“Meet the medical students who pushed the boundaries of science”
To ensure progression of their careers, medical students are being encouraged earlier and earlier to take part in research—and to publish the resulting papers in indexed journals. UK students will find the publication of research, such as case reports and systematic reviews, beneficial on application to the foundation programme; students with publications can gain up to two extra points in their application, which might put them ahead of their peers in the rankings and help them to secure their foundation school of choice. Likewise, when applying for specialty training programmes later on, relevant research experience is often listed as a “desirable” quality; indeed, a BMA report found that the main motivation cited by doctors for currently taking part in research was the enhancement of their career prospects or securing a national training number.
This pressure can result in medical students taking part in a research project simply to “get ahead,” rather than to make a meaningful contribution to their specialty of study. Some students might think that they have nothing to add to the medical discipline, since they are relatively inexperienced both clinically and in the practice of research. But throughout history, medical students have been responsible for a wide range of discoveries and inventions, proving that taking part in research as a medical student can benefit patients as well as improve both career prospects and the critical evaluation and integration of evidence. This feature discusses eminent medical students and their scientific breakthroughs.
Johan Ham (1651-1723) and Anton van Leeuwenhoek (1632-1723)
Ham discovered spermatozoa while studying as a medical student in Holland in 1677.  He took a specimen of semen from a man with gonorrhoea “in which Ham had found small living ‘animalcules’ with tails,” to Leeuwenhoek, a Dutch lens grinder and optics manufacturer (later described as the “father of microscopy”). Leeuwenhoek reported the finding by letter to the Royal Society in Latin (owing to its delicate nature), crediting Ham. Although some have argued that Ham first suspected the relevance of the discovery to reproduction, it was Leeuwenhoek who initially outlined the role of spermatozoa in fertilisation.
Auguste Maurice Raynaud (1834-81)
This eponymous phenomenon, which involves the vasoconstriction of blood vessels in the fingers resulting in the classic discoloration, is named after the medical student who described the condition as part of his thesis for his medical doctorate in 1862. Raynaud saw the phenomenon in 25 patients, and also observed a loss of sensation, pain, and localised gangrene. He spent the next 30 years investigating his findings, and today the phenomenon is recognised as “a manifestation of a wide spectrum of clinical disorders.” Raynaud’s phenomenon is seen worldwide, in both adults and children, and is thought to affect 2.9-20.0% of women and 0.5-13.0% of men. Prevalence varies with temperature, with the risk increased in colder climates.
Paul Langerhans (1847-88)
Islets of Langerhans
Between 1867 and 1869, while still at medical school, Langerhans studied the microscopic anatomy of the pancreas, recognising “clusters of small irregularly polygonal cells with clear cytoplasm diffusely scattered throughout the gland.” Over 20 years later the French histopathologist Edouard Laguesse, named these cells the “islets of Langerhans” and correctly suggested they were part of endocrine secretion.   More than 50 years later, another medical student, Charles Best, would take part in research that identified this secretion as insulin and its role in treating diabetes.
Augusta Klumpke (1859-1927)
As a medical student in 1885, Klumpke described injuries of the inferior brachial plexus. While working at a Paris hospital, she diagnosed a brachial plexus palsy associated with Horner’s syndrome. Further experimental work formed the basis of her undergraduate thesis, and she later called the condition Klumpke’s palsy. The condition is rare, and mostly seen in newborns as a result of difficult deliveries.  Klumpke was a champion of women’s rights and managed to succeed in a predominantly male environment, becoming the first woman intern at a Parisian hospital. She later became the first woman president of the French Society of Neurology and was awarded the French Legion of Honour.
Ruggero Oddi (1864-1913)
Oddi was a fourth year medical student when he discovered the common bile duct sphincter (also known as Oddi’s sphincter).  His research led him to conclude that it controlled the “intermittent flow of bile from the liver to the duodenum,” the dysfunction of which might cause biliary tract disease. He eventually became director of the Genoan Physiology Institute, gaining “substantial academic recognition,” but later lost his job and left Italy for “reasons that may have been related to family, drug addiction, or illness.”
Alejandro Posadas and Charles Smith (dates for both unknown)
In 1892, Argentine medical student Posadas reported the case of a soldier with a cutaneous manifestation of coccidioidomycosis, a fungal disease seen in specific areas of the Americas. In 1926, another medical student, Smith, contracted the disease while studying it in a laboratory. He went on to present with “pleuritic chest pain and purulent productive cough,” which helped him to identify the disease’s clinical presentation. In 1937, Smith began a 17 month study in California, in which he visited 432 patients with the disease, determining the incubation period, mode of transmission, and populations most at risk. He spent the rest of his career researching the disease.
Ernest Duchesne (1874-1912)
Bactericidal properties of Penicillium
For his 1897 graduation thesis, Duchesne demonstrated the ability of the fungus Penicillium glaucum to treat pathogenic bacterial infections caused by Escherichia coli and Salmonella typhi. He experimented on guinea pigs, but suggested that the toxin produced by the fungus would have therapeutic potential in humans. He did not continue the research, and Chain, Florey, and Jennings who themselves researched the medical potential of penicillin in 1942 did not confirm his work—the benefits of his discovery were left unrealised. Like his wife shortly before him, Duchesne died of tuberculosis, aged 37.
Martin William Flack (1882-1931) and Arthur Keith (1866-1955)
Flack was persuaded by Keith, his anatomy lecturer, to spend the summer of 1906 studying the hearts of moles, mice, and hedgehogs.  As a result of his studies, Flack discovered what was later named the sinoatrial node—the structure responsible for the “dominating rhythm of the heart.” Keith went on to become a celebrated anatomist, and Flack became a lecturer in physiology, later becoming first director of medical research for the Royal Air Force.
Jay McLean (1890-1957)
The anticoagulant heparin, primarily used to treat and prevent blood clots, “revolutionised the management of thromboembolic disorders and cardiac surgery after its introduction into clinical practice in the 1940s” and is commonly recognised as the discovery of McLean in 1916. As a second year medical student at Johns Hopkins, McLean started working in the laboratory of physiologist William Henry Howell, and identified a phosphatide anticoagulant in liver tissue from dogs. At the time, the discovery received little attention “because Howell considered that its anticoagulant activity should be investigated further.” In 1918, however, Howell, with another medical student, named the substance heparin. The attribution of heparin’s discovery to McLean has been a controversial one, and he spent much of his career laying claim to it. His early life had been difficult, and he considered the discovery a “result of his determination to accomplish something by his own ability.” 
Charles Herbert Best (1899-1978), Frederick Grant Banting (1891-1941), and John Macleod (1876-1935)
While still a medical student in Canada, Best was introduced to Banting, a practising doctor, in 1920 by his physiology professor Macleod. Banting was convinced that the “crucial substance preventing diabetes mellitus would be found in the islets of Langerhans,” and thought that he could relieve the symptoms of diabetes in a dog by injecting it with an extract from the islets. Banting recruited Best to help him. They first tested the theory in 1921 and within months they had confirmed Banting’s conviction. By 1922 they had published their paper and successfully treated their first patient with diabetes. The discovery of insulin revolutionised the treatment of diabetes; a disease estimated to affect around 285 million people worldwide in 2010. Banting, Best, and Macleod’s work was awarded the Nobel prize in 1923, although to Banting’s disgust, Best was not recognised. Later, the Nobel Foundation acknowledged that Best should have shared the award.
Thomas J Fogarty (1934-present)
As a teenager, Fogarty worked as a scrub technician, where he saw many operations to remove blood clots from arteries. Later, as a medical student, this experience led him to develop an approach to the removal of blood clots—a balloon catheter prototype that he created from latex gloves, making them by hand for himself and other vascular surgeons during his fellowship training. His invention was patented in 1963, and two years later his paper detailing its use was published in Annals of Surgery.  Today, the Fogarty catheter is used extensively worldwide in around 300 000 procedures every year. It is thought that Fogarty, primarily through the pioneering of less invasive vascular surgery, has saved “tens of millions of lives.”
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- Jamjoom A, Nikkar-Esfahani A, Fitzgerald J. Research and audit. Student BMJ 2009;17:b202.
- The Foundation Programme, EPM FAQs. 2014. www.foundationprogramme.nhs.uk/pages/home/how-to-apply/EPM-FAQs.
- NHS. Person specification. 2014. http://specialtytraining.hee.nhs.uk/wp-content/uploads/sites/475/2013/03/2014-PS-CPT-CT1-1.02.pdf.
- Udani S, Haylett K. The road to research. Student BMJ 2005;13:397-440.
- Stinger M, Ahmadi O. Famous discoveries by medical students. Aust NZ J Surg 2009;79:901-8.
- Ahmadzai H. Medical students, innovation and medical discoveries, Aust Med Student J 2012;3:7-9. www.amsj.org/archives/1963.
- Lawrence CR. Spermism. The embryo project encylopedia, 2008. http://embryo.asu.edu/pages/spermism.
- Garcia-Carrasco M, Jimenez-Hernandez M, Escarcega RO, Etchegaray-Morales I, Perez-Alva JC. Raynaud phenomenon. In: Shoenfeld Y, Cervera M, Gershwin E, eds. Diagnostic criteria in autoimmune diseases. Humana Press, 2008. [Online.] http://books.google.co.uk/books?id=A_vtzMxtd9AC&pg=PA53&lpg=PA53&dq=raynaud%27s.
- Islam S. One hundred fourty years after the discovery of islets by Paul Langerhans, Islets, a new journal dedicated to these mini-organs, is born. Islets 2009;1:1 www.landesbioscience.com/journals/islets/IslamISLETS1-1.pdf.
- Islam S. The islets of Langerhans. Adv Exp Med Biol 2010;654. [Online.] http://books.google.co.uk/books?id=2ROMea4yhY0C&pg=PA2&lpg=PA2&dq=Edouard±Laguesse±islets±langerhans&source.
- Moore K. Klumpe paralysis. In: e-Study guide for clinically oriented anatomy, 7th edn. Cram101, 2014. [Online.] http://books.google.co.uk/books?id=jw_vm1nTeuwC&pg=PT249&lpg=PT249&dq=klumpke%27s±palsy±named±after&source.
- Office of Rare Diseases Research. Klumpke paralysis. 2010. http://rarediseases.info.nih.gov/gard/3123/klumpke-paralysis/resources/1.
- National Institute of Neurological Disorders and Stroke. Erb-Duchenne and Dejerine-Klumpke Palsies information page. 2014. www.ninds.nih.gov/disorders/brachial_plexus_birth/brachial_plexus_birth.htm.
- Shoia M, Tubbs R. Augusta Déjerine-Klumpke: the first female neuroanatomist. Clin Anat 2007;20:585-7.
- Loukas M, Spentzouris G, Tubbs R, Kapos T, Curry B. Ruggero Ferdinando Antonio Guiseppe Vincenzo Oddi. World J Surg 2007;31:2260-5.
- Hospenthal D, Thompson G, Oppenheimer A, Arsura E. Coccidioidomycosis. Medscape 2013. http://emedicine.medscape.com/article/215978-overview.
- Hirschmann J. The early history of coccidioidomycosis: 1892-1945. Clin Infect Dis 2007;44:1202-7.
- Silverman M, Hollman A. Discovery of the sinus node by Keith and Flack: on the centennial of their 1907 publication. Heart 2007;93:1184-7.
- NHS Choices. Datapharm. Heparin sodium. www.nhs.uk/medicine-guides/pages/medicineoverview.aspx?condition=blood+clotting&medicine=heparin+sodium&preparation=heparin+sodium+125%2c000units%2f5ml+solution+for+injection+vials.
- McLean J. The discovery of heparin. Circulation 1959;19:75-8.
- Diabetes UK. Diabetes in the UK 2010: key statistics on diabetes, 2010. www.diabetes.org.uk/Documents/Reports/Diabetes_in_the_UK_2010.pdf.
- Nobelprize.org. The discovery of insulin. Nobel Media, 2013. www.nobelprize.org/educational/medicine/insulin/discovery-insulin.html.
- Fogarty T, Cranley J. Catheter technic for arterial embolectomy. Ann Surg 1965;161:325-30.
- Lemelson-MIT. Inventor of the week. Thomas Fogarty. Embolectomy balloon catheter. Massachusetts Institute of Technology. http://web.mit.edu/invent/iow/fogarty.html.
Cite this as: Student BMJ 2014;22:g2138