Vote Now! The Most Important NEJM Article (1930-1959)

Posted by • March 1st, 2012

In January, you voted for an article documenting the beginning of ether anesthesia, and in February, for the first description of platelets. This month we’re asking you to consider five articles from 1930-1959 and tell us which you think is most important.

In 1948, Sidney Farber reported promising results in treatment of early childhood leukemia.  He and his team gave 16 infants and children with acute lymphocytic leukemia a folic acid inhibitor, aminopterin; 10 showed improvement by clinical and hematologic parameters after 3 months.  The authors were emphatic that this was not a “cure” for leukemia, but it was the first time the disease course had been interrupted.

In a 1951 article, Drs. Greer and Keefer wrote, “The occurrence of a disease entity incurred through cat scratches in a young adult male has prompted this report.  [It’s] a disease remarkable in that there were “no characteristic clinical or laboratory findings…the infective agent has never been identified; it is apparently a virus.”  The virus was identified 40 years later as Bartonella henselae.

In 1952, Paul Zoll — one of the pioneers in the development of the cardiac pacemaker and defibrillator — and his colleagues described the first application of a transthoracic pacemaker to patients whose hearts had stopped beating.  The authors wrote: “Effective ventricular beats were regularly produced in 2 patients with ventricular standstill after complete heart block by the application of electric stimuli from an artificial, external pacemaker by way of subcutaneous needle electrodes. The heart was kept beating for twenty-five minutes in 1 patient, who finally died of cardiac tamponade, and for five days in the other, who recovered and ultimately resumed spontaneous idioventricular beats.”

In the 1950s, confirmation of the diagnosis of acute myocardial infarction (MI) relied entirely on EKGs.  Adelstein et al. studied the patterns of zinc and zinc enzymes, lactate dehydrogenase, and malic dehydrogenase in patients with acute MI.  Lactate dehydrogenase proved to be elevated in MI, but not in angina, coronary insufficiency, and myocardial ischemia. This 1956 article helped establish the role for serum biomarkers in diagnosing acute MI.

In 1957, E. Donnall Thomas and coauthors reported the first study of bone marrow transfusions in humans.  Dr. Thomas and his team collected bone marrow from both fetal and adult cadavers, then injected it into six patients who had whole-body radiation.  The bone marrow re-populated in several of the patients.

Read these articles, as originally written, and vote for the article you think is most important. At year’s end, we’ll have a run-off of all the winners.

2 Responses to “Vote Now! The Most Important NEJM Article (1930-1959)”

  1. Leo van der Reis MD says:

    all papers are important for various, but good reasons.

  2. I vote for Paul Zoll article! Thanks to him and his team of thousands of lives have been saved!