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PubMed2005

Between Galen, Geddes, and the Gael: Arthur Brock, modernity, and medical humanism in early-twentieth-century Scotland.

Arthur Brock (1879-1947) is generally remembered as the physician who treated poet Wilfred Owen for shell shock and as the translator of Galen and other ancient physicians. He was also a key figure in the early-twentieth-century humanist revival within medicine. Brock's interest in humanism, I argue, was inspired by a broader concern about modernity and by a desire to return medicine and society to the more harmonious, organic existence that he believed was characteristic of ancient Greece and could still be found among "primitive" peoples, such as the Scottish Gaels. This article explores Brock's anxieties about modernity and its relations to his interests in ancient and "primitive" peoples; to his medical thought and practice; to his interests in history, sociology, language, and translation; and to his involvement in the social and political life of Edinburgh and North Queensferry, where he moved in 1925. Crucially, it shows how all these interests and activities were influenced by Brock's mentor, Edinburgh polymath Patrick Geddes. The article concludes with a discussion of Brock's place in early-twentieth-century medical humanism.

History, 19th Century↗
PubMed2006

Infection, contagion, and public health in late medieval and early modern German imperial towns.

From today's point of view, the concepts of "miasma" and "contagion" appear to be two mutually exclusive perceptions of the spread of epidemic diseases, and quite a number of historians have tried to discuss the history of public health and epidemic diseases in terms of a progression from the miasmic to the contagionist concept. More detailed local studies, however, indicate how extremely misleading it may be to separate such medical concepts and ideas from their actual historical context. The article presented here, based on local studies in late medieval and early modern imperial towns in southern Germany, demonstrates to what extent the inhabitants of these towns had notions of both "miasma" and "contagion." Furthermore, a contextual analysis of language shows that they did not see a necessity to strictly distinguish between these different concepts relating to the spread of diseases. Tracing the meaning of "infection" and "contagion," we find that these terms were used in connection with various diseases, and that a change in the use of the expressions does not necessarily imply a change of the corresponding notion. Moreover, a coexistence of differing perceptions cannot--as some historians have suggested--be attributed to a divergence between the academic medicine and the popular ideas of that period. A survey of measures and actions in the public health sector indicates that a coexistence of--from our point of view--inconsistent concepts helped the authorities as well as the individuals to find means of defense and consolation during all those crises caused by epidemic diseases--crises that occurred very frequently in these towns during the late medieval and early modern periods. As the article demonstrates, the interaction during such crises reveals the continuity of ancient rituals and concepts as well as the adoption of new insights resulting from changes in the economical, political, scientific, religious, and social structures.

Communicable Diseases↗
PubMed1993

Personhood, moral strangers, and the evil of abortion: the painful experience of post-modernity.

The epistemological and sociological consequences of post-modernity include the inability to show moral strangers, in terms they can see as binding, the moral wrongness of activities such as abortion. Such activities can be perceived as morally disordered within a content-full moral narrative, but not outside of the context it brings. Though one can salvage something of the Enlightenment project of justifying a morality that can bind moral strangers, one is left with moral and metaphysical views that can be recognized as impoverished and incomplete by those who live their lives within the embrace of a content-full moral narrative. The cardinal dualism of post-modernity is not that which separates mind from body, but the gulf between the morality binding moral strangers and that binding moral friends.

Abortion, Legal↗
PubMed1997

Breast cancer screening outcomes in women ages 40-49: clinical experience with service screening using modern mammography.

The several randomized controlled trials (RCTs) of breast cancer screening among women of ages 40 to 49 now collectively show a statistically significant reduction in breast cancer mortality. However, there have been numerous recent advances in mammography, such that it now is demonstrably better than when the RCTs were conducted. The use of surrogate measures of screening efficacy (tumor size, lymph node status, cancer stage), readily derived from modern service screening programs, demonstrates how the improved mammography of the 1990s should produce a greater degree of mortality reduction among women ages 40-49 than that already demonstrated in the RCTs. Indeed, these surrogate measures of mortality reduction are as favorable for women of ages 40-49 and 65+ as they are for women of ages 50-64, strongly suggesting that, since modern service screening is accepted as effectively reducing mortality among women of ages 50-64, it should also effectively reduce mortality among women in the 40-49 and 65+ age groups.

Adult↗
PubMed1996

Serum lipids and modernization in coastal and highland Papua New Guinea.

Previous studies in Melanesians of Papua New Guinea have documented low serum cholesterol concentrations with no age-related rise and a virtual absence of coronary heart disease. However, because of recent reports of the emergence of coronary heart disease in this population, serum lipid concentrations in adults aged > or = 25 years in three coastal (n = 1,489 and three highland (n = 388) village communities at different stages of modernization were examined as part of a survey undertaken in 1991. Total cholesterol concentrations were clearly higher than were levels recorded in earlier studies. Moreover, age-related increases in total cholesterol, low density lipoprotein cholesterol (LDL cholesterol), high density lipoprotein cholesterol (HDL cholesterol), and triglycerides (in women) were apparent. Mean total cholesterol levels in an urban community with a high risk of diabetes were similar to those observed in Australians, while HDL cholesterol concentrations were lower. Total cholesterol and LDL cholesterol levels were higher in urban coastal and periurban highland subjects than in their rural counterparts. Prevalence of hypercholesterolemia (> or = 5.2 mmol/liter) varied from 16% in rural highlanders to 56% in urban coastal subjects. Sex, age, village, body mass index, fat distribution, glucose intolerance, physical activity, and an index of relative modernity all contributed to variations in cholesterol and triglyceride concentrations. These results show that Papua New Guineans are by no means protected from dyslipidemia and serve warning that, unless effective preventative strategies can be developed, this and similar rapidly developing populations can expect an increasing incidence of coronary heart disease.

Acculturation↗
PubMed2001

Testing multiregionality of modern human origins.

In order to examine the possibility of multiple founding populations of anatomically modern Homo sapiens, we collected DNA sequence data from 10 X-chromosomal regions, 5 autosomal regions, and 1 Y-chromosomal region, in addition to mitochondrial DNA. Except for five regions which are genealogically uninformative and two other regions for which chimpanzee orthologs are not available, the ancestral sequence and population for each of the remaining regions were successfully inferred. Of these 10 ancestral sequences, 9 occurred in Africa and only 1 occurred in Asia during the Pleistocene. Computer simulation was carried out to quantify the multiregional hypothesis based solely on the premise that there was more than one founding population in the Pleistocene. Allowing the breeding size to vary among the founding populations, the hypothesis may account for the observed African ancestry in 90% of the genomic regions. However, it is required that the founding population in Africa was much larger than that outside Africa. Likelihood estimates of the breeding sizes in the founding populations were more than 9,000 in Africa and less than 1,000 in outside of Africa, although these estimates can be much less biased at the 1% significance level. If the number of African ancestral sequences further increases as more data accumulate in other genomic regions, the conclusion of a single founding population of modern H. sapiens is inevitable.

Africa↗
PubMed2002

MOSFET dosimetry on modern radiation oncology modalities.

The development of MOSFET dosimetry is presented with an emphasis on the development of a scanning MOSFET dosimetry system for modern radiation oncology modalities. Fundamental aspects of MOSFETs in relation to their use as dosemeters are briefly discussed. The performance of MOSFET dosemeters in conformal radiotherapy, hadron therapy, intensity-modulated radiotherapy and microbeam radiation therapy is compared with other dosimetric techniques. In particular the application of MOSFET dosemeters in the characterisation and quality assurance of the steep dose gradients associated with the penumbra of some modern radiation oncology modalities is investigated. A new in vivo, on-line, scanning MOSFET readout system is also presented. The system has the ability to read out multiple MOSFET dosemeters with excellent spatial resolution and temperature stability and minimal slow border trapping effects.

Boron Neutron Capture Therapy↗
PubMed2004

Investigating the eggshell conductance and embryonic metabolism of modern and unselected domestic avian genetic strains at two flock ages.

The objective of this study was to determine if broiler strain and breeder flock age affect eggshell conductance, fertility, and hatchability parameters; heart and hepatic glycogen concentrations at hatch; and embryonic metabolism throughout incubation. The 3 broiler strains investigated were HBY, a modern commercial broiler strain selected for high breast yield; WBM, a modern commercial broiler strain selected for the whole bird market; and UN78, a female broiler parent strain unselected since 1978. Fertility and hatchability parameters for each of the 3 strains were determined when the flocks were 32, 34, 37, and 38 wk of age. Eggshell conductance was measured on separate eggs produced from flocks at 37, 45, and 53 wk of age. Concurrently, fertile hatching eggs from the 3 broiler strains at 2 flock ages (33 and 38 wk) were incubated in individual metabolic chambers. Total daily CO2 production of each embryo was measured. Strain and flock age did not influence any of the fertility or hatchability parameters. Strain had no effect on conductance, but eggs from the 37-wk-old flocks had higher conductance than eggs from the 45- or 53-wk-old flocks, which did not differ from one another. Strain had no significant effect on average total CO2 production over the entire 21.5 d of incubation. However, embryos from the 38-wk-old flock produced more total CO2 than did embryos from the 33-wk-old flocks. Also, there was an interaction between strain and flock age for total CO2 production; UN78 embryos from the 33-wk flocks had higher CO2 production than WBM embryos, and the CO2 production of HBY did not differ from either strain. When embryos from the 38-wk flocks were compared, WBM embryos had higher CO2 production than did UN78 embryos, and HBY embryos did not differ from either strain. The data showed that in the 3 strains examined in this study, genetic differences in embryonic metabolic rate were dependent upon breeder flock age.

Age Factors↗
PubMed1997

Chasing the ambulance. The emerging crisis in the preservation of modern health records.

In this brief essay we argue that the best efforts of archivists, scholars, and practitioners within the National Health Service have not prevented the wholesale destruction of the bulk of patient records created during the twentieth century. This is a matter of vital concern not merely for historians of modern medicine. Important clinical work has frequently been undertaken on materials which have survived, usually by chance or by the foresight of physicians, matrons, and administrators. Even the significant fragments of historical documents which remain in the hands of the health authorities have been threatened by the continuing drive to reduce storage and maintenance costs within hospitals. Archivists and academics have struggled to address the problems of sampling, storage, and access which the enormous bulk of modern records present. In this essay we suggest that the first step must be to raise awareness amongst professionals and the public of the extent to which any future history of the medical services and of patient care will depend on a reasonable rate of survival of these records. The second step must be to confront the problem of resources and the inevitable task of selection which must form the foundations of any long-term policy of preservation. An initial survey of archival materials in Devon indicates that the records of community health care form a substantial and potentially invaluable research source for future historians, though their relevance has rarely been recognized within the academic community.

Archives↗
PubMed1994

A never-ending succession of epidemics? Mortality in early-modern York.

Early-modern cities are often perceived to be centres of high mortality and under constant siege from a barrage of epidemics. However, few urban mortality rates have been calculated and by employing parish register evidence from the regional capital of York, the thesis that the city was subjected to continual sudden increases in mortality can be firmly rejected. Infant mortality was high but remained virtually constant between 1561 and 1700. About a quarter of all infants did not survive to reach their first birthday and neonatal mortality was especially severe. From the mid-seventeenth century a series of epidemics increased child mortality although overall levels of mortality were not significantly affected. Relatively little can be said about adult mortality and apart from two periods of 'crisis' mortality there is little to suggest that adults were greatly affected by epidemics. Indeed, for many adults the urban environment appears to have posed no great threat to health and most could look forward to a relatively long life in the city. York's mortality regime was very similar to that of the smaller market town of Gainsborough where high levels of mortality remained stable throughout much of the early-modern period.

Disease Outbreaks↗
PubMed2006

Milk-alkali syndrome: a historical review and description of the modern version of the syndrome.

Formerly recognized primarily for its historic interest as a disorder found in those taking milk and bicarbonate for peptide ulcer disease, milk-alkali syndrome (MAS) is experiencing a resurgence in its incidence largely due to the increased usage of calcium carbonate. The modern version of MAS affects a different patient population and has a different etiologic basis than was characterized in the original descriptions of the syndrome. Advances in parathyroid hormone measurement have allowed for improved diagnostic separation between MAS and hyperparathyroidism and have further explained some of the physiologic responses in the resolution of hypercalcemia. We have reviewed the reasons for the increasing incidence of MAS, described the typical patient with the modern form of the syndrome, and further elaborated on the pathophysiology of MAS, as it is currently understood. MAS is an important diagnostic consideration in the patient with hypercalcemia because the syndrome is now common and prompt diagnosis limits permanent kidney function impairment but depends strongly on considering the diagnosis as well as obtaining an over-the-counter medication history.

Calcium Carbonate↗
PubMed1996

Use of modern craniofacial techniques for comprehensive reconstruction of the acromegalic face.

The severe acromegalic patient poses a difficult reconstructive dilemma to the craniofacial surgeon. Significant facial deformities can include frontal bossing, prominent supraorbital ridges, malar flatness, maxillary hypoplasia, mandibular prognathism with class III malocclusion, and macrogenia. Reports on the correction of these deformities are rare. Prior publications describe long hospital stays, weeks of intermaxillary fixation, requirement for a tracheostomy, as well as the need for multiple, staged procedures and interdisciplinary teams. In an effort to extend the advances of modern craniofacial techniques to this group of patients, we performed an extensive reconstruction on a 28-year-old acromegalic patient using a one-stage procedure without the use of intermaxillary fixation and without the added morbidity of a tracheostomy. The procedure addressed the skeletal deformities of the upper face, the midface, and the lower face. The operation was performed by a single plastic surgery team and the patient was extubated in 36 hours and discharged in 6 days. We believe that the use of rigid fixation and the judicious application of modern craniofacial principles can allow a complex yet safe one-stage procedure to reconstruct the acromegalic face. Such an approach showed decreased perioperative morbidity and provided an excellent functional and aesthetic result.

Acromegaly↗
PubMed2002

Complete versus partial atrioventricular canal: equal risks of repair in the modern era.

OBJECTIVE: To assess the authors' hypothesis that with modern techniques, the current risks of repair for both complete and partial atrioventricular canal (AVC) are equal. SUMMARY BACKGROUND DATA: Repair of complete AVC in infancy has traditionally carried a substantial mortality. In contrast, partial AVC has been considered low-risk for repair and can be performed later in childhood. METHODS: This was a retrospective review of 63 infants and children who underwent complete (n = 40) or partial AVC repair (n = 23) from 1990 to 2001. Among complete AVC patients, the ventriculoseptal defect was repaired via an individualized approach according to each patient's specific anatomy: direct suturing without a patch (n = 5) and/or interposition of a small pericardial patch with a running suture (n = 35). In all 63 patients the left AV valve cleft was closed with interrupted sutures, and all atrial defects were closed with a pericardial patch. Data were analyzed with the Student test and Fisher exact test. RESULTS: Results are expressed as the mean +/- SEM. Age at operation was 6.3 +/- 2.0 months for complete AVC and 47.5 +/- 6.1 months for partial AVC (P <.001). Bypass time was 65.2 +/- 2.3 minutes for complete AVC and 58.3 +/- 3.9 minutes for partial AVC ( P=.1). Reoperation rate was 7.5% (3/40) for complete AVC and 13.0% (3/23) for partial AVC ( P=.6). Early mortality was 2.5% (1/40) for complete AVC and 0% (0/23) for partial AVC ( P=.6). CONCLUSIONS: Compared to partial AVC, patients presenting for complete AVC repair are significantly younger and manifest more complex anatomy and pathophysiology. However, utilizing modern techniques, including an individualized surgical approach to the ventricular component, repair of complete AVC yields reoperation and early mortality rates similar to those of partial AVC.

Child, Preschool↗
PubMed1995

Are modern imaging techniques over diagnosing ureteropelvic junction obstruction?

Since the widespread use of real-time ultrasonography in the early 1980s, ureteropelvic junction obstruction has been diagnosed at earlier ages and prenatally on a presumptive basis. However, substantial controversy exists over the diagnosis and treatment of ureteropelvic junction obstruction. We conducted an epidemiological study to determine if modern imaging techniques are leading to the over diagnosis of ureteropelvic junction obstruction. Records were collected retrospectively from 3 hospitals serving 2 adjacent counties to determine the number of pyeloplasties performed in 1970 to 1992. The 2 university hospitals and 1 large private hospital provide a wide variety of services and choice of urologists, and so it was assumed that most patients requiring pyeloplasty in the area would be captured. Of the 555 pyeloplasties 240 (43%) were performed on children 12 years old or younger. Logistic regression analysis revealed an overall increase of pyeloplasties per year of 56.8% in 23 years, which was not markedly different from the population growth in the area in the same period (49.3%). A statistically significant increase in the number of pyeloplasties performed in the first year of life was noted. This trend appeared to begin in 1981: 8 pyeloplasties were performed in the first year of life between 1970 and 1980 compared to 91 between 1981 and 1992. Pyeloplasties in children 1 to 6 years old increased with time at a much lower rate that was not statistically significant and the number of pyeloplasties decreased in those 7 to 12 years old. Therefore, it appears that modern imaging techniques are not leading to an over diagnosis of ureteropelvic junction obstruction but to detection of the disease at an earlier age.

Adolescent↗
PubMed2000

Simultaneous irradiation for prostate cancer: intermediate results with modern techniques.

PURPOSE: In this study of men with early stage prostate cancer we evaluated treatment outcome after modern simultaneous irradiation, comprising transperineal implantation followed by external beam radiation. Disease-free survival rates were calculated according to an undetectable prostate specific antigen (PSA) nadir. MATERIALS AND METHODS: From 1992 to 1996, 689 men with clinical stage T1-T2, N0, Nx prostate cancer were treated with ultrasound guided transperineal 125iodine seed implantation followed 3 weeks later by external beam radiation. Disease-free status was defined as the achievement and maintenance of a PSA nadir of 0.2 ng./ml. or less. Median followup was 4 years (range 3 to 7). None of these men received neoadjuvant or adjuvant hormonal therapy. RESULTS: Overall 5-year disease-free survival was 88%. The 5-year rate according to PSA 4.0 ng./ml. or less, 4.1 to 10.0, 10.1 to 20.0 and greater than 20.0 was 94%, 93%, 75% and 69%, respectively. Multivariate analysis revealed that pretreatment PSA was the strongest indicator of subsequent disease-free status in regard to Gleason score or clinical stage. CONCLUSIONS: Intermediate treatment outcome analysis of modern simultaneous radiation supports the principles of radiation dose intensification for intracapsular disease plus the treatment of potential microscopic capsular penetration.

Aged↗
PubMed2002

Historical contributions to the modern understanding of function in the central area.

OBJECTIVE: To review the historical developments leading to the modern understanding of central area physiological features. METHODS: Important scientific writings related to stimulation and function of the central area were studied, beginning with the first electrolytic battery description. RESULTS: Volta's description of the electrolytic battery provided a reliable tool for mapping cortical function. However, 70 years elapsed before Fritsch and Hitzig convincingly demonstrated an excitable cortex and challenged Flourens' theories of cerebral function. The localization of sensory and motor cortical representations was hampered by difficulties in interpreting responses to stimulation in animals and in relating animal data to the human brain. Nevertheless, by the beginning of the 20th century, the evidence for a separate sensory and motor gyrus within the central area was overwhelming. Pioneering surgeons such as Keen, Krause, Foerster, Frazier, and Cushing demonstrated the motor and sensory areas in human subjects during the course of surgery. CONCLUSION: The interpretation of central area function has evolved from the 19th century view that diffuse areas of the cortex and the limbic system serve motor and sensory functions to the theories of Grünbaum, Sherrington, Campbell, and others at the beginning of the 20th century, who suggested segregated functional regions defined by sulcal and architectonic anatomic features. Subsequently, Penfield and Rasmussen supported the idea of a sensorimotor area in which central area function is not strictly separated by the central sulcus. Modern research using microelectrode recordings and functional imaging indicates localized primary sensory and motor functions defined by architectonic anatomic features.

Brain Mapping↗
PubMedDate not supplied

Anger expression, age, and blood pressure in modernizing Samoan adults.

OBJECTIVE: Relationships among anger expression, age, and blood pressure (BP) were studied in a cross-sectional sample of 593 American and Western Samoan adult men and women, 25 to 55 years of age. Prior studies indicated that anger coping is an important psychosocial domain in modernizing Samoans. METHODS: Anger expression was assessed using a modified 24-item version of the State-Trait Anxiety Inventory composed of anger-in, anger-out, and anger-control, along with 4 Samoan culture-specific anger items. Age and sex stratified analyses were performed. Body-mass adjusted BP was regressed on the anger expression subscales and age. RESULTS: In women < or = 40 years of age, anger-out was significantly (p < 0.01) and negatively related to adjusted diastolic BP. Young women from American and Western Samoa who outwardly expressed anger least frequently had higher adjusted diastolic BP. CONCLUSION: The significant influence of anger expression on BP in young modernizing Samoan women may be because: a) increased stress from the interaction of traditional gender role-related domestic demands and more opportunities for individual socioeconomic activities; and b) the culturally normative pattern of suppressed emotional expression.

Adult↗
PubMed2003

Renal cell carcinoma: modern surgical approach.

PURPOSE OF REVIEW: In the past decade, minimally invasive therapy options for renal cell carcinoma have been devised in an attempt to minimize operative morbidity while achieving comparable oncologic and functional outcomes. Herein, we evaluate the new developments related to the modern surgical and energy ablative techniques for renal cell carcinoma. RECENT FINDINGS: When compared with the open counterpart, laparoscopic radical and partial nephrectomies have equivalent operative time, decreased blood loss, superior recovery, and improved cosmesis. Nowadays, laparoscopic radical nephrectomy can be performed for pT2 tumors (up to 15 cm), and level I renal vein thrombus is not a formal contraindication for the laparoscopic procedure. Ongoing advances in laparoscopic techniques and operator skills have allowed the development of a reliable technique of laparoscopic partial nephrectomy, which includes the ability to achieve effective intracorporeal renal hypothermia. Cryoablation and radiofrequency ablation therapies have been performed through a laparoscopic or percutaneous approach, using a combination of fine probes and high-resolution imaging studies to precisely target the lesions and accurately monitor the freezing or heating ablation process. Noninvasive tumor ablation can now be achieved by extracorporeally induced high-intensity focused ultrasound. SUMMARY: These minimally invasive techniques represent the modern surgical approach for renal cell carcinoma, aiming to decrease patient morbidity. Laparoscopic radical and partial nephrectomy techniques duplicate the open approach. Results obtained with energy ablative techniques are encouraging. Based on the known slow growth rates of small renal cell carcinoma, one should be cautious when interpreting the short-term results of energy ablative therapies monitored by imaging only.

Carcinoma, Renal Cell↗