Acute Myocardial Infarction in Doncaster. II—Delays in Admission and Survival

The speed of admission of patients with suspected acute myocardial infarction was observed over a period of 12 months during which a “no refusal” coronary care scheme was functioning, with emphasis on minimizing delay. During the same period the duration of survival of cases diagnosed as coronary thrombosis by the coroner''s pathologist was measured. Comparison of the two series shows that 75% to 80% of the coroner''s cases had died before the median time of notification of the general practitioner by those patients referred to hospital.We argue that the provision of mobile coronary care on request from general practitioners is unlikely to have an appreciable effect in preventing deaths from acute myocardial infarction outside hospital.     

Contributions to the mathematical theory of epidemics—II. The problem of endemicity

(1) A mathematical investigation has been made of the prevalence of a disease in a population from which certain individuals are being removed as the result of the disease, whilst fresh individuals are being introduced as the result of birth or immigration. Allowance is made for the effects of the immunity produced as the result of an attack of the disease, but the effect of deaths from other causes is not taken into account, and the action of the disease is supposed to be independent of the age of the individual. (2) As a special case of the above, results have been obtained for a closed population in which no deaths occur and to which no fresh individuals are added, but in which the individuals after being infected acquire immunity, and then may be again infected. A threshold density of population exists analogous to that described in the previous paper, which is such that no disease can exist in a population, the density of which is below the threshold. (3) In other special cases investigated when either immigration or birth is operative in the supply of fresh individuals, as well as in the general case, only one steady state of disease is possible. To reach this state the population must be of a certain density which will be determined by the functions characterizing the infectivity, morbidity, etc., of the disease. (4) Increase of the immigration rate or of the birth-rate results in an increase in the rate of infection of the healthy individuals and also in the percentage rate of infection, the percentage of sick, and in the percentage of mortality from the disease. This result is, of course, a necessary consequence of our assumption that the disease is the only cause of death. (5) More particular results have been obtained by substituting constants in the place of the undetermined functions assumed in the general theory. Further, under these conditions the nature of the steady states has been more fully investigated and it has been shown that in all cases, except one, the steady states are stable ones. In the exception, a disturbance would result in purely periodic oscillations about the steady state.     

The Special Orthopedic Hospital—Past and Present

Pioneer orthopedic institutions established in Europe in the late 18th and early 19th centuries, and in the U.S.A. in the second half of the 19th and the first decade of the 20th century, can trace their ancestry in ideas back to the practice and teachings of Hippocrates. Experience in treatment of great numbers of injured soldiers in the First World War opened a new era in reconstructive surgery of the locomotor system.After the Second World War, in advanced nations the pattern of crippling diseases showed a spectacular change. Problems that justify the existence of large special orthopedic hospitals are, in children, the more complex congenital deformities, cerebral palsies, and the increasing number of injuries due to hazards of modern life; in the adult, the reconstructive surgery of trauma and of arthritis.In modern orthopedic hospitals physicians have joined orthopedic surgeons in the study of the natural history of the various forms of arthritis. These centres provide facilities for biomechanical research and postgraduate training which acute general hospitals cannot offer.     

The Other Abortion Myth—the Failure of the Common Law

The 2006 trial of Suman Sood put criminal abortion on the public agenda for the first time in 25 years in NSW. Response to the case highlights tenacious myths about abortion law in Australia; namely that the common law “is an ass” that allows for abortion only by way of a lack of application of the law. By briefly explaining the history of abortion in Australia, I argue that the Sood case does not represent a general failure of the common law to allow abortion, nor does it support the popular myth that abortion is “technically” illegal, or that doctors who perform abortions have historically been the target of the criminal law in Australia. I show that contrary to myths promoted particularly around the 1998 Western Australian reforms, abortion has long been lawful in Australia, and the common law has merit compared to other regulatory regimes. Hence, arguments for alternative abortion regimes should not depend on myths which are shown to be unrepresentative of the political and legal situation in Australia.

Indigenous Research: A Commitment to Walking the Talk. The Gudaga Study—an Australian Case Study

Increasingly, the role of health research in improving the discrepancies in health outcomes between Indigenous and non-Indigenous populations in developed countries is being recognised. Along with this comes the recognition that health research must be conducted in a manner that is culturally appropriate and ethically sound. Two key documents have been produced in Australia, known as The Road Map and The Guidelines, to provide theoretical and philosophical direction to the ethics of Indigenous health research. These documents identify research themes considered critical to improving the health of the nation’s Indigenous peoples. They also provide values that, from an Indigenous perspective, are foundational to an ethical research process. This paper examines these research themes and values within the context of a current longitudinal birth cohort study of Indigenous infants and children in south-west Sydney: the Gudaga Study. Considerable time and effort have been invested in being true to the values stated in these documents: reciprocity; respect; equality; responsibility; survival and protection; and spirit and integrity. We have learnt that it is vital to be true to these values when conducting Indigenous health research—to quite literally “walk the talk”.     

The Hospital Medical Advisory Committee—The Cabinet of the Medical Staff

Before a hospital medical staff can realistically accept responsibility for the professional practices of its members, a principle initially fostered by the American College of Surgeons and adopted by both the Canadian and American accreditation programs, it must have an effectively functioning medical staff organization. The medical advisory committee is the most important committee of the medical staff organization. A representative composition, adherence to sound administrative principles, and recognition of its prime functions of co-ordination, supervision and jurisdiction will permit this committee—and the total medical staff organization—to discharge adequately the very important responsibilities delegated to them by the governing board of the hospital. Properly structured medical staff bylaws with clearly defined terms of reference assist the smooth functioning of the “cabinet” of the medical staff and safeguard the prerogatives of the individual members of the staff.