Future role of neurologists.

Clinical neurologists in the health care system of the future should have a multifaceted role. Advances in the basic understanding of the nervous system and therapeutics of neurologic disease have created, for the first time in human history, an ethical imperative to correctly diagnose neurologic disease. In many situations, the neurologists may function as a consultant and principal physician for patients with primary nervous system disorders including Parkinson''s disease, multiple sclerosis, Alzheimer''s disease, epilepsy, migraine, cerebrovascular disease, movement disorders, and neuromuscular disease. Other important roles for neurologists include the training of future physicians, both neurologists and primary care physicians, the application of cost-effective approaches to care, and the support of health care delivery research and academic programs that link basic research efforts to the development of new therapy. To be successful, future residency training programs should include joint certification opportunities in both neurology and general medicine, and training programs for clinical investigators should be expanded. Despite its threats to specialists, managed care should also provide opportunities for new alliances among neurologists, other specialists, and primary care physicians that will both improve patient care and increase efficiency and cost-effectiveness.     

Minimally invasive surgery. Future developments.

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.     

Early English steroid history.

Following the revelation of the presence of vitamin D in fish liver oils and of estrogenic hormones in pregnancy urine in the 1920s, active interest in the steroids began in England. Most of this interest originated from the studies of Ian Heilbron at Liverpool and of Otto Rosenheim at the National Institute for Medical Research in London.     

Early history of bioelectromagnetics.

The early history of bioelectromagnetics is reviewed as I experienced it. The period of time chosen extends from my joining the Institute for Physical Foundations of Medicine in Frankfurt in 1937 to the early 1970s, when I retired from the chair of my department at the University of Pennsylvania. Several themes emerge from these recollections. First, clinical and biological work led almost immediately to a heated controversy about the role of athermal vs. thermal effects; this issue has never been settled to the satisfaction of most. Second, good quantitative work on electrical properties and dosimetry began early, well before World War II; its impact on future developments was significant.