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PBS NewsHour

Was Charles Dickens the first celebrity medical spokesman?

Charles Dickens

Charles Dickens was a great supporter of the Great Ormond Street Children’s Hospital in London.

In our present era of public service announcements, telethons, fun-runs, cyber-fundraising events and “ice bucket challenges,” it seems as if every disease or medical cause has a celebrity spokesman drumming up donations and interest.

Yet such effective fundraising practices are hardly new. They predate the Internet, television, radio and even the movies.

This Feb. 6, we celebrate Charles Dickens, the novelist and literary superstar of his day. He may well have been the first celebrity spokesman for a medical charity. The cause was London’s Great Ormond Street Children’s Hospital and it first opened its doors 164 years ago today in 1852. As an added bonus, we have the opportunity to celebrate Charles Dickens’s 204th birthday, which falls the on following day, Feb. 7. (He was born in 1812 and died in 1870).

Dickens’s interest in helping to establish a children’s hospital should not be surprising to those who have read his wonderful novels. His works teem with the stories of children and especially those youngsters who were rejected, orphaned, or stricken by physical and social calamities. Charles, too, suffered a traumatic childhood when his father was declared insolvent and the Dickens family was sentenced to the Marshalsea Debtor’s Prison. It was then that the 12-year-old Charles was removed from school and forced to work at Warren’s Blacking (shoeshine) Warehouse for five months. He recreated this trauma, of course, in his favorite novel, “David Copperfield,” but it continued to fester in his psyche as one of the most harrowing events of his life.

Moreover, Dickens often portrayed real diseases (both physical and psychological), which many of his various characters developed in the course of his story telling. The illnesses he describes are accurate and based on real disorders rather than invented maladies with inconsistent symptoms, as was the more common practice among many Victorian novelists.

But his careful attention to detail went far deeper than leafing through the pages of a medical textbook or pestering the many physicians he knew. In fact, Dickens was a regular reader of medical journals and followed the latest advances in public health and medicine. He was also a frequent visitor to several London hospitals where he observed sick people to incorporate into his fiction.

Great Ormond Street Hospital

Part of London’s Great Ormond Street Hospital, seen today.

Less well appreciated was his advocacy for a hospital built specifically for the needs and illnesses of children. It may be hard to believe but before 1852, London still did not have a dedicated children’s hospital, even though many other European capitals, such as Paris, St. Petersburg and Vienna had long established such institutions.

Thanks to the tireless activism of a physician named Charles West, a 32-bed hospital for children did open, in a house on Great Ormond Street, on Feb. 6, 1852, just one day before Dickens’ 40th birthday.

Dickens’s involvement with this great cause began at the request of several friends of his who just happened to be trustees of the nascent Great Ormond Street Hospital. At their invitation, Dickens visited the hospital during its first weeks of operation. The writer was so moved by what he saw that he and an assistant named Henry Morley composed an essay about the sick children recuperating there, entitled “Drooping Buds.” It appeared in the April 3, 1852 issue of Household Words, the magazine Dickens edited from 1850 to 1858. In the essay, Dickens describes the alarming infant and childhood mortality rates in Victorian England, the need to develop a better understanding of children’s health and the then revolutionary point that children are, indeed, different in the diseases they develop and how their bodies confront such illnesses. A line or two of this essay merits repeating:

“Our children perish out of our homes: not because there is in them an inherent dangerous sickness (except in the few cases where they are born of parents who communicate to children heritable maladies), but because there is, in respect to their tender lives, a want of sanitary discipline and a want of knowledge…It does not at all follow that the intelligent physician who has learnt how to treat successfully the illnesses of adults, has only to modify his plans a little, to diminish the proportions of his doses, for the application of his knowledge to our little sons and daughters. Some of their diseases are peculiar to themselves; other diseases, common to us all, take a form in children varying as much from their familiar form with us as a child varies from a man…”

The essay was widely read by 40,000 readers of the magazine but its influence hardly stopped there. Dickens gave the hospital trustees permission to reprint the essay and distribute it to potential donors as a publicity tool.

A few years later, on Feb. 9, 1858, the Great Ormond Street trustees asked Charles Dickens to chair a “festival benefit” at the Freemason’s Tavern. The event was so important that Queen Victoria herself consented to be its royal patron but it was Dickens’s sterling celebrity who really attracted a crowd of potential donors.

He did not disappoint. Always a brilliant speaker and actor (he gave public readings of many of his works across England and the United States to great acclaim), Dickens delivered a rousing speech on the plight of ill children and the need to support the children’s hospital. As an extra bonus, the author threw in a reading of his beloved “A Christmas Carol.” The journalist T.A. Reed, said of Dickens’ performance that night, “I never heard him, or reported him, with so much pleasure … his speech was magnificent.”

Magnificent, indeed. The speech raised more than £3,000 (nearly £270,000 or almost $400,000 in 2016) for the hospital, which was desperately needed to increase both bed space and the medical staff.

Dickens made many more trips to the hospital and participated in several fundraising events. He also wrote about the Great Ormond Street Hospital in his collection of essays “The Uncommercial Traveler” (1860), in an essay entitled “From Cradle to Grave,” which ran in Feb. 1, 1862 issue of another magazine he edited, All the Year Round, and in his last complete novel “Our Mutual Friend” (1865).

So vital was his advocacy for the Great Ormond Street Hospital that in 1867, its founder, Dr. Charles West wrote, “Dickens, the children’s friend, first set [the hospital] on her legs and helped her to run alone.”

Upon his death in 1870, at age 58, the British Medical Journal eulogized Dickens with the statement, “what a gain it would have been to physic [medicine] if one so keen to observe and facile to describe had devoted his powers to the medical art.”

To this, we say “Bah Humbug.” We have plenty of doctors but we have only one Charles Dickens.


Dr. Howard Markel writes a monthly column for the PBS NewsHour, highlighting the anniversary of a momentous event that continues to shape modern medicine. He is the director of the Center for the History of Medicine and the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan.

He is the author or editor of 10 books, including “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed” and “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”

The post Was Charles Dickens the first celebrity medical spokesman? appeared first on PBS NewsHour.

Brazil grapples with Zika health emergency as Carnival begins

Revellers wear mosquito masks in a reference to the Aedes aegypti mosquito, which can spread dengue as
         well as the Zika virus, during a street carnival in Sao Paulo, Brazil, February 4, 2016. REUTERS/Paulo Whitaker - RTX25I6U

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JUDY WOODRUFF: U.S. health officials put out new guidance today about the Zika virus. For the first time, they recommended that men who have traveled to an area with Zika should use condoms if they have sex with a pregnant woman for the entire duration of the pregnancy. The CDC also says those men may want to consider abstaining from sex with women who are trying to get pregnant.

While the disease is overwhelmingly spread by mosquitoes, questions about three possible cases of sexual transmission led to these new guidelines.

In Brazil, Zika has been found in the saliva and urine of two people. And more than one million people there are said to be infected with Zika.

Our science correspondent, Miles O’Brien, is covering the story. He joins me now from Recife, Brazil, where Carnival celebrations are beginning.

So, Miles, this is a country that’s hardest-hit. It also happens to be you’re there at the time of this big annual holiday.

MILES O’BRIEN: Yes, Judy. Here we are in the middle of this public health crisis and this celebration, this national holiday begins on this night, Carnival.

What’s interesting about Carnival is that at the very core the philosophy is, forget your troubles and party like there is no tomorrow. That’s how the Brazilians view it and that’s why in most cases the party has gone on.

I talked to a lot of public health officials and doctors and scientists who have been involved in this hurt for some action and some way to control the Zika outbreak, and many of them express misgivings about it, frankly, but the show is going on.

JUDY WOODRUFF: Now, Miles, we know the Centers for Disease Control said today that the cooperation with Brazil is getting better. That’s the CDC here in the U.S. But they also have some expressed some frustration about not getting enough data from down this. What do you know about that?

MILES O’BRIEN: We heard a lot about this when we spoke to some of the scientists on the front lines here, some of the epidemiologists and the virologists who are working on this scientific riddle.

This is a virus that has presented a whole new problem for them, and it’s a virus, like so many things these days, that instantly become a global problem. The problem is, there is legislation, there is law in this land which makes it all but impossible for them to share samples with their colleagues in Atlanta or Glasgow or elsewhere In Europe.

And so they have been frustrated by that inability to share their data. Having said that, in a briefing today, the head of the CDC, Tom Frieden, said that is improving. But it’s a reminder that when you’re in a situation like this with a fast-moving virus, it’s time to bring all kinds of borders and privileges and scientific prerogatives down and try to fight the problem.

JUDY WOODRUFF: And, Miles, for the medical profession, I know you’re talking to physicians there, researchers. You were saying this has to be very frustrating for them, that they don’t feel, you said, that they have the tools in the toolbox that they need.

MILES O’BRIEN: I spoke to a gynecologist today who’s dealt with several mothers who have had to contend with this, and she’s so frustrated.

She said: “I feel like I’m in the Stone Age. I can see this coming, I see the problem developing, and I have no tools in my toolbox to help these women.”

It’s an unfortunate case. They have got this virus that came out of the blue, and they really don’t have a way of coping with it right now.

JUDY WOODRUFF: And, Miles, in terms of the science of it and dealing with the mosquitoes who are carrying this virus around, what about that front? Are they able to — I mean, are they able to project any kind of precautions that can be taken? Where are they on that front?

MILES O’BRIEN: Well, obviously, they’re telling pregnant women to be very careful and to guard against being bitten by mosquitoes. It’s worth mentioning that those are the people. It’s the pregnant women and their babies in utero that are of concern.

When an adult gets bitten by a mosquito and gets Zika, four out of five people don’t even know they have had it. So, part of it is public education. Part of it is going through and doing some spraying, which has limited efficacy.

They have got 200,000 troops in the military knocking on doors, looking for standing water, but ultimately they’re way outnumbered by the mosquitoes. We were in a lab just the other day where they’re actually genetically engineering mosquitoes, male mosquitoes, to mate with females, creating progeny which will die very quickly.

And that kind of clever approach is part of putting some tools in the toolbox to try to control how mosquitoes are carrying Zika.

JUDY WOODRUFF: But, meantime, finally, Miles, warnings going out to women and to men about the dangers of this virus.

MILES O’BRIEN: You know, Judy, it’s really a heartbreaking scenario, how this cropped up. It’s dangerous and it caught public health officials by surprise.

Today, I was with a mother with a 2-month-old son who is drastically affected by this microcephaly. And it means a lifelong problem of disability and care for this now 2-month-old child of hers. And so it’s — the danger cannot be understated for pregnant women. And that set against this Carnival offers up quite a contrast this year.

JUDY WOODRUFF: Well, it’s heartbreaking. It’s frightening.

And, Miles, I know we look forward to the reporting that you’re doing down there. And we will be having that in the days to come.

Miles O’Brien, we thank you.

MILES O’BRIEN: You’re welcome, Judy.

The post Brazil grapples with Zika health emergency as Carnival begins appeared first on PBS NewsHour.

No stage of pregnancy safe for unprotected sex with Zika-exposed male, CDC says

Gisele Felix, who is five months pregnant, applies repellent on her arm at her home in Rio de Janeiro, Brazil, January
         28, 2016. Photo by Pilar Olivares/REUTERS

Gisele Felix, who is five months pregnant, applies repellent on her arm at her home in Rio de Janeiro, Brazil, January 28, 2016. Photo by Pilar Olivares/REUTERS

The Centers for Disease Control and Prevention announced today that men who travel to Zika-affected regions should practice abstinence or safe sex with condoms with pregnant partners for the entirety of a woman’s pregnancy.

The announcement followed this outbreak’s first case of sexually transmitted Zika, which was reported in Dallas on Tuesday. Another report today from Brazil suggests the virus can also be found in saliva and urine. However, the CDC’s new guidelines on sexual transmission don’t include advice on whether partners should avoid kissing, given that more research is needed to determine whether the disease can be transmitted via saliva.

“I understand that this is a stressful situation for women and families. I wish we knew more about Zika today. I wish we could do more about Zika today,” CDC director Tom Frieden said in a press conference. “We’re committed to finding out what we can, as fast as we can.”

Frieden’s remarks ushered in two sets of guidelines on the Zika virus, which has been blamed for a swell of microcephaly cases — a fetal development disorder — in Brazil. The virus has also been speculatively tied to Guillain-Barre disease, which can cause paralysis in adults.

“With each passing day, the linkage between Zika and microcephaly becomes stronger. In addition, the linkage between Zika and Guillain-Barre syndrome also appears stronger,” Frieden said.

The first set of guidelines deal with sexual transmission and recommend that pregnant women practice abstinence or safe sex with condoms with male partners who reside in or have traveled from Zika-stricken areas. As of now, this advice applies for the entire duration of pregnancy.

That’s because of a current gap in the understanding of when a developing fetus is most at-risk for Zika-related microcephaly. The Pan American Health Organization has stated the greatest risk of microcephaly and malformations appears to be associated with infection during the first trimester of pregnancy. Frieden echoed this point.

Director of the U.S. Center for Disease Control (CDC) Tom Frieden attends the World Health Organization Executive Board
         meeting in Geneva, Switzerland, January 25, 2016. The mosquito-borne Zika virus, which is suspected of causing brain damage
         to babies in Brazil, is expected to spread to all countries in the Americas except for Canada and Chile, the World Health
         Organization said. Photo by Denis Balibouse/REUTERS

Director of the U.S. Center for Disease Control (CDC) Tom Frieden attends the World Health Organization Executive Board meeting in Geneva, Switzerland, January 25, 2016. The mosquito-borne Zika virus, which is suspected of causing brain damage to babies in Brazil, is expected to spread to all countries in the Americas except for Canada and Chile, the World Health Organization said. Photo by Denis Balibouse/REUTERS

“If Zika behaves as many other infectious and toxic causes of fetal malformations, then the first trimester and the early part of the second trimester would be the highest risk time,” Frieden said.

However, he continued, if researchers ultimately learn that the virus is “neurotropic” — that it targets brain tissue — then the disease could be a threat to any stage of pregnancy. That’s why the CDC advises that women in any stage of pregnancy should not travel to areas where Zika is spreading, should use mosquito-fighting techniques to lower their risk of infection and should avoid unprotected sex with men exposed to the virus, he said.

“We know that semen may have large quantities of viable virus for at least a short period of time after Zika virus infection. We will be doing studies of how long the virus can persist in semen, but we know it goes away from the blood within about a week,” Frieden said. Though the CDC is investigating oral, anal and vaginal sex as modes of Zika virus transmission, their risk assessment only applies to sex between pregnant women and sex with a potentially infected male.

Despite the connection to sexual transmission, Frieden emphasized that mosquitoes are still the primary route for catching Zika virus and warned about the aggressiveness of the primary carrier in the tropics: the Aedes aegypti mosquito.

“It bites four to five people with every meal, it has a relatively painless bite so you don’t swat and kill it, and it can breed in as much as a drop of water in a bottle cap,” Frieden said. He added that anytime there are lots of cases of a condition, you will see rare cases of a virus getting transmitted via sexual transmission of a virus without a prior history of doing so. So far, sexual transmission of the virus from infected women to their partners has not been reported.

The findings on saliva and urine, even with the report from Brazil, are less clear, Frieden said. When asked whether couples impacted by Zika virus should refrain from kissing, he said more evidence is required before the CDC can issue guidance.

“The fact that the infectious particles are found in the saliva does not mean that a person can become infected by ingesting saliva,” University of Pittsburgh microbiologist Ernesto T.A. Marques said in an email to PBS NewsHour.

For saliva to transmit Zika, the virus would need to cross the internal skin lining of the throat or the gut, in order to gain access to a person’s blood, and “so far we do not have any data that indicate that is possible,” Marques said.

Blood transfusions, however, are a rare but possible route for spreading the disease. The AABB, formerly known as the American Association of Blood Banks, said on Tuesday that it would deny prospective donors who have visited Zika-affected areas in the last 28 days.

The CDC’s second set of guidelines update their advice for health care providers, given new improvements in serological tests for the Zika virus. These tests look for IgM antibodies that are produced by the human body to fight the microbe and, in theory, they could be administered several weeks after the virus has been cleared from the blood.

So far, genetic testing has been the best method for spotting the virus, while ultrasounds serve as a means for catching the signs of microcephaly in a developing fetus.

“We’ve heard from the provider community that serial ultrasounds were very challenging….and we’re rolling out the availability of serological testing,” Frieden said. The CDC is aiming to increase production of these tests and deliver them to health care providers who have complained of having limited means to diagnose Zika in pregnant women. “Not everyone who wants a test can get it, we’re working as fast as we can to increase the availability of testing.”

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Amid death’s throes, young doctor examines life for meaning

NewsHour Bookshelf

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JUDY WOODRUFF: What makes a life worth living? What gives it meaning? And how does that change when the time one has left collapses? These are some of the profound questions taken up in a new memoir by a doctor who suddenly faced his own mortality.

Jeffrey Brown has our newest addition to the “NewsHour Bookshelf.

JEFFREY BROWN: As a neurosurgeon, Paul Kalanithi was used to dealing with life-and-death issues. He was, by his own account, a driven man who studied literature and philosophy before turning to medicine, earning five degrees along the way.

He was near completion of a rigorous residency at Stanford when, at age 36, he got a diagnosis of lung cancer.

DR. PAUL KALANITHI, Author, “When Breath Becomes Air”: Five years down the line, I don’t know what I will be doing. I may be dead. I may not be.

JEFFREY BROWN: He would live just 22 months more, and in that time have a child with his wife, Lucy, and write an indelible memoir, “When Breath Becomes Air.”

DR. LUCY KALANITHI: He had thought maybe he would have a long career as a neurosurgeon or a scientist and then maybe a writer.

JEFFREY BROWN: He had planned on all this, right?

DR. LUCY KALANITHI: That’s right. He said: “I think I may be years into my retirement now, at age 36. And so what do I want to do?” And the answer was write.

JEFFREY BROWN: Lucy Kalanithi is also a doctor. The two met at Yale Medical School and were married nine years before Paul’s death in 2015.

DR. LUCY KALANITHI: He was sort of a perpetual learner and a seeker and somebody who was very interested in kind of understanding what it is to be human and what makes — what sort of makes life meaningful. And he approached that…

JEFFREY BROWN: From the beginning, right?

DR. LUCY KALANITHI: That’s right, yes.

JEFFREY BROWN: Yes.

DR. LUCY KALANITHI: He went to grad school in English literature, and sort of made his way into neuroscience because he wanted a real understanding of kind of consciousness and what makes us human. So he kind of came at that from different angles.

JEFFREY BROWN: One of the themes that comes through clearly in his life and his book is identity, right, is sort what makes us, us.

DR. LUCY KALANITHI: Yes.

You know, when you have a brain disorder or you’re having surgery on your brain, you are thinking about questions like, will this affect my language, will this affect my personality, not just, how does this illness affect my body in other ways?

So it’s kind of a very intense place for decision-making about identity. And he was very interested in that.

JEFFREY BROWN: And then, of course, it happens to him. And he starts — as he’s dying, he’s thinking about, if you’re dying, rather than living, in a sense, then are you still you?

DR. LUCY KALANITHI: In the moment of diagnoses, he sort of saw his life trajectory and his self kind of come tumbling down. He wasn’t going to be a neurosurgeon for years and years.

And we thought initially that he actually had less time to live. We thought he might have months or less than a year. And then he started a therapy that allowed him a lot more kind of functionality than he expected and a longer prognosis potentially. And so then it was this big question of, I don’t know how much time I have left and how do I spend that time? Who am I?

JEFFREY BROWN: Paul spoke of this in a video released by his publisher.

PAUL KALANITHI: It’s a careful load to balance. If you don’t think about the bad case, that ending is going to be very rough on you and your family.

But if you don’t think about the good case, you’re going to miss an opportunity to really make the most out of your life and time.

JEFFREY BROWN: You know, one of the things that struck me also here is, he learns a lot about doctoring, right, that he had never seen as a doctor.

DR. LUCY KALANITHI: Yes, yes, yes.

JEFFREY BROWN: He writes, for example, at one point, “Realizing how little doctors understand the hells through for which we put patients.”

He was really getting to see things from a different side.

DR. LUCY KALANITHI: He had been in medicine for a decade as a student and then a resident, but all these tiny little experiences — like, as an example, when you get an I.V. and they start infusing normal saline into your vein, you can taste the salt.

And he said: “I have been a doctor for a decade, and I never knew you could taste the salt.”

And it’s all these tiny details that sort of come to the fore. And that’s not even to mention the physical and emotional suffering that comes with being sick and the way it rocks you and rocks your family. So, yes, we really kind of felt that.

JEFFREY BROWN: He could look at it intellectually, but he also then had to look at it very realistically.

DR. LUCY KALANITHI: Yes.

When we got the news of this terrible chest X-ray that looked really kind of dense with tumors, and kind of helped explain why he had been having weight loss and back pain and real kind of health troubles for a few months, both of us knew that the next day we were going to the hospital. He would have a C.T. scan and it would likely show metastatic cancer.

Being doctors, we could see that path. And when we packed for the hospital, I was packing socks and pillows and phone chargers, and he just packed three books. He packed “Mere Christianity” by C.S. Lewis, Heidegger’s “Being and Time,” and Solzhenitsyn’s “Cancer Ward.”

And I think it was that transition right away where he said: “This is becoming so personal that I need my books. Like, I need to understand this through literature.”

When he became ill, he kind of translated the experience back into writing and words to make sense of it. And this book is part of that.

JEFFREY BROWN: And what about for you? What did you feel when you read it?

DR. LUCY KALANITHI: So, I read it in real time, as he was writing it.

I would read it daily or weekly. And it was kind of a great communication tool for us, actually.

JEFFREY BROWN: Oh, really?

DR. LUCY KALANITHI: Because he would talk about — oh, yes.

Seeing him write the book was really amazing, because even though his body was sort of in this state of physical collapse, his mind was so engaged, still, in this process.

And kind of the reviews of the book that I like the best capture that somewhat. There’s an author named Gavin Francis who wrote a blurb for the book. And he wrote something like, “This is a tremendous book, crackling with life.”

And that idea, like, it brings tears to my eyes to think of crackling with life, because, if you had seen Paul, you know, he’s wrapped up in a blanket, he’s sitting in this armchair. He looks frail and wan, you know? He looks ill.

JEFFREY BROWN: As he’s writing?

DR. LUCY KALANITHI: But he’s crackling with life. And that was just really true. And the book was a big part of that.

JEFFREY BROWN: The two of you made a very important, major decision in the midst of this, which was to have a child.

DR. LUCY KALANITHI: That’s right.

JEFFREY BROWN: Was that a tough decision?

DR. LUCY KALANITHI: We had always wanted to have children together. We hadn’t done it by the end of his residency. That was around the time we had pictured we always would.

And right at that time was when he was diagnosed with terminal cancer, terminal lung cancer. And it was a series of really intense conversations to figure out if we wanted to do that and could we handle that, and both of us had the instinct to do it.

But we needed to think very hard about what it would mean. You know, we talked really frankly about his prognosis and what was happening. And I said that, “Don’t you think that saying goodbye to a child would make your death even more painful?”

And he said, “Well, wouldn’t it be great if it did?”

PAUL KALANITHI: Since Cady’s birth, my time with her has had a very peculiar and free nature. In all probability, I won’t live long enough for her to remember me, and so the time is — just is what it is.

DR. LUCY KALANITHI: That was kind of this amazing thing, where it’s like life isn’t just about avoiding suffering. It’s about finding meaning. And having a child was part of that for us.

JEFFREY BROWN: The very powerful book is “When Breath Becomes Air” by Paul Kalanithi.

Lucy Kalanithi, thank you so much.

DR. LUCY KALANITHI: My pleasure. I wish it were Paul here. Thank you.

The post Amid death’s throes, young doctor examines life for meaning appeared first on PBS NewsHour.