Post-war mothers. childbirth letters to Grantly Dick-Read 1946-1956

No Abstract

Amniotic fluid embolism

Amniotic-fluid embolism is a rare but catastrophic complication of pregnancy. Awareness of this entity will lead to earlier clinical diagnosis. This is essential since treatment, to be effective, must be energetic. This case report, the secondl in the South African literature, is presented together with a brief review of the possible mechanism, complications and treatment

Tuberculous infection of the female genital tract

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Flat Foot II

The most important varieties of 'flat foot' are described and are classified into the 'congenital' and the 'acquired' groups. A foot which on casual inspection appears to be 'flat' will on careful examination prove to be within the limits of normal in the majority of cases. The hasty labelling of a patient as 'flat-footed', whether child or adult, is severely condemned and is generally not justified. Both knowledge and skill are required in the diagnosis of a condition which is as important to the individual as wheels to a carriage and wings to a bird. General rules in the choice of footwear suitable for; children and adults in their various daily activities are laid down. Pedicure is strongly urged, so that the humble feet may enjoy the same degree of fragrance and pride of ownership as the hands. Let our motto be: 'Pale feet, pink-tipped, [loved beside sweet Shalimar' (with apologies)

Uteri E inversion revisited

No Abstract

The blood supply of the human spinal cord at birth: a report on a micro-dissection study of 27 foetal and neonate cadavers

The Vascular system of the human spinal cord at birth has been investigated, and a report is submitted on the detailed pattern of the arterial and arteriolar vessels in 27 cadavers. In 21 instances, the anterior median spinal arterial trunk and in 9 instances the postero-lateral spinal arterial trunks have been recorded. Selection of cadavers has been on the basis of the absence of obvious congenital deformity or disease of the spine and spinal cord. Particular attention has been paid to the feeder arteries which contribute to the main longitudinal channels, both anteriorly and posteriorly. The number of feeder vessels, their ;.., sources of origin .and their approximate size~ have been determined. In 21 specimens the anterior vessels have been recorded and charted in detail. (Plates I - VII). In 9 specimens the posterior vessels have been recorded and the detailed charts of 3 of the latter are presented. (Plate X, p.46). Material and Methods Newborn cadavers, obtained on average 3-5 days after death from various causes such as prematurity, cerebral trauma, pneumonia and pulmonary hyaline membrane have been used. In each case the body was warmed to room temperature, before the introduction into the right femoral artery of a plastic tubular cannula of appropriate gauge. Dilute Ammonia, 2-3 ml., was introduced to promote the flow of the injection material and the specimens were injected with latex under pressures which varied from 5 lbs per square inch to 20 lbs per square inch. The manometric readings of intra-arterial pressure were between 300 mms. Hg and 1200 mms. Hg, and the optimal pressure of delivery was 15 lbs per square inch. Both the arterial and the venous sides of the circulation were well-filled by the injection material, which in all instances was administered via the femoral artery. Rupture of vessel walls with leakage of injection material was not excessive. The number of cadavers rejected on account of inadequate filling or excessive leakage was less than 10 out of approximately 50 cadavers. The injection material consisted of a prevulcanised latex, "Revultex", coloured red with an appropriate dye, and stained through fine muslin before use to ensure freedom from solid particles which could cause obstruction of vessels of fine calibre. The injection material was allowed to penetrate the vascular tree for periods varying from 5 to 15 minutes and the cadaver was then embalmed, injecting the body cavities and infiltrating the limbs as far as possible with a standard embalming fluid consisting of: White Industrial Spirits, 45%; Glycerine, 35%; Formaldethyde, 15%; Thymol, q.s. The cadaver was preserved in a 50% solution of the embalming fluid, and dissections were commenced not less than 14 - 21 days after preparation. Use was made in all instances of the binocular surgical microscope, and magnifications of 10 or of 16 were found to be optimal. Photographic reproductions were made in colour, and the dissected specimens have been preserved. The findings in respect of the anterior arterial system of supply of the cord have been consistent with those of a number of workers, in particular Woollam and Millen (1958) of Cambridge. Additional findings have been reported in respect of the smaller arteries (arteries of the 4. 4th order) including the perforating arteries of the median sulcus. The value of a computerised "average" for the vascular pattern of the cord is disputed. In the opinion of the author, it is likely to be misleading to the clinician and to the surgeon. Reliance upon an average picture in an individual case is liable to be harmful; in the present series of 21 specimens, the average picture as offered by Suh and Alexander (1939) was, in some respects only, applicable to 1 case. The presence of arterio-arterial anastomoses as a common feature in the spine is reported, and the possible significance discussed. Reference is made to a "critical narrow zone" which the author has determined by the radiological examination of 50 vertebral columns in people of all ages. When the region of the "narrow critical zone" is related to the regional blood supply of the spinal cord, then a significant factor in the post-operative development of paraplegia in scoliosis cases has been found to emerge. Vascular factors have been sought in the etiology of idiopathic scoliosis, but not found

Man's atrophic feet

No Abstract

The vulnerable, rapidly growing thoracic spine of the adolescent

The upper and lower surface of the vertebral bodies are covered with a thick carfilaginous plate in which the secondary ossification centres develop at puberfy and continue to grow throughout adolescence. Congenital indentations in the cartilaginous plates are not uncommon and they constitute regions of diminished resistance, which yield under physical stress. Prolapse of disc tissue occurs into the verfebral body, causing a disturbance of growth but little if any pain. The vertebrae in the mid-thoracic region become wedge-shaped, and a kyphotic deformity results, the so-called Scheuermann's disease, or adolescent kyphosis. A plea is made for the screening of children exposed to risk

Profile of Research Methodology and Statistics Training of Undergraduate Medical Students at South African Universities

Background: Medical practitioners need to have knowledge of statistics and research principles, especially with the increasing emphasis onevidence-based medicine. The aim of this study was to determine the profile of research methodology and statistics training of undergraduatemedical students at South African universities in terms of which topics are taught, by whom teaching is done, when these topics are taught and howthey are taught.Method: Respondents for this descriptive study were persons responsible for the teaching of statistics and research methodology at the eightmedical schools in South Africa. They were identified by the head of each school who also gave permission for the school to participate. Therespondents completed a questionnaire and checklist after giving informed consent. No response was obtained from one university. Responses werecompared to international guidelines.Results: At five universities the material is taught in the first year, at one in the second year and one in the third or fourth year, depending on whenit is selected as an elective. The material is reinforced in other modules in the medical programme at three universities. The persons responsible forteaching are mainly statisticians (six universities). Class sizes vary from 40 to 320 students with four universities having 200 or more students perclass. At two universities the current course has been in place since 2003, at two since 2000, and at two since the 1970/80s. The following topicsare taught at the majority of universities: study designs in medical research, exploring and presenting data, summarising data, probability, sampling, statistical inference, analysis of cross tabulation and critical reading. At four universities there are practical classes, three of these mainly for computer work. At three universities tutors are used, at two of these the tutors are postgraduate students in statistics whereas at one university registrars, doctors and researchers are used as tutors. Students at three of the universities complete a research project, at two of these the students complete the full research process from planning up to reporting, whereas the project at the other university focuses mainly on the analysis of data.Conclusion: Recommendations have been made regarding topics which should be covered and teaching methods which should be used at alluniversities. Doctors should be involved in the training to ensure clinically appropriate material and examples