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By F. Kerth. City University of Los Angeles.

On entering the Victoria University of mary buy luvox 50mg free shipping, subsequently to become its first professor Manchester without previous scientific training cheap 100 mg luvox with amex, of orthopedic surgery in 1939 safe luvox 50 mg. Between the two world wars cheap luvox 50 mg line, Harry were three women student contemporaries who sometimes claimed that he had won the Ashes for were then kept completely separate in their England in 1932 discount luvox 50mg, having declared one of Harold studies! After an outstanding undergraduate Larwood’s knees as fit for the notorious “body- career, he qualified in 1909 from both Victoria line” tour. After resident and registrar ant adviser in orthopedic surgery to the Emer- appointments at Manchester Royal Infirmary with gency Medical Service and an active member of Sir William Thorburn, he demonstrated anatomy innumerable government committees and other in Grafton Elliot Smith’s department at Manches- public bodies after the war. He later passed the mastership and fellowship to the Council of the Royal College of Surgeons examinations, and secured the MD, Manchester, in 1940, serving there for 18 years and being vice with gold medal, for his thesis on peripheral nerve president 1949–1950 and president 1954–1957. His orthopedic training was mainly at the He had received the accolade of Knight Bachelor Royal National Orthopaedic Hospital in London, in 1948 and, as was then the custom, was awarded and in Boston, USA, with Elliot Brackett and a baronetcy on completing the presidency of the R. He also became a member of the Court and the Children’s Hospital, while he also of Patrons of the College and an Honorary Fellow observed Harvey Cushing’s neurosurgery at Peter of the Faculty of Dental Surgery and, quite excep- Bent Brigham Hospital. In the days before trav- tionally, continued to serve on one College com- eling scholarships, he depended upon his father’s mittee until well into his 80s, when he was also support and recalled how he had sailed from Liv- appointed a Knight of the Order of St. Franconia for £15 in a received honorary degrees from the universities small first-class cabin. While in Boston he read of Berne, Manchester, Liverpool, Belfast, Leeds voraciously the orthopedic journals in English, and Paris; honorary fellowships of the surgical 271 Who’s Who in Orthopedics colleges of America, Canada, South Africa, Aus- 1986, attended by a company of 338, with all of tralasia and Denmark, and honorary membership whom he insisted on shaking hands while seated of the orthopedic associations and societies of in his wheel-chair. After several speeches and pre- most countries in the western world and of Latin sentations had been made, the hardy old warrior America. He had been a founder member of the stood up and spoke for 25 minutes in a firm voice British Orthopaedic Association in 1916, its presi- and without a note. A month later, in a last visit dent in 1934–1935 and ultimately an Honorary to his surgical Alma Mater, he was entertained to Fellow. A founder member of the Société Inter- dinner in the council room by the president and nationale de Chirurgie Orthopédique et de Trau- vice presidents, and by four of the five surviving matologie in 1929, he was its president from 1948 fellow past presidents. When he died a few to 1953; he was also president of the International months later on December 20, 1986, he was sur- Federation of Surgical Colleges 1955–1966, and vived by his son, who inherited the baronetcy, and its honorary president from 1970. He contributed to nine textbooks on orthopedic surgery and peripheral nerve injuries, 1. The Times 22 December 1986 and a list of all his publications is recorded in The 2. Br Med J 1987, 294:129–130 Journal of Bone and Joint Surgery, Harry Platt 3. Br Med J 1986, 293:864–866, Sir Harry Platt: 100 not out Birthday Volume, 48-B, No. As a man, Sir Harry displayed formidable energy and drive, both physical and mental, despite the handicap of a much shortened leg sup- ported by an appliance. In early years he had a rather shy nature, married to considerable intel- lectual arrogance, making it difficult for many folk to get to know him well, though friends became more numerous as increasing age brought greater tolerance. Many were greatly amused and enlightened by his astringent—often acidulous— comments on colleagues and affairs in general. Privately it was his firm belief that a committee of one was the quickest way to get things done! But his many great qualities of mind and heart, his organizational ability and his far-seeing philo- sophical outlook more than compensated for any abruptness of manner on first encounter. He married Gertrude Sarah Turney in 1917 and they had one son, who is a barrister, and four daugh- ters. His wife predeceased him in 1980 after 63 years of marriage, though for some time prior to her death she had been under institutional care. William Ward PLUMMER He continued to live alone with an ever lively mind and intellect, and he had a prodigious 1877–1953 memory, even as he approached his century. Plummer’s activities in the orthopedic field a reporter from the British Medical Journal, in had spanned the era of almost nonsurgical which he showed a remarkable recollection of conservatism to that of the aggressive, brilliant names and past events. His birthday was marked accomplishments of the modern orthopedic by an orthopedic festschrift attended by surgeons surgeon.

Developing this relationship is so important that it is the last of the Eight Steps for self-diagnosis cheap luvox 100 mg mastercard. Surgeon General Throughout our discussion of the Eight Steps to Self-Diagnosis buy luvox 100mg on line, including how to create a partnership with your physician purchase 50 mg luvox mastercard, we have empha- sized the need for you to assume a proactive role in sleuthing out the solu- tions to your mystery malady cheap luvox 50 mg free shipping. In addition to observing and recording the exact nature of your symptoms buy luvox 50mg with amex, your sleuthing may involve outside inves- tigation from whatever sources of information you have available. Many people, especially seniors, use the public library to learn about topics of interest. The library is an especially good resource when there is a reference librarian to help direct your research efforts, and the libraries at many med- ical schools are open to the public. There is, however, a more convenient place to do your medical inves- tigation—your own computer. The Internet can be a gold mine of medical information if you know how to use it effectively. Many hospitals now have computer terminals available for the community to use when researching health topics. Whether you grew up in front of a keyboard or you’re a “surfin’ senior,” this chapter aims to help you do your own medical detective work on the Internet. If you’re not computer savvy, we recommend that you enlist 73 Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum. Searching the Internet could turn up a unique and invaluable clue to your mystery malady. Before You Start For you library-card holders who are about to explore the Internet for the first time, understand first that there is no reason to be intimidated by the computer. Think of the Web as a library literally at your fingertips that is a little more challenging than the orderly world of library stacks. Although the Web may not be as rationally organized, it is without a doubt the biggest library you’ll ever find! It has been determined that it takes an average of five minutes and forty-two seconds on the Inter- net to find information relevant to specific health questions. We will suggest where to look and, more importantly, how to deter- mine if the information you turn up is accurate and trustworthy. We will give you nine questions you should ask yourself to assess the websites you propose to use and point out some pitfalls to avoid. A recent study found that physicians are increasingly encountering patients who have conducted online health searches. Some physicians even reported having changed their treatment protocols as a result of consumer requests. It is our opinion that physicians should be willing and able to help patients who want to research their own condition. The Agency for Health- care Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate self- education into their treatment process. According to a 2003 Pew Internet & American Life Project, 80 per- cent of U. Two authors attempted to determine the prevalence of health-related searches on the Web. Medical Detective Work on the Internet 75 Another study published in the Canadian Journal of Psychiatry reports that a review of the most common search engines reveals that “the Internet has eliminated the distance barrier and has given the general public equal access to scientific articles, clinical trials, and guidelines. While you should be concerned or at least aware that potential harm can come from using poor-quality health information sometimes accessed on the Internet, studies have revealed very few cases of actual harm. The Montreal Children’s Hospital group, for example, in studying 1,512 abstracts on this topic found few reported cases of such harm. We found some that, among other things, promote the health benefits of drink- ing one’s own urine, oxygenation cures for AIDS, and use of colloidal silver as a cure for Gulf War syndrome. Knowing that such misinformation exists, researchers, organizations, and website developers are exploring alternative ways of helping people find and use the high-quality information that is available on the Internet. We believe if you follow these recommenda- tions and check the accuracy of any information you find with your physi- cian, then any risk is substantially minimized if not eliminated.

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It is not a far cry to see that whether in surgery or in any other activity discount 100 mg luvox with mastercard, great men do not remain parochial purchase 50mg luvox free shipping, or local buy generic luvox 100mg online, or national cheap luvox 50 mg overnight delivery, but rather international and worldwide in their endeavors purchase luvox 100 mg online. The humble origin of Robert Jones in this small Welsh town led ulti- mately to a great British–American alliance in the world of surgery, and then to his establishment of the International Society of Orthopedics and Traumatology, of which he was the first president, this body of surgeons expressing almost inarticu- late admiration by creating for him the unprece- dented title of “Permanent President. Robert Jones qualified in medicine in 1878, and gained the Fellowship of the Royal College of Surgeons of Edinburgh in 1889. He was soon appointed general surgeon to the Liverpool Robert JONES Stanley Hospital and, while still a young man of 1857–1933 30 years, general surgeon to the Royal Southern Hospital of Liverpool. This broad surgical expe- The kindly word, the encouraging smile, the twin- rience stood him in good stead in later years, kling eye with creases all going up in the right when his abilities were applied to that part of direction, and the whole magnetic personality of general surgery concerned with disorders of the Robert Jones, seem as vivid today as they were limbs and spine—orthopedic surgery. He was of 30 years ago when he was at the peak of his course strongly influenced by his uncle Hugh endeavor in creating and establishing the princi- Owen Thomas, to whom he was apprenticed at 11 ples, science and art of orthopedic surgery. Nelson Street—the house that became a Mecca Perhaps his greatest contribution was to the art of for surgeons from all over the world. We have surgery because he taught us all to be so infec- said that Hugh Owen Thomas was descended tious in our happiness that disabled and distressed from a long line of Welsh bone-setters; but even patients also became happy. I never knew a more his father Evan Thomas, unqualified as he may joyful man with his quips, pranks, jokes and have been, treated thousands of patients not only beaming smile, so that when he went to from the industrial north of England but from 164 Who’s Who in Orthopedics every corner of the globe. Robert Jones could London, though always maintaining his free hardly have escaped this traditional influence, or Sunday clinics at Nelson Street. But before he did the powerful personality of his uncompromising so, his alliance with Agnes Hunt had been created uncle, who battled and fought continuously in and firmly established. She had first brought chil- favor of safe and conservative treatment as dren from her derelict country home at Baschurch opposed to unsafe, sometimes wild and often in Shropshire, where stables had been converted dangerous operations. So every Saturday she a wrench concealed beneath his coat-tails to would arrive in Liverpool with two or three correct a recently malunited Colles’ or Pott’s frac- perambulator-loads of crippled children for ture before the patient had time to breathe or Robert Jones to operate upon, and take back a wonder what it was all about; and here it was that similar number of loads to Baschurch. From this Robert Jones learned not to waste time, and to very simple, undignified, perhaps illicit, some- know the great possibilities of conservative treat- times naughty, but always happy and joyful activ- ment. This famous house, having been visited by ity, there developed the great hospital at Gobowen surgeons from throughout the world, who, like the in Shropshire, now the Robert Jones and Agnes Mayo brothers, intended to stay for a day but Hunt Orthopedic Hospital, which with its after- found themselves magnetized for a week, was care clinics serves ten or more counties, most of destroyed by a time-action bomb in the Second the central part of England and Wales, and World War. Fortunately, the stone above the receives patients not only from all parts of this doorway chiselled “H. It was the recovered from the debris and is preserved in the first hospital ever to organize so complete a Hugh Owen Thomas and Robert Jones Library in service—preventive, curative and securative— Liverpool. I, for my sins, having paid some sort first seeking out miserable children who had for- of pilgrimage several days after the raid, stole merly been locked away in hamlets because the some of the broken tiles from that famous corri- crippling had been thought to be a visitation from dor—and I still treasure those fragments. God, bringing them to the hospital for treatment, With this background Robert Jones was versed following up the after-care in their homes, and in the principles of manipulative and conservative then training the disabled in trades, occupations treatment, often uncompromisingly antagonistic and recreations by which to make them self- to the accepted teachings of that day; but to it he supporting men and women. Here again, at what was then the Shropshire Thus he became one of the founders of modern Orthopedic Hospital, but is now the Robert Jones orthopedic surgery. Quite soon his operating and Agnes Hunt Orthopedic Hospital, he would lists at the Southern Hospital, varying in length undertake incredibly long lists of operations, from 20 to 30 operations, starting at 2 o’clock never less than 20 and often as many as 30. These endeavors have occasionally been a few cases of cleft palate, nephropexy or salpin- described since then, rather disparagingly, as gitis put at the end. These were left more and “marathons of surgical exploit”; but this belittles more to Theodore Armour, who probably did not and quite fails to understand the skill of organi- mind starting at seven or 8 o’clock at night zation, and the skill of operative technique, that because he never knew one hour from the other, made it possible. Certainly the also of the extensor tendons on the dorsum of the most dramatic was the vast organization he devel- feet and the flexor tendons at the interphalangeal oped during the First World War, when the loyal level—a technique that is being forgotten; and endeavors of American and British surgeons were while those feet were having plaster-of-Paris fused so happily. It may be true that Lieutenant- applied to the tips of the toes to maintain correc- Colonel, soon Major-General, Robert Jones was tion of the clawed toes as well as of the clawed quite likely to walk down Bond Street with his feet, a subtrochanteric osteotomy was being done general’s cap worn inadvertently back to front; he to correct flexion–adduction deformity of the hip was a terrible soldier; but he was a wonderful joint; and while the abduction frame with skin- friend. What more can of the staff with Robert Jones and the chiefs, the we say? We can say much more, and this is what house surgeons, theater sisters, nurses and order- matters most. He was a mild, lovable, under- lies—most of them seriously crippled themselves. Bernards If you are as breathless in reading that sentence and Irish wolfhounds; he enjoyed boxing, and as I am in writing it, you are not half as breath- how strenuously he boxed himself; he was fond less as we all were in sharing the magnificent of cricket; he loved children, who soon learned to organization and skilled surgery of Robert Jones. He expressed displeasure by gravely deformed and seriously crippled children unruffled and restrained feeling, which was felt for whom the best operative treatment was a rel- rather than heard. He was atively simple procedure, occupying only a few kind, generous and encouraging to young sur- minutes provided that the after-treatment was geons but always with a cloak of anonymity. Since then, these gross defor- was the very great friend of young surgeons, and mities have not arisen because of the sustained few know how very great a friend he was to them. When I was as after-care (a truth that must be declared loudly very young, Robert Jones said that it would be when some socialist ministers of health belabor wise for me to visit European orthopedic centers us on the need for preventive as opposed to cur- and see the work of surgeons in other countries, ative medicine).

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The antiserum constitutes part of the plasma order 100 mg luvox overnight delivery, the clear See also Antibiotics; Infection control component of the blood that is obtained when the heavier blood cells are separated by spinning the blood in a machine called a centrifuge generic luvox 50mg line. AAntiserum and antitoxinNTISERUM AND ANTITOXIN Examples of antisera are those against tetanus and rabies buy luvox 50 mg without prescription. Typically generic luvox 50 mg without a prescription, these antisera are administered if someone Both antisera and antitoxins are means of proactively combat- has been exposed to an environment or purchase luvox 50 mg without prescription, in the case of rabies, ing infections. The introduction of compounds to which the an animal, which makes the threat of acquiring the disease immune system responds is an attempt to build up protection real. The antisera can boost the chances of successfully com- against microorganisms or their toxins before the microbes actually invade the body. After the threat of disease is The use of antiserum and antitoxin preparations is now gone, the protective effect is no longer required. The beginnings of the The advent of antibiotics has largely replaced some strategies dates to the time of Edward Jenner in the late eigh- types of antiserum. Then, Jenner used an inoculum of cowpox antiserum can cause allergic reactions that in some people are material to elicit protection against the smallpox virus. The allergic nature of antiserum, which is also known as Jenner’s strategy of using a live organism to elicit an serum shock, arises from the nature of its origin. Because it is antibody response led to a “third-party” strategy, whereby derived from an animal, there may be components of the ani- serum is obtained from an animal that has been exposed to an mal present in the antiserum. When introduced into a human, antigen or to the microorganism that contains the antigen. This the animal proteins are themselves foreign, and so will pro- so-called antiserum is injected into the human to introduce the duce an immune response. For this reason antiserum is used protective antibodies directly, rather than having them manu- cautiously today, as in the above examples. In this case, the risk of acquiring a life-threatening malady if treatment is not material injected into the animal would consist of active toxin, undertaken. The intent of the latter is to stimu- Serum sickness is a hypersensitive immune reaction to late antibody production against a toxin that has not been changed by the procedures used to inactivate toxin activity. The antibod- The use of antitoxin has been largely supplanted by the ies that are produced bind to the antigen to make larger parti- injection of a crippled form of the toxin of interest (also cles called immune complexes. The complexes can become known as a toxoid) or a particularly vital fragment of the toxin deposited in various tissues, causing a variety of symptoms. The risk of the use of a toxoid The symptoms typically do not appear for a few weeks after or a fragment of toxin is that the antibody that is produced is the antiserum or antitoxin has been administered. For example, the genetic sequences that are responsible for the example, even in the 1930s, the form of influenza caused by protein toxins of the anthrax bacterium are now known. From the bacterium Hemophilus influenzae was almost always these sequences the proteins they encode can be manufactured lethal to infants and children. These pure proteins can then form the basis trician and microbiologist, introduced an anti-influenzal anti- of an antitoxin. The use of this antiserum reduced obtained in very pure form as well, free of contaminating ani- Hemophilus influenzae influenza-related mortality to less than twenty per cent. These antibodies will block the binding of the Antiserum can contain just one type of antibody, which toxin to host tissue, which blocks the toxic effect. This is known as monovalent other cases, such as an antitoxin being developed to antiserum. Or, the antiserum can contain multiple antibodies, Escherichia coli O157:H7, the use of antitoxin is superior which are directed at different antibody targets. They have no effect, however, The indirect protective effect of antiserum and antitoxin on action of the toxin that is released by the bacteria. That is, a protective response is produced in someone who has not been immunized by direct exposure See also Anti-adhesion methods; Antiviral drugs; E. Passive immunity provides immediate but 0157:H7 infection; Escharichia coli; Immune stimulation, as a temporary protection. The incorporation of Antiviral drugs are compounds that are used to prevent or treat the acyclovir derivative exclusively into the viral DNA stops viral infections, via the disruption of an infectious mechanism the formation of the DNA. Acyclovir has success against her- used by the virus, or to treat the symptoms of an infection. Another drug that Different types of antiviral drugs have different modes acts in a similar fashion is famiciclovir.

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