gene, called KL-VS, tend to live longer and have lower chances of suffering a stroke whereas people who have two copies may live shorter lives and have a higher risk of stroke. In this study, the investigators found that people who had one copy of the KL-VS variant performed better on a battery of cognitive tests than subjects who did not have it, regardless of age, gender or the presence of the apolipoprotein 4 gene, the main genetic risk factor for Alzheimer’s disease.

 

The investigators tested a variety of cognitive skills, including learning, memory, and attention. More than 700 subjects, 52 to 85 years old were tested as part of three studies. None had any sign of dementia. Consistent with previous studies, 20-25% of the subjects had one copy of the KL-VS variant and performed better on the tests than those who had no copies. Performance on the tests decreased with age regardless of whether a subject had one or no copies of the KL-VS gene variant.

 

The KLOTHO gene provides the blueprint for a protein made primarily by the cells of the kidney, placenta, small intestine, and prostate. A shortened version of the protein can circulate through the blood system. Blood tests showed that subjects who had one copy of the KL-VS variant also had higher levels of circulating klotho protein. The levels decreased with age as others have observed. The researchers speculate that the age-related decrease in circulating levels of klotho protein may have caused some of the decline in performance on the cognitive tests.

 

To test this idea the researchers genetically engineered mice to overproduce klotho protein. The klotho-enhanced mice lived longer and had higher levels of klotho in the blood and in a brain area known as the hippocampus, which controls some types of learning and memory. Similar to human studies, the klotho-enhanced mice performed better on a variety of learning and memory tests, regardless of age. In one test, the mice remembered the location of a hidden target in a maze better, which allowed them to find it twice as fast as control mice.

 

Learning is thought to strengthen communication between nerve cells in the brain at structures called synapses. In the hippocampus, many synapses use a chemical called glutamate to communicate. Electrical recordings suggested that klotho makes it more likely these synapses will be strengthened during learning and memory.

 

NMDA receptors control communication at many glutamate synapses. GluN2B subunits are components of some NMDA receptors. Previous studies have shown that the presence of GluN2B at synapses is associated with changes in synaptic strength and learning and memory. In this study, the researchers found that synapses in the brains of klotho-enhanced mice had more GluN2B subunits than control mice. Treating klotho mice with a drug that selectively blocks GluN2B-containing NMDA receptors reduced their ability to perform on learning and memory tests. The results suggest that increasing the presence of GluN2B-containing NMDA receptors may be one way that klotho could enhance cognitive skills.

 

According to the authors, the overall results suggest that klotho may increase cognitive reserve or the brain’s capacity to perform everyday intellectual tasks

 

For more information about dementia, please visit:

 

<http://www.ninds.nih.gov/disorders/dementias/dementia.htm>

<http://www.nia.nih.gov/health/topics/dementia>

 

The htm version of this release contains a video of Dr. Dena Dubal, M.D., Ph.D., University of California San Francisco, and Dr. Lennart Mucke, M.D., Gladstone Institute of Neurological Disorders, San Francisco, CA, discuss their latest study showing that a variant of the longevity gene, KLOTHO, may improve brain skills such as thinking, learning and memory. <http://youtu.be/9zBj37nsvPE>

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The htm version of this release contains image of boosting brain power <http://www.nih.gov/news/health/may2014/images/ninds-09_l.jpg>

 

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