Opera Occulta

With a mixture of pride and humility I began to turn the pages of the great leather-backed volumes which enclose the early Dissertations of the Royal Medical Society. It was something to be done with care, for the pages are brittle and cachetic. The regular, flowing, almost copper-plate writing is only s lightly faded and is eminently legible. We, who can achieve immaculate script only through the medium of machinery, might pause and consider the scholarship of our predecessors who wrote Greek, Latin or English with artists’ hands

The Use of Controls in the Assessment of Clinical Evidence

The prize-winning essay from the B.M.A. Essay Competition for Provisionally Registered General Practitioners. 1961. The essay is abridged.The incorporation of standards or controls into clinical experimentation has become, over the past decade, a widely accepted practice. So much so that there is a danger that the medical profession in general may become uncritical of the practical and, more important, the ethical problems involved. The subject should be under constant review.Are controls really necessary? How best can they be employed? How is the resulting evidence to be assessed? Under what circumstances can the use of controls be justified on ethical grounds

Res Medica, Spring 1958, Volume 1, Number 2

TABLE OF CONTENTSTHE ROYAL MEDICAL SOCIETY TO-DAYTHE CONCEPTUAL BASIS OF MODERN SURGERY: Professor John Bruce, C.B.E., T.D., P. R.C.S.E., F.A.C.S. (HONS.)SOME PATHOLOGICAL ASPECTS OF DISSECTING ANEURYSM: M. J.MacLeanCHANGING FASHIONS IN DIABETES: Professor D. M. Dunlop, B.A., M.D., F. R.C. P. F. , F.R.C.P.OPERA OCCULTA: C. Vaughan RuckleySOME ASPECTS OF NUTRITIONAL AND TOXIC LIVER INJURY: A. W. DellipianiSIR JAMES YOUNG SIMPSON: William L.FordTHE AETIOLOGY OF DISSEMINATED SCLEROSIS: J. G. TurnbullHAZARDS OF RADIATION: Andrew Gun

Opera Occulta: Interrupted Fertility

Collected from the Society’s ArchivesMrs Buff, wife of Mr Buff, silk weaver in Fashion Street in Spitalfields, London, aged twenty-seven years, the mother of several Childrine, on 27th of July 1774, having gone her usual time of pregnancy, was attended by her midwife several days, but the labour pains ceasing, the midwife left her promising to return soon, but did not fulfill her promise, Mrs B. not being delivered of her child, thought she might have a month longer to go & went about her domestic affairs as usual

Res Medica, Volume 1, Number 1, 1957

TABLE OF CONTENTSEDITORIAL                                                                      TO BE OR NOT TO BE — A DOCTOR: Sir Stanley Davidson, B.A., M.D., P.R.C.P.E., F.R.C.P.( LOND.), Q.H.P.                                                BENJAMIN FRANKLIN: Forrester Cockburn   MODERN CONCEPTS OF BREAST CARCINOMA: Sir Arthur Porritt , K.C.M.G., C.B.E.,M.A., M.ch., F.R.C.S.                                                         NORTH AMERICAN KALEIDOSCOPE: Alastair G. MacGregor , B.SC., M.D., F.R.F.P.S.G.,M.R.C.P.E., M.R.C.P.                                                               BRONCHOGENIC CARCINOMA: James A. GrayOPERA OCCULTA: Collected from the Society’s archives: C. Vaughan Ruckle

Prevention of recurrence of venous ulceration: randomised controlled trial of class 2 and class 3 elastic compression

ObjectiveTo compare venous ulcer recurrence and compliance with two strengths of compression hosiery.MethodsThis study was a randomized controlled trial with a 5-year follow-up. The setting was the leg ulcer clinics of a teaching and a district general hospital in Scotland, United Kingdom. Patients were 300 outpatients with recently healed venous ulcers, with no significant arterial disease, rheumatoid disease, or diabetes mellitus. Interventions were fitting and supply of class 2 or class 3 compression hosiery. Four-monthly refitting by trained orthotists and surveillance by specialist nurses were performed. The main outcome measures were recurrence of leg ulceration and compliance with treatment.ResultsThirty-six percent (107/300) of patients had recurrent leg ulceration by 5 years. Recurrence occurred in 59 (39%) of 151 class 2 elastic compression cases and in 48 (32%) of class 3 compression cases. One hundred six patients did not comply with their randomized compression class, 63 (42%) in class 3 and 43 (28%) in class 2. The difference in recurrence is not statistically significant, but our estimate of the effectiveness of class 3 hosiery is diluted by the lower compliance rate in this group. Restricted ankle movement and four or more previous ulcers were associated with a higher risk of recurrence.ConclusionsThere was no evidence of a difference in recurrence rates at the classic level of significance (5%), but the lowest recurrence rates were seen in people who wore the highest degree of compression. Therefore, patients should wear the highest level of compression that is comfortable