Pub Date : 1977-12-01DOI: 10.1177/003591577707001219
N. S. Galbraith
Introduction Public health in Britain effectually began with the publication of the famous report of the Poor Law Commissioners, 'on an inquiry into the sanitary condition of the Labouring Population of Great Britain' in 1842, the principal author of which was Edwin Chadwick. He suggested 'that for the promotion of the means necessary to prevent disease it would be good economy to appoint a district medical officer,...' (Poor Law Commissioners 1842), a suggestion which was taken up first by the City of Liverpool with the appointment of Dr Andrew Duncan as Officer ofHealth in 1847; in 1848 Dr John Simon was appointed the Medical Officer of Health of the City of London. These and all the subsequent appointments ofmedical officers of health were district or local appointments, a most appropriate base because the diseases they were appointed to prevent were local diseases. The cholera outbreak in Soho, London, investigated by Dr John Snow in 1854, was caused by contaminated water from the local Broad Street pump (Snow 1855), and even at the end of the nineteenth century communicable disease still remained predominantly local; for example, the Maidstone typhoid outbreak in 1897 (Borough of Maidstone 1898) was caused by contamination of the local reservoir at Barming by sewage-polluted water from the nearby catchment area at East Farleigh. However, the spread of communicable -disease began to change from local to national and then international by the turn of the century, and particularly after World War I, as a result of the widespread national and international distribution of foodstuffs and other materials and the greatly increased movement ofpopulation. The foodborne outbreak of typhoid fever in Aberdeen in 1964 (Aberdeen Typhoid Outbreak 1964) was caused by the contamination of canned corned beef in South America, where sewage-polluted river water had been used in the cooling process of the cans; it was one ofa series ofsuch episodes which had been taking place since at least as early as 1929 (Anderson & Hobbs 1973).
{"title":"Communicable Disease Control","authors":"N. S. Galbraith","doi":"10.1177/003591577707001219","DOIUrl":"https://doi.org/10.1177/003591577707001219","url":null,"abstract":"Introduction Public health in Britain effectually began with the publication of the famous report of the Poor Law Commissioners, 'on an inquiry into the sanitary condition of the Labouring Population of Great Britain' in 1842, the principal author of which was Edwin Chadwick. He suggested 'that for the promotion of the means necessary to prevent disease it would be good economy to appoint a district medical officer,...' (Poor Law Commissioners 1842), a suggestion which was taken up first by the City of Liverpool with the appointment of Dr Andrew Duncan as Officer ofHealth in 1847; in 1848 Dr John Simon was appointed the Medical Officer of Health of the City of London. These and all the subsequent appointments ofmedical officers of health were district or local appointments, a most appropriate base because the diseases they were appointed to prevent were local diseases. The cholera outbreak in Soho, London, investigated by Dr John Snow in 1854, was caused by contaminated water from the local Broad Street pump (Snow 1855), and even at the end of the nineteenth century communicable disease still remained predominantly local; for example, the Maidstone typhoid outbreak in 1897 (Borough of Maidstone 1898) was caused by contamination of the local reservoir at Barming by sewage-polluted water from the nearby catchment area at East Farleigh. However, the spread of communicable -disease began to change from local to national and then international by the turn of the century, and particularly after World War I, as a result of the widespread national and international distribution of foodstuffs and other materials and the greatly increased movement ofpopulation. The foodborne outbreak of typhoid fever in Aberdeen in 1964 (Aberdeen Typhoid Outbreak 1964) was caused by the contamination of canned corned beef in South America, where sewage-polluted river water had been used in the cooling process of the cans; it was one ofa series ofsuch episodes which had been taking place since at least as early as 1929 (Anderson & Hobbs 1973).","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 1","pages":"889 - 893"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/003591577707001219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64931816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-12-01DOI: 10.1177/003591577707001220
S. Peiris, R. Marten, E. Reynolds
The patient, Mrs V W, was born prematurely by breech delivery on 21 April 1937. At birth it was noticed that she had talipes equinovalgus deformity of both feet. During infancy there was a marked delay in motor milestones and generalized hypotonia. The hypotonia persisted through childhood, but intellectual development seemed normal. Frequent bruising and purpura of the skin and a tendency to laceration of the skin on minor trauma with poor healing were noted. An increased range of joint movements was noticed and she underwent various orthopedic procedures including bilateral rotation osteotomies of tibia and femur to improve her gait. On account of poor circulation of her legs, lumbar ganglionectomy was performed in 1951. Symptoms in more recent years include slowly progressive 'weakness' and at present she can walk approximately fifty yards with the aid of calipers and crutches.
{"title":"Cases","authors":"S. Peiris, R. Marten, E. Reynolds","doi":"10.1177/003591577707001220","DOIUrl":"https://doi.org/10.1177/003591577707001220","url":null,"abstract":"The patient, Mrs V W, was born prematurely by breech delivery on 21 April 1937. At birth it was noticed that she had talipes equinovalgus deformity of both feet. During infancy there was a marked delay in motor milestones and generalized hypotonia. The hypotonia persisted through childhood, but intellectual development seemed normal. Frequent bruising and purpura of the skin and a tendency to laceration of the skin on minor trauma with poor healing were noted. An increased range of joint movements was noticed and she underwent various orthopedic procedures including bilateral rotation osteotomies of tibia and femur to improve her gait. On account of poor circulation of her legs, lumbar ganglionectomy was performed in 1951. Symptoms in more recent years include slowly progressive 'weakness' and at present she can walk approximately fifty yards with the aid of calipers and crutches.","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 1","pages":"894 - 897"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/003591577707001220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64931837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"President's address. Problems of communication of the medicines division of the DHSS.","authors":"E L Harris","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 12","pages":"835-9"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543546/pdf/procrsmed00088-0017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11804679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The evidence justifying immunosuppression therapy in multiple sclerosis.","authors":"J Mertin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 12","pages":"871-4"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543529/pdf/procrsmed00088-0063.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11418751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-12-01DOI: 10.1177/003591577707001207
S. Sherlock
Hyperglobulina?mia Elevation of total serum globulin levels is a wellknown phenomenon accompanying most forms of liver disease. It was the basis of positivity of many of the seroflocculation tests now no longer used. Recognition of the different fractions of the total serum globulin concentration has been fruitful and has led to the first indications of an abnormal immune response in patients with chronic liver disease. Since gammaglobulin levels to a great extent reflect antibody-like protein levels, the hypergammaglobulinxmia, which is associated with an increased turnover rate, is likely to be part of an immunological response. Electrophoresis of the serum proteins shows a polyclonal response in patients with chronic hepatocellular disease. The increase in gammaglobulin also involves fast gammaglobulin and leads to a characteristic filling in of the gap normally present between the beta. and gammaglobulins (Fig 1). Rarely, a monoclonal picture may be seen. Of 27 patients 18 were found with liver disease and cryoglobulinaemia and 6 of these with monoclonal immunoglobulins were found to have antibody activity, directed to human gammaglobulin, alpha y
{"title":"Immunological Disturbance in Diseases of Liver and Thyroid","authors":"S. Sherlock","doi":"10.1177/003591577707001207","DOIUrl":"https://doi.org/10.1177/003591577707001207","url":null,"abstract":"Hyperglobulina?mia Elevation of total serum globulin levels is a wellknown phenomenon accompanying most forms of liver disease. It was the basis of positivity of many of the seroflocculation tests now no longer used. Recognition of the different fractions of the total serum globulin concentration has been fruitful and has led to the first indications of an abnormal immune response in patients with chronic liver disease. Since gammaglobulin levels to a great extent reflect antibody-like protein levels, the hypergammaglobulinxmia, which is associated with an increased turnover rate, is likely to be part of an immunological response. Electrophoresis of the serum proteins shows a polyclonal response in patients with chronic hepatocellular disease. The increase in gammaglobulin also involves fast gammaglobulin and leads to a characteristic filling in of the gap normally present between the beta. and gammaglobulins (Fig 1). Rarely, a monoclonal picture may be seen. Of 27 patients 18 were found with liver disease and cryoglobulinaemia and 6 of these with monoclonal immunoglobulins were found to have antibody activity, directed to human gammaglobulin, alpha y","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 1","pages":"851 - 855"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/003591577707001207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64931085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-12-01DOI: 10.1177/003591577707001212
A. Ridley
Background: There have been reports of demyelinating syndromes in association with COVID-19 and to a much lesser extent COVID 19 vaccines. The association between demyelination and vaccines, in general, remains controversial. We review a presentation of fulminant demyelination, and discuss antecedent COVID-19 vaccination, the formulation of a broader differential diagnosis and ultimately the pathologic diagnosis. Case presentation: An 80-year-old woman presented with seizure, encephalopathy, quadriparesis and ultimately expired. She received a SARS-CoV-2 vaccine one day prior. Imaging revealed contrast enhancing cerebral lesions, longitudinally extensive transverse myelitis. CSF was markedly inflammatory. Pathologic examination of the CNS lesions revealed demyelination and inflammation beyond white matter, not restricted to a perivenular distribution. Conclusion: This case depicts a seemingly fulminant course of a diffuse demyelinating syndrome characterized clinicopathologically as Marburg’s variant of multiple sclerosis. There are several unique aspects of this case including the extremely rapid course, the unusual evolution of CSF abnormalities, with hypoglycorrhachia and markedly elevated protein. The proximity to vaccination is a pertinent association to document, though we cannot unequivocally prove causation
{"title":"Neuroimmunology","authors":"A. Ridley","doi":"10.1177/003591577707001212","DOIUrl":"https://doi.org/10.1177/003591577707001212","url":null,"abstract":"Background: There have been reports of demyelinating syndromes in association with COVID-19 and to a much lesser extent COVID 19 vaccines. The association between demyelination and vaccines, in general, remains controversial. We review a presentation of fulminant demyelination, and discuss antecedent COVID-19 vaccination, the formulation of a broader differential diagnosis and ultimately the pathologic diagnosis. Case presentation: An 80-year-old woman presented with seizure, encephalopathy, quadriparesis and ultimately expired. She received a SARS-CoV-2 vaccine one day prior. Imaging revealed contrast enhancing cerebral lesions, longitudinally extensive transverse myelitis. CSF was markedly inflammatory. Pathologic examination of the CNS lesions revealed demyelination and inflammation beyond white matter, not restricted to a perivenular distribution. Conclusion: This case depicts a seemingly fulminant course of a diffuse demyelinating syndrome characterized clinicopathologically as Marburg’s variant of multiple sclerosis. There are several unique aspects of this case including the extremely rapid course, the unusual evolution of CSF abnormalities, with hypoglycorrhachia and markedly elevated protein. The proximity to vaccination is a pertinent association to document, though we cannot unequivocally prove causation","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 1","pages":"867 - 869"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/003591577707001212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64931667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Immunological changes in liver disease.","authors":"S Sherlock","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 12","pages":"851-5"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543549/pdf/procrsmed00088-0035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11553455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Premyxœdema: entity or nonentity?","authors":"B Lewis","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":" ","pages":"900"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1543543/pdf/procrsmed00088-0096a.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29326932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-12-01DOI: 10.1177/003591577707001210
J. Wigglesworth
It is often assumed that the respiratory distress syndrome (RDS) and hyaline membrane disease (HMD) are synonymous. The findings at necropsy are best explained, however, by thinking of RDS and HMD as involving separate but overlapping groups of infants (Fig 1). In infants with RDS who die, about 75 % have HMD but 25 % do not. There are also, as indicated in Fig 1, a number of babies with HMD at necropsy who have not been recognized as having RDS during life. The findings reported in this paper are derived from information on neonatal deaths at Hammersmith Hospital stored on the perinatal data bank over the period 1966-75, and relate both to deaths in babies
{"title":"Expansion of the Infant Lung","authors":"J. Wigglesworth","doi":"10.1177/003591577707001210","DOIUrl":"https://doi.org/10.1177/003591577707001210","url":null,"abstract":"It is often assumed that the respiratory distress syndrome (RDS) and hyaline membrane disease (HMD) are synonymous. The findings at necropsy are best explained, however, by thinking of RDS and HMD as involving separate but overlapping groups of infants (Fig 1). In infants with RDS who die, about 75 % have HMD but 25 % do not. There are also, as indicated in Fig 1, a number of babies with HMD at necropsy who have not been recognized as having RDS during life. The findings reported in this paper are derived from information on neonatal deaths at Hammersmith Hospital stored on the perinatal data bank over the period 1966-75, and relate both to deaths in babies","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 1","pages":"861 - 863"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/003591577707001210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64931285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-12-01DOI: 10.1177/003591577707001206
Morag L. Ellison
destruction. These should be used in conjunction with estimations of conventional liver-related enzymes. In this way we may hope to combine as many independent variables as possible. The other twelve parameters gave disappointing results; in particular, calcitonin, the beta subunit of human chorionic gonadotrophin placental alkaline phosphatase and the polyamines were not found in abnormally high concentrations in more than a minority of patients with overt metastases. When the results in the patients without overt metastatic disease are examined, the situation is much less clear. Few of the markers are abnormal in more than one or two patients (Table 1) and of the seven most commonly elevated markers, many were normal at the time of mastectomy in the patients who have relapsed within eighteen months of sampling, although some were abnormal in those that relapsed. Because of the small number of patients it is not yet clear whether these parameters have any place in management, but it seems likely that by combining them in follow up of post-mastectomy patients they may have some predictive value. The other twelve parameters measured disclosed some abnormalities scattered throughout Groups 2 and 3, but appear to bear little relationship to prognosis. All the parameters studied here are relatively nonspecific and much more fundamental work will be needed to obtain a sensitive and specific tumour-index-substance for breast cancer.
{"title":"Tumour Markers","authors":"Morag L. Ellison","doi":"10.1177/003591577707001206","DOIUrl":"https://doi.org/10.1177/003591577707001206","url":null,"abstract":"destruction. These should be used in conjunction with estimations of conventional liver-related enzymes. In this way we may hope to combine as many independent variables as possible. The other twelve parameters gave disappointing results; in particular, calcitonin, the beta subunit of human chorionic gonadotrophin placental alkaline phosphatase and the polyamines were not found in abnormally high concentrations in more than a minority of patients with overt metastases. When the results in the patients without overt metastatic disease are examined, the situation is much less clear. Few of the markers are abnormal in more than one or two patients (Table 1) and of the seven most commonly elevated markers, many were normal at the time of mastectomy in the patients who have relapsed within eighteen months of sampling, although some were abnormal in those that relapsed. Because of the small number of patients it is not yet clear whether these parameters have any place in management, but it seems likely that by combining them in follow up of post-mastectomy patients they may have some predictive value. The other twelve parameters measured disclosed some abnormalities scattered throughout Groups 2 and 3, but appear to bear little relationship to prognosis. All the parameters studied here are relatively nonspecific and much more fundamental work will be needed to obtain a sensitive and specific tumour-index-substance for breast cancer.","PeriodicalId":76359,"journal":{"name":"Proceedings of the Royal Society of Medicine","volume":"70 1","pages":"845 - 850"},"PeriodicalIF":0.0,"publicationDate":"1977-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/003591577707001206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64931461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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