Physicians' private clinics in a Northern Thai Town — Patient-healer “Collaboration” and the shape of biomedical practice

Physicians' private clinics in small Northern Thai towns offer the patient the services of official biomedicine's most sophisticated clinical talent, and the physicians themselves an opportunity to significantly supplement their incomes. The clinic form, while familiar to Westerners and Japanese, has been adapted to the Northern Thai medical environment and Northern Thai notions of the therapeutic process. Because of sociocultural constraints and the pressure of the plural medical environment, physicians' private clinics result in a collaboration between patient and practitioner in which some prerogatives of each are compromised and others upheld to shape a clinical institution that satisfies the needs of each. This paper discusses three private clinics in a small Northern Thai town from the perspectives of the physicians and the patients, and then describes the collaboration that shapes practices within the clinics.     

The ultrastructure of the corpus luteum of the guinea-pig

Summary An electron-microscopic investigation, based on the suggestion that differences seen in progesterone levels under differing hormonal conditions might be reflected in the ultrastructural organisation of the lutein cells of the guinea-pig was undertaken. Comparisons were made between corpora lutea taken from animals during the normal oestrous cycle, pregnancy and lactation, and after hysterectomy or hypophysectomy.The lutein cells from the oestrous cycle corpus luteum appeared to be of two types, light and dark. The former were more numerous. The main difference between them lay in the arrangement of the endoplasmic reticulum. Lutein cells from corpora lutea (with the exception of the old degenerating corpora lutea) all contained well-developed agranular endoplasmic reticulum, little granular endoplasmic reticulum, several electron-dense lipid granules, lysosomal bodies which ranged from small spherical bodies to large autophagic vesicles and mitochondria. The mitochondria were numerous, and in the corpus luteum of pregnancy, they were closely associated with the parallel arrays of granular endoplasmic reticulum.With minor exceptions, the lutein cells of the guinea-pig present a strikingly uniform picture despite their hormonal condition.The manner in which this uniformity of ultrastructure may be related to observed differences in progesterone levels in the corpus luteum of the guinea-pig is discussed.Meat and Livestock Commission (MLC) Scholar.The authors wish to thank Dr. J. S. Perry for doing the surgery involved in this work and for the specimens of corpora lutea of hysterectomy. They are also grateful to him for his helpful discussions and interest throughout.     

Origin,destination and mapping of tritocerebral neurons of locust

Summary The connectivities of the tritocerebrum of locust (Locusta migratoria L., Schistocerca gregaria (Forsk.)) were studied histologically and by means of cobalt chloride infusion. Its neuropil consists partly of fibers which traverse the tritocerebrum and areas consisting of neuropilar agglomerizations (glomeruli). The following direct connections between the tritocerebrum and other regions were observed: connections to 1) dorsal and lateral brain regions (mushroom body, optic lobe), 2) the ventral nerve cord, 3) the stomatogastric nervous system (here the protocerebrum and the subesophageal ganglion are also involved in these connections), 4) the retro-cerebral glands (corpora cardiaca, corpora allata), and 5) muscles of the foregut. Acknowledgements. This study was supported by grants from the Deutsche Forschungsgemeinschaft to N.K. The authors wish to thank Dr. H.-W. Honegger (Fachbereich Biologie, Universität Konstanz) and Dr. N.J. Strausfeld (E.M.B.L., Heidelberg) for helpful comments and for assisting with the English text     

Juvenile hormone and the ultrastructural properties of the fat body of the adult Colorado beetle,Leptinotarsa decemlineata say

Summary In the fat body of ovipositing female Colorado beetles, two types of lobes occur. The first type, the internal fat body, is highly specialised for protein synthesis. A lobe of the second type, the peripheral fat body, contains two types of cells, oenocytes and glycogen cells. Ovariectomy, performed at adult moult results in hypertrophy of the glycogen cells of the peripheral fat body. The lobes are characterized by the storage of lipid bodies and glycogen and by numerous mitochondria. Short-day conditions ab ovo, which induce diapause in adults, also result in hypertrophy of glycogen cells of the peripheral fat body. Furthermore, only few mitochondria occur but many proteinaceous bodies may be observed, which conditions are in contrast to the observed effects of castration. The fat body of allatectomized long-day females, has the same structure as that of short day beetles. Consequently a lack of juvenile hormone induces the proteinaceous bodies.Dr. A. De Loof gratefully acknowledges a scholarship as Aspirant of the National Foundation of Scientific Research in Belgium. We wish to thank Prof. Dr. h. C. J. de Wilde for his suggestions and helpfull criticism. We also thank Mr. W. Bohijn for his help in operating the EM and Mr. G. Maes for photography.     

Immunocytochemical demonstration of somatotropin-like and prolactin-like activity in the brain of Calamoichthys calabaricus (Actinopterygii)

Summary Cellular binding of anti-bSTH and anti-oPRL IgG is demonstrated in the brain and the pituitary gland of the African freshwater fish Calamoichthys calabaricus by means of the unlabeled antibody enzyme method at the light microscopic level. In the brain, somatotropin and prolactin are demonstrated in separate neurons in the preoptic area. The somatotropinergic and prolactinergic perikarya are distinct from those of the hypothalamic-hypophysial neurosecretory neurons, i.e., those stainable with aldehyde fuchsin presumed to be vasotocinergic and isotocinergic. The somatotropinergic and prolactinergic neuronal perikarya give rise to separate beaded axons which pass either ventroposteriorly into the infundibulum, terminating in the neurohypophysis, or ventro-laterally through the wall of the preoptic recess, terminating near the superficial capillary bed covering this part of the brain surface. Moreover, coarse dendrite-like processes of both kinds of immuno-reactive neurons extend towards, and end in, the third ventricle. Binding sites in the brain to antisera against hLH, hFSH, hTSH and anti-(1–24) ACTH IgG, all reactive in the pituitary, are not observed in the neurons confined to the preoptic area.Supported by the Danish Natural Sciences Research CouncilThe authors wish to thank Professor Dr K.G. Wingstrand, University of Copenhagen, Denmark, for placing two series of C. calabaricus at their disposal. They would also like to thank the National Institute of Arthritis, Metabolism and Digestive Diseases, Bethesda, USA, for the generous gift of antisera against the subunits of human LH, TSH and FSH, and likewise Dr L. Hummer, Glostrup Hospital, Copenhagen, Denmark, for the gift of the anti-(1-24)ACTH IgG     

In vivo estrogen uptake by individual cell types of the rat anterior pituitary after short-term castration-adrenalectomy

Summary In vivo estrogen uptake was measured in five anterior pituitary cell types of the rat by a quantitative autoradiographic-immunocytochemical technique. In male and female rats that had been castrated and adrenalectomized for one day all five cell types showed nuclear concentration of label one hour after injection of ³H-estradiol. The order of labeling intensity was lactotropes > somatotropes > gonadotropes > corticotropes > thyrotropes. No significant overall sex difference in estrogen uptake was apparent although male pituitaries tended to take up slightly more. Physiological correlates to these data are discussed.Supported by PHS grant HD 12173 and Research Career Development Award HD 00243I wish to acknowledge Mr. Sing Kung Lau for his excellent technical assistance and Dr. P. Rodier for her advise and assistance with the statistical analysis. I also wish to thank Dr. A.F. Parlow and NIAMDD for antisera against rLH, hFSH, rPRL and rTSH and Dr. P. Petrusz, University of North Carolina, for antisera against bGH and h endorphin     

Microbodies (peroxisomes) in the toad,Bufo marinus

Summary Microbodies (peroxisomes), a group of cytoplasmic organelles enriched in catalase, are demonstrated in the toad, Bufo marinus, by light and electron microscopy by means of a cytochemical staining procedure that demonstrates the peroxidatic activity of catalase with diaminobenzidine (DAB). Amphibian microbodies are similar to those of other classes in their fine structure and localization in hepatocytes and kidney, where they are prominent in the proximal tubular cells. Nucleoids are present only in renal microbodies. In the proximal renal tubule an unusual group of large brown granules are identified as lysosomes by their acid phosphatase, -glucosaminidase and -glucuronidase activities.This work was supported by U.S. Public Health Service Grants Nos. NS-06856 and HD 00674. We wish to thank Dr. Richard M. Hays who generously supplied us with toads; Dr. Alex B. Novikoff for making available facilities for ultramicrotomy, Miss Betty De Prest for technical assistance; Miss Marianne Van Hooren for preparation of the photomicrographs.     

Rational men and the explanatory model approach

The previous issue of Culture, Medicine and Psychiatry (Vol. 5, N. 4) included my article When Rational Men Fall Sick: An Inquiry into Some Assumptions Made by Medical Anthropologists together with a series of comments. This paper consists of my replies to some of the commentators and a case study illustrating my points.My collaborators in this research were two physicians, Dr. Robert Like, of the Department of Family Practice of Case Western Reserve University and Dr. Rivka Plotkin of the Ben-Gurion University of the Negev (Israel). Also, I want to thank Avraham Blidstein for his invaluable assistance.     

Induction by progesterone of a sexual dimorphism of estrogen uptake by anterior pituitary cells in situ

Summary The effects of progesterone pretreatment on in vivo ³H-estrogen uptake by five anterior pituitary cell types was analyzed by means of a quantitative autoradiographic-immunocytochemical technique. Male and female rats castrated for 14 days show nuclear concentration of label in all five cell types one h after injection of ³H-estradiol, whether progesterone treated or not. The order of labeling intensity is gonadotropes lactotropes = somatotropes > thyrotropes = corticotropes. Progesterone treatment induces a dramatic sexual dimorphism in estrogen uptake; it significantly increases ³H-estrogen uptake in all female cell types. In males, progesterone decreases uptake in gonadotropes while not altering uptake in other cell types.Supported by PHS grant HD 12173 and Research Career Development Award HD 00243. Portions of these data were presented at the American Association of Anatomists meeting, Omaha, 1980I wish to acknowledge Mr. Sing Kung Lau for his excellent technical assistance and Dr. P. Rodier for her advice and assistance with the statistical analyses. I also wish to thank Dr. A.F. Parlow and NIAMDD for antisera against rLH, hFSH, rPRL and rTSH and Dr. Peter Petrusz, University of North Carolina, for antisera against bGH and h endorphin     

Production of specific-protein secretion granules by fat body cells of the blowfly,Calliphora erythrocephala

Summary During the first four days of the imaginai stage the fat cells of ovariectomized females of Calliphora develop a protein synthetic apparatus, and produce dense bodies (lysosomes) as do the fat cells of normal females, but apparently they cannot synthesize the protein secretion granules that characterize the productive phase of the fat cells of normal females and that we believe to represent vitellogenin. Injection of ovariectomized females with -ecdysone restored the ability of the fat cells to produce the secretion granules. It is suggested that the ovary gives off a factor which induces the production of the protein secretion granules by the fat cells, and that the factor from the ovary can be substituted by -ecdysone. This, we believe, is the first ultrastructural evidence for an effect of the ovary and of -ecdysone on the synthesis of specific protein.We are grateful to the Carlsberg Foundation and to the Danish Science Research Council for generous grants, and to the latter for placing an electron microscope at our disposal. It is a pleasure to thank Dr. Gareth Griffiths for valuable advice as to the preservation of the fat body tissue. We also thank Mrs. Lotte Bakhoj and Mrs. Elsebeth Lund for skilful technical assistance1896–1976     

In vivo sterol biosynthesis by pea aphid symbiotes as determined by digitonin and electron microscopic autoradiography

Summary Pea aphid primary symbiotes have previously been shown to synthesize cholesterol in vitro. Two electron microscopic techniques were used here to determine whether the symbiotes also synthesize cholesterol in vivo and whether this cholesterol is made available to the aphid. We also inquired into a possible role of secondary symbiotes in cholesterol biosynthesis. Treatment of aphids with digitonin resulted in significant alteration of ultrastructural sites in primary and secondary symbiote membranes. We concluded that these sites are areas of high cholesterol concentration in the symbiotes.Electron microscopic autoradiography with ³H-mevalonate precursor indicated that both primary and secondary symbiotes synthesize cholesterol; in both cases, the majority of grains were associated with the symbiote membranes. While the frequency of grains on the symbiotes remained constant, irrespective of incubation time in labelled media, the frequency of grains over surrounding tissues increased exponentially as the time of incubation was increased from 30 min to 8 h, indicating that symbiote cholesterol is transported to other tissues. High voltage electron microscopic autoradiography permitted thick section autoradiography, reducing the time of emulsion exposure from 54 days (thin section) to 12 days (0.5 m sections).Research supported by the College of Agricultural and Life Sciences, University of Wisconsin, and by a research grant (PCM 74-2401 A01) from The National Science FoundationThe authors wish to thank Dr. G.A. DeZoeten for his invaluable advice and assistance with the autoradiographic techniques, Mr. Gary Gaard for his help with electron microscopy, and Dr. Dale Johnston and Dr. Damien Neuberger for their generous help in the use of the high voltage EM     

Histochemical localization of adenosinetriphosphatase in the testicular and pre-testicular nephridia of the Indian leech Hirudinaria granulosa (Savigny)

Summary Adenosinetriphosphatase has been histochemically demonstrated in the initiallobe cells and the central canal in its first round in the pre-testicular and testicular nephridia of the Indian leech Hirudinaria granulosa. The apical-lobe cells are positive in the pre-testicular and negative in the testicular nephridia. The functional significance of the enzyme at these sites has been discussed.I wish to express my gratitude to Dr. H. B. Tewari, under whose guidance the present work has been carried out. I am also indebted to Dr. M. L. Dhar, Director, Central Drug Research Institute, Lucknow; Dr. P. S. Krishnan, Professor of Biochemistry, University of Lucknow; and Dr. (Miss) Usha Gupta, Department of Pathology, University of Lucknow, for the hospitality which they have accorded me in their laboratories.     

Ultrastructure and function of the labial nephridia and the rectum of Orchesella cincta (L.) (Collembola)

Summary The collembolan Orchesella cincta possesses a well-developed coelomoduct kidney. The presence of podocytes in the wall of the sacculus and the fact that the epithelium of the nephridial tubule has the ultrastructural characteristics of resorbing cells, indicate that this is an ultrafiltration-reabsorption kidney.Apparently also the rectum is lined by a reabsorptive epithelium; the cells possess an extensive system of apical and basal infoldings. This view is sustained by the fact that the stereology of the apical channel system varies in animals kept under different moisture conditions. During the intermoult period, both organs are subject to strong morphological changes, which are obviously related to the feeding rhythm.The authors wish to thank Dr. T. Sminia for his stimulating interest during the investigations, Dr. J.C. Jager for statistical advice and Mr. G.W.H. van den Berg for drawing the figures     

Ultrastructural localization of some phosphatases in the prothoracic gland of the insect Leucophaea Maderae

Summary The cytochemical localization of acid phosphatase and thiamine pyrophosphatase activity was studied by light and electron microscopy in prothoracic gland cells of the cockroach Leucophaea moderae. Nymphal and young adult animals were used.Prominent sites of acid phosphatase activity included large membrane-bounded dense bodies or lysosomes, and certain cisternae of the Golgi apparatus. The results suggest a possible difference in the enzymatic activity toward glycerophosphate and aromatic phosphates as substrates.Thiamine pyrophosphatase activity was localized in elements of the Golgi apparatus and endoplasmic reticulum, and in lysosome-like dense bodies. This latter activity was abolished by sodium fluoride treatment, whereas the phosphatase activity in the Golgi apparatus and endoplasmic reticulum is unaffected by such inhibition.The cytochemical results confirm through direct evidence the suggestions of Scharrer (1964), that the large dense bodies present in the prothoracic gland cells are lysosomes, and that their activity may be related to stages in the life history of the glands. Furthermore, the lysosomes or their derivative structures may play an essential role in the autolysis of the prothoracic glands toward the end of their active period.The enzymatic activity of the endoplasmic reticulum may indicate the involvement of this organelle in the metabolism of steroid-like precursor materials necessary for the synthesis of ecdysone.This study was supported by U.S.P.H.S. grants 5 T1-MH-6418 and NB-05219, and grant RO 1-AM-3984 to Dr. Berta Scharrer. I would like to express my appreciation to Dr. Scharrer for her encouragement and assistance during this study. I also wish to thank Mrs. Sarah Wurzelmann for her competent technical aid.     

Improvements in immunostaining samples embedded in methacrylate: localization of microtubules and other antigens throughout developing organs in plants of diverse taxa

Microtubules are important in plant growth and development. Localizing microtubules in sectioned material is advantageous because it allows any tissue of interest to be studied and it permits the positional relations of the cells within the organ to be known. We describe here a method that uses semi-thin (0.5–2 m) sections of material embedded in butyl-methylmethacrylate, to which 10 mM dithiothreitol was added. After removing the embedding material and using indirect immunofluorescence staining, we obtain clear images of microtubules, actin microfilaments, callose and pulse-fed bromodeoxyuridine. This method works on the root tissues of Arabidopsis thaliana(L.) Heynh, Pinus radiataD. Don, Zamia furfuraceaAit., Azolla pinnataR. Br. and on sporophytic tissues of Funaria hygrometricaHedw. In general, most of the cells in the organs studied are successfully stained. Using this method, we find that interphase meristematic cells in all of these species have microtubules not only in the usual cortical array but also throughout their cytoplasm. The presence of the calcium chelator ethylene glycol-bis(-aminoethyl ether)N,N,N,N-tetraacetic acid EGTA in fixation buffers led to some tissue damage, and did not enhance the preservation of microtubules. The common assumption that EGTA-containing buffers stabilize plant microtubules during fixation appears unwarranted.Abbreviations BrdU 5-bromodeoxyuridine - DTT dithiothreitol - EGTA ethylene glycol-bis(-aminoethyl ether) - N,N,N,N tetraacetic acid We thank Ann Cork for technical assistance, Professor B.E.S. Gunning (Australian National University) and Drs. A.R. Hardham (A.N.U.) and R.E. Williamson (A.N.U.) for intellectual and material support, Dr D. McCurdy (A.N.U.) for the purified anti-actin antibody, and Professor B. Stone (La Trobe University, Melbourne, Australia) for generously providing the anti-callose antibody. We also thank the Electron Microscopy Unit of A.N.U. for the use of facilities. L.C.F. gratefully acknowledges financial support from the National Sciences and Engineering Research Council of Canada.     

Specific binding of anti-myosin and -actin γ-globulins to the surface of trypsin-dissociated embryonic chick cells

Summary ¹²⁵I-labelled sheep anti-rabbit -globulin antibodies were used to locate rabbit antibodies to smooth- and striated-muscle actomyosins at the surface of trypsin-dissociated embryonic chick cells. Statistical analysis of electron microscope autoradiographs revealed that the plasma membrane of these cells was significantly labelled with both antibodies. Further tests revealed that there were a significantly greater number of antigenic sites present on the cell surface for the gizzard smooth-muscle antibodies than for those against pectoralis striated-muscle actomyosin.It was further shown that both the rate and extent of binding of the ¹²⁵Ilabelled smooth-muscle actomyosin antibodies to the cells were greater than for anti-striated-muscle -globulins. Binding of the former was reduced to a level similar to that of ¹²⁵I-NIS conjugate by preincubation of the y-globulins with smooth-muscle heavy meromyosin, while a similar reduction was observed when anti-pectoralis actomyosin was treated with actin.It was concluded that actin- and myosin-like proteins must now be considered as integral components of the plasma membrane.The authors wish to thank Dr. W. Sinclair (Zoology) and Miss S. Lutkins (Statistics Department) for assistance with the statistical analysis and are grateful to Professor N. A. Mitchison (Zoology Department, University College London) for providing a control sample of ¹²⁵I-labelled sheep anti-rabbit -globulin, Dr. D. Catty (Experimental Pathology Department, Birmingham University) for donating sheep anti-rabbit serum and Dr. U. Gröschel-Stewart (Zoologisches Institut der TH., Darmstadt, Federal Republic of Germany) for the rabbit anti-actomyosin antibodies. Miss B. Morris and Messrs. P. C. Lloyd, D. Williams and J. Meredith gave skilled technical assistanceThis investigation was supported by grants from Science Research Council, Cancer Research Campaign and Deutsche Forschungsgemeinschaft.     

The ultrastructure of the oyster brown cell,a cell with a fenestrated plasma membrane

Summary The oyster brown cell, a connective tissue cell of uncertain function and affinity, was characterized in the electron microscope by (1) the presence of large cytoplasmic granules, (2) fenestrations of the plasma membrane, and (3) an extensive tubular network originating in, or emptying into, the plasma membrane fenestrations. The brown cell did not appear to be a cell involved in glycogen storage or in the manufacture of exportable protein. The extensive tubular network and the membrane slits suggested that the brown cell may have been involved in the processing of biological fluids.This work was supported in part by Public Health Service Contract No. 5 To 1 ES00038-02, Health Sciences Advancement Award No. RR06138, and Tumor Biology Training Grant, NIH CA 05245.We wish to thank Miss Grete Nilsen for her expert technical assistance and Mr. Bob Munn for his help in the use of the electron microscope and for proof reading our MS. Our appreciation is also extended to Dr. J. Luft, Dr. A. K. Sparks, Miss P. Phelps, Mr. M. DeVault, and to the personnel of the Johnson Oyster Company, Inverness.     

Pigeon navigation: Effects upon homing behaviour by reversing wind direction at the loft

Summary In order to test the nature of the information acquired by pigeons at home and utilized as map component in their navigational mechanism, groups of birds were kept since fledging time in glass corridors, which had their main axis oriented E-W (or ESE-WNW). Referring to the quadrants centered by these directions as experimental quadrants, the treatment of the birds was as follows. Whenever a wind was blowing from one of the experimental quadrants, C1-and C-birds were subjected to an artificial air current blowing from the center of the same quadrant, and E-birds to air currents from the center of the opposite quadrant. C2-birds, reared in a corridor which was unscreened at both ends, were not treated with artificial winds and could perceive the natural winds from the experimental quadrants. Finally, S-birds were never exposed to either natural or artificial winds.When released from directions comprised in the xperimental quadrants, C-, C1-, and C2-birds were homeward oriented, while E-birds oriented themselves toward the opposite direction (Fig. 7), and S-birds' bearings were random. The homing performances of E-birds were poorer than those of the other birds, and on some releases, disastrous.It is concluded that the information that pigeons acquire at home and then use for navigational purposes is wind borne and can be conveyed by an artificial air current. This confirms previous results which indicated the olfactory nature of the information.Dedicated to Prof. Dr. H. Autrum, on occasion of his seventieth birthdayThis study was supported by the Cosiglio Nazionale delle Ricerche. We thank the Command of the Brigata Paracadutisti Folgore, Italian Army, which kindly allowed us to use a power boat for the releases from over the sea. We also wish to thank Dr. R.F. Hartwick for valuable help with some experiments and for stimulating discussions, Mr G. Mela and Mr D. Moretti for constructing the control drices for the fans.     

Hunting behavior and strategies of the Valley Bisa in Zambia

This article describes the hunting tactics and prey selection of the Valley Bisa, a matrilineal, subsistence-oriented society in the Luangwa Valley of Zambia. Although Valley Bisa hunters explain their behavior in their own idioms, many of their tactics, including the stimuli for and timing of hunts, the circular morphology of their hunting patterns, and randomized searches, appear functionally related to the behavior and ecology of their prey. The effects of outlawing traditional harvest techniques and the imposition and enforcement of external constraints on Valley Bisa hunting patterns are discussed. Data on habitats, density of cover, wind direction, species, and initial distance to prey from 50 hunts, in which 16 mammals were killed, are compared and related to success and failure of stalking attempts. Graphs, comparing the numbers of observations for each of four variables with the frequency of stalking attempts, illustrate the cultural style of predation for this group of hunters.This article was initially presented as part of my contribution to a graduate seminar, Public Management of the African Environment, African Studies Program, Indiana University, October 9, 1975. I wish to thank Professor J. Gus Liebenow for extending the invitation to participate in this program.