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Junior Year

First & Second Semester Projects 

Human Anatomy 

Course Description 

Lecture and laboratory studies of the histology and gross morphology of the human form, utilizing a cell-tissue-organ system- body approach 

History Through the Eyes of Surgery

Introduction  

      As time moves by as a species, we have cultivated a perfect [JW1] study of the sciences and medicine and have advanced them exponentially. The United States alone according to the National Institutes of Health, Spends about  48 billion dollars [JW2] [JW3] to work on what may seem very minuscule that take a lifetime to discover can be seen having a much greater impact when put together. From anesthetics to surgical procedures and tools that are used today, were discovered centuries ago and are only the beginning to what is to come in the field of medicine, specifically surgery. 

 

Before the 19th Century 

          The first step into medicine was estimated to be taken in 6500BC. According to Arani, Fakharian, and Sarbandi, those who wrote the article about Ancient Legacy of Cranial Surgery, the first ever documented surgery dating back to the Neolithic age. In this age it was common practice for the head to be protected. As humans we knew the delicacy of the brain and the head itself even though we had not yet grasped the gross anatomy of the human body and all its complexities. However, we were not inseparable to head injuries and in the times of many head injuries it was common to seek help. So a procedure called trepanation was performed on those 

to “alleviate pressure on the brain following an injury to the head, or to release evil spirits from the heads of mentally ill people” (Arani, Fakharian, sarbandi).

 

            Trepanation itself was a procedure where a part of the skull is removed to release pressure off the brain when swelled.  Specific tools during this procedure consisted of “a drill that was not to penetrate the brain” it was shaped in a cylindrical style attached to a string like object, there was also different appliances like forceps to grab the skull and its particles that were left behind (Arani, Frakharian, Sarbandi). During this time period it was believed according to Arani, one of the writers of  “Greek physicians thought it was better for the wound in the head to be left without a bandage so often times after the procedure the portion of the skull taken out was not placed back into the head and was left to ooze and breathe freely” (Arani, Fankharian, Sarbandi).

 

Trepanation being one of the first ever documented surgeries is still used today. This procedure, however, are used for different circumstances. Today it is not used for purposes for healing mental illnesses but rather used for exploratory surgery and specifically relieving intercranial pressure. Though this procedure was performed in 6500BC it allowed doctors/ physicians to record and observe the consequences of mistakes made during the procedure and knowledge on different types of injuries to the head, propelling us into faster diagnosis and a better understanding of the brain today. This ultimately aided in leading us to study the human body and learn from it. For instance, it was common for this procedure to need different tools depending on the size of the skull and the human body, which is another reason that in todays operating rooms we have so many tools that are of different shapes and sizes at hand in order to be used immediately when needed to prevent a patient’s life slipping through the cracks of the operation (Arani, Fankharian, Sarbandi).  

 

Time without Pain 

        During this time period of trepanation all the way until 1842 any surgery or medical treatment was done without anesthetics. Because of the amount of gruesome pain that a patient would have to endure, many doctors and patients would opt out of treatment unless it meant death and was the only option. For this until 1842 if treatment through surgery was need many doctors according to Josh Bicker, the author of Ether in Surgery, would throw punches to knock out their patients seeing that many didn’t feel pain while passed out, or put ice over the area of insertion to numb the area.  

 

           However, in 1540 ether was created by Valerius Cordus, by combining sulfuric acid with fortified wine (Bicker). For over 200 years this solution was used as medicine to stop muscle spasms (Bicker). However, it was commonly used in colleges as a party drug. Doctor Crawford Williamson Long had observed that this solution caused people to not feel little too any pain when put into activates such as fights. So, after this observation during 1842 a Dr. long was the first to use Ether in surgery removing a tumor in a patient’s neck (Bicker). He went on to study an observe the use and its effects of ether on many patients for about 7 years, however during that time someone else had published their own work (Bicker). This led to confusion on who truly was the first to use it during surgery. 

 

             Although Ether had many significant positives to use during surgery, it also came with many side effects and dangers. For instance, Ether is highly flammable, so because of this when our medical tools were renovated and we used more heat, fire became common in the operating room. When administered to patients, it blocked the pain receptors however it was often that in the process patients would feel a choking sensation make the procedure very uncomfortable and agonizing. Another huge impact ether had was its unique distasteful smell that made many nauseas and sick during its use in surgery. However, it was continued to be used until 1960 when more anesthetics were introduced that had far less side effects. 

 

             Though ether as an anesthetic was outdated in the 1960’s due to other anesthetics working far better, it allowed the process of controlling the amount of anesthetic administered though the use of a plethora of devices being created to solve the problem of overdosing patients with ether. The first process created was putting ether into a cloth and placing it over the patients nose so the vapors would be inhaled. We still use this process today not necessarily with anesthetics but with ways of getting rid of side effects like nausea. For instance, the cloth method is used when a woman is having a C-section, they can become nauseous so, they will often put rubbing alcohol on a cloth and have them smell it to get rid of the nausea. Then there was a new creation that had an ether-soaked sponge in the center of two tubes and the patient breathed through one of the two tubes. This is similar to that of an oxygen mask one tube for moisture while the other is for oxygen. This invention led to the Roux Sac. The Roux Sac according to Bicker, “was a bag lined with pig skin that could be opened and closed to different degrees to change the amount of ether inhaled”. This creation led to the common day use of a ventilator used in every operating room today to administer anesthetics. The use of ether ultimately allowed for the creation of an anesthesiologist, and all the tools that they use such as the ventilator. The study and use of ether also propelled us to the studies of how chemicals react in the human body, allowing us to discover specific medications and multiple anesthetics if one is allergic to one. This also allowed a safer practice of surgery and allowed us to explore the inside of the human body without sacrificing someone’s life and endurance of pain. 

 

19th Century Surgery 

           An example of a much more invasive surgery that was allowed due to the anesthetics created, starts with a doctor named Daniel Hale Williams, who started out as a shoemaker. According to Columbia Surgery, Dr. Williams “was born in 1858 in Hollidaysburg, Pennsylvania, the fifth of seven children”.  He created one of the first hospitals to allow both white and black doctors to practice medicine and allowed black nurses to obtain training, opening medicine to those giving and receiving it to all races (Columbia surgery). 

 

              After the hospital was open, in 1893 a young black boy named James Cornish was rushed in with extensive stab wounds to the chest. Dr. Williams himself checked the boy out specifically observing the wound found between two ribs which had exposed the breastbone (Columbia surgery). Here he had created a whole between the intercostal muscles to reach the heart and repair the left internal mammary artery. Without the procedure it was thought that the boy would have died, but he was not in the clear yet. Dr. Williams noticed that the pericardium, the tissue that surround the heart keeping the proper pressure between the heart and the rest of the cavity, was not fully intact. So, he held it together and sutured it, completing the first every heart surgery. This procedure allowed for James Cornish to recover in 51 days in the hospital and walk away from a life threating stab wound and live and extra 20 years (Columbia Surgery).

 

        The extensive stab wound that Dr. Williams successfully sutured, created the world of cardiac surgery. Though not everyone believes that the pericardium suture Is exactly heart surgery it was the first ever to deal with the heart and healing of it with mans hands. Even though this surgery was an emergency that could have landed a young boy to death it instead opened the doors to much more anatomy in the living body. It not only opens the doors to cardiac surgery but also a world of medicine to black doctors, due to the success of Dr. Williams, and ultimately gave light to the physical touching and manipulation of the internal cavity at which the heart sits and is seen as one of the vital organs to keep someone alive. It allowed us to experiment and research what could do to prolong life as itself becomes injured and degrades over time. For instance, pericardiectomy where the pericardium is to be taken away from the body due to inflammation and complication in some, was never thought of until this surgery.  

 

20th Century Surgery 

       With the research and surgery being operated on the most fragile and important organs in the human body, one must be careful with any instrument and that of an internal organ such as the brain and heart. However, many humans who posses the tittle of a surgeon are flawed. Not every surgeon has the most stable hands, or even the best eye sight. So, there was technology engineered in order to alleviate some of the mistakes that were common in surgery. 

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        In 1985 a robot specifically the PUMA 200 was used in order to place needle in a CT-guided brain biopsy (Shah, Vyas, Vyas). This was the start of a new era. Later on the robots were upgraded to have camera that would be held steadily compared to that of a human holding a camera for a surgeon to operate off of. Later on, two arms were added to the camera version of the robot. This tool according to The History of Robotics in Surgical Specialties, “was designed as a cardiothoracic surgical tool for internal mammary artery takedown- and received FDA approval for limited use in 2001”, the beginning of the 21st century. 

 

         The creation and acceptance of robots within the operating room allowed for the creation of non-invasive procedures throughout the entire body, requiring no bigger than an inch incision of the skin. This was possible due to the robotics giving “more stability, accuracy, integration with modern imaging technology, as well as greater range of motion with little room” (Shah, Vyas, Vyas) The non-invasive procedure allowed hospitalized stays to shorten form what could be a month to one day. Another benefit from having robotics aid in surgery and the non-invasive cuts there is less likely to be bacterial infections seeing that the internal body is not as exposed to the external environment. With both creations of new procedures as well as robotics that are still being improved to this day allow for the life of patients to be maximized and allow those who need surgery possible and those who want to become surgeons a great window of different procedures to learn. 

 

The Creation of Syringes 

            In order for these procedures and surgeries to continue a new way to administer drugs for anesthetics as well as post operational care was created, the syringe.  The history of syringes all began in 1656 when the first ever intravenous needle was created with a quill feather and a bladder which was tested originally on dogs (MDDI). The next part of the syringe that was created was the hollow metal needle in the 19th century. However, the syringe was not fully accepted and well known until Maxwell W. Becton and Fairleigh S. Dickinson formed a medical device company where they would mass produce each version of the syringe. 

 

               The company, BD co., would later create what is called a yale luer-lok syringe where an interchangeable needle can be safely attached and displaced, which is still widely used in the 21st century. This company was also known for taking pharmacist Colin Albert Murdoch creation of the disposable plastic syringe design and putting it on the market. Without the BD co, most hospitals would still be using glass syringes. Many doctors believed that the glass syringes were more sterile than plastic syringes until the BD co. showed the world of the newest syringe. 

 

               If it weren’t for the BD co. and the many physicians who invented and renovated the syringe, administering specific drugs would have been very difficult. These drugs that are used on a regular basis would be vaccine such as the COVID-19 Vaccine, or even morphine to aid in killing the pain of dying loved ones, or even administering specific and newer anesthetics, and hydrating those who are needing fluids.

 

21st Century Surgery 

               One of the newest surgeries that as soscity we have propelled to is synthetically growing new internal organs for transplantation. According to the Science Daily, “a 36-year old male patient had trachea cancer that extended through out his entire neck to the point of not being able to 

breath. The patient had gone through extensive radiation therapy and the cancer was still overcrowding the trachea. 

 

              Due to limited options on June 9th, 2011 professors and doctors of University of college London (UCL) , and Harvard partnered together to synthetically grow a new trachea (Science Daily). UCL designed a tube-like structure similar to that of a trachea that is called a nanocomposite tracheal scaffold. This solid material like trachea gets its name because of similarly repeated particles that form the tube itself (Science Direct). While Harvard bioscience created a container that creates the perfect environment to produce and grow stem cells called a bioreactor (Infors).  They collected the stems cells from the 36-year old male patient and placed them into the bioreactor. The stem cells took approximately 2 days to grow onto the scaffold before it was ready for transplantation. After the scaffold replaced the patients own trachea there was no need for immunosuppressive drugs normally taken with transplantations. The reason behind this was because the stem cells came from the patient’s body, therefore his immune system would not fight off his new and improved trachea like any other transplant would do because it did not have any outside characteristics or antibodies that would seem like a foreign object to the body. The creation of a trachea from stem cells outside of the body at the age of 36, created a new era and possibility of saving lives. Tracheas specifically are very scarce in the donor realm especially for children (Science Daily). Even if a donor trachea was a possibility for some patients there was still always the factor of the body not accepting the organ creating further complications. However, this creation could even extend further than just the trachea. If it's possible to create different types of scaffolds it would be possible to grow other organs such as hearts and possibly kidneys later in the future. Though this would be more difficult due to their functions all it would take would be finding the specific gene that tells the stem cell what to grow into. If this was a possibility, there would be far less people on the donor list and many lives would be saved. It is also a possibility that if this were to create long term care for those that need organ donation that time of hospitalized visits would decrease, and post-operational care would be shorter. This study on growing specific organs would also allow us to further our studies on each individual gene within the organ and not just focus on the gross anatomy.  This creation and procedure would allow humans to live a fuller life without immunosuppressant pills. 

 

Conclusion

               Without the first ever surgery of trepanation the study of the brain would not have been studied as quickly and would not lead us to the anatomy of the body. Without the production of ether surgery would have been agonizing further into the century causing many to die due to not choosing surgery. Without any of the exploration into the human body through surgery our health and life could not be lived as long or as fulfilling as it is today. From the first cut made into the human body in 6500 BC to the latest cut made in 2023 we have exponentially progressed surgery and our abilities to understand and heal the human body allowing us to extend life further than ever before. 

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References

 

Briefly tell us what you accomplished in your Honors project.
 

For my honors credit in BIOL-N261 (anatomy), I went beyond the class material and looked into how it would be relevant to my future careeer of being a surgeon. I collected sources about the history of surgery, the medication, and tools we currently use and how they have progressed over time. After collecting the data I then wrote a ten page paper over the scientific progression we have made through out the years. I started by the first ever surgery to eve be done before the 19th century and followed that pattern until the 21st century. The major milestones in each century that I wrote about was the first surgery of trepanation (cutting the skull), followed by the first heart surgery, the first anesthesia, and lastly the technology we use in surgery today. This allowed me to explain how the human body works and how we started studying it

What did you learn about yourself, your educational growth, and being an Honors student by completing this project?


Something that I learned this year with my honors project was that it is okay to have to ask for a small extension when life gets chaotic! For instance this year I had some family health issues and I was the one to have to step in and be the poa essentially so at one point I had to ask for a week extension on my first draft and I had to learn to not beat my self up over it. Overall I think this project not only allowed me to be nicer and have grace with myself but also allowed me to work on my communication skills!

What will you take with you into your next Honors experience or your life after graduation? How will this experience impact your future?


I think one thing I will be taking with me to my next honors paper is the idea of starting the project sooner if possible so that if family issues are to arise again I won’t have to stress about it! I think I will also take what I have learned about giving myself grace not only with my project but with my grades and to understand the an A- is still okay and not a bad thing. I think after graduation going through the history of surgery will allow me to be greatful with each thing I learn within medical school and I think it even helped me understand the material I’m the class overall!

Reflection Essay

Philosophy: Biomedical Ethics 

Course Description 

A philosophical consideration of ethical problems that arise in current biomedical practice, e.g., regarding abortion, euthanasia, determination of death, consent to treatment, and professional responsibilities in connection with research, experimentation, and health care delivery.

Mentally Incoherent Questions

Start of a Medical Emergency 

               A male patient who is 68 years of age laying in bed with an arm swollen as big as a boxing glove and a weeping hole in the elbow, cry’s out wishing to die because of the pain and agony he is suffering from. He cannot get out of bed and walk, hold any food down, use the restroom, and refuses to go to the hospital for help. Once passed out you must dolly his lifeless body to the car and to the hospital. Confused and dazed they rushed him to the ER because he became tachycardia, and his blood sugar levels were reading at 560. He then got the diagnosis of diabetes, a urinary tract infection (U.T.I.), and has become septic with streptococcus bacteria. 

           As they rush him for emergency surgery to relieve the fluid caused by the bacteria of his legs, they ask him medical questions such as, what medications do you take, do you have any metal in your body, are you a smoker, and do you snore. He answers every single one wrong, but the doctor still writes his answers into his medical chart knowing that he was confused before coming in. They then allowed him to go home alone with at home IV’s with barely being able to walk and fluid filled sacs between his vertebrae because he requested to go home. This was the life of my father-in-law Larry. While in the hospital they would not explain the medication that was being administered, did not explain how to properly eat or what his sugar levels meant because he could not comprehend what was going on, due to his sugar levels and UTI clouding his judgement, but expected him to answer medical questions. 

            When presented with a patient like Larry the question at hand is, should medical personnel be allowed to ask patients who are mentally incoherent due to their diagnosis, medical questions or should they go to next of kin if there are no other documents on file. Through the Utilitarian theory, it can be implemented in this scenario to ethically rationalize the best outcome depending on happiness (positive utils) compared to levels of unhappiness (negative utils), regarding weather mentally incoherent patients should be asked medical questions or if another route should be taken. 

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First Scenario: Asking the Mentally Incoherent Patient 

            To decipher whether this is ethically sound the patient, medical personnel, and family perspective will be analyzed through utils depending on the results that may come from each scenario. The first scenario operates on the idea that when brought to the hospital and the patient is confused, medical personnel would still ask medical questions, similar to that of Larry. However, in this scenario the medical personnel would not be able to fact check anything the patient was telling them or know what was true due to not having any medical background of the patient. 

           Before any treatment is given let’s say the patient was asked allergy questions and if there were any metal that could be found in the body? This would allow medical personnel to do proper tests and go forward with treatment. But from the patient’s perspective if they answer incorrectly this can cause bodily harm, or death. When the patient is harmed, this would cause much discomfort showing as negative utils. In addition, the family members that have to aid in health once out of the hospital could be negatively impacted because of the role they may have to take on as caretaker. If the patient becomes deceased, this could also negatively impact the family because the loss of a loved one could have been prevented creating a negative util as well. Then there are the medical personnel, and the impact of medically impairing someone because they received false information from someone that was confused could cause guilt to be accounted for as negative utils as well. 

            Although asking the patient medical questions seems to create only negative util it could be argued that asking the patient allows for them to have autonomy which gives them dignity as a human being resulting in positive util. However, this argument is weakened by the fact that the person is not coherent to what is going on due to the status of their health having a negative impact on their ability to rationally make decisions so the alteration of the mind frame would not necessarily impact their dignity. The idea of allowing the patient to answer their medical questions also would open a door of embarrassment once becoming medically inclined if they answered questions wrong, or wasted hospital supplies resulting in even more negative util.

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Second Scenario: Asking Next of Kin or Direct Family Member if No Kids

          The next position that the medical team could take would be to ask the next of kin or a direct family member the medical questions of the patient, which did not occur during Larry’s hospital stay. Taking this approach would save the patient form embarrassment or losing dignity and take the negative util off the table and allow for a safe treatment plan to be enacted. This would cause positive util from a family aspect because they do not risk the fate of medical errors due to improper medical answers. There is also the impact that the family could have on the patient when they properly answer the medical questions which could show the patient that their family member cares and listen, resulting in positive util. There is also the positive util that could come from the medical team because they are able to aid the patient more quickly and accurate as well as aid others quicker when the medical questions are answered properly, which created a positive util for the other patients. 

            One may argue though that allowing the next of kin to answer medical questions may cause negative util if the patient and next of kin are not close or do not get along. This could cause complication and tensions within the room affecting the health of the patient and they could be inclined to answer questions wrong out of spite. This would also result in negative util for the patient and the care team for the same reasons if the patient were to just answer the questions incorrectly. However, there is a weak spot in this argument, because the next of kin and the patient could use this as a way to get past their differences. This would allow for a new relationship to be created because of the vulnerability of the patient. This would result in a positive util on the fact that a positive relationship could become of the scenario. This would also result in positive util because the patient will be on the road to health and the medical team could walk away from a successful case. 

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Third Scenario: Not Asking Anyone and Strictly Looking at The Science

         The last scenario that could be implemented by the medical team would to be instead of asking anyone any medical questions, rather do medical testing to answers the questions. In this case this would allow there to be no wrong answers given and it would avoid the issue if someone didn’t have family or if the patient had a negative relationship with the next of kin. Overall eliminating of the negative util found in the last scenario. 

However medical testing instead of asking questions could cause a great deal of stress on the medical team causing negative util because they would have to take full responsibility for any actions taken. It could also result in a negative util or positive util depending on the results. This take on the case could also impact the family and patient negatively because receiving any information on what would be going on would take longer causing anxiety resulting in negative util. There is also the factor that running tests to answer medical questions could take away much time and resources that could be used on other patients, causing more negative util. 

       On one hand though, one may argue that with using scientific testing there would be very little error making sure that the patient is able to get the specific treatment that would be needed. This would result in positive util however there is a weak spot in this argument. With any experiment or lab test there is always some form of human error. This can cause the results to be read wrong, which can result in the wrong treatment causing negative util for the patient because their condition could worsen, which would have been the same if you had just asked the patient to begin with. 

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Conclusion: the similarities compared to the difference that sets it apart 

         In each scenario there are a lot of positive and negative util that are represented very similarly in each option for the medical team. However, when looking at each scenario independently, asking the patient would result in mostly negative util, while asking next of kin would result in mostly positive util. Lastly, the option of just performing lab tests to answer medical questions would result in mostly negative util as well. Overall applying the utilitarian theory would allow the ethical answer to be asking next of kin.

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References

  • Munson, Ronald, and Ian Lague. Intervention and Reflection Basic Issues in Bioethics. Tenth ed., Cengage Learning, 2017. Chapter 12, Intro and Utilitarianism, pp. 900-910

Reflection Essay 

Briefly tell us what you accomplished in your Honors project.
 

By accomplishing my Honors contract in Biomedical Ethics, I was able to apply the theory’s and lessons to an everyday situations. For instance, I wrote a paper based an ethical issue that I have lived through but also others live through on a daily bases. In this paper I was able to apply the theory’s of accomplished philosophers and analyze situations to see if they were ethically sound and if we should continue to treat patients in a hospital the way that I had experienced them. This class taught me how to make ethical discussions and how to reason through large everyday issues.

What did you learn about yourself, your educational growth, and being an Honors student by completing this project?


Something that I learned about myself during this term was that I often am very hard on myself when i misunderstand information, and I often need to learn how to give myself some grace. I have learned that it on an educational bases I have accomplished a lot and that I can’t accomplish anything without a few falls and its how you pick yourself up from those falls not the fall itself.Being an Honors student has allowed me to take a different perspective when it comes to school. It has allowed me to learn how to immerse my self into the educational portion and how to slowly but surly forgive myself for my mistakes.

What will you take with you into your next Honors experience or your life after graduation? How will this experience impact your future?


The first thing that I will be taking into my next honors college experience will not only my communication skills but the ability to create reasonable time lines. I this is one thing that I struggled with this year so I want to become better at this! Another thing that I will be taking with me that I learned this year is the ability to recognize when i mess up and how to professionally ask for help to aid with anything I do. These are two concept’s/ skills that I learned that will most defiantly allow me to use in my future honor contracts/ projects.

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