
                             MEDICAL MILESTONES

                              By ANNE MULLENS
                               Vancouver Sun

     VANCOUVER - There is little debate that Canada's most famous
     contribution to medicine was the discovery of insulin in 1921-22.

     The historic breakthrough made Frederick Banting and Charles Best
     household names, earned Banting and advisor J.J.R. Macleod the 1923
     Nobel Prize in medicine, and saved the lives of millions of
     diabetics worldwide.

        See <20health> for a discussion of research funding crunch
        See <18health> for a discussion of technician shortage

     But insulin is far from being the only significant Canadian medical
     achievement over the years.

     Other personalities, discoveries and inventions sprinkle the
     history of Canadian medicine.

     Although not a definitive list, some notable landmarks follow:

      - SIR WILLIAM OSLER: Born in Ontario in 1849, Osler rose to
     become one of the world's most respected and renowned physicians,
     teaching and practising in Canada, the U.S. and England.

     ``He was the most brilliant and influential medical teacher of his
     day,'' says his biographer Harvey Cushing.

     Although he made many medical observations, he is remembered mostly
     for his technique of bedside teaching, which was adopted by medical
     schools around the world, and his text, The Principles and
     Practices of Medicine (1892), which was translated into four
     languages and remained a standard western medical text until the
     late 1950s.

      - PABLUM: In the late 1920s, three doctors at Toronto's Hospital
     for Sick Children - Frederick Tisdall, Alan Brown and T.G.H. Drake
     - came up with the formula for the first vitamin enriched, pre-
     cooked cereal as a way to combat the scores of malnourished
     children they saw admitted to hospital.

     Pablum is now a staple of infant feeding around the world.

      - HEPARIN: Although discovered in 1916 by a young student
     researcher at Johns Hopkins University in the U.S., the blood
     thinner heparin sat unused until it was purified under a team at
     University of Toronto's Connaught Laboratories, directed by insulin
     co-discoverer Charles Best.

     Toronto surgeon Dr. Gordon Murray pioneered the animal and human
     research of the extract, purified from beef lungs and pork
     intestines, to establish its safe and effective use to prevent
     clotting.

     The use of heparin opened the door to heart surgery, renal dialysis
     and the treatment of blood clotting disorders.

      - NORMAN BETHUNE: Born in Gravenhurst, Ont. and trained at the
     University of Toronto, the hero of Communist China organized the
     first blood transfusion service in the world in Madrid during the
     Spanish civil war.

     He went to China in 1938 to help the guerrilla army, organizing the
     first mobile hospital unit there and training schools for nurses
     and medical assistants.

     He died of blood poisoning contracted during an operation in 1939.

      - ELECTRON MICROSCOPE: Using the theory and crude model
     developed by German engineer Ernst Ruska, University of Toronto
     physicists James Hillier and Albert Prebus built a much-improved
     electron microscope in 1937 that magnified 7,000 times.

     Their design became the forerunner of all electron microscopes,
     which now magnify 200,000 times and make visible the most intimate
     details of cells, tissues, viruses and micro-organisms.

      - WILDER PENFIELD: A world-renowned neurosurgeon, the U.S.-born
     Penfield (1891-1976) was a professor of neurology and neurosurgery
     at McGill, where he founded the Montreal Neurological Institute.

     His systematic mapping of the human brain earned him world
     attention, as did his development of an operation for epilepsy.

     ``Starting with Penfield and the MNI, a standard of excellence in
     neurological sciences developed in Canada that continues to this
     day,'' said Dr. Pierre Bois, president of the Medical Research
     Council.

      - BARR BODY: University of Western Ontario researcher Murray
     Barr was the first to identify the female sex nucleus of a cell,
     named the Barr body in his honor.

     Barr and graduate student Ewart Graham found that only the cells
     from female cats had a mass of chromatin, or genetic material,
     called sex chromatin.

     The 1942 discovery helped determine genetic abnormalities and
     chromosomal disorders.

      - CURARE: While performing an appendectomy on a young man in
     1942, Montreal anesthetist Dr. Harold Griffith became the first
     doctor to use the South American arrow poison, curare, during an
     operation.

     The drug, which causes temporary paralysis by interfering with
     nerve impulses, enables doctors to work on relaxed muscles, to use
     less anesthetic and to reduce anesthetic complications.

     Derivatives of curare are used in operations to this day.

      - HYPOTHERMIA: In the early 1950s Dr. William Bigelow of the
     Toronto General Hospital developed the technique in heart surgery
     of gradually lowering a patient's temperature to slow their
     metabolism and reduce their need for blood.

     It enabled blood flow to the heart to be stopped for eight to 10
     minutes, allowing a bloodless, clear field of vision to operate on
     the heart, paving the way for a range of heart repairs.

     Hypothermia is now combined with heart-lung machines that oxygenate
     blood outside the body and has enabled surgeons to operate on the
     heart for hours without damage to the tissue.

     - VINCA ALKALOIDS: In the 1950s a research team led Dr. Robert
     Noble, then at the University of Western Ontario, discovered that
     extracts from the leaves of the Jamaican periwinkle plant, Vinca
     rosea, stopped the growth of cancerous cells.

     The compounds, called vinca alkaloids, were the first Canadian
     contributions to chemotherapy and have dramatically improved the
     cure rate of Hodgkins and non-Hodgkins lumphoma, and childhood
     leukemia.

      - CARDIAC PACEMAKER: Toronto General Hospital scientists, along
     with researchers at Ottawa's National Research Council, designed
     and demonstrated the effective human use of the first cardiac
     pacemaker in the 1950s.

     Too large to be implanted under the skin, the devices did not
     become practical until the transistor was refined 10 years later in
     the U.S.

      - ENDOCRINE HORMONES: Canadians have isolated a number of
     important hormones over the years. Biochemist J.B. Collip, who
     purified insulin for Banting and Best, went on to later isolate a
     hormone from the parathyroid, called parathormone, which raises
     blood calcium levels.

     Collip did extensive work on reproductive hormones secreted from
     the pituitary and was also the first to isolate the hormone ACTH
     (adrenocorticotrophic hormone) from the adrenal glands.

     Montreal endocrinologist Dr. Jacques Genest demonstrated the role
     of the hormone aldosterone in high blood pressure in the 1950s.

     In 1962, University of B.C. researcher Harold Copp isolated the
     hormone calcitonin, produced by the thyroid and parathyroids, which
     lowers blood calcium. University of Manitoba physiologist Dr. Henry
     Friesen, while at McGill, isolated and purified human prolactin,
     which stimulates milk production and can be a major cause of
     infertility.

     In 1981, Queen's University biochemist Dr. Aldopho de Bold
     isolated the heart hormone, atrial natriuretic factor (ANF), which
     naturally lowers blood pressure.

      - ``BLUE BABY OPERATION:'' Until a surgeon at the Toronto Sick
     Children's Hospital developed a technique to repair ``transposition
     of the great vessels'' of the heart, infants with this
     malformation, who were blue from the lack of oxygenation of their
     blood, usually died a few months after birth.

     Dr. Bill Mustard decided to reroute the blood flow between the
     chambers inside the heart by taking a piece of tissue from the
     tough sack around the heart and building a baffle between the left
     and right atrium of the heart to reverse the blood flow.

     Said Mustard of the first few minutes after operating on the first
     patient, Maria, in 1963: ``We could hardly believe it, the blue
     child turned a beautiful pink right before our eyes.''

     Now called the ``Mustard procedure,'' the operation has become the
     standard correction for the heart defect and is performed around
     the world.

      - LUNG TRANSPLANTS: The world's first successful single lung
     transplant was performed at the Toronto General Hospital in 1983 by
     Drs. F.G. Pearson and Joel Cooper.

     The world's first successful double lung transplant was performed
     at the same hospital in 1986 by Dr. Alex Patterson.

     The first successful double lung transplant on a patient with
     cystic fibrosis followed there in 1988.

      - GENETICS: Canada has developed an international reputation for
     high-calibre genetics research. In the last five years, genetic
     researchers at the Hospital for Sick Children and the University of
     Toronto have made enormous strides in pinpointing genes that cause
     hereditary diseases.

     In 1987, Drs. Ronald Worton and Peter Ray identified a portion of
     the gene for Duchenne muscular dystrophy; in 1988 Drs. Roy Gravel
     and Don Mahuran identified one of the key enzyme defects that cause
     Tay Sachs disease; and in 1989 Drs. Lap-Chee Tsui and Jack Riordan,
     along with Dr. Francis Collins at the University of Michigan,
     discovered the gene for cystic fibrosis.

     All the discoveries open the door for greater understanding of the
     disease, and the potential for drug treatments or prenatal
     diagnosis.


