Refrigerator Cars, Prohibition, Bandaid Surgery and National Without a Scalpel Day

OK, work with me here.  There’s a lot to say about 16 January: Octavian became Caesar Augustus in 27 BCE, the Ostrogoths sacked Rome in 550, the battle of Cape St. Vincent (aka the Moonlight battle) was fought in 1780,  and Khrushchev claimed to have a 100 megaton thermonuclear weapon in 1963. But, today, we talk about saving lives.

The mechanical means of refrigeration that followed soon became not just practical for railroad cars, but for stand-alone refrigerators (as opposed to ice boxes) that began to appear in 1913.

On 16 January 1868, Detroit meat packer George H. Hammond inaugurated the use of ice-cooled boxcars–called reefers–to ship meat to New England.  While this early experiment was ultimately a failure (not because the idea didn’t work but because the cars were unbalanced and derailed several times), it did inspire other work in the area of whole-car refrigeration as opposed to insulated cars that had been in use since the 1840s. The mechanical means of refrigeration that followed soon became not just practical for railroad cars, but for stand-alone refrigerators (as opposed to ice boxes) that began to appear in 1913. While ice boxes lasted until the 1950s in the US and somewhat later in the developing world, the powered refrigerator led a revolution in food preservation that led, eventually to the invention of the supermarket and the TV dinner.

By WWI, the chorus of voices wanting to ban alcoholic beverages altogether was thunderous.

Since the beginning of colonization of North America by religious refugees, the issue of alcoholic beverages has been a contentious area of public debate. The main issues were, at first, sale of intoxicants to the Indians, then of public drunkenness.  The taxes on liquor that started to pay down the national debts after the Revolution were seen by social reformers as “sin taxes” that would discourage consumption, and temperance societies began to sprout. Thomas Jefferson killed the tax early in his presidency, but moral objections to alcohol consumption continued to grow. States like Maine banned the sale of liquor, only to be repealed itself in an election cycle. Federal alcohol taxes were re-imposed in 1864, and by 1898 it was at 1.1 cents per gallon of beverage. By WWI, the chorus of voices wanting to ban alcoholic beverages altogether was thunderous. Amendment XVIII to the Constitution passed in 1918 before Congress passed enabling legislation called the Volstead Act, which was signed into law on 16 January 1920, when Prohibition began.  Much to the chagrin of the social reformers it simply didn’t work, being by and large unenforceable because the consumption of alcohol was so widely popular. The Great Depression helped end the popularity of the law, since about 14% of pre-1920 Federal tax revenues were from alcohol taxes. Amendment XXI repealing Amendment XVIII went into effect on 5 December, 1933.

While most of us would say “um…yeah” to such things today, this was a breakthrough that prolonged the first patient’s life for two and a half years, and probably saves tens of thousands of lives every year.

Venturing into completely unfamiliar territory, on 16 January 1964, Charles Dotter threaded a stent into the leg of a patient using only x-rays for guidance, saving the limb.  While today this sort of thing is regarded as routine, at the time it was Nobel-Prize territory.  Dotter is now known as the “father of interventional radiology,” a sub-field of medicine that covers direct-viewing medical imagery to guide surgical procedures.  While most of us would say “um…yeah” to such things today, this was a breakthrough that prolonged the first patient’s life for two and a half years, and probably saves tens of thousands of lives every year.  Non-invasive surgery has since expanded, with revolutions in fiber optic imagery, x-ray and fluoroscopy, and even ultrasonic imaging that now enables surgeons to save tens of thousands of hours of recovery time, millions of dollars in medical expenses, and billions more in the reduction of hospital contagions.

Though I know less about medicine than I do a lot of other things, I and my family have reaped the benefits of minimally invasive techniques for several years.

Which brings us to National Without a Scalpel Day, marked every 16 January since 2016 by The Interventional Initiative to commemorate Dr. Dotter’s achievement, and to expand awareness of minimally invasive, image-guided procedures (MIIP) that are now a matter of routine in medicine.  Though I know less about medicine than I do a lot of other things, I and my family have reaped the benefits of minimally invasive techniques for several years.  My hat’s off to the late Dr. Dotter (who passed in 1985), and to all the pioneers in the fields of medicine, surgery and medical imagery that he inspired.

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