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By: T. Randall, M.A., M.D., M.P.H.
Medical Instructor, Charles R. Drew University of Medicine and Science College of Medicine
In the last year of his life acne hairline generic 10 mg noitron with amex, Lambrinudi made plans to write a book on orthopedic surgery acne and diet buy noitron 30 mg line. It is lamentable that now it can never be written skin care guide purchase noitron online now, for it might well have brought out his emphasis upon function and vital mechanics from beneath the shapeless mass of pathological data, carpenters’ tricks, and shaky generalizations that we find in Sir William Arbuthnot LANE most textbooks on orthopedic surgery and that obscure the fact that whatever else it may be, the 1856–1943 greater part of the body is, in a literal sense, a machine. Sir William Arbuthnot Lane was a surgeon of sur- There is, however, no need to fear that passing operative dexterity and by his pioneer Lambrinudi will be forgotten. Lane, a brigade surgeon who saw service in the During his 6 years’ demonstrating in the dis- Indian Mutiny. The boy’s grandfather was secting room, Lane conducted researches upon William Lane, MD, of Limavady, County Derry, the function of the skeleton and its adaptation to Ireland. He made an intense study of was the daughter of an inspector general of hos- changes in bones, cartilages and joints due to pitals, whose ancestors also derived from County occupational posture, pressure and strain of Derry. His other words, the form of the skeleton depends father feared his love of athletics but this did not upon and varies with the mechanical relation of prevent the boy from winning several school the individual to his surroundings. He forebears in the study of medicine, and his father, noted that in each of these occupations there was being posted to Woolwich, entered him as a a peculiar bodily disposition during activity, with student at Guy’s Hospital in October 1872 many tendencies to skeletal change; the habitual because it was near London Bridge station, to assumption of this attitude eventually induced which traveling from home was easy and inex- structural change. He was only 16 years old and looked drayman who carried a heavy barrel on his right even younger; his bearded and frock-coated shoulder, the spine had become adapted to meet fellow students began by tolerating his youthful its burden. The upper thoracic vertebrae were appearance with an air of condescension; but they deflected to the left side so there had been greater were soon to learn of his exceptional ability. This unequal Wilkes and Pavy, men who left a permanent influ- stress was plainly manifest by well marked ence on medicine. Lane considered these osseous changes of Surgeons in 1877 but was advised to take a to be an adaptive reaction designed to broaden London degree. This meant retracing his steps, the surfaces of the vertebrae to meet the unusual beginning with matriculation; he did so with grat- occupational stress. This was certainly an origi- ifying results, being awarded the gold medal in nal interpretation of the pathological changes anatomy at the intermediate examination and the occurring in the vertebrae; the fact that only a gold medal in medicine at the final examination few vertebrae were affected and those at the site in 1881. The following year he became a Fellow of greatest strain, lent some support for this of the Royal College of Surgeons and in 1883 pro- view—what Lane called “crystallisation of the ceeded to the degree of Master of Surgery. That view, the prospect of election to the staff was much however, seems less illuminating than Lane’s more promising on the surgical than the medical interpretation of the change as an adaptation to side; thereupon he decided for surgery. In 1883 he was of perforating the mastoid process with a small appointed assistant surgeon to the Hospital for trephine. Lane was the first surgeon in this Sick Children, Great Ormond Street, and in 1888, country to open and explore the mastoid antrum, 184 Who’s Who in Orthopedics employing specially devised gouges and chisels tary tract. Lane, reporting the proce- view that the toxemia causing these diseases was dure, wrote: due to the obstructive action of the colon, he embarked on extensive colectomy for their cure. I found many cases of empyema which had been Intestinal stasis and Lane’s remedy for it aroused treated in the usual way by aspiration, followed if nec- a good deal of controversy. A discussion at the essary by intercostal incision and drainage, both of Royal Society of Medicine, extending over six which are not infrequently totally inadequate. Lane was quite def- this difficulty, after determining the lower limit of the inite in his affirmations as to the fact of intestinal pus-containing cavity, I removed a sufficient length of stasis and its cure by colectomy. In however, was not sufficiently convincing; there the aperture so made, a tube of considerable calibre could be fastened so that its internal opening was flush were no follow-up reports submitted to prove the with the pleura. Through such an opening it was readily permanent value of so drastic a procedure.
Stimson was an important and influential figure in the New York surgical community acne quick fix discount noitron online mastercard, and he had a significant role in the development of the Cornell University Medical College acne natural treatment cheap noitron 20 mg on-line. Stimson acne 3 day cure discount 10 mg noitron, held positions in the cabinets of Presidents Taft, Hoover, and Franklin Roosevelt. Lewis Atterbury STIMSON 1844–1917 Lewis Atterbury Stimson was born in Paterson, New Jersey. His family was of old colonial stock, and his father was a successful stockbroker who counted Jay Gould and Jim Fisk among his acquaintances. Stimson graduated from Yale in 1863, just in time to see active service in the final period of the Civil War. In the next few years, he became interested in the study of medicine, perhaps because of the chronic illness of his wife, who had become diabetic. In 1871, he took his family to Paris to seek help for Frank STINCHFIELD his wife and to begin his medical education. At this time, he studied with Pasteur, Nelaton, Gos- 1910–1992 selin, and others. Returning to the United States, he obtained his medical degree from Bellevue Dr. Stinchfield had made the most outstanding Hospital Medical College in 1875. At graduation contributions to the unique 125-year history of the he was awarded the Wood Prize of the Alumni New York Orthopedic Hospital. He combined Association of Bellevue Hospital Medical the qualities of a superb clinician who developed 323 Who’s Who in Orthopedics numerous advanced techniques, particularly in techniques. The year abroad turned out to be one the treatment of the spine and the hip, with a gift of the most exciting and educational periods of for leadership that transformed not only New his life, as it coincided with the outbreak of World York Orthopedic Hospital, but also the practice War II. Stinchfield recalled having his of orthopedic surgery, both nationally and American identity concealed by his hosting internationally. Stinchfield was one of two sons of Charles avoid potential problems throughout his Euro- and Mary-Frank Stinchfield, and was born on pean travels. His father Despite the danger seen during his travels, managed a grain elevator company and there was Dr. Stinchfield felt compelled to join the Allied no history or succession of physicians in his Forces in Europe, and between 1942 and 1946 his family, but by the age of 12 Dr. Stinchfield knew medical services were enlisted to the army of the that he wanted to become an orthopedic surgeon. This second excursion to Europe Like most young boys, he enjoyed playing sports was both stimulating and horrific as he witnessed and was fortunate to have never suffered any some of the worst wounds seen in his medical serious injuries. Many of the bloodiest casualties were seen fascination with bones, and he became commit- while he was running the American Army Field ted to the idea of healing, researching, and explor- Hospital in Oxford, Britain. As one of two physicians tending make funding for his education possible (he grate- medical needs during the liberation of Buchen- fully paid back his benefactors in full less than 1 wald, he was asked to be the orthopedic consult- year after he began working as a full-time ortho- ant in the Surgeon-General Headquarters to the pedic surgeon). By 1946, he had been He received a BS in Medicine in 1932 from the decorated with a Legion of Merit, First Bronze University of North Dakota after transferring Star, European Theater Operation Unit Citation, from Carleton College, and received his MD in and Second Bronze Star. Stinchfield’s 1934 from Northwestern Medical School in army service, his wife, Margaret Taylor Stinch- Chicago. He remained in Chicago, and began field (whom he wed in 1939), supported the Allied his internship, and later residency, at the Wesley Forces as a liaison to the British lend-lease Memorial and Passavant Memorial Hospitals.
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Ensure that the patient is on his or her back and lying on a firm acne 50 year old woman generic noitron 5mg, flat surface acne boots buy 10 mg noitron with amex, then start chest compressions acne care purchase 40 mg noitron otc. The correct place to compress is in the centre of the lower half of the sternum. To find this, and to ensure that the risk of damaging intra-abdominal organs is minimised, feel along the rib margin until you come to the xiphisternum. Place your middle finger on the xiphisternum and your index finger on the bony sternum above, then slide the heel of your other hand down to these fingers and leave it there. In an adult compress about 4-5cm, keeping the pressure firm, controlled, and applied vertically. Try to spend about the same amount of time in the compressed phase as in the released phase and aim for a rate of 100 compressions/min (a little less than two compressions per second). After every 15 compressions tilt the head, lift the chin, and give two rescue breaths. Return your hands immediately to the sternum and give 15 further compressions, continuing compressions and rescue breaths in a ratio of 15:2. It may help to get the right rate and ratio by counting: “One, two, three, four. The compression rate should remain at Hand position for chest compression 100/min, but there should be a pause after every 15 compressions that is just long enough to allow two rescue breaths to be given, lasting two seconds each. Provided the patient’s airway is maintained it is not necessary to wait for exhalation before resuming chest compressions. The precordial thump is taught as a standard part of advanced life support Precordial thump Studies have shown that an initial precordial (chest) thump may restart the recently arrested heart. This is particularly the case if the onset of cardiac arrest is witnessed. Unconscious Choking Open airway A patient who is choking may have been seen eating or a child may have put an object into his or her mouth. Check mouth If the patient is still breathing, he or she should be encouraged to continue coughing. If the flow of air is Check breathing completely obstructed, or the patient shows signs of becoming weak, try to remove the foreign body from the mouth. If this is Attempt ventilation not successful give five firm back blows between the scapulae; this may dislodge the obstruction by compressing the air that remains in the lungs, thereby producing an upward force Yes No behind it. If this fails to clear the airway then try five abdominal Basic life Check circulation Chest compressions thrusts. Make a fist of one of your hands and place it just below support the patient’s xiphisternum. Grasp this fist with your other hand and push firmly and suddenly upwards and posteriorly. Adapted from Resuscitation Guidelines alternate abdominal thrusts with back slaps. If breathing does not resume, open the patient’s airway by lifting the chin and tilting the head, and then attempt to give two effective rescue breaths. If this fails, start chest compressions, alternating 15 compressions with a further attempt to give rescue breaths.
He would fall asleep with the bottle in his mouth at naptime and at night skin care not tested on animals cheap noitron uk. David’s pediatrician surmised that the sugar in the milk lingered in David’s mouth and caused his teeth to decay skin care 1 month before marriage buy cheap noitron 20 mg on line. As a result skin care collagen buy noitron no prescription, the little boy had fillings in his teeth begin- ning at the age of three. As his decaying baby teeth fell out one by one and began to be replaced by permanent ones, everyone rejoiced at the chance to be proactive and pre- vent any further tooth decay. He got his new teeth cleaned regularly and the dentist applied a protective coating to his teeth to prevent cavities. But after all he had been through, David was so nervous about getting any new cav- ities that he avoided most sweets and took his toothbrush wherever he went. As he grew older, his mother, Hilary, allowed him to have artificially sweet- ened drinks, desserts, and gum so he wouldn’t have to feel so deprived next to the other kids. Other than tooth decay, David was a healthy boy with only the usual array of common childhood diseases like colds, occasional ear infections, and a hefty case of whooping cough. Starting inexplicably at about age seven, he began having a constant runny nose, stomachaches, and diarrhea. On some days, the diarrhea was so bad he was afraid to go to school because he had once soiled his pants when he couldn’t make it to the restroom on time. The pediatrician, who at first thought he was looking at a stomach virus, soon became concerned with the chronicity of the symptoms. This specialist eliminated all the usual causes of diarrhea in children including E. He ruled out parasites like giardia and cryptosporidium and even rotavirus. He had David’s blood tested for hemolytic-uremic syndrome, which was nega- tive, and as a last resort ordered a series of upper and lower gastrointestinal tests to rule out anything more serious. When all of these tests turned out negative, he suggested David should see an allergist to determine if there were any food allergies. The pediatric allergist guessed David might be allergic to the milk he so adored because his symptoms were a common indication of a milk allergy. She performed a number of tests that revealed that David had devel- oped an allergy to milk and milk products. The allergist told Hilary that once she eliminated these products from her son’s diet, his gastrointestinal symptoms would most probably disappear. Hilary followed the doctor’s orders, and interestingly enough, while David’s runny nose stopped, the stomachaches and diarrhea did not. Her son had suffered enough; first with the tooth decay and now for almost a year with stomachaches and diarrhea. Rosenbaum and passed along a copy of the Eight Steps to Self-Diagnosis for Hilary to do on David’s behalf. Using this model, Hilary was actually able to solve David’s problem all on her own. She paid particu- lar attention to the timing of his symptoms in Step One. Every time David complained of a stomachache or had a bout of diarrhea, she tried to deter- mine what had happened immediately before and whether there was a rela- tionship. She instructed David to do the same thing himself when he was at school. Then she thought about the history, particularly the inception of these symptoms, in Step Two and recalled exactly what was happening in David’s life at the time.