Specific Learning Disorders—Natural History and Current Views

Each professional, whether pediatrician, neurologist, psychiatrist, psychologist or teacher, in evaluating behavioral, neuromuscular, and emotional factors with the tools of his discipline, can arrive independently at very similar views regarding etiology and diagnosis of learning and language disorders. Even though this is possible, it is essential to have the many disciplines work together. This manner of sharing information is not only supportive to the patient, but to the physician as well.The pediatrician''s role does not stop, however, with the diagnosis, but continues with the working through of problems that the child and parents present to one another.     

Osler and the Jewish people

In his writings and actions, Sir William Osler betrayed no evidence of anti-Semitism. In his era, this trait was unusual. Two of his articles, "Letter from Berlin" and "Israel and medicine," dealt directly with his thoughts on the Jewish people. In both he spoke out against anti-Semitism. Osler had friendships with Jewish colleagues--an example is the great regard in which he held US pediatrician Dr. Abraham Jacobi. Osler was not a saint, and he had his "rough side," but in his relationships with Jewish colleagues his example remains relevant.     

The Primary Care Network: A New Type of HMO for Private Practice Physicians

A new type of health maintenance organization has been developed to encourage primary care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all hospital admissions and care by specialists. The primary care physician authorizes all payments from his own account for care provided to his patients. He shares any deficit or surplus remaining at the end of the year.Hospital admission rates and length of stay are lower than those of Blue Cross, with only one of three dollars paid to hospitals. The plan is providing care to 38,000 persons with 750 participating physicians in Northern California, Washington and Utah.This plan represents an attempt by physicians to control costs without government regulation.     

NEUROLOGICALLY HANDICAPPED CHILDREN—The Role of the Pediatrician in Rehabilitation

In the application of the broad services now available to assist a child having a major neurologic impairment, the pediatrician occupies an important role owing to his ability to consider the problem of the handicapped child in the context of his specialized knowledge of the developmental process. He thus has a large responsibility for interpretation of the problem to the child, to the parents and to his professional colleagues and for guidance of the rehabilitation regimen within the limits of the child''s developmental readiness for new experiences.The pediatrician has the opportunity to contribute significant clinical observations which may provide stimuli for future basic research and to exercise his skill as a practitioner of preventive medicine.Goals for the future achievement of the child having a major neurologic impairment must be set realistically and with great caution.     

The Goldwyn diary of November and December 1960, at the Albert Schweitzer Hospital, Lambaréné, Gabon

Through unexpected circumstances, I went to Lambaréné, in Gabon, to be Dr. Albert Schweitzer's surgeon for 2 months, November and December of 1960.This diary I can honestly say I never thought would become public. The years have passed; I am now 77. I realize that not many of those who served in a medical capacity at his hospital are still alive and not everyone will share his or her experiences.I want to make clear that I was with Dr. Schweitzer only 2 months. I would not want anyone to think that I played a strategic role at the hospital. I did not, but I helped as best I could.Although I have traveled throughout the world and have been a surgeon in many out-of-the-way places, I have not returned to Lambaréné. The reason, I confess, is that I wanted it to remain in my mind as it was. For Dr. Schweitzer and those who served there, his hospital was a way of life. It was a world of its own and, though small, it came into being because of the arching ideals and unflagging dedication of a remarkable man. His example should inspire us to enlarge our personal horizons, not just to recognize the less fortunate but to act without delay on their behalf. For each of us, there is an Ogowe waiting to be crossed.     

Parent development

Today's parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child's development; otherwise, his advice and counsel do not "take" and he becomes tired and frustrated and angry. PARENTS PROGRESS THROUGH DEFINITE STAGES OF DEVELOPMENT: Stage 1: Learning the cues-the struggle of the parents to interpret the infant's needs. Stage 2: Learning to accept growth and development-the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate-the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting-the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one's teenager-the parent learning to live independently while the teenager struggles to develop his own identity.The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease.     

Medical Care of the Alcoholic Patient

Alcoholism is an illness that constitutes a major health problem at all levels of society. The physician should accept his responsibility to prevent it and to care for the alcoholic. If he knows that one of his patients is drinking immoderately, he should warn him of the outlook. A patient''s acquired dependence on alcohol may be overt, or revealed only on examination for organic disease or emotional disturbance. The diagnosis may be accepted reluctantly, or denied despite positive evidence, but the patient should be persuaded to give up drinking. He may require psychiatric help or advice from a social worker. He may be so ill as to require treatment in hospital, and hospitals must recognize the urgency of such admissions. Discharge from hospital does not end treatment, for alcoholism is a chronic disease, requiring long-term planning, persistent follow-up and enduring sympathy by the physician, who must always be as available to his alcoholic patient as he is to his patient with diabetes, epilepsy or cardiac disease.     

PARENT DEVELOPMENT

Today''s parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child''s development; otherwise, his advice and counsel do not “take” and he becomes tired and frustrated and angry.Parents progress through definite stages of development: Stage 1: Learning the cues—the struggle of the parents to interpret the infant''s needs. Stage 2: Learning to accept growth and development—the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate—the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting—the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one''s teenager—the parent learning to live independently while the teenager struggles to develop his own identity.The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease.     

The new role of the hospital emergency department

The volume of medical services delivered within hospital emergency departments in the City of Saskatoon is increasing rapidly. These probably are not “new” medical services but rather represent a transfer of “old” services to the emergency departments from other sites where they were previously rendered. The visit to the emergency department is initiated more often by the patient than the doctor and once there the patient is treated in a relatively short period of time. The illnesses so managed do not have a diagnostic, therapeutic or prognostic uniformity but rather are characterized by their acute and totally unexpected onset. This acute and non-programmable nature of the illness makes it difficult to deliver the service in a physician''s office where the appointment system prevails and efficiently deals with the great majority of his patients. Data to determine whether or not this is a desirable development have not yet been obtained but it is clear that in its present usage the emergency department must be thought of as a facility which not only provides exceptional diagnostic and therapeutic equipment but as one which also provides a treatment facility without prior appointment available at any hour of the day or night.     

Office treatment of ambulatory schizophrenics

There are many advantages of treating schizophrenic patients outside a hospital setting, if it can be managed. These advantages include the lesser pecuniary cost to the family and patient and the maintenance of the patient's self-esteem by his continued life in the community, particularly if he can be kept at some sort of gainful occupation. There is also a tendency for schizophrenic persons to increase their loss of contact with reality if, as in a hospital, they are taken care of and not expected to assume any responsibility for themselves. The office treatment of a schizophrenic person entails special problems not only of therapy but of dealing with relatives and the community. It is felt that attention to these matters results in the successful social restoration of patients who formerly would have been thought too ill to remain outside a hospital setting. Although this is among the most demanding work a psychiatrist can engage in, the rewards are great.     

Dr. Jon Gerrard's attention switches from federal cabinet to evidence-based child care

Dr. Jon Gerrard, a Winnipeg pediatrician who went from the heights of political success with a post in the federal cabinet to a narrow defeat in the 1997 federal election, is now devoting his attention to improving health care for children. He thinks the internet can play a lead role in these improvements.     

Disability under social security; medical evaluation and decision as to rehabilitation

Recent amendments to the Social Security Act give privileges to persons who are found to be disabled. In California, the State Bureau of Vocational Rehabilitation has responsibility for determining whether or not an applicant is disabled within the meaning of the Act. Each applicant must submit medical evidence provided by his own physician or by a hospital. The evidence is reviewed by both a physician and a counselor, who determine not only whether disability exists but also whether rehabilitation services might be helpful. In the first 9,000 cases in which determinations were made, 49 per cent of applicants were found to be disabled and 51 per cent not; but in recent months the proportion found disabled has increased. Diseases of the circulatory system and nervous system, including late effects of cerebrovascular accidents, were the largest groups of conditions causing disability. Psychoneurotic conditions and orthopedic and respiratory disorders were next in order. Some 10 to 15 per cent of applicants were referred for rehabilitation services, but of these only about one in six is accepted for rehabilitation, and only half of those accepted actually receive the services. Thus, it appears that only one per cent of workers applying for disability benefits are getting the services made available through state and federal sources to restore them to productive employment. Physicians need to be alert to opportunities provided in programs such as these to utilize all facilities to round out the full cycle of medical care.     

DISABILITY UNDER SOCIAL SECURITY—Medical Evaluation and Decision as to Rehabilitation

Recent amendments to the Social Security Act give privileges to persons who are found to be disabled. In California, the State Bureau of Vocational Rehabilitation has responsibility for determining whether or not an applicant is disabled within the meaning of the Act. Each applicant must submit medical evidence provided by his own physician or by a hospital. The evidence is reviewed by both a physician and a counselor, who determine not only whether disability exists but also whether rehabilitation services might be helpful.In the first 9,000 cases in which determinations were made, 49 per cent of applicants were found to be disabled and 51 per cent not; but in recent months the proportion found disabled has increased. Diseases of the circulatory system and nervous system, including late effects of cerebrovascular accidents, were the largest groups of conditions causing disability. Psychoneurotic conditions and orthopedic and respiratory disorders were next in order.Some 10 to 15 per cent of applicants were referred for rehabilitation services, but of these only about one in six is accepted for rehabilitation, and only half of those accepted actually receive the services. Thus, it appears that only one per cent of workers applying for disability benefits are getting the services made available through state and federal sources to restore them to productive employment. Physicians need to be alert to opportunities provided in programs such as these to utilize all facilities to round out the full cycle of medical care.     

Survey of general practitioners' attitudes to management of patients with heart attacks.

Out of 305 general practitioners sent a questionnaire asking how they would treat three hypothetical patients with heart attacks 231 (76%) replied. Of these, only 179 were prepared to make an unqualified choice of home or hospital treatment for a middle-aged man with an uncomplicated attack, 70 (39%) saying that they would keep the patient at home. Practitioners qualifying before 1960 were more likely to do this than those qualifying in 1960 or later. If a patient declined hospital treatment 161 (70%) of the practitioners would keep him in bed for a week or less, but the date of the practitioners'' qualification significantly affected the time they would advise him to remain off work. Faced with a patient acutely ill after a heart attack, 162 (70%) of the practitioners would arrange his immediate admission to hospital and 51 (22%) would send him to hospital after initial treatment at home. The numbers of partners in the practice, the nature of the premises, and the location of the practice in urban or rural areas affected the practitioners'' attitude to the management of severely ill patients but not to the management of patients with uncomplicated attacks.     

Pediatric Virology

Pediatric virology is not an isolàted discipline. Rather, the syndromes associated with viral infection are modified by the unique characteristics of infancy and childhood. Fortunately for the pediatrician, and certainly for children, viral infections in childhood are rarely fatal, and are almost never serious. Future efforts of the pediatrician and virologist should be directed toward increased fetal salvage as with rubella and the prevention of severe, viral lower respiratory tract disease.     

Coleridge's “Theory of Life”

Coleridge has been seen by some not so much as a poet spoiled by philosophy, but as a philosopher who was also a poet. It could be argued that his major endeavor was an attempt to save the life sciences form the mechanistic interpretation which he saw as the outcome of Lockean “mechanico-corpuscularian” philosophy. This contribution describes that endeavour. It shows its connection to the social circumstances of the time. It discussess its relationship to the poetic sensibility of the “Lake poets” and to the German thought which Coleridge absorbed during and after his sojourn in Gottingen in 1798--99. It describes the nature of his “Theory of Life” as seen not only from the posthumous publication itself, but also from the numerous hints and struggles recorded in his voluminous notebooks, letters and lecture notes. It is concluded that, although never adequately assembled, it forms the only serious attempt to construct a profound alternative to the ultimately mechanistic biology of Charles Darwin and the physiologists of the second half of the century. As such it strongly influenced the young Richard Owen and, as is well known, was eventually overwhelmed by the Darwin-Huxley synthesis of the 1860s. Nevertheless, insofar as Coleridge's concept of life ultimately derived from his ambition to find a way of healing the Cartesian divide, we may wonder whether the recent upsurge in consciousness studies may cause us to look again at his panentheistic ideas and, discarding the obsolete and fanciful metaphysics, recast them into a more acceptable form. This revised version was published online in July 2006 with corrections to the Cover Date.     

CARDIAC ARREST—Successful Resuscitation in the Hospital Outside the Operating Rooms

It is believed that if physicians generally can bring themselves to carry out the drastic action necessary, the benefits of cardiac massage for patients with reflex inhibition of heartbeat can be extended to most cases of this kind occurring anywhere in a hospital, even though there is not time to summon a surgeon or anesthesiologist.This concept requires that attending physicians be prepared to recognize and treat cardiac arrest in salvageable patients. To carry out massage of the heart, a short incision must be made beneath the left breast to permit grasping the heart and starting it again. Mouth-to-mouth breathing until a mask and oxygen arrive is a necessary part of the procedure.Whether to attempt massage must be a decision entirely up to the physician on his appraisal of the circumstances; but the procedure is probably not advisable outside a hospital.     

Tschermak: a non-discoverer of mendelism. II. A critique

An examination of Tschermak's two papers of 1900 not only reinforces our conclusion cited in our first paper on Tschermak that he was not a rediscoverer of Mendelism, but also he did not understand Mendel when he had read it. His concept of dominance differed from that of Mendel, and his use of his own concept is inconsistent and contradictory. His discussion of his backcross data indicated that he had no idea of the nature of Mendelian ratios. Nowhere did he develop the ideas of segregation and independent assortment.     

Thomas Hunt Morgan as an Embryologist: The View from Bryn Mawr

Thomas Hunt Morgan taught at Bryn Mawr College from 1891 until1904. During his years there he concentrated his research interestson embryology; he included regeneration as an integral partof development. This article maintains that Morgan did not abandonhis interest in embryology when he became a geneticist at Columbia,but it deals mainly with his teaching and research while atBryn Mawr. He worked on the development of a great diversityof organisms, plant and animal, he used widely differing experimentalmethods to investigate them, and he concerned himself with manydifferent general and special problems. He strove to investigateproblems that were directly soluble by experimental intervention,and was highly critical, in the best possible way, of the experimentsand interpretations made by his contemporaries, who regardedhim as a leader. He exerted his influence on developmental biologynot only through his research, but also through a number offine textbooks, and by his teaching. During his Bryn Mawr yearshe encouraged his students, undergraduate and graduate, to carryout independent research. He sometimes published with them asco-author, but dozens of articles by his students were publishedwithout carrying Morgan's name as co-author.     

Mendel's experiments: A reinterpretation

Conclusion My conclusion is that Mendel deliberately, though without any real falsification, tried to suggest to his audience and readers an unlikely and substantially wrong reconstruction of the first and most important phase of his research. In my book I offer many reasons for this strange and surprising behavior,⁵³ but the main argument rests on the fact of linkage. Mendelian genetics cannot account for linkage because it was based on the idea of applying probability theory to the problem of species evolution. Central to the theory is the law of probability according to which the chance occurrence of a combination of independent events is the product of their separate probabilities. This is the common basis of Mendel's first and second laws, but this is why Mendel's second law on independent assortment is enunciated in too general a way. From Morgan's work we now know that characters may not always be independent if their genes are located very close one to the other on the same chromosome. And this was also the basis of Mendel's personal drama: he surely observed the effects of linkage, but he had no theoretical tools with which to explain it. So he presented his results in a logical structure consistent with the central idea of his theory. Had he described the real course of his experiments he would have had to admit that his law worked for only a few of the hundreds of Pisum characters — and it would thus have been considered more of an exception than a rule. This is why he insisted on the necessity of testing the law on other plants, and this is why in his second letter to Carl Nägeli he admits that the publication of his data was untimely and dangerous.⁵⁴.We can argue that already in 1866 Mendel was less confident that his so-called second law had the same general validity as the first — and that later he lost his confidence altogether. Contemporary testimony indicates that in the end he became as skeptical as all his contemporaries as to the scientific relevance of his theory.⁵⁵ But he was wrong. His research is in no way the fruit of methodological mistakes or forgery, and it remains a landmark in the history of science. He was only the victim of a strange destiny in which the use of probability theory was responsible, at the same time, for the strength and for the weakness of his theory. We must still consider him the father and founder of genetics.