Biological design — a neglected art

I ought now, perhaps, to offer a summary of what I have been trying to convey in this lecture — but I am haunted by the failure which attended an effort, by an eminent scholar of this city, to do something of the same kind many years ago. Sir John Sheppard, Provost of King's, once gave a public lecture during one of the University's ceremonial gatherings. His subject was the Trojan War. The large audience sat spellbound in admiration of his depth of insight, breadth of knowledge and grasp of detail. As he was leaving after the meeting, a young man came up to him and explained that he was a graduate studuent engaged in research on the economic consequences of the Trojan War. He had, however, been spellbound by the lecture and had been too engrossed to write anything down. Would Sir John be so kind as to lend him his notes so that he could make a summary of the lecture? “My dear chap”, said Sheppard, “I'd be delighted; here are my notes — use them as you wish and let me have them back whenever they have served your purpose”. So saying he handed the young man a postcard on which was written: Agamemnon — Achilles — Agamemnon.I hope that members of the audience won't mind if I leave them to make their own summary of my remarks to which they have listened so patiently this evening.     

Donizetti and the music of mental derangement: Anna Bolena, Lucia di Lammermoor, and the composer's neurobiological illness.

The composer Gaetano Donizetti, who died in a state of mental derangement due to neurosyphilis, created some of opera's greatest scenes of psychosis. His letters reveal the clinical progression of his neurobiological illness, which was confirmed by autopsy. One can hypothesize that the composer's brain disease, which led to his psychosis and death, may have had an influence on his ability to create the powerful and unforgettable scenes of psychosis in his operas. In Anna Bolena, he captured in musical and dramatic terms Anne Boleyn's historically corroborated mental disorder during her imprisonment in the Tower of London. Sixteen years after having composed Anna Bolena, Donizetti himself would be locked up, against his will, in a mental institution. In Lucia di Lammermoor, Donizetti portrayed a girl given to hallucinations who, in her unforgettable "mad" scene, comes on stage, a pathetic embodiment of a human being in the throes of psychosis. Thirteen years after Lucia's première, Donizetti would die, psychotic and paralyzed, of untreated neurosyphilis. Studying Donizetti's neurosyphilis and the portrayals of psychosis in his operas can help one to appreciate the pain of human beings trapped in the prison of a brain subjected to the devastation of mental derangement.     

Survivre �� l��inceste : de l��adolescence �� l��age adulte. ��tude du cas d��un ��tudiant s��n��galais �� Dakar

The disclosure of incest is often difficult to accept. Denial or incredulity is common. Furthermore, attitudes to the consequences vary according to the period and the culture. The adverse effects of incest in children and young people could justify the prohibition of incest the world over. In this article, the authors report a case of a young student who consulted several health practitioners. Finally, he made a connection between his memories of incest with his grandmother and his failures in life. Recognition and long-term treatment of this sexual abuse within the family seem to be essential for the re-establishment of psychological development and social integration of this young man.     

Personalia and the current health crisis.

Recent changes in the Russian government introduced by Boris Yeltsin include the appointment of Eduard Nechaev as health minister at the beginning of this year. The appointment received little publicity in the West, although his predecessor was sacked after only one year for failing to make any effort to improve health care. The challenges facing the new minister are enormous. Not only does he have to introduce a new medical insurance system but he has to tackle the problems of falling population, rising childhood illness linked to poor diet, and the spread of polio and diphtheria. It remains to be seen whether his experience in the military medical service has equipped him for the job.     

A rendezvous with the queen of ion channels: Three decades of ion channel research by David T Yue and his Calcium Signals Laboratory

David T. Yue was a renowned biophysicist who dedicated his life to the study of Ca²⁺ signaling in cells. In the wake of his passing, we are left not only with a feeling of great loss, but with a tremendous and impactful body of work contributed by a remarkable man. David's research spanned the spectrum from atomic structure to organ systems, with a quantitative rigor aimed at understanding the fundamental mechanisms underlying biological function. Along the way he developed new tools and approaches, enabling not only his own research but that of his contemporaries and those who will come after him. While we cannot hope to replicate the eloquence and style we are accustomed to in David's writing, we nonetheless undertake a review of David's chosen field of study with a focus on many of his contributions to the calcium channel field.     

Youth and personality formation--the world belongs to the strength of the young and to the wisdom of the elderly (a point of view of the communicologist)

It is known from the pedagogic, didactic and experience coordinates that a man doesn't become better by using words but by his actions. They are matchless examples for the self-apprehension process and the perception of the action itself as well as the only worthy and accurate offer for the assessment of the range and the significance of the achieved result. From the earliest stage of their life, from the childhood and then later on in different stages of their development and growth, the human being as a social being has a double need: to feel himself in the range of his "I" and to feel himself as a member of a group, a family and of the society in general. Satisfying the sense and the level of those needs doubtlessly depends on the examples given by the life itself and the circumstances of the living within the family, the school and finally the society, that is, the surroundings where the individual is affirming himself by his individual creative capability and skills with which he realizes himself as a subject on its own as well as within the social group he lives and works in. The conditions of the life and work of the elderly are necessary for this important and precious task in the development of a young man so that the applications of their experiences could ensure reliable guidelines for the harmony and success of the life and work of the young. On this bridge of generations the experience of the old is affirmed along with the need for its aimed, creative and fruitful offer to the young in the dynamic process of their development to the maturity and creativity.     

Mental health services--the user's view.

The needs of people with serious mental illnesses have dominated much of the debate on reforming community care. In this article Peter Campbell, who has used mental health services many times in the past, explains how the reforms could affect people like him. He welcomes the thinking behind the changes, particularly the idea that people who use community care should take part in planning services, but he warns that implementing the new philosophy might prove very difficult. Mr Campbell is secretary of a voluntary organisation for users of mental health services called Survivors Speak Out. The views he expresses here are his own, and do not necessarily reflect those of Survivors Speak Out.     

Hubert Lynes:A Biographical Sketch

O rnithology has suffered a grievous loss by the death of Rear-Admiral Hubert Lynes, which occurred after a short illness at a Naval Hospital in Wales on 10 November, 1942, a few days before his sixty-eighth birthday. Those who knew him will remember him not alone for his talents and achievements, but as a man of exceptional character and as an ever faithful friend and good companion.     

Hidde Ploegh: immunologist, journeyman. Interview by Nicole LeBrasseur

From the moment he finished his Ph.D., Hidde Ploegh has been a wanted man. Invited to join one institution after another, he always packed with him his keen interests in the immune system.     

Don't forget the children.

Serious illness or hospitalization of a parent is potentially destructive to the mental health of the child. Stress is caused by both the separation and the illness itself. If the physician does not ensure that the situation is explained to the child, it is likely the child will be confused and frightened and any attempts at clarification will be blocked in the attendant family dysfunction. The general principles of prevention are to share the facts of the situation with the child and to allow him his natural and varied reactions. The family interview is useful in clearing up misunderstandings, sharing feelings and working out family roles.     

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.     

Garland Allen,Thomas Hunt Morgan,and Development

Garland E. Allen’s 1978 biography of the Nobel Prize winning biologist Thomas Hunt Morgan provides an excellent study of the man and his science. Allen presents Morgan as an opportunistic scientist who follows where his observations take him, leading him to his foundational work in Drosophila genetics. The book was rightfully hailed as an important achievement and it introduced generations of readers to Morgan. Yet, in hindsight, Allen’s book largely misses an equally important part of Morgan’s work – his study of development and regeneration. It is worth returning to this part of Morgan, exploring what Morgan contributed and also why he has been seen by contemporaries and historians such as Allen as having set aside some of the most important developmental problems. A closer look shows how Morgan’s view of cells and development that was different from that of his most noted contemporaries led to interpretation of his important contributions in favor of genetics. This essay is part of a special issue, revisiting Garland Allen's views on the history of life sciences in the twentieth century.     

The Practical Application of Narrative Medicine at Mayo Clinic: Imagining the Scaffold of a Worthy House

American health care institutions increasingly recognize narrative medicine as a means to developing quality patient care. More commonly applied in health care professional development settings, narrative medicine is less overtly employed with patient populations. In this article, we describe the application of various narrative practices in the patient care and medical education programs of a major health care center in Minnesota. We discuss the impact of these programs on their participants in relation to the evidence based in current scholarship. Further, we examine narrative externalization of illness in Katherine Butler Hathaway’s disability memoir “The Little Locksmith,” a text which implicates the work of metaphor-making as a transformative step in healing. While several reports demonstrate that patients can find creative writing during times of illness to be therapeutic, there are many for whom the practice is problematic or unattractive, obstacles to practice implementation that the authors discuss. However, based on the experience of our institution, for health care institutions seeking to build a legacy of leadership in empathic patient care, narrative—employed in mentoring physicians in training and in establishing strong, dialogic relationships with patients and colleagues—should serve as a central strategy, or scaffold.     

Poetry, physiology, and puerperal fever: understanding the young Oliver Wendell Holmes

The 19th-century American physician Oliver Wendell Holmes (1809-1894) is known, internationally, more for his literary output than for his contributions to medical science. Yet a single paper he wrote in 1843--"The Contagiousness of Puerperal Fever"--has made him a hero in the eyes of many (especially in the United States) of the struggle against that scourge. Why that one article, written when Holmes was still in his thirties, should--even in its expanded 1855 version--so routinely be referred to as a "classic of medical literature", and why its author should have been raised on such a high pedestal that some grant him a position beside Ignác Semmelweis, are complicated questions. This present paper is an attempt to begin assessing what it is that makes someone a medical hero by looking at three different aspects of Holmes's early career. He was even as a young man a poet and a physiologist/anatomist as well as the author of this important essay. Whether and how those three features of Holmes's many-sides public persona are connected is discussed as a prelude to considering whether his work on puerperal fever legitimates his status as a medical hero.     

Ernst Blasius's contributions to plastic surgery

Blasius was a famous teacher and surgeon. Apart from his own writings on surgery and his new methods for reconstructions, such as the replacement of nose, lips, and eyelids, some theses were also inspired by him. His main work is his three-volume Handbuch der Akiurgie, to which he added an excellent atlas, from which a few illustrations are presented here. His books dealt not only with reconstructive problems, but also with almost every surgical event, e.g., amputations, laparotomy, dental extraction, and so on. Blasius's efforts were concerned with overcoming and preventing the worsening of the shape of newly reconstructed noses, lips, and eyelids due to secondarily healed scars, which was the common practice of the great surgeons of his time, such as von Graefe and Dieffenbach. Therefore, his efforts were toward the primary closure of wounds. In rhinoplasty, Blasius extended the forehead flap into three long points, and then extensions were made by infolding them. Furthermore, he mentioned the first use of a nasolabial flap to reconstruct the lower eyelid. Moreover, Blasius laid down basic principles in flap surgery, such as the V-Y plasty and probably the earliest record of the Z-plasty. His publications and illustrations give an excellent picture of the great advances made by him during the first half of the nineteenth century, thus making him an important contributor to the renaissance of plastic surgery.     

Internet access

A 65-year-old man undergoes a routine checkup before retiring. His wife has urged him to have his prostate examined, because she has read about testing for prostate cancer and a friend has just died of this disease. During the rectal examination, the man''s physician discovers some firmness in the right lobe of the prostate gland. The patient has had no urinary symptoms and is in excellent general health. Sexual function is normal. There is no history of prostate cancer; his father died of a stroke at age 86 years. Testing shows that the patient''s prostate-specific antigen level is 9.3 ng/mL, and he is referred to a urologist. Transrectal ultrasound-guided needle biopsy reveals adenocarcinoma with a Gleason score of 7 (intermediate grade). At a follow-up meeting with his physician, the patient says, "I have been doing some research, and it appears that I should have treatment. However, what is less clear to me is what form of therapy is best--surgery or radiation treatment. Please tell me what you can about the state of the art with respect to surgery."     

The winter projects grey from the eyes

Selected texts derived from the edited diaries of an eighty year old man shed a light on the troubles of old age, declining health and wellbeing in a year prior to death. The author, Hans Warren (1921-2001) is a well known Dutch poet. Despite his poor physical condition and his mental frailty he confides his daily anguish and his lonely sufferings to his diary, resulting in an upsetting story of unhappiness and frustration. Although quite a few doctors are consulted, their advice seems inadequate or futile. The author's relationship with his supporting partner, who is nearly forty years his junior, suffers under the strain of daily conflicts and humiliating dependency. Despite all this they share moments of love and friendship until the end. The author expresses thankfulness for all things of beauty he can still enjoy.     

Nutritional modulation of cognitive function and mental health

The important role of diet in cardiometabolic health is generally well recognised; for mental health, it is not so well understood. However, lifestyle risk factors for poor physical health are the same risk factors for mental illness, including poor diet. This is reflected by the high level of poor physical health in people with mental illness. Mediterranean, whole food diets have been associated with reduced risk for chronic disease, but very little research has investigated their mental health benefits. We provide a model for the pathways by which food components provided by a Mediterranean-style diet can facilitate healthy brain function. We then review evidence for the role of selected nutrients/food components — antioxidants, omega-3 fatty acids and B vitamins — in the brain and, hence, modulation of cognitive function and mental health. Converging evidence indicates multiple pathways by which these nutrients can assist in brain function, drawing from studies investigating them in isolation. There is very little work done on synergistic actions of nutrients and whole diets, highlighting a need for human intervention studies investigating benefits of Mediterranean-style diets for mental, as well as cardiometabolic health.     

Paul Ehrlich--in search of the magic bullet

In 2004, we celebrate the 150th anniversary of the birth of Paul Ehrlich, considered the founder of immunology. His life and work can be divided into three creative periods: first, he developed histological staining, then he accomplished his ground-breaking work on immunology, and eventually invented chemotherapy. Paul Ehrlich can be perceived as a man whose success was not the consequence of a will to power, but of his substantial interest in science.     

Of Mice and Men: Evolution and the Socialist Utopia. William Morris,H.G. Wells,and George Bernard Shaw

During the British socialist revival of the 1880s competing theories of evolution were central to disagreements about strategy for social change. In News from Nowhere (1891), William Morris had portrayed socialism as the result of Lamarckian processes, and imagined a non-Malthusian future. H.G. Wells, an enthusiastic admirer of Morris in the early days of the movement, became disillusioned as a result of the Malthusianism he learnt from Huxley and his subsequent rejection of Lamarckism in light of Weismann’s experiments on mice. This brought him into conflict with his fellow Fabian, George Bernard Shaw, who rejected neo-Darwinism in favour of a Lamarckian conception of change he called “creative evolution.”