Res Medica (E-Journal)
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Cruelty to Children and its Complications
Get PDFA dissertation read before the Society on Friday, 24th February, 1967.The concept of what constitutes cruelty to children is best described in the Children and Young Persons Act as “Assault, ill-treatment, neglect, abandonment or exposure such as will cause unnecessary suffering or injury to health, including any mental derangement.
The Chloroform Controversies
Get PDFIt was the introduction of ether by Morton in 1846 that provided the necessary conditions for the development of Modern Surgical practice. Previous to its use Surgery was swift and brutal, its scope confined to the body surface, i.e. the evacuation of pus, amputation of limbs, excision of superficial tumours. It is revealing to examine the operations performed in the Royal Infirmary, Edinburgh, in the years 1831-34, a total of one hundred and forty, an average of thirty-five a year. Hovell remarks, “Although in 1829 the staff of the Royal Infirmary included surgeons of great reputation, very few operations were performed, and the operation theatre served little purpose.”It is hard today to realise the impact of the new discovery on the medical profession, yet in a very short time ether was to be supplanted by chloroform. I have often wondered why this happened. History is rather vague on this point. The major objection appears to have been its unpleasant smell. I suspect there were other reasons. The entrepreneurs of the time, realising the importance of the event, were anxious to participate in it. A frantic search for new drugs began and in November 1847 Simpson of Edinburgh used chloroform, first in obstetrics and then nearly six months later in general surgery.
Editorial
Get PDFThe Society’s image has subtly changed in Edinburgh. In other parts we are held in the same regard, but students here look at us with different eyes. We are rich now, amazingly so for a student society. We have exchanged a pared of our tradition and history, the work of 50 generations of past members, for hard cash. Our books for money. The tangible for the tangible and the intangible for the tangible.The Society has not yet realised what kind of bargain it has made. It has not been able to adjust its thinking to this new state of its affairs. Like the man in the street who suddenly wins a lot of money we do not know what to do with it. A large proportion, of course, must be set aside for the building of our new and much needed premises, but after this deduction, the Society still remains possessed of a considerable sum. The last editorial on this page spoke about the Society’s position “ at the crossroads” of the future. We are still dithering indecisively in the middle of the road
The Treatment of Head Injuries
Get PDFTrauma has become the endemic disease of modem civilisation. Head injury occurs in 70% of all injuries and causes death in 25%. The number of significant head injuries is rising year by year as shown by the table of the figures at the Royal Infirmary of Edinburgh.TABLE 1Year Number1962 8301963 6911964 9411965 10201966 1251In no other system of the body is a knowledge of the functional anatomy more essential than in the diagnosis and treatment of the head-injured. The brain is contained loosely within the bony skull. It is separated from it by the meninges and by a subarachnoid layer of cerebro-spinal fluid (C.S.F.). The brain maintains continuity with the bony skeleton by means of the cerebral veins which pass from the cortical surface to the dural sinuses. The width of the space between brain and skull depends on brain bulk. Thus in states of cerebral atrophy due to age or disease the space will be increased
The Biochemistry of Schizophrenia
Get PDFFor many years there have been two schools of thought concerning the aetiology of Schizophrenia. Some psychiatrists have been impressed by the disturbed family relationships and early upbringing that is commonly seen in cases of schizophrenia and have felt that the condition is largely psychogenic: that is that anyone subjected to these malign influences would develop the disease. Other psychiatrists have felt that schizophrenia results from a genetically determined metabolic disorder and that the disturbed behaviour results from a brain with specific faults in its biochemical mechanism. Two recent studies of what happens to the children of schizophrenic mothers who have been removed from their mothers shortly after birth and reared in foster homes have provided powerful, and I believe conclusive, evidence in favour of the latter view. This work was carried out by Heston in Oregon and by Rosenthal and Kety in Denmark. The results showed that these children in foster families nevertheless developed schizophrenia at the same rate (about 12% — as compared with the normal expectancy of 0.8%) as do the children of one schizophrenic parent reared by their biological mother. A control group of adopted children of normal mothers reared in similar foster homes showed no increased incidence. Then the foster families in which these children actually developed schizophrenia were compared with those in which the children remained normal, and no difference could be detected between them. Both lots appeared to be ordinary families. Thus what counts for the development of schizophrenia appears to be the genes and not the early family environment
Obesity
Get PDFINTRODUCTIONDuring last year about a quarter of the adult population of the United Kingdom tried to lose weight, demonstrating that our society is becoming increasingly aware of the problems of obesity. This may partly be cultural and attributable to Twiggy and the miniskirt but may also reflect the relatively recent medical appreciation that not only is obesity the commonest nutritional disorder in the United Kingdom but also a major health hazard. An American male 20% in excess of ideal weight carries an increased mortality of 30% or, in other words it is as dangerous to be 10 lbs. overweight as it is to smoke 25 cigarettes a day.DEFINITION & INCIDENCEObesity is an excessive accumulation of body fat — but unfortunately it is difficult to make easy and accurate measurements of body fat. The practised fingers are probably as accurate as calipers in measuring skin fold thickness and although weighing by total body immersion may be accurate the facilities to undertake this are not readily available at Chemists or Airports. It seems likely in the meantime that obesity will be related to Ideal Weight which is a Life Insurance Company concept whereby weight is related to optimum life expectancy.This has obvious limitations; one has only to watch the caponised caperings of modern shot-putters or even the front-row of Scotland’s present scrum to appreciate that not everybody who is overweight is obese; likewise some flabby women may carry considerable excesses of fat but remain within a few pounds of their ideal. In spite of these limitations it is usually accepted that patients who are more than 10% in excess of their ideal weight are “OVERWEIGHT” and those more than 20% in excess are “OBESE”.Using these criteria it has been roughly estimated that 1 in 5 of the adult population of the United Kingdom is obese
Travel Fund Reports: Nepal
Get PDFLiving in a valley, lush and green, 4600-ft. above sea level, filled with paddy fields, surrounded by terraced hill slopes and dominated by an inspiring backcloth of snow-capped Himalayas is a personal experience to be cherished. Working among a people, poor and poorer yet happy and cheerful, seeing textbook cases of gross, unattended pathology, tropical and “Western” , is a medical experience never to be forgotten.The valley of Kathmandu in Nepal provides the setting. Until 1951, when the King regained control from the Rama family, a hereditary line of Prime Ministers since since 1846, all Nepalese borders were closed to foreign travellers. The country maintained a mediaeval lifestyle with a mediaeval medical care.Since 1951 the influx of foreign influence has been accelerating. Now Kathmandu isa popular tourist stop. The people, however, are caught between the wealth and status of the visitors and their ancestral customs and poverty. Owing to the very rough terrain of the region and the poor communications within the country, most areas outside the city still retain their original life-style and value system.In 1953, the United Mission to Nepal began a hospital which still exists as the Shanta Bhawan Hospital (Palace of Peace). It caters mainly for the Nepali inhabitants of the area but also extends its foreign residents and tourists. Charity or credit concessions are available to the poor whilst the rich and foreign patients are over-charged
Natriuretic Hormone
Get PDFUntil about 1957 it was generally accepted that the regulation of renal sodium excretion was dependent solely upon changes in(a) glomerular filtration rate (Factor 1) and(b) the activity of the renin-angiotensin-aldosterone system (Factor 2).coupled with the effect of changes in intrarenal haemodynamics and physical factors, such as hydrostatic pressure surrounding renal tubules, and plasma protein osmotic pressure in peritubular capillaries.Since that time, however, evidence has gradually been accumulated to suggest that these are not the only factors which are relevant in this context, and the existence of a humoral inhibitor of renal sodium reabsorption has therefore been postulated. This ‘third factor\u27 has been given the name of natriuretic hormone, and indications of its presence have been found in two principal situations. These are(a) \u27Sodium escape’ during chronic mineralocorticoid administration(b) Volume expansion with (i) isotonic saline (ii) bloo
Measurement of Breath-holding time in the Acute Respiratory Patient
Get PDFIn 1909, Douglas and Haldane (1) demonstrated the relationship of Pa02 and PaC02 to breath-holding time (BHT). Muxworthy (7) described the direct effect of initial lung volume on breath-holding time in 1951.At the present, it is felt that breath-holding time is determined by, " . . . the interaction of a number of independent variables which can be classified in two major sets of stimuli: those related to lung volume and those derived from changes in gas tension and pH.” (3)Although a considerable body of knowledge has been acquired about breath-holding in a laboratory setting, very little work has been done to date on breath-holding in a clinical setting with respiratory patients. It was the object of the present study to determine the feasibility of measuring BHT’s on acutely ill patients in a clinical situation
Book Reviews
Get PDFCLINICAL RESEARCH FOR ALL Cyril Maxwell Cambridge Medical Publications Ltd. (1973) Price £2.85pA COMPANION TO MEDICAL STUDIES Editors-in-Chief: R. Massmore and J. S. Robson Vol. 3, parts 1 and Oxford; Blackwell Scientific Publication- £11.50 each part (£8.00 paper-back)CHEMOTAXIS AND INFLAMMATION P.C. Wilkinson Churchill Livingstone 1974. £4.00THOMSON\u27S CONCISE MEDICAL DICTIONARY William A.R. Thomson, M.D. Churchill Livingstone, 1973. £1.80CLINICAL EXAMINATION Editor, J.G. Macleod: Edinburgh: Churchill Livingstone. £4.2