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Following publication of Kite’s article malegra dxt 130 mg amex erectile dysfunction creams and gels, his December 1 buy malegra dxt 130 mg fast delivery erectile dysfunction homeopathic, 1987, at the age of 84. He was sur- method became standard practice for advanced vived by his wife Eva; sons, Donald and Douglas; deformed cases throughout the orthopedic world. Auguste Dejerine KLUMPKE 1859–1927 Joseph Hiram KITE 1891–1986 Auguste Dejerine-Klumpke was born in San Francisco in 1859 and educated in Switzerland Joseph Hiram Kite is generally associated with along with her three sisters. She subsequently the Scottish Rite Hospital for Crippled Children went to Paris for her medical education, which in Decatur, Georgia. He was trained at Johns was obtained only by surmounting all of the bar- Hopkins Hospital and practiced in Atlanta. His riers placed in the way of women who wished to greatest work, however, was done at the hospital pursue a medical career in those days. Dejerine- in Decatur, an institution that primarily served the Klumpke was the first woman extern and intern children of the Kentucky–Tennessee mountain in the Paris hospital system. Early in her career, country, where little medical care was available she described a form of brachial plexus palsy during and before the 1930s. At a time when con- affecting the lowest branches, which is still genital club foot was already being treated in known as Klumpke’s paralysis. Jules Dejerine, a young neu- where he graduated from the college of medicine rologist, while she was still a student and they in 1920. Following this he went to Chicago and tigations that resulted in her husband rising to the took a residency at St. Knowles’inventiveness extended into other neurology at the Salpetriere Hospital in Paris. He designed a fascinating home on the Dejerine-Klumpke was highly respected as a banks of the Des Moines River in the outskirts neurologist in her own right. His inter- est in art continued during his medical career and he carried on with his painting and was involved with several local art groups. Knowles was active in the American Academy of Orthopedic Surgeons since its founding in 1933. He was a past president of the Iowa Orthopedic Society, and a member of the Mid-Central States Ortho- pedic Society, the International College of Sur- geons, and national, state, and local medical societies. Knowles’ productive life can serve as an excellent model for those of us who find our intel- lectual pursuits hurried in the turmoil of private orthopedic practice. Knowles practiced orthopedics pri- vately in the small and academically isolated community of Fort Dodge, Iowa, for over 40 years, he remained a remarkable innovator in the mechanical aspects of orthopedic surgery. We are all familiar with the Knowles pin, which he developed for the treatment of femoral- neck fractures. In addition, he invented a portable fracture table, which was quite useful in the days when itinerant orthopedic surgery was a com- monly accepted practice. He was most well known by his patients for his method of treatment of disc disease with metal internal vertebral support. This procedure required minimum surgi- cal exposure and in his hands, at least, was highly successful. He spent 1 year at the Art Institute in Chicago in 1913, but decided to Theodor Köcher was born in Bern, Switzerland, turn to medicine. In his early 178 Who’s Who in Orthopedics schooling he showed special talent for languages ceeding surgeons and is used now primarily for and art. He graduated with highest honors from the repair of fractures of the hip and acetabulum the medical school at the University of Bern in and for total joint replacement. He sought postgraduate training in surgery in Berlin in Langenbeck’s clinic, but this was impossible because of his Swiss nationality. After prolonged visits to Berlin, London, Paris, and Vienna, he returned to Bern where he obtained a position in the surgical clinic. The medical school in Bern was relatively new, having been founded in 1835.

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After a year at the front buy malegra dxt 130 mg lowest price impotence exercises for men, he joined a nerve injuries unit at Rennes buy discount malegra dxt 130mg on-line erectile dysfunction when pills don't work, and later was at Paris with Babinski. During this time he evolved a series of tests for nerve dysfunction, the best known being his sign of ulnar nerve weakness; another was loss of the hollow of the anatomical snuff box in radial nerve injury. After the war he ran a Red Cross Hospital in Lyons, and the encephalitis epidemic of 1918–1922 provided another intellectual chal- Ronald FURLONG lenge. In 1926 he nearly died as a result of being 1909–2002 severely injured by one of his patients. Froment pointed out the difference between a pinch grip and grasping, both of which are Ronald Furlong, the pioneer of hydroxyapatite- impaired by a low ulnar nerve palsy due to weak- coated hip replacements, died on August 12, 2002 ness of adductor pollicis. Today it is used to assess flexor polli- Switzerland, which fittingly reflects his strong cis brevis. He was honored by Pope Pius XII with a special blessing for his work among the civilian popula- tion in Milan at the end of World War II. In Italy with the Royal Army Medical Corps (RAMC), Furlong developed a particular expertise in plating fractures of the femur and, at the base hospital in Caserta, accumulated a per- sonal series of 200 cases. After the Allied Army took Italy, he was responsible for inspecting a German military hospital. Here, he recognized something very unusual in the treatment of a frac- tured femur and, at the end of the war, was instructed by Whitehall to find out about this new device. After a hair-raising journey through war-torn Europe, he eventually located Professor Küntscher in Kiel via the good offices of Profes- sor Böhler (a friend of Ronnie Furlong’s old chief, Rowley Bristow), whom he found in hiding in Vienna. The currency for this extraordinary adventure was cigarettes and the mode of trans- port a jeep. He returned to Britain much impressed by Küntscher’s work, together with a precious trefoil-shaped intramedullary nail, which he personally delivered to Maurice Down of Down Brothers, the famous old British manu- 107 Who’s Who in Orthopedics facturing company. Thomas’ comprehended that he had ad- Later in his career he would once again turn mitted a 16-year-old is not recorded, but Ronald toward continental Europe for inspiration and probably appeared far older. He was giant of a man, tall, broad shouldered, undoubt- one of the very few British surgeons to be a per- edly handsome and always elegant; even as a sonal friend of Professor Pauwels and one of only schoolboy he doubtless had an imposing style. Thomas’, that was it and the Dean, poor wrote only in “High German” so, in his early man, was probably not given an option to refuse. It is a tribute to his his early admission, winning the Cheselden remarkable intelligence that it took only 3 months Medal for Surgery. As was possible in those days, of early-morning daily German lessons for him to he passed his primary before he qualified in 1931. It seems unlikely his friend, Paul Maquet, one of Pauwels’ disciples he ever actually applied for a job; certainly he and the pioneer of the understanding of the never seems to have attended an interview. He leg alignment in knee surgery, he was translating was appointed a house surgeon to Sir Max Page, the works of Pauwels, Braun and Fischer into a fine clinician who clearly had a tremendous English. He appointed himself sold well in Germany, as the text was more com- to his next post, informing Rowley Bristow at a prehensible when written in English than in the garden party that he proposed to come and work complexity of classical German! Bristow was the first orthopedic consult- 1960, I can recall the often animated debates on ant at St. Thomas’ and had been placed there by biomechanics that would take place among his mentor, Sir Robert Jones. Even though the Messrs Furlong, Maquet, Kummer, the distin- First World War had given a great boost to ortho- guished anatomist and pioneer of comparative pedic and trauma surgery, the specialty was, in the biomechanics from Cologne, and Bombelli, the 1930s, still tiny. Such expansion that had occurred Italian guru of proximal femoral osteotomy. Finally, it was the link with the From the former Furlong learned the art of clini- German faciomaxillary surgeon Dr. Osborn that cal surgery and, from the latter, the art of leader- would introduce hydroxyapatite coatings and ship. He duly became registrar and then chief revolutionize prosthetic fixation. Furlong’s career was extraordinary in the true The medical world of the 1930s was very dif- sense of the word, for nothing about him or what ferent from today.

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Burnett (1979) reminds us that it is the ‘point’ 130 mg malegra dxt erectile dysfunction vacuum, not just the words buy 130mg malegra dxt amex impotence by smoking, that needs to be recorded. What point or message do you think the lecturer is attempt­ ing to communicate? The lecturer will often help you by giving verbal and non-verbal cues about the importance of an item and how topics link together. Listen out for prompt phrases that signal a main point, for example, ‘this is the key concept’ or ‘there are three principles’. Other phrases, like ‘in contrast’ or ‘simi­ larly’, tell you about the connection between ideas. Non-verbal cues will also give you information; for example, speakers often pause before an im­ portant point. Make a conscious selection from the explanations, examples and refer­ ences used to support the lecturer’s main arguments. Thinking of your own examples is one way to help make sense of the information. Set aside 20 minutes to review your notes as soon as possible after the end of the lecture. This task is often more usefully done in conjunction with another student or in a study group. Check you have all the main points and look out for any informa­ tion you have omitted or were unclear about. Try to fill in the gaps or iden­ 162 WRITING SKILLS IN PRACTICE tify where you can follow up information. This may be in a tutorial or a reading session, or you may need to go back to the lecturer. Written material Before making any notes think carefully about your purpose in reading the material. This will help you in only not­ ing the details relevant for your task, rather than spending time in writing a précis of the whole article or chapter. This includes dates, names, references to further reading, quotes and defini­ tions. However, in written material it may be quicker to photocopy reference lists and de­ tailed illustrations. Start to compile a bibliography by recording the books and articles you have used for your notes. Record the information either manually us­ ing a card index or electronically on a computer database. Notes can be quickly scribbled down as you browse through the shelves at the library. However, if you need to compile a reference list, then a data­ base is the preferred method. See Chapter 17, ‘Getting the Best Out of Your Personal Computer’, for more information on databases. Make sure you record all the information required to fulfil your institu- tion’s guidelines on writing references. See Chapter 12, ‘Dissertations’, for more information about writing references. For books: ° title ° author(s) (including first names) ° year of publication ° edition ° publisher ° place of publication ° library and classification number NOTE-TAKING 163 ° précis of content ° personal notes on usefulness, readability. For articles: ° title ° author(s) (including first names) ° year of publication ° journal title ° journal volume/issue number ° pages containing article ° library and shelf number or topic code. Practical demonstrations Keep note-taking to a minimum in any sort of practical demonstration. The emphasis will be on showing you what is happening, and in some cases on you joining in and having a go yourself.

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It is unlikely that anybody who was not already suspicious that immunisation might be harmful would suspect a link buy malegra dxt 130mg low cost erectile dysfunction doctors fort worth. The MMR scare led to a period of intensive and prolonged discussions in the baby clinic as parents agonised over the decision whether to have their baby vaccinated order 130 mg malegra dxt fast delivery impotence hypertension medication, baffled and confused by contradictory medical opinions. It has led inevitably to a fall in the 19 HEALTH SCARES AND MORAL PANICS uptake of the vaccine, raising fears of a return of measles if the general level of immunity in the community fell any lower. Minor health scares Health scares have something in common with showbiz celebrities, both owing much to the media. Some appear suddenly and after their ‘fifteen minutes of fame’ disappear as rapidly; others emerge more gradually and remain on the stage for years, though largely in the background; others still have an initial flurry in the limelight, then fade for a while, only to make periodic comebacks before slowly fading. Here is a far from exhaustive list of scares which have one common feature: they have all been raised in one form or another by patients in my surgery over the past decade. In the event, fears of an upsurge in malignancies resulting from Chernobyl were not realised and the theory about leukemia clusters has not been substantiated. Ten years later an out- break of gastroenteritis traced to beef contaminated with E. The fear of lethal infection was added to existing concerns about food safety, arising from the use of pesticides on plants, antibiotics and other drugs on animals and diverse additives and preservatives. The main consequence is a flourishing trade in bottled water, though this also became the focus of a scare when contaminated stocks provided by a leading supplier had to be removed from supermarket shelves. Signs around canals and waterways warning of the danger of Weil’s disease, a rare infection transmitted by the urine of rats and almost exclusively affecting sewage workers, have led to at least two requests for blood tests in my surgery. Perhaps the greatest irony of the recent wave of scares is that they have taken off at a time when everyday life in Western society is safer than ever and when the quality of our environment and of our food, water and air is higher and more highly regulated than at any time in history. Contracep- tion is risky, but so is unprotected sex and the menopause only brings the choice between worrying about osteoporosis and fractures or the side-effects of HRT. In the context of detailed advice on how to avoid these terrifying infections, the pamphlet’s comment that they are all ‘very rare, and it is unlikely that you or your baby will be affected’ is scarcely reassuring. While ‘breast is best’ and formula feeds potentially harmful, breast milk has also been shown to transmit numerous toxins. The spectre of meningitis, a rare condition whose features are now familiar to millions, hovers over every viral illness which pro-duces a fever and a rash. Jealous at having been left out of earlier health scares, advocates of men’s health have tried to catch up by promoting anxieties about prostate and testicular cancer as well as concerns about falling sperm counts. Key features A number of common features emerge from our brief survey of some of the more significant health scares of the past decade. At the source of each lies a serious disease, often with a powerful symbolic 22 HEALTH SCARES AND MORAL PANICS character. The risk to any particular individual of acquiring this disease may be low, but it is often also either indeterminate or difficult to establish with any accuracy, creating great scope for speculations which invariably feature worst-case scenarios. Though there have been scares in the past, the recent wave is unique in its scope and impact. The diseases at the root of the major scares are generally terrifying and often rapidly fatal. Some are grossly debilitating (Aids, nvCJD), others disfiguring (malignant melanoma). Some cause sudden death in previously healthy individuals (cot death in babies, pulmonary embolism in women on the Pill), others cause lifelong disability (autism). They often appear to strike the most vulnerable, or even if that is not generally the case, as with Aids, ‘innocent victims’—babies infected by their mothers, or recipients of infected blood transfusions—are singled out for particular sympathy. Health scares are all the more frightening when they are associated with some intimate or familiar activity, like sex, eating, sunbathing, putting the baby to bed. The apparently random way in which these demons strike, reinforced by the vogue for quoting risks like gambling odds, encourages gloomy forebodings and reinforces a fatalistic outlook. Health ministers and medical authorities have been criticised for their failings in communicating the subtleties of risk to the public— and thereby inflaming public fears, particularly in relation to mad cow disease and the Pill.

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