Showing papers in "BMJ in 1956"
TL;DR: The deaths of doctors that have occurred since October, 1951 are related to the non-smoking, present smoking, and exsmoking groups as constituted at that date.
Abstract: On October 31, 1951, we sent a simple questionary to all members of the medical profession in the United Kingdom. In addition to giving their name, address, and age, they were asked to classify themselves into one of three groups-namely, (a) whether they were, at that time, smokers of tobacco; (b) whether they had smoked but had given up; or (c) whether they had never smoked regularly (which we defined as having never smoked as much as one cigarette a day, or its equivalent in pipe tobacco or cigars, for as long as one year). All smokers and ex-smokers were asked additional questions. The smokers were asked the ages at which they had started smoking and the amount of tobacco that they were smoking, and the method of smoking it, at the time of replying to the questionary. The ex-smokers were asked similar questions but relating to the time at which they had last given up smoking. On the basis of their replies to the questionary, we classified the doctors in a few broad groups according to their sex and age, the amount of tobacco they smoked, their method of smoking, and whether smoking had been continued or abandoned. Subsequently we have recorded the deaths occurring in each of these groups. To ensure a high proportion of replies we intentionally made the questionary extremely short and simple. In particular, we did not ask for a life-history of smoking habits, though in studying the incidence of lung cancer, with a long induction period, we realized that the habits of early adult life might be more relevant than the most recent habits. In addition, we have made no further inquiry into any change of habits that may have taken place since October, 1951. In short, we have related the deaths of doctors that have occurred since October, 1951, to the non-smoking, present smoking, and exsmoking groups as constituted at that date. It follows that, while we can make an accurate comparison between life-long non-smokers and all smokers past or present, any gradient of mortality that we may observe in relation to the amount of smoking will be an understatement of the true relationship. We shall, for instance, have included in the group of " light" smokers persons who had previously smoked " heavily " but at November 1, 1951, had reduced their consumption. Similarly, a " heavy " smoker at November 1, 1951, may previously have been a light smoker or may since then have given up smoking altogether; we shall have continued to count him, or her, as a heavy smoker. If there is a differential death rate with smoking, we must by such errors tend to inflate the mortality among the light smokers and to reduce the mortality among the heavy smokers. In other words, the gradients we present in this paper may be understatements but (apart from sampling errors due to the play of chance) cannot be overstatements. In 1954 we published a preliminary report on the results of this inquiry (Doll and Hill, 1954a). The number of deaths from lung cancer was then small (36) and standing alone they would not have justified a firm conclusion. In showing a steadily rising mortality from lung cancer as the amount of smoking increased, they were, however, in close conformity with the figures we had previously found in our extensive retrospective inquiries into the smoking histories of patients with cancer of the lung and other diseases. With the passage of another two years we are now able to present from this prospective inquiry a considerably increased body of data, and, in consequence, a more exhaustive analysis. The four main questions to which we have sought answers are: (1) What are the relative risks of lung cancer associated with the smoking of different amounts of tobacco by different methods ? (2) Is there a reduction in the risk if smoking is given up ? (3) What is the most likely explanation of the observed association ? (4) Is there a relationship between smoking and any other cause of death ?
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TL;DR: It is doubtful whether a general work of this calibre should contain even brief accounts and exiguous illustrations of operations, but the editors have produced a magnunm opus which for many years will be indispensable to those who practise obstetrics and gynaecology.
Abstract: These companion volumes have been edited by two of the leading personalities in British obstetrics and gynaecology. Both have made notable contributions to their subjects, and each is an outstanding teacher who has always subscribed to the dictum that teaching needs research and research needs teaching. With such a philosophy inspiring their professional work, it would follow, therefore, that any publication of theirs would be devoid of pedantry. The reader will not be disappointed and will find an original, lucid, and constructive presentation. Their aim has been to present, so far as possible, a description of obstetrics and gynaecology as practised in Britain. It may be pertinently asked in what way British practice differs from that in other countries. The editors have forestalled this question. They believe that in obstetrics the chief modern contribution from Britain has been \" the results of the study of the relation of social and economic conditions to the health of the pregnant woman and the condition of her child.\" In gynaecology it is conservatism that has been the characteristic British contribution. Sir Eardley Holland has been responsible for the general editorship of the volume on obstetrics and has been assisted by 38 contributors selected from almost all the university and teaching centres. Professor Bruce Mayes, of Sydney University, is the sole overseas contributor. Included in this obstetric oligarchy are physicians, paediatricians, anatomists, a psychiatrist, a venereologist, a medical statistician, and a barrister. The co-authors have been allocated subjects in which they are acknowledged experts; thus each chapter is authoritative and at the same time original. Mr. Aleck Bourne has enlisted the help of 21 authors for the volume on gynaecology, and among these is an anatomist, a psychiatrist, a venereologist, and a barrister. He has always emphasized the importance of the basic sciences in relation to clinical medicine ; the reader will appreciate this from the contents and their presentation. It is doubtful whether a general work of this calibre should contain even brief accounts and exiguous illustrations of operations. The excellent chapter on the cervix uteri is impaired by the descriptions (and diagrams) of the operations for amputation of the cervix and trachelorrhaphy. Those who need pictorial assistance for their surgical technique would refer to a tome on operative surgery. Both volumes are illustrated with diagrams and plates of artistic distinction, and the publishers are to be congratulated on their production. The editors have succeeded in their aim. Their task has been sisyphean, but they have produced a magnunm opus which for many years will be indispensable to those who practise obstetrics and gynaecology. W. C. W. NIXON.
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TL;DR: The incidence of ganglionic block over the various autonomic functions tested was different in every one of the 41 subjects for which complete records were obtained.
Abstract: light and to accommodation (30-40 % incidence). Sweating was also reduced. The incidence of ganglionic block over the various autonomic functions tested was different in every one of the 41 subjects for which complete records were obtained. Variability in the response to a ganglion-blocking agent is as great in normal subjects as in patients. It may be regarded as a result of the varying autonomic constitution of different individuals.
452Â citations
TL;DR: The main object in the present paper is to present the relationships between the clinical state, sigmoidoscopic appearance, and histological findings in serial biopsy studies of the colonic mucosa in ulcerative colitis.
Abstract: In a previous paper (Truelove, Horler, and Richards, 1955) we described an instrument for making serial biopsy studies of the colonic mucosa. We have continued such studies in ulcerative colitis and in addition have made isolated examinations of a number of other patients, including some not suffering from ulcerative colitis, who constitute a control group. Our main object in the present paper is to present the relationships between the clinical state, sigmoidoscopic appearance, and histological findings. The method has so far proved entirely harmless. There have been no local complications such as bleeding or spread of infection through the bowel wall; nor has there been any evidence that biopsy examinations, even when repeated several times, have had adverse effects on the course of ulcerative colitis. Biopsy specimens were obtained at 6-8 in. (15-20 cm.) from the anal margin. The specimen consisted of a round piece of colonic mucosa measuring up to 0.4 cm. in diameter. In most cases part of the muscularis mucosae was included in the sample, and sometimes the whole thickness of this layer together with a small portion of submucosa. The tissue was fixed in 10% formol saline. Paraffin-wax sections were stained routinely with haematoxylin and eosin.
374Â citations
TL;DR: (1955b).
Abstract: (1955b). Neural Control of the Pituitary Gland, p. 150. Arnold, London. Hartman, F. A., and Brownell, K. A. (1930). Science, 72, 76. Hays, E. H., and White, W. F. (1954). Recent Progr. Hormone Res., 10, 265. Hechter, O., Jacobsen, R. P., Jeanloz, R. W., Levy, H., Marshall, C. W., Pincus, G., and Schenker, V. (1950). Arch. Biochem., 25, 457. Hellman, L., Bradlow, H. L., Adesman, J., Fukushima, D. K., Kulp, J. L., and Gallagher, T. F. (1954). J. din. Invest., 33. 1106. Henriques, S. B., Henriques, 0. B., and Selye, H. (1949). Endocrinology, 45, 153. Hill, R. T. (1948). Ibid., 42, 339. Hill, S. R., Reiss, R. J.. Forsham, P. H., and Thorn, G. W. (1950). J.
201Â citations
TL;DR: Two further cases of myelomatosis with peripheral neuritis and other striking features are reported, similar to that which occurs in diabetes and pernicious anaemia.
Abstract: In myelomatosis there is a high incidence of neurological lesions. Neurological abnormalities were reported by Geschickter and Copeland (1928) in 40% of 425 cases, by Batts (1939) in 35% of 40 cases, by Adams et al. (1949) in 35% of 61 cases, and by Snapper et al. (1953) in 40% of 97 cases. The commonest type of lesion is direct compression of nervous tissue or its blood supply by a pathological fracture or tumour mass (Davison and Balser, 1937; Clarke, 1954). Occasionally vascular thromboses or haemorrhages due to gross abnormality of serum globulin occur (Wintrobe and Buell, 1953; Marshall and Malone, 1954). Rarely the meninges, and with them cranial or peripheral nerves, are infiltrated by direct spread from tumour tissue (Sparling et al., 1947). Extramedullary deposits of myeloma, which have been found in most organs, have not been reported in nervous tissue. Peripheral neuritis, distinct from these mechanical or vascular lesions, also occurs in myelomatosis. Senator (1899) reported a case with bulbar palsy for which no anatomical cause was found. Scheinker (1938) described the case of a man of 39 with a solitary myeloma of the sternum who had a painful progressive peripheral neuritis. This patient also developed two large patches of thickened, deeply pigmented skin on the anterior chest wall. Scheinker postulated a specific \" toxic \" metabolite of myelomatous tissue which affected skin and peripheral nerves, and he suggested that in many cases the pain of myelomatosis is due to a \" toxic disease\" of the nerves. Davison and Balser (1937) reported a case of multiple myelomatosis in a woman of 49 who had a painful peripheral neuritis mainly affecting the arms. There was an iron-deficiency anaemia (haemoglobin 50%), and they attributed the neuropathy to the \" severe secondary anaemia \" or to \" unknown toxic factors.\" Kurnick and Yohalem (1948) described extensive painful peripheral neuritis in two cases of multiple myelomatosis, and regarded the neuropathy as comparable with that which occurs in \" some metabolic diseases such as diabetes and pernicious anaemia.\" Snapper et al. (1953) mention four cases with \" glove and stocking\" type of peripheral neuritis, and also several cases showing \" striking atrophy of the interosseous muscles and the musculature of the arms without other evidence of neurological involvement.\" One of Brewer's (1948) cases had \" some loss of feeling in the hands and feet.\" The purpose of this paper is to report two further cases of myelomatosis with peripheral neuritis and other striking features. Case 1 In May, 1953, a married man aged 54, who worked as a lorry driver, developed sudden pain and limitation of movement in the right shoulder without preceding trauma. These symptoms subsided in a few weeks, but mild intermittent pain persisted. About the end of 1953 a painless swelling
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176Â citations
TL;DR: The venous ulcer, far from being an ischaemic lesion, is a hyperaemnic lesion which is sitting on a honeycomb of dilated venules which in fact is rather like a haemangioma.
Abstract: Thus, the venous ulcer, far from being an ischaemic lesion, is a hyperaemnic lesion. It is sitting on a honeycomb of dilated venules which in fact is rather like a haemangioma. The longer the ulcer has been present the more profuse and sponge-like is the venous sump on which the ulcer sits. Moreover, as time goes on, this hyperaemic area acquires an increased arterial supply; and this venous \" sump \" under the ulcer can be filled equally well from the arterial or venous side of the circulation, and therefore can be shown equally well by an arteriogram or a venogram (see Fig. 9). Finally, the cause of destruction of the strategic valve in the ankle-perforating veins, and therefore the cause of their incompetence, is deep thrombosis in the majority of cases. Post-thrombotic ankle-perforator incompetence is therefore the main immediate cause of the ulceration, induration, and swelling of the ankle, which is such a prominent feature of the post-thrombotic syndrome of the leg.
165Â citations
TL;DR: The present volume is essentially the mixture as before, but it lacks the unobtrusive artistry which characterized the earlier book and there has been a notable increase in the amount of autobiographical material.
Abstract: The Clinical Approach in Medical Practice. By G. E. Beaumont, M.A., D.M., F.R.C.P., D.P.H. (Pp. 469+xiv; illustrated. 45s.) London: J. and A. Churchill Ltd. 1956. Dr. Beaumont's Applied Medicinte was published in 1950. It achieved considerable popularity, being one of the rare successes in the difficult art of interweaving clinical description and personal reminiscence. The present volume is essentially the mixture as before, but it lacks the unobtrusive artistry which characterized the earlier book. There has been a notable increase in the amount of autobiographical material. The colouring and flavouring agents now form a disproportionately large part of the mixture, which is not to its advantage. The point may be illustrated by comparing the titles of the \" Descriptive Cases \" in Applied Medicine and in the new book: they are, respectively, \"Spirochaetal Jaundice\" and \" How I entered Basingstoke on a Milk Tanker.\" There is a good deal of rather turgid and florid writing-for example, \"Early next morning she was carried over to the silent shore.\" In format the new book closely resembles its predecessor. In both there are sections entitled \"Descriptive Cases,\" \"Cases Demonstrated at the Bedside by Question and Answer,\" and \" Idle Thoughts,\" the last being a somewhat disingenuous description for a collection of commonplaces and personal prejudices couched in epigrammatic form. Two discursive essays, \"The Trials of the Tuberculous\" and \" Resuscitation in Congestive Heart Failure,\" occupy the space formerly given to \"Short Notes on Cases.\", \"Cases Demonstrated at the Bedside by Question and Answer\" offers to a wider audience something of the instruction and entertainment which many postgraduates obtained from Dr. Beaumont's ward rounds at the Middlesex. This section is written with deceptive ease, as anyone may prove by trying to do it himself. Though few will accept all the views expressed, the author's skill in capturing and holding his reader's interest is such that the temptation to read \"just one more\" is almost irresistible. That the chief actor in these dramatic reconstructions should assume an Olympian air is inevitable, but a certain pedantry displayed in some of Dr. Beaumont's digressions is distasteful. Mention, for example, of the name of Gowers initiates a detailed account of the modifications in his mixture which have been made down the ages; at the end of it all one's sympathies go out to the wretched \" Dr. W.,\" who was at least admirably succinct in describing Gowers as \" a great neurologist.\" One envies Dr. Beaumont his erudition, but could wish he wore it more lightly. A volume of this nature invites carping criticism. Having set so high a standard with his previous book, Dr. Beaumont must expect his occasional lapses in the present one to attract a degree of attention which is a tribute to the skill of his best performance. D. M. DUNLOP.
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TL;DR: In order to manage many of these modern treatments properly, it is necessary to perform venepunctures and skin punctures with unusual frequency on these very patients who for one reason or another are more liable to the development of infection.
TL;DR: (3) Patients with sarcoidosis do not require sanatorium treatment with its unwarranted exposure to tuberculosis and the associated psychological trauma and the patient should be speedily rehabilitated to his normal occupation even when receiving steroid hormones.
Abstract: (3) Patients with sarcoidosis do not require sanatorium treatment with its unwarranted exposure to tuberculosis and the associated psychological trauma. The patient should be speedily rehabilitated to his normal occupation even when receiving steroid hormones. (4) The majority of patients enjoy a spontaneous and permanent remission without treatment. The cortisone group of drugs have undesirable side-effects and should be reserved for the minority with a definite indication. (5) When sarcoidosis is suspected, histological confirmation should be sought by all available means. This applies especially to the patient with bilateral hilar lymphadenopathy in whom malignant reticulosis may be confused with sarcoidosis and unnecessary radiotherapy contemplated.
TL;DR: The following case is of interest in that the fears implicit in psycho-analytical theory, and stressed by East and Hubert (1939), of releasing homosexual or sadistic drives have not so far been confirmed.
Abstract: Fetishism, or more accurately "erotic fetishism," is the tendency to be sexually attracted by some special part or peculiarity of the body or by some inanimate object. Of all the sexual aberrations, fetishism is one of the most intriguing, perplexing, and varied. The literature is rich in detailed case reports and in speculation about theories of causation. I have been able to find, however, only three apparently successful results in established cases; one attributed to a co-operative wife (Hirschfeld,1939), one to psycho-analysis (Romm,1949), and the third to temporal lobectomy (Mitchell, Falconer, and Hill, 1954). I have been unable to find any previous record of a fetishist who responded favourably to aversion therapy. The following case is also of interest in that the fears implicit in psycho-analytical theory, and stressed by East and Hubert (1939), of releasing homosexual or sadistic drives, have not so far been confirmed. The patient, a married man aged 33, was referred in November 1954, from the outpatient department of a mental hospital for consideration of a prefrontal leucotomy after he had attacked a perambulator. This was the twelfth such attack known to the police, and because of his previous incidents they were taking a serious view of his recent actions in following a woman with a perambulator and smearing it with oil. The patient said that he had had impulses to damage perambulators since the age of 10 and that he had attacked perambulators many times more than the incidents known to police. Among the documented incidents were slashing empty prams on a railway station and setting them on fire; several times he slashed prams and spread mucus from his handkerchief; several times he used his motorcycle to bump a pram that contained a baby; he also used his motorcycle to drive through muddy rain puddles to splash the pram and the mother; he carried with him containers of oily liquids and would squirt the substance on the perambulator and the woman who pushed it..... Language: en
TL;DR: The appearance of paired narrow white bands in the finger-nails of patients with serum albumin levels persistently below 2.2 g per 100 ml is called attention to.
Abstract: Abnormal changes in the finger-nails often provide evi dence of systemic diseases. This paper calls attention to a hitherto undescribed change which has been related to severe hypoalbuminaemia. This is the appearance of paired narrow white bands in the finger-nails of patients with serum albumin levels persistently below 2.2 g. per 100 ml. These two transverse bands run parallel to the lunule. They are not palpable, do not indent the nails, and are separated from each other and from the lunule by areas of normal pink nail (Special Plate, Fig. 1). The distal white band may be slightly wider than the proxi mal band (Plate, Fig. 2).
TL;DR: What do you do to start reading principles of embryology?
Abstract: What do you do to start reading principles of embryology? Searching the book that you love to read first or find an interesting book that will make you want to read? Everybody has difference with their reason of reading a book. Actuary, reading habit must be from earlier. Many people may be love to read, but not a book. It's not fault. Someone will be bored to open the thick book with small words to read. In more, this is the real condition. So do happen probably with this principles of embryology.
TL;DR: This review focuses on the work of Greene, C. H., Walters, W., and Rowntree, L. (1933), a large number of which dealt with the treatment of central giant cell granuloma, which affected the ability of the central nervous system to process adrenaline.
Abstract: Benians, R. G. (1952). Brit. J. Tuberc., 46, 66 Browne, J. S. L., Aronovitch. M., Beck, J. C., Leith, W., and Meakins, J. F. (1954). Amler. J. med. Sci., 228, 491. Fourman, P., and Horler, A. R. (1954). Lancet, 1, 334. Fred, L., Levin, M. H., Rivo, J. B.. and Barrett, T. F. (1951). J. Amer. med. Ass., 147, 242. Greene, C. H., Walters, W., and Rowntree, L. G. (1933). Ann. Surg., 98, 1013. Guttman, P. H. (1930). Arch. Path. (Chicago), 10, 742, 895. Hartman, F. A.. and Brownell, K. A. (1949). Thie Adrenal Gland, p. 344. Kimpton, London. Houghton, L. E. (1954). Lancet, 1, 595. King, E. Q., Johnson, J. B., Batten, G. S., and Henry W. L. (1951). J. Amer. med. Ass., 147, 238. Michael. M., Cummings, M. M., and Bloom, W. L. (1950). Proc. Soc. exp. Biol. (N.Y.), 75, 613. Popp, C. G., Ottosen, P., and Brasher, C. A. (1951). J. Amer. med. Ass., 147, 241. Ragan, C., Howes, E. L., Plotz, C. M., Meyer, K., and Blunt, J. W. (1949). Proc. Soc. exp. Biol. (N.Y.), 72, 718. Rowntree, L. G., Greene, C. H., Ball, R. G., Swingle, W. W., and Pfiffner, J. J. (1931). J. Amer. mned. Ass., 97. 1446. Spain, D. M., and Molomut, N. (1950). Amer. Rev. Tuberc., 62, 337. Thorn, G. W., Dorrance, S. S., and Day, E. (1942). Ann. intern. Med., 16, 1053, Forsham, P. H., Frawley, T. F., Hill, S. R., Roche, M., Staehelin, D., and Wilson. D. L. (1950). New Engl. J. Med., 242,-183.
TL;DR: Laryngoscope design has been modified to simplify further the manceuvre of laryngoscopy (Macintosh, 1943), and the position of the head and neck which brings the axes of the larynx, pharynx and mouth into line has been described.
Abstract: Laryngoscope design has been modified to simplify further the manceuvre of laryngoscopy (Macintosh, 1943), and the position of the head and neck which brings the axes of the larynx, pharynx, and mouth into line has been described (Bannister and Macbeth, 1944; Gillespie, 1948), so that Most endotracheal intubations provide no difficulty. There are, however, occasional cases in which direct laryngoscopy presents great difficulty. The following cases are worth reporting for this reason. It proved impossible to intubate one of these patients orally by the means available, while in the other four intubation was time-consuming.
TL;DR: From the retrospective studies of the smoking habits of nearly 1,500 patients with lung cancer and over 3,000 patients with other illnesses, it is concluded that if large groups of persons of different smoking habits were observed for a number of years they would reveal distinct differences in their rates of mortality from lung cancer.
Abstract: cancer of sites other than the lung shows a mortality of 2.04 per 1,000 in non-smokers and 2.02 per 1,000 in smokers. It reveals no gradient by amount smoked (Table XIII). In other words, the marked and steadily increasing mortality from lung cancer in association with smoking is not compensated for by a decrease in cancer of other sites. The result indicates a total mortality from cancer in the smoking groups in excess of the mortality that would have prevailed in the absence of smoking. 11. If the causes of death as certified are accepted at their face value, mortality from coronary thrombosis reveals a slight but significant relationship with smoking (Table V). Division by age, however, shows that the trend is distinct only at the youngest ages, 35-54 years (Table XV). 12. Three other causes of death show a steady increase in mortality from non-smokers to heavy smokerschronic bronchitis, peptic ulcer, and pulmonary tuberculosis (Table XVI). Only with chronic bronchitis is the gradient statistically significant. The remaining causes of mortality reveal no trend (Table XVII). 13. From our retrospective studies of the smoking habits of nearly 1,500 patients with lung cancer and over 3,000 patients with other illnesses we concluded that if large groups of persons of different smoking habits were observed for a number of years they would reveal distinct differences in their rates of mortality from lung cancer. They would show, we believed, (1) a higher mortality in smokers than in non-smokers, (2) a higher mortality in heavy smokers than in light smokers, (3) a higher mortality in cigarette smokers than in pipe smokers, and (4) a higher mortality in those who continued to smoke than in those who gave it up. In each case the expected result has appeared in the prospective inquiry here reported. These results are evident in spite of the fact that our method of inquiry is such as constantly to underestimate the mortality differences. The reason for the underestimate is that our classifications are based, for the most part, upon a statement of the smoking habits at one point of time. We have seldom been able to take previous habits into account, and any subsequent changes have been unknown to us. As a result we shall sometimes have included in the light smoking group persons who had previously smoked heavily for a long time; we shall sometimes have included as \" pure pipe smokers persons who had previously smoked cigarettes and vice versa; we shall sometimes have continued to class as smokers persons who have given up. All such errors in classification must inevitably have reduced the, nevertheless, clear associations between the mortality from lung cancer and the smoking of cigarettes which we have observed in these British doctors.
TL;DR: The lesion in this artery was considered by the pathologist to be traumatic in origin, but there was no history of injury, and the immediate disappearance of well-marked pyramidal signs and symptoms once a normal flow through the internal carotid artery had been re-established was the most striking finding.
Abstract: Discussion The first point of interest is the lesion in this artery. This was considered by the pathologist to be traumatic in origin, but there was no history of injury. One of us (C. R.) believes that this lesion was a localized plaque of atheroma, both because of its appearance and because of its situation at the common site near to the origin of the internal carotid artery. The next and most striking finding was the immediate disappearance of well-marked pyramidal signs and symptoms once a normal flow through the internal carotid artery had been re-established. The explanation of this and of the temporary episodes of disturbance of function in the central nervous system which occurs in patients with a partial occlusion of the internal carotid artery is of interest. In our view the most likely explanation is that the narrowing of the lumen reduces the internal carotid blood flow. In our patient this, coupled with a greater reduction of flow due to haemorrhage into the arterial wall at the time of the onset of his major attack, was enough to maintain the symptoms and signs of pyramidal insufficiency but not enough to cause complete death of the cerebral cells. The same type of explanation will account for the transitory attacks which occurred earlier in this patient, in the patient reported by Eastcott et al. (1954), and in those reported by other authors, including Chambers (1954) and Millikan and Siekert (1955). In these the narrowing of the carotid reduces the flow. Under ideal conditions this is sufficient to maintain normal cerebral function, but when the flow is further reduced by such events as a change of posture or a reduction of blood pressure transitory symptoms of cerebral ischaemia may result. Others have postulated that these attacks of transitory carotid ischaemia are due to spasm of the carotid vessels. It is possible that this may occur, but in the presence of an organic reduction in the size of the internal carotid artery a further reduction in flow by some general or local cauise other than spasm is more likely. Another explanation is that thrombi may form on the narrowed part 2nd peripheral emboli result, but this again s unlikely in view of the short duration and repeated occurrcnce of similar attacks. We believe that the correct treatment of a patient with a partial occlusion of the internal carotid artery is surgical because of the disability it causes and because of the great risk of complete carotid occlusion; this view is shared by Denman, Ehni, and Duty (1955). By this means we have completely relieved three patients, greatly improved two others, and six patients with complete occlusions have been made no worse by exploration of this vessel; there has been no mortality. The alternative is to treat these patients with long-term anticoagulant therapy. We believe that this measure should be used after operation to reduce, if possible, the occurrence of further thrombosis in this vessel or elsewhere. An important step in the diagnosis of this lesion is the correct interpretation of the carotid arteriogram. This should always show the bifurcation of the common carotid artery, and as much attention should be paid to this region as to the intracranial vessels. The actual operation is aimed at restoring the flow through the internal carotid artery. This may be achieved by either a direct anastomosis, a thrombo-endarterectomy, or an arterial graft or transplant, depending on the type of abnormality which the surgeon encounters. We have employed each of these procedures with success in patients requiring reconstruction of the carotid arteries. In our view hypothermia is a valuable aid to this type of surgery, but the body temperature need not be reduced below 28' C. (oesophageal temperature). Summary The case of a man with a partial occlusion of the left internal carotid artery is reported; as a result he was unable to sign his name, suffered from difficulty in speaking, and had abnormal pyramidal signs and symptoms in his right upper and lower limbs. These neurological abnormalities had been present for eight weeks. Reconstruction of the internal carotid artery was followed by immediate and complete relief of his neurological abnormalities. We believe that this is the first report of the complete recovery of definite and persistent neurological symptoms and signs due to internal carotid obstruction. In 1954 a similar case was reported by Eastcott, Pickering, and Rob, but in this case the neurological abnormalities were intermittent and not persistent. REFERENCES
TL;DR: The many distressing post-leucotomy cases now in the community, and relatives are concerned not now with breakdowns of human endeavour, but with after-effects of very questionable neurosurgical procedure, make me wish to restate my view.
Abstract: 1955, p. 1502) make me wish to restate my view: (1) There are many distressing post-leucotomy cases now in the community, and relatives are concerned not now with breakdowns of human endeavour, which are understandable, but with after-effects of very questionable neurosurgical procedure. Irreversible changes have been produced in patients whose illnesses were at any rate theoretically capable of remission prior to this operation. The emotional burden of these cases is not likely to be taken up by the psychiatrists, who are responsible for throwing back on to the community something worse than the awful burden of a defective child. (2) All mental hospital patients, 'voluntary or certified, become quickly concerned with the problem: Will I be subjected to E.C.T., to insulin shock, to leucotomy ? For some reason or other, psychiatrists do not seem to know this. Mental patients talk of very little else. They are in a dilemma that they should never be in, by which the doctor seems to be coming in on the side of the self-destructive impulse, and in this respect leucotomy is much worse than the other physical methods. They are permanently under the shadow of a threat of leucotomy which they come to know as a surgical procedure which changes them from themselves into something else, they know not what. Those who are capable of artificially getting well organize themselves on to a pseudo-recovery out of fear, and so escape to the world outside psychiatry. There are now almost no asylums for those patients who need and can make use of a period of breakdown; there are only mental hospitals for the quickest possible cure of the mentally sick; and unfortunately fear of leucotomy has become a real factor in the production of a rapid turnover in mental hospitals. This rapid turnover looks well on paper. (3) The existence of leucotomy as an accepted procedure is very bad for the doctor and nurses. It provides the extreme example of a psychiatry that by-passes the study of human nature and of mental health as a matter of maturity of emotional development of the individual. Nothing better than leucotomy divides psychiatry as a blind therapy from psychiatry as a complex but interesting concern for the human being who finds life difficult and whose problems we can feel to be represented in ourselves. If the medical profession were to give up the practice of leucotomy a great deal would be gained. So substantial would be the gain, according to my view, that the possible loss of therapeutic relief in certain cases would be an insignificant consideration.-I am, etc., London, S.W. D. W. WINNICOTT.
TL;DR: Details of Charcot's scientific work, his debatable conception of hysteria, his quarrel with Bouchard, his generosity towards his erstwhile vilifier "Ignotus " when helplessly paralysed, and many other intriguing topics are outlined.
Abstract: LIFE OF CHARCOT J.-M. Charcot, 1825-1893: sa Vie, son UEuvre. By Georges Guillain. (Pp. 188. 1,400 fr.) Paris: Masson et Cie. 1955. Ask the man in the street-even Wimpole Street-who was the founder of neurology, and you will be told, Charcot. And rightly so, for Charcot above all his contemporaries dominated the academic scene and firmly established the study of organic nervous disease. As a teacher he was supreme, for as his disciples scattered they in turn founded departments of neurology throughout the world. We have had to wait many years for a serious biography of this great man, and Professor Guillain's book gives us a fascinating and intimate aper u of Charcot's professional and personal life. Born in 1825, he was thus 10 years older than our national pioneer Hughlings Jackson, and 20 years older than Gowers. A Parisian of middle-class origin, with an outstanding student career, he was influenced early by Rayer, Napoleon III's private physician and dean of the faculty. Close friendship with Vulpian, and later with Duchenne, perhaps directed his interests towards chronic maladies, and especially those which we would to-day term geriatric. Gradually Charcot's attention became focused more closely upon the mysterious terrain of organic nervous disease. It seemed inevitable that he should abandon his professoriate of pathological anatomy in order to assume, at the age of 57, the newly created chair of clinical neurology. Charcot established his service at the Salpetriere, that unique institution the history of which we already owe to Professor Guillain, who himself succeeded to Charcot's chair some years later. Here he would drive each morning, a cold and aloof figure, to watch in silence his assistants displaying the clinical phenomena of the new admissions. The original consulting-room is still preserved with its antique furnishings; and on the wall there still hangs the one portrait that Charcot chose-that of Jackson. Later, Charcot instituted a Friday afternoon teaching session, where a series of patients, all typifying a particular syndrome, would be demonstrated as a group. Still later a Tuesday morning clinic was established, where Charcot would examine and teach upon new patients. Thus began one of the institutions of French neurology, the le ons de mardi. To these two teaching occasions would come a throng of fascinated visitors-not all of them medical men. In this manner Charcot and his pupils disinterred many clinical treasures among the oddities who lingered as reposantes in the \" Cite grise,\" as the hospital came to be called. At midday Charcot would return to his magnificent home-now a bank-in the Boulevard Saint-Germain. In his vast sombre cabinet, with its book-lined walls and stained-glass windows, he would work far into the night attending to his clientele, for he was at that time the most authoritative as well as the most fashionable neurologist in private practice. Among our own forebears in neurology Charcot must be contrasted with Hughlings Jackson. Charcot was a much greater formal teacher than Jackson, though he had none of the latter's foresight or profundity of thought. Charcot had broader interests and greater culture than Jackson, but lacked his warmth and sheer benevolence. Charcot inspired the many, and was the better propagandist for neurology; Jackson wrote for the elect among his contemporaries, and indeed mainly for future generations. Where Charcot was crystal-clear, simple, and didactic, Jackson was obscure, involved, and allusive. In this biography by Guillain details of Charcot's scientific work, his debatable conception of hysteria, his quarrel with Bouchard, his generosity towards his erstwhile vilifier \"Ignotus \" when helplessly paralysed, and many other intriguing topics are clearly and dispassionately narrated. Neurologists and medical historians will be deeply grateful to the author for this delightful addition to their library shelves. MACDONALD CRITCHLEY. NEURAL CONTROL OF THE PITUITARY
TL;DR: It is felt that it is possible to save some at least of those 30% dying during the first weeks following rupture of an aneurysm (who would be denied surgery by many), and have instituted a system of clinical and specialized investigation which is applied to every case as soon as the patient is admitted to hospital, irrespective of how recent the haemorrhage may be.
Abstract: Since the advent of angiography it has been possible to subdivide cases of subarachnoid haemorrhage into three main groups: those in which an aneurysm can be displayed, those harbouring an angioma, and those in which no causal lesion can be demonstrated. We exclude, of course, all cases of subarachnoid haemorrhage due to general disease processes or to craniocerebral injury. Before the days of angiography it was permissible to write of a series of cases of subarachnoid haemorrhage on the assumption that the majority were due to \" berry \" aneurysm, but we feel with others that the time has come to deal with subarachnoid haemorrhage not generally but with relation to the actual sites of the causal aneurysm in one series and the angioma in another. There will also be a third group in which it has been impossible to demonstrate any lesion by angiography or skull radiography. Hamby (1952) has given an excellent lead in this direction in his book on intracranial aneurysms, dealing with symptomatology, signs, treatment, and prognosis according to the exact anatomical position of the aneurysm on the intracranial vascular tree. By contrast the great majority of recent papers on intracranial aneurysms and subarachnoid bleeding, particularly those relating to conservative or surgical treatment, serve only to confuse an already difficult issue. They fail to provide much relevant information regarding the selection of cases for surgical treatment, the state of the patient at the time surgery has been undertaken, and its time relationship to the last haemorrhage, to mention but a few of many similar vital factors. Norlen and Olivecrona (1953) emphasize this point. A notable exception to this general rule lies in the papers by Norlen (1952) and Norldn and Olivecrona (1953) showing that, in cases that have survived the initial two to three weeks after the first haemorrhage, direct surgical attack on the aneurysm can be undertaken with relative safety and with a lower mortality rate than that which obtains for similar patients given conservative treatment alone. It must not be forgotten, however, that the greatest number of deaths from ruptured aneurysms occur in the first weeks following the initial haemorrhage, and Norlen and Olivecrona feel that surgical methods do not alter the prognosis during this critical period, when 30% of patients die from the disease process. An additional 20% die in the next few weeks, and it is against this mortality rate alone that the admirable results of Norl6n and Olivecrona must be measured. We feel, and indeed are convinced from personal experience, that it is possible to save some at least of those 30% dying during the first weeks following rupture of an aneurysm (who would be denied surgery by many), and have therefore instituted a system of clinical and specialized investigation which is applied to every case as soon as the patient is admitted to hospital, irrespective of how recent the haemorrhage may be. In other words, our system of investigation is applied even to patients admitted in coma only a few hours after a haemorrhage has taken place. It has been suggested that there is danger in performing angiography in the acute phase, and we recognize that this may well be true. We are not, however, convinced that this is so, and, in any case, it has seemed to us justifiable to apply such diagnostic methods early owing to the absence of any sure method of establishing at what time a second, and possibly fatal, haemorrhage may occur.
TL;DR: The severity of the disease is well illustrated, as four of the ten patients died, and tunless radiological examination has been possible from the onset.
Abstract: Infantile hypercalcaemia has only recently been recognized (Lightwood, 1952a; Payne, 1952), btut it is clear that there are two varieties of the disease. In the-simple or benign form, described by Lightwood and Payne, the prognosis is good. A more severe type with a definite mortality can be recognized by a characteristic facies, present from an early age. All survivors so far followed have been mentally retarded. Physical growth is also affected at the height of the disease ; it becomes accelerated as the condition improves, though the skull remains small and craniostenosis may be a complication. The renal impairment which invariably accomupanies the hypercalcaemia is apt to be more severe than in the simple type. Though hypertension can resuilt and prove fatal, kidney function may improve in survivors. Hypercholesterolaemia is often present. A svstolic murmur is audible in most cases. Increased radiological density of the skeleton appears at some stage, involving principally the base of the skull, the epiphyses. and the growing ends of the long bones. This may be severe enough to be confused with Albers-Schonberg's disease or so slight as to escape recognition, tunless radiological examination has been possible from the onset. A report of a case fulfilling these criteria was made by one of us (Butler, 1951), and a similar case was published by Fanconi (1951). These were more fully discussed in a joint paper (Fanconi et al., 1952). Since then others have discovered five further examples of the disorder (Creery, 1953; Lowe et al., 1954 : Dawson et al., 1954; Russell and Young, 1954). A child described earlier by Lightwood (1932) showed many features characteristic of this condition. She was a girl with a squint and facial palsy, who was mentally retarded and dwarfed. Intermittent vomiting from birth was the chief symptom, and at about 2 years of age she died of renal failure. The x-ray picture showed increased density of the skull and long bones ; this was confirmed at necropsy, which also revealed widespread calcification in the kidneys, viscera, and cardiovascular system. The serum calcium level originally reported was 11 mg. per 100 ml. Unfortunately, no note was made of the facies. We have already summarized our ideas on this disorder (Schlesinger et al., 1954). In the present paper we review seven cases previously recorded and report three more (Table I). The severity of the disease is well illustrated, as four of the ten patients died. Two of these cases have already been published (Lowe et al., 1954; Dawson et al., 1954), and two other cases eXCamined post mortenm are described here.
TL;DR: A pathological classification of stillbirths and neonatal deaths (perinatal mortality) is put forward based on the routine morbid anatomical and histological study of 337 consecutive necropsies performed on babies born at U.C.H. Obstetric Hospital between January, 1948, and September, 1955.
Abstract: This paper presents two sets of data. The first set concerns the pathological definitions of the conditions causing perinatal death. The definitions form the basis for the second set of data, which deals with the clinical associations, maternal and foetal, of these causes of death. The object of this method of classification is to correlate pathological and clinical findings so that a clearer picture of the causes of perinatal death will be seen, and from this to prevent such deaths. Perinatal mortality is a term used for both stillbirths and neonatal deaths during the first week (Crosse and Mackintosh, 1954). Most published studies of perinatal mortality have been concerned with the causes of such deaths and with classifying them. The earliest classifications were clinical (Holt and Babbitt, 1915; McQuarrie. 1919; Holland and Lane-Claypon, 1926), the death of the baby being ascribed to maternal diseases or obstetric complications present. As routine post-mortem examinations came to be performed these classifications based on presumed aetiology were superseded by pathological or clinico-pathological systems based on the morbid anatomical findings (Browne, 1922; Palmer, 1928; Serbin, 1928; D'Esopo and Marchetti, 1942; MacGregor, 1946; Labate, 1947; Potter, 1952; Morison, 1952). Routine histological study of the post-mortem material extended the scope of the pathological contribution in several directions. The present paper puts forward a pathological classification of stillbirths and neonatal deaths (perinatal mortality) based on the routine morbid anatomical and histological study of 337 consecutive necropsies performed on babies born at U.C.H. Obstetric Hospital between January, 1948, and September, 1955. The total number of births during this period was 10,028. In addition, the paper deals with a further 69 neonatal deaths in babies admitted to the U.C.H. Premature Baby Unit from outside sources. This classification shows a correlation between some abnormalities of pregnancy and labour, and some maternal factors, and the cause of death of the infant. For this reason a part of the paper is devoted to a study of these obstetric factors. The intention, therefore, is to relate the stages of pregnancy and labour and the types of maternal complication to the perinatal mortality. Finally, it was thought desirable to include a section on a clinical study of neonates prior to their death, so that their signs and symptoms could be compared with the post-mortem findings.
TL;DR: Lundbaek bases his belief on the existence of specific diabetic angiopathy largely on statistical grounds, sex incidence, and the presence of such associated lesions as retinopathy and the renal lesions described by Kimmelstiel and Wilson (1936).
Abstract: It is generally held that there is an association between diabetes and arterial disease. Joslin et al. (1940) state that \" arteriosclerosis is excessive and has become the major cause of death among diabetics generally,\" and this view has many supporters. Opinion, however, differs on the nature of the arterial lesion, which is regarded by some-for example, Warren and Le Compte (1952), Barach and Lowy (1952), and Katz and Stamler (1953)-as atherosclerosis, and by others-for example, Lundbaek (1954)-as a specific form of angiopathy associated with long-standing diabetes. Histologically it would appear to be impossible to diffe.entiate between non-diabetic and diabetic arterial disease, and, although Lundbaek and Posborg Petersen (1953) have found statistically significant differences in the calcium, cephalin, and lecithin content of the coronary arteries in non-diabetic and diabetic subjects, these differences are admitted by them to be small. Lundbaek bases his belief on the existence of specific diabetic angiopathy largely on statistical grounds, sex incidence, and the presence of such associated lesions as retinopathy and the renal lesions described by Kimmelstiel and Wilson (1936).