[Places the medical historian should visit: Sevres].
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Biomedical subjects
Publications and source records attributed to A Lellouch.
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During the nineteenth century, tumultuous relationships existed between the public authorities, the Paris Medical Faculty, its students and teachers, the medical and the popular press. These agitated debates concerned the value of teaching history in medical studies. This paper aims to follow the main steps of these debates through various texts: the new plan for the structure of Medicine in France (1790); the creation (1795), suppression (1822) and restoration (1870) of the Paris chair of the History of Medicine; Guerin's report (1830) concerning the a new reorganization of the Paris Medical Faculty; Dr. Dezeimeris's petitions (1837) addressed to the French Minister of State for Education. These debates remain topical and instructive.
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Through a brilliant medical way, Charcot was, at the same time, rheumatologist, geriatric, clinician, pathologist - and mainly neuro-pathologist - ending as a psychiatrist (according to todays medical terminology). Here, we will point out how much scientific theory and philosophy may support an original concept very unusual during the second half of XIXth century medicine. Describing connection between biology and medicine according to Auguste Comte thoughte, the author is thoroughly going into the course introduced by Charcot: scientific medicine instead of empirical one; structural medical-anatomy against rudimentary approach and rising of experimental medicine; impact of human sciences on medical knowledge; appearance of specialists near general practitioners; idea of organic disturbances denying any 'faith healing". In fact, Charcot asserts that bedside instruction prevails against accurate sciences.
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The aim of this study is to show the various aspects of Charcot's methodology from examples provided by Charcot's publications in the field of geriatrics. The source material consists of unedited Charcot's manuscripts, stored in Charcot's library at the Salpêtrière hospital, in Paris. Mainly inspired by Müller's and Virchow's methodologic pattern, J.M. Charcot filled the gap which concerned French medicine, in the middle of the nineteenth century, when the rhythm of its discoveries decreased. Charcot substituted successfully the old Parisian 'hospital medicine' for new features of medicine initiated by German doctors. Charcot's methodology implied also a new scientific theory in medicine.
Severe stenosis (greater than 70%) of the main stem of the left coronary artery may rarely be asymptomatic. This particular clinical presentation, which has recently been highlighted, is probably commoner than had previously been thought. Though usually a chance finding, its presence should be suspected when exercise stress tests are strongly positive at low work loads; confirmed at coronary angiography, asymptomatic stenosis of the left main coronary artery is no different from symptomatic stenoses with regard to the extent and severity of the coronary lesions; they do differ, however, in that left ventricular function is preserved and may remain normal over a long period. This has therapeutic implications in that systematic surgery of first intention may not be mandatory in these cases.
In 40 hypertensive patients continuous ECG recording was done before and after 30 days treatment with indapamide 2.5 mg. There was no change in heart rate. In addition, the incidence of extrasystoles was not changed in patients in whom the ECG was normal before treatment (30 cases) or in 8 of the 10 patients who had an incidence of more than 1% extrasystoles. However, in the other 2 patients who presented with an incidence of more than 1% extrasystoles the incidence of extrasystoles rose.