Showing papers in "Journal of the Royal Society of Medicine in 1954"

The growth of the human face.

Abstract: THE growth of the human face presents some of the most complex problems of biology, problems which continue to attract the attention of many anatomists and dental research workers. It is not intended in this paper to deal with all the data, experimental and clinical, which has accumulated but rather to attempt the construction of an hypothesis adequate to correlate some of the accumulated information.

Pain in paraplegia; clinical management and surgical treatment.

Abstract: DIMINIHED or absent sensation below the level of the lesion is a conspicuous feature following spinal cord injury. Of equal importance is the frequent occurrence of pain referred to the portion of the body rendered anasthetic. The nature and severity of the pain is assessed by the patient in relation to his past experience, emotional stability, intelligence and state of well-being. Severe pain is successfully endured by certain patients and they are able to live useful lives, while others are unable to cope with the problem. A few suffer so severely that surgical treatment is required if survival and rehabilitation are to be made possible. In this study pain is evaluated in terms of severity, quality, location and incidence; aggravating and alleviating factors are discussed; the means whereby pain is produced are considered. The total reaction of the patient to suffering is described. The results of surgical treatment are assessed.

Initial treatment of traumatic paraplegia.

Abstract: 774 out of the 1,000 cases have been discharged from the Centre. 591 returned to their own homes, after these had been adjusted to their disability, and were able to live in their old environments with their families-an achievement which no doubt represents the ideal type of domestic resettlement of paraplegics. 183 live either singly or with their families in permanent settlements. 22 of these 774 paraplegics were too old to work. 518 (69%) of the remaining 752 were employed, the majority of them (405 or 78 %0) full time, including full-time workers in factories. The number of employed is probably even higher, as some of the 18 cases which we were unable to contact at the time of making the statistics and which were therefore included in the number of unemployed will doubtless be in employment. Many more of the remaining 224 paraplegics are, of course, employable, had more facilities for employment been available at the time of compiling the statistics (December 1953). From all our experience, it can now be concluded that the percentage of paraplegics unemployable on account of their spinal cord lesions will be extremely small, provided society is able to accept.them. \"Life is worth living now! \" These words, quoted from a letter from a former patient of this Centre, are the conclusion of the many men and women who have made a full readjustment to a new life by returning to productive activity and employment, in spite of such a serious physical handicap, and, of all the results achieved in the rehabilitation of the spinal man, during the last decade, this is the most gratifying of all. REFERENCES GuTrMAN, L. (1945) Med. Times, N.Y., 73, 318. (1947) Proc. R. Soc. Med., 40, 219. (1953) In: Medical History of Second World War: Surgery. (Editor: Sir Zachary Cope.) H.M.S.O., London; p. 422.

Loss of Visualization

Abstract: as well as his physical requirements. If these needs are met, the majority of patients learn to live with their pain. Those few who cannot carry on should be relieved by surgical means. (6) Bilateral spinothalamic tractotomy at the level of the first or second thoracic vertebra or higher, has proved most efficacious in relief of pain. 6 cases are reported with a two to eight year follow-up. (7) One case of bilateral prefrontal lobotomy is reported, with a five-year follow-up.

Basilar artery stenosis and thrombosis.

Abstract: hair, heavy eyebrows, grey-blue eyes, a retrouss6 nose and full mouth.\" He then said: \"Everything is more easy with the eyes open without exception.\" He was then asked to close his eyes again and describe his own foot. He said: \"I can't see a foot: I can't visualize anything at all when my eyes are shut.\" He was then asked to open his eyes and promptly described a naked foot in detail. He had no aphasia or agnosia. Y' s answers in the 100-7 test were correct. He was able to repeat 7 digits forwards and 4 backwa;i s, and he succeeded in repeating a Babco. Pntence accurately at the second attempt. Routine examination revealed no abnctmaijity in the fundi, visual acuity, visual fields or central nervous system elsewhere. The patient was seen again six years later and his condition in respect of the symptoms described was unchanged. Six months previously, however, he had been admitted to a mental hospital on account of an attack of depression for which he had been treated with electrical convulsant therapy and modified insulin treatment. 'When I saw him on the second occasion he was again depressed and I admitted him to hospital with a view to treatment and in the hope of carrying out further investigations, including electro-encephalography. IJnfortunately, however, he became worse and had to be certified. He was sent to a mental hospital, where he was subsequently regraded as a voluntary patient, and one day he walked out of the hospital without giving notice and was later found dead on the railway line. The two patients whom I have described present more features of theoretical interest than it is possible to discuss fully now. Loss of visualization is usually found in association with other forms of higher visual disability; Charcot's patient, for example, suffered from word-blindness-but only when it is encountered in relative isolation can its nature be investigated. The suggestion was made in the case of my first patient that it might be a neurotic symptom, and my second patient suffered also from psychotic depression. But my first patient had in no way a neurotic personality ahd I do not believe that so clear-cut a syndrome, characterized by symptoms possessing no cotnscious relationship to each other, and occurring in every case after organic lesions of the brain, is other than organic in origin. If this be accepted, the main interest of the syndrome is psychophysiological. The loss of visual imagery was more complete in Case I than in Case II, in whom visual images sometimes occurred spontaneously though in an impoverished form, and not under the control of the will. The patient exhibited a striking enhancement of visualization when his eyes were open, as though stimulation of the visual cortex strengthened visual imagery. It is unfortunate that this could not be tested electroencephalographically. In Case I there was an asymmetry in the response to photic stimultion. Perhaps the most surprising feature is how little the loss of voluntary visualization impaired functions in which visual imagery might have been expected to play some part. Thus, patient No. 1 had a normal memory span for visual objects and could draw designs and-describe pictures from memory. Similarly, though he could not visualize parts of his body, he could chart a point touched upon an outline drawing of the body. Charcot's patient showed the same features. It would seem, therefore, that a patient who has no power of voluntary visualization can, nevertheless, recognize objects and persons, accurately propositionize about them, as Hughlings Jackson might have put it, and also reproduce objects graphically. It follows that visual imagery is not essential to these processes, which therefore must depend upon neurophysiological schemas which do not themselves enter consciousness, And the same is true of dreaming, which in patients who have lost the power of visualization continues without visual images. What, then, is the value of visual images? The image, whether visual or otherwise, in so far as it is a representation of an object reproducible at will, has the great value of enabling thought to deal with the object in its absence, and the visual image being spatially extended has the special advantage of facilitating imagined action in space. Its function, in fact, is well illustrated by the hampering effect of loss of visualization upon the builder -designing a house. My patients throw no light upon the situation of the lesion responsible for the loss of visualization, but there is some evidence suggesting that it is probably in the parastriate region.

Dr. Edward Wilson of the Antarctic; a biographical sketch, followed by an inquiry into the nature of his last illness.

Abstract: EDWARD WILSON was one of the party of five that reached the South Pole with Captain Scott in 1912, and perished on the return journey. It was on the return journey that he sustained a painful leg condition, the account of which in his Journal leads me to believe that he suffered from a rare and interesting malady that sometimes follows over-exertion, namely ischaemic necrosis of the anterior crural muscles (also called the \"anterior tibial syndrome\"). The second part of this paper therefore deals with his penultimate illness rather than his last one which must have been the effects of inanition and exposure to cold. It is the rarity of the syndrome, coupled with the interest attaching to Dr. Wilson, that justifies an inquiry into the nature of his disorder.

A note on the anatomy of the anal canal.

Abstract: leading, 71 grams protein and 1,956 calories might seem to be a reasonable intake, whereas, when related to intake per kg. only those receiving the supplement reached the desired levels. (3) There is variation in weight-loss. (a) Case S. Z. showed no weight-loss and in this patient the negative nitrogen phase was of very short duration, despite the fact that the supplement provided little extra protein. Was it then that the protein given was available because of the sufficiency of calories from other sources, and that the caloric intake was adequate for weight to be maintained? (b) Similarly, was the much shorter duration of weight-loss in J. K., as opposed to that in H. B., due to his receiving an adequate caloric intake rather than to his extra protein intake? (c) There is little doubt that the low intakes in H. B. and N. Mc. following anaesthesia did much to bring down their average intakes, whereas in J. K. and S. Z. the supplements were acceptable and well tolerated in the post-anaesthetic period and did much to maintain average intakes at a higher level. Any form of therapy which will hasten recovery and shorten the duration of hospital stay is important. I believe that adequate nutrition is such a form of therapy.

General anaesthesia for out-patients, with special reference to dental extraction.

Abstract: Addendum Since this paper was read it has been established (Newton-Andrews, 1954; Bourne, 1954) that under certain conditions it is possible to strike sparks when dental forceps slip. Cyclopropane should not, therefore, be used in aneesthesia for extraction of teeth until this matter has been fully investigated (Bourne, J. G., 1954, Brit. med. J.-, i, 937; Newton-Andrews, H., 1954, Brit. med. J., i, 641).