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The twentieth century hypnosis literature regarding the use of direct symptom removal with hypnosis is in strong contrast with that of the nineteenth. It shows much ambivalence about the use of symptom removal. Objections, largely based on conclusions drawn from psychoanalytic theory, led many twentieth century psychotherapists to reject direct symptom removal. However, a certain amount of empirical evidence, scattered through the literature, has accumulated during the twentieth century to support this rejection. The lack of satisfactory twentieth century statistics and of nineteenth century details concerning hypnotic interventions that were used, makes it impossible to satisfactorily account for the discrepancy in experiences of the nineteenth and twentieth centuries. Although therapists did not altogether abandon working directly with symptoms, many opted instead for modifying and manipulating them by suggestion instead of completely removing them, usually allowing the patient to retain a psychodynamically suitable substitute. Here again a lack of adequate statistics prevents one from being able to properly appraise the effectiveness of this approach which has remained the preferred one for a number of therapists.
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"In the twentieth century the Danish population has, in demographic terms, aged considerably, the proportion of the population aged 60 years and over having increased from 9.8 to 19.6 per cent. The expected population development for the remainder of this century suggests that this ageing will continue until about 1990, after which the effects of previous fertility experience will reduce the proportions of elderly. Although the proportion of elderly begins to decrease after 1990, the number of persons aged 85+ by the year 2000 is expected to increase substantially."
"This survey of Portuguese migration to Brazil analyses the Portuguese and Brazilian statistics to determine the volume, timing and quality of Portuguese immigrants to Brazil as well as the importance of Brazil in the overall Portuguese emigration. The patterns of geographic and economic mobility for the Brazilian resident Portuguese is examined, especially for the period since 1900." The analysis suggests that "though their rapid integration into the Brazilian economy may explain their very low rates of return migration--the lowest of the major European immigrants--they were also the most endogamous of the European migrants, having relatively low rates of intermarriage with native Brazilians and other immigrants." (SUMMARY IN ENG)
Neurology in the twentieth century has undergone extraordinary change, particularly in the past 40 years. We trace the major trends, including the growth of the field, the technological advances, the revolution in neuroscience, the emergence of neurology as a free-standing specialty, the rise of child neurology, and the development of neurological subspecialization. Subsequent articles in this series will expand on these subjects.
Both the rate and causes of twentieth century global sea-level rise (GSLR) have been controversial. Estimates from tide-gauges range from less than one, to more than two millimetre yr(-1). In contrast, values based on the processes mostly responsible for GSLR-mass increase (from mountain glaciers and the great high latitude ice masses) and volume increase (expansion due to ocean warming)-fall below this range. Either the gauge estimates are too high, or one (or both) of the component estimates is too low. Gauge estimates of GSLR have been in dispute for several decades because of vertical land movements, especially due to glacial isostatic adjustment (GIA). More recently, the possibility has been raised that coastal tide-gauges measure exaggerated rates of sea-level rise because of localized ocean warming. Presented here are two approaches to a resolution of these problems. The first is morphological, based on the limiting values of observed trends of twentieth century relative sea-level rise as a function of distance from the centres of the ice loads at last glacial maximum. This observational approach, which does not depend on a geophysical model of GIA, supports values of GSLR near 2 mm yr(-1). The second approach involves an analysis of long records of tide-gauge and hydrographic (in situ temperature and salinity) observations in the Pacific and Atlantic Oceans. It was found that sea-level trends from tide-gauges, which reflect both mass and volume change, are 2-3 times higher than rates based on hydrographic data which reveal only volume change. These results support those studies that put the twentieth century rate near 2 mm yr(-1), thereby indicating that mass increase plays a much larger role than ocean warming in twentieth century GSLR.
The rate of twentieth-century global sea level rise and its causes are the subjects of intense controversy. Most direct estimates from tide gauges give 1.5-2.0 mm yr(-1), whereas indirect estimates based on the two processes responsible for global sea level rise, namely mass and volume change, fall far below this range. Estimates of the volume increase due to ocean warming give a rate of about 0.5 mm yr(-1) (ref. 8) and the rate due to mass increase, primarily from the melting of continental ice, is thought to be even smaller. Therefore, either the tide gauge estimates are too high, as has been suggested recently, or one (or both) of the mass and volume estimates is too low. Here we present an analysis of sea level measurements at tide gauges combined with observations of temperature and salinity in the Pacific and Atlantic oceans close to the gauges. We find that gauge-determined rates of sea level rise, which encompass both mass and volume changes, are two to three times higher than the rates due to volume change derived from temperature and salinity data. Our analysis supports earlier studies that put the twentieth-century rate in the 1.5-2.0 mm yr(-1) range, but more importantly it suggests that mass increase plays a larger role than ocean warming in twentieth-century global sea level rise.
The author examines four major turning points in twentieth-century American psychiatry, emphasizing the movement during the post-World War II period toward a psychotherapeutic/psychoanalytic approach and the emergence of biological psychiatry, neuroscience, and logical positivism during the 1970s and 1980s. He discusses the impact of Adolf Meyer during the mid-twentieth century and his ongoing influence. The final turning point involves a prediction of a late twentieth-century change, including new directions in nosology, emphasis on combined pharmacotherapeutic/psychotherapeutic treatments, efforts to create alternatives to full inpatient care, better outcome data for psychiatric treatments, and beginning resolution of major boundary problems of current practice.
By surveying myriad ways that twentieth-century American experts and nonexperts grappled with the health implications of aerial exposures to lead or substances that may have contained lead, this paper urges medical historians' attention toward environments-workplaces, homes and the outdoors-and their extrabodily ontology. Health histories framed around dust, toxins, fumes, and pollution rather than around particular diseases challenge long-accepted narratives, such as Hibbert Hill's old generalization about a "New Public Health" shift from "the environment to the individual." Greater environmental focus can also advance "bottom-up" health history. Pushing the gaze of twentieth-century medical and public health historians beyond hospitals, "public health" departments, clinically confirmable disease, and "patient" roles, it draws historians' attention to health-related realms in which laypeople often claimed greater knowledge and competence.
During the twentieth century, disease ecology emerged as a distinct disciplinary network within infectious diseases research. The key figures were Theobald Smith, F. Macfarlane Burnet, René Dubos, and Frank Fenner. They all drew on Darwinian evolutionism to fashion an integrative (but rarely holistic) understanding of disease processes, distinguishing themselves from reductionist "chemists" and mere "microbe hunters." They sought a more complex, biologically informed epidemiology. Their emphasis on competition and mutualism in the animated environment differed from the physical determinism that prevailed in much medical geography and environmental health research. Disease ecology derived in part from studies of the interaction of organisms - micro and macro - in tropical medicine, veterinary pathology, and immunology. It developed in postcolonial settler societies. Once a minority interest, disease ecology has attracted more attention since the 1980s for its explanations of disease emergence, antibiotic resistance, bioterrorism, and the health impacts of climate change.
For most of the twentieth century the central theme in the history of health policy in the United States was the elaboration and implementation of a consensus that health services should be organized in regional hierarchies. This consensus was based on shared beliefs about how medical advances were made and disseminated. Hierarchical regionalism became national health policy in several stages that culminated in the 1960s. Since the 1970s, however, the national policy of hierarchical regionalism has been eroded by the unexpected consequences of its success.
This commentary evaluates progress made in the treatment of breast cancer during the twentieth century. Most of the period from 1900 to 1970 was governed by the 'non-science' of anecdotalism and classical inductivism and was marked by the absence of a scientific gestalt. In keeping with the Halstedian concept that breast cancer was a local disease that spread throughout the body by contiguous extension and could be cured by more expansive surgery, the disease was treated with radical surgery. In 1950, however, a new era of enlightenment began to emerge. The awareness that there was a scientific process in which hypotheses generated from laboratory and clinical investigation could be tested by means of randomised clinical trials was a seminal advance, as were findings from studies that laid the groundwork for the modern era of steroid hormone action, including identification of oestrogen receptors. Expanding knowledge regarding tumour cell kinetics, tumour heterogeneity, and technological advances related to mammography and radiation therapy were also to play a role in making possible the advances in therapy that were subsequently to occur. In the past 30 years, as a result of laboratory and clinical investigation, the Halstedian thesis of cancer surgery was displaced by an alternative hypothesis that was supported by findings from subsequent clinical trials. A new paradigm governed surgery for breast cancer, and lumpectomy followed by radiation therapy became accepted practice. A second paradigm that governed the use of adjuvant systemic therapy arose as a result of laboratory and clinical investigation. Treating patients who were free of identifiable metastatic disease with systemic adjuvant therapy because some of them might develop distant disease in the future was a revolutionary departure from prior treatment strategy and became a new exemplar. Not only did the chemotherapy favourably alter the outcome of breast cancer patients, but the anti-oestrogen tamoxifen benefited patients with all stages of the disease. Tamoxifen also reduced the incidence of contralateral breast cancer, as well as tumour in the ipsilateral breast following lumpectomy. The use of preoperative therapy was also found to enhance breast-conserving surgery in women with large tumours, although its value in other circumstances is still being defined. The observation that, as a result of tamoxifen administration, invasive and non-invasive breast cancers can be prevented in women who are at increased risk for such tumours, and the finding that pathological entities such as atypical hyperplasia, lobular carcinoma in situ (LCIS) and intraductal carcinoma (DCIS) can identify women who should be considered candidates for tamoxifen serve as a fitting capstone to the accomplishments of the twentieth century. Breast cancer prevention has now become a reality. Unfortunately, a variety of circumstances have arisen as the result of advances in the understanding and treatment of breast cancer over the last 30 years that threaten to nullify the progress that has been achieved. This distressing phenomenon may be reviewed as a 'paradox of accomplishment'. The numerous uncertainties, issues and questions that have arisen following the report of each advance in treatment, the surfeit of new information that has not yet been integrated into treatment strategies, the undesirable consequences of enhanced tumour detection, a reversion to Halstedianism and anecdotalism, and the uncertainty of therapeutic decision making resulting from the demonstration of small but statistically significant benefits, particularly in patients with good prognosis, need to be addressed. Inappropriate interpretation of those circumstances threatens to deny women with breast cancer and those at high risk for the disease the opportunity to benefit from treatments that have been proven to be of worth. Perhaps the most important accomplishment of the twentieth century relates to the change in the pro
Twentieth-century warming could lead to increases in the moisture-holding capacity of the atmosphere, altering the hydrological cycle and the characteristics of precipitation. Such changes in the global rate and distribution of precipitation may have a greater direct effect on human well-being and ecosystem dynamics than changes in temperature itself. Despite the co-variability of both of these climate variables, attention in long-term climate reconstruction has mainly concentrated on temperature changes. Here we present an annually resolved oxygen isotope record from tree-rings, providing a millennial-scale reconstruction of precipitation variability in the high mountains of northern Pakistan. The climatic signal originates mainly from winter precipitation, and is robust over ecologically different sites. Centennial-scale variations reveal dry conditions at the beginning of the past millennium and through the eighteenth and early nineteenth centuries, with precipitation increasing during the late nineteenth and the twentieth centuries to yield the wettest conditions of the past 1,000 years. Comparison with other long-term precipitation reconstructions indicates a large-scale intensification of the hydrological cycle coincident with the onset of industrialization and global warming, and the unprecedented amplitude argues for a human role.
At the beginning of the twentieth century the transplantation or implantation of either human or animal testicular tissue was an appealing form of androgen therapy in hypogonadal and aging males. This article on the history of medicine discusses the work of the American urologist G. Frank Lydston from Chicago, who was a well-known and respected surgeon in the academic world and was involved in the early clinical trials of this procedure.