NOAH WEBSTER--HISTORICAL EPIDEMIOLOGIST.
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In this case report, we examine Franklin Delano Roosevelt's prognosis, clinical course, and rehabilitation from poliomyelitis, and we examine the criticisms of errors in his diagnosis and management on the basis of current knowledge of the pathophysiology of poliomyelitis. Medical and historical records reveal the onset of severe paralysis, which progressed over several days, with minimal improvement in hips and lower limbs, but recovery of facial, upper limb, and upper trunk muscles. There is no scientific basis for assertions of mismanagement that led to more severe paralysis; the paralysis was most likely caused by strenuous activities in the preparalytic phase of his illness.
Jim Jones and Jonestown are discussed from a "political control" point of view. Seven basic techniques of political control are identified: Control of property and income, weakening of family ties, a sociopolitical caste system, control of egression (escape), control of verbal expression, cognitive control and emotional control. Jonestown is identified as a mini-totalitarian state ruled by a delusional and paranoid person.
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As a group of accounts that span the decades from the mid-1940s to the present, the published polio narratives enable us to align their shifting perceptions of disability with social, cultural, and technological change. This paper identifies two distinct groups of narratives. Authors of the first group, writing between the mid-1930s and mid-1950s--a period of relative prosperity, conformity, and homogeneity--were uncomfortable with radical movements, diversity, and conflict; their narratives typically told of either full or substantial recovery. Beginning in the mid-1950s--the period of both McCarthy and the Civil Rights movement--a second wave of narratives begins to tell stories of partial to serious disability; typically, they reflect on a lifetime of coping with chronic disability. Both sets of narratives, however, represent a dialogue with Franklin Delano Roosevelt. Roosevelt himself, journalists, and the National Foundation for Infantile Paralysis all helped to create and promote a core polio narrative featuring FDR's triumph over disease and disability that would become a national myth. Yet while the early narratives reinforced the core elements of the Roosevelt myth, the later ones began to challenge them.
As President of the United States from 1909 to 1913, William Howard Taft's minimum body mass index was 42 kg/m(2). This article presents evidence that he suffered from obstructive sleep apnea, manifested by excessive daytime somnolence, snoring, systemic hypertension and, perhaps, cognitive and psychosocial impairment. As president, Taft's hypersomnolence was severe and obvious, but never prompted official discussion of his fitness to govern. Within 12 months of leaving office, Taft permanently lost over 60 pounds. His somnolence resolved. As Chief Justice of the United States from 1921 to 1930, he was not somnolent. President Taft's case illuminates historical puzzles of his performance as President, raises public awareness of sleep apnea, and informs discussions of presidential disability and the 25th Amendment to the Constitution of the United States.
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PURPOSE: Earlier studies by our unit documented frequent disability in world leaders resulting from stroke but did not quantify the incidence of cerebrovascular accidents. We sought to identify the frequency and impact of strokes in world leaders. METHODS: Using various sources, we identified world leaders who had sustained strokes while in office from 1970 to 1999 and tabulated information on symptoms and subsequent ability to lead. RESULTS: Twenty leaders were identified who had sustained strokes during the study period, for an incidence of 0.444 strokes/100 leaders/year. Half of the affected leaders lost their political power within the year; most had persistent disabilities, which included motor, speech, cognitive, and emotional deficits. CONCLUSION: Strokes in world leaders may be slightly less common than expected based on studies of Western populations of similar age, but they are often devastating to a political career. Nonetheless, loss of political power is not inevitable.
BACKGROUND: At the start of the Bone and Joint Decade 2000-2010, a paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders and attitudes towards the afflicted in the past compared to today. OBJECTIVE: To analyze "The procession of the Cripples," a representative drawing of 31 disabled individuals by Hieronymus Bosch in 1500. METHODS: Three specialists--a rheumatologist, an orthopedic surgeon and a neurologist--analyzed each case by problem-solving means and clinical reasoning in order to formulate a consensus on the most likely diagnosis. RESULTS: This iconographic study of cripples in the sixteenth century reveals that the most common crippling disorder was not a neural form of leprosy, but rather that other disorders were also prevalent, such as congenital malformation, dry gangrene due to ergotism, post-traumatic amputations, infectious diseases (Pott's, syphilis), and even simulators. The drawings show characteristic coping patterns and different kinds of crutches and aids. CONCLUSION: A correct clinical diagnosis can be reached through the collaboration of a rheumatologist, an orthopedist and a neurologist. The Bone and Joint Decade Project, calling for attention and education with respect to musculoskeletal disorders, should reduce the impact and burden of crippling diseases worldwide through early clinical diagnosis and appropriate treatment.
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