Medical Aspects of Violence

Physicians see violence in beaten wives, battered children, rage reactions, murder, and suicide. They should recognize that it may be a symptom of disease if it is unprovoked or bizarre, or is associated with impaired consciousness, confusion or irrationality. Violence in episodic trance-like states suggests limbic disease (temporal lobe lesions, psychomotor epilepsy, or “dyscontrol syndrome”); in association with personality change, dementia, or psychosis, it indicates cortical disease (structural, toxic, or idiopathic).     

Medical Aspects of Chemical Warfare

The first-aid treatment of mass casualties from nerve gas relies mainly upon the use of drugs, and provision for their self-injection is recommended. Means for giving artificial respiration must also be provided, even though its large-scale use is regarded as impracticable. Prophylactic oxime (2 g. PAM chloride orally) is recommended if the situation permits. Some nerve gases are extremely rapid in action, and following exposure (or suspicion of exposure) 4 mg. of atropine and 2 g. of PAM chloride should be injected intramuscularly without delay. Preferably, atropine should be given intravenously. At the same time any clothing contaminated with liquid nerve gas should be removed and the skin cleansed thoroughly with a suitable fluid. Following this, the casualty should be watched closely for one hour. If poisoning develops despite these measures, or is already established, injection of atropine should be continued at short intervals until improvement occurs.     

Myasthenia Gravis: Medical Aspects

The diagnosis of myasthenia gravis is often difficult and calls for a broader use of pharmacological and electrodiagnostic tests. The decamethonium-edrophonium test, which has proved superior to other procedures for this purpose, is based on neurophysiological principles and depicts the behaviour of the neuromuscular junction. A state of resistance to depolarizing agents in the limited form of myasthenia and a state of a non-depolarizing (competitive) block in advanced cases has been shown. This test has demonstrated that the neuromuscular defect exists throughout the skeletal musculature, including muscles clinically unaffected. It produced no false-positive results either in normal or neurasthenic persons or in patients with neurological diseases with myasthenic symptoms. In a patient with botulism and in a patient with ocular palsies from brain-stem encephalitis the edrophonium test gave a false-positive result, while the decamethonium-edrophonium test was negative.Diagnosis, treatment and management of myasthenic emergencies are described.