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Ingham (3) reported that at least 75% of cases of stuttering speculate that there is a genetic contribution to the aetiology seroquel 300 mg low cost. However buy seroquel 50 mg overnight delivery, it must be realised that there are several nongenetic Shprintzen (4) considered that virtually all instances of reasons why a disease phenotype, causally unrelated to a genetic human disability and disease have a genetic component, even if predisposition, can be seen recurrently in the same family. He was referring nongenetic familial aetiologies should be taken into account primarily to craniofacial anomalies, but his comment applies when postulating a genetic contribution to a particular disorder. Members of a family are frequently exposed to the same It is well known that clefts of the lip with or without clefts environmental insults. This may lead to recurrent manifestation of the palate may be of genetic origin or may be produced by of the same condition. A poor or rich educational environment environmental factors or chromosomal anomalies. The often multifactorial or, as many geneticists believe, caused by a combined effects of such factors as age, sex, education, parental single mutant gene with allelic restriction (5). Medical conditions such as diabetes, lupus ery- yet, no concrete evidence of a connection between genes or thematosus, and phenylketonuria can all result in sequelae that some combination of genes and grammatical abilities, but that can give the appearance of a genetic relationship. However, before learning can begin, children must be Dialects and language-related difficulties, despite recurrence in ready to learn; that is, they must be biologically, socially, and a family, may be due to a shared cultural (rather than genetic) psychologically mature enough to undertake the task. Differences in habits and abuse of drugs or alcohol As Kies reported (22), linguists do not agree on exactly may result in a phenotype that can be misconstrued as being of how biological factors affect language learning, but most agree genetic origin. Foetal alcohol syndrome shows a constellation with Lenneberg (23) that human beings possess a capacity to of features that may include a characteristic facial appearance; learn language that is specific to this species and no other. Lenneberg also suggested that language might be expected from By chance, two members of a family may develop the same the evolutionary process that humans have undergone, and that condition with no underlying genetic or environmental predis- the basis for language might be transmitted genetically. Also, some members of a family may acquire a condi- As part of genetically endowed language abilities, tion for reasons completely unrelated to other members of the Lenneberg (24) hypothesized a “critical period” during which family. A “phenocopy” is an individual with a phenotype simi- language learning proceeds with unmatched ease. A child’s lar to other members of a family but with a different aetiology early years are especially crucial for language development (11). However, some stochastic events may be influenced to because that is the period before the two hemispheres of the some degree by a genetic predisposition (12). As Mendel (13) first delineated the methods by which genetic partial proof of this, Lenneberg discussed cases in which chil- factors are transmitted and first discovered the basis of heredity dren in bilingual communities were able to learn two languages in his studies of peas. Although most communicative disorders fluently and without obvious signs of effort before the age of appear to have a complex inheritance pattern, a select group of about 12. However, learning a second language after the age of communicative disorders has inheritance patterns that directly 12 becomes enormously difficult for most people. Similarly, many neurolinguists have argued that children’s brains are biologically too immature to comprehend several grammatical concepts commonly used in languages around the world. Concepts such as plurals, auxiliary verbs, inflectional end- Language development ings, and temporal words will develop in all languages in stages. One of the earliest scientific studies to record the language The fact that those stages of language development are “identi- development of a child was that by a German biologist cal” and “predictable” in all languages further suggests that there Tiedemann in 1787 (14). He was interested in starting a col- are strong biological preconditions for learning language. The concept of a sentence is the main guiding principle in Interest in language development intensified with the publica- a child’s attempts to organize and interpret the linguistic evi- tion of Darwin’s theory of evolution, and Darwin (15) himself dence that fluent speakers make available to him. These ideas contributed to the study of language development in children, are a part of the “nativist” position discussed later. When the German physi- insufficient evidence to conclusively specify the contribution of ologist Preyer (17) published a detailed descriptive work care- biology to human language, but all linguists acknowledge that fully recording the first three years of his son’s development, the biology does have a role. Even before the child has uttered the first word, ■ Critical periods and “feral” children a long process of growth and language development has already ■ Genetically predetermined aspects of language processing started. For instance, a newborn baby will recog- nize his mother’s voice at birth and can see with perfect visual Preconditions for language development acuity his mother’s face when nursing him, but no further. Although children will begin to vocalise and verbalise at differ- All the neurons are already present at birth. What does ent ages and at different rates, most children learn their first increase after birth is the number of dendrites and synapses. In language, a highly complex and abstract symbol system, without humans, a considerable degree of development continues far Genetics of communicative disorders 175 Figure 12. The brain overproduces neural connections, tribute to increase the speed of neural transmission (Fig. The frontal lobes first kick in at about six months, bring- tiple specific genes involved” (26).

Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia buy seroquel 50mg with amex. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia cheap seroquel 50mg with visa. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Hospital infection control: recent progress and opportunities under prospective payment. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units. Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients. Changing bacterial ecology during a five-year period of selective intestinal decontamination. Sedation, sucralfate, and antibiotic use are potential means for protection against early-onset ventilator-associated pneumonia. Gastro-oesophageal reflux in mechanically ventilated patients: effects of an oesophageal balloon. Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. Care of the ventilator circuit and its relation to ventilator- associated pneumonia. Weekly versus daily changes of in-line suction catheters: impact on rates of ventilator-associated pneumonia and associated costs. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Subglottic secretion drainage for preventing ventilator- associated pneumonia: a meta-analysis. Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials. Efficacy of heat and moisture exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. Antiseptic impregnated endotracheal tubes for the prevention of bacterial colonization. Endotracheal tubes coated with antiseptics decrease bacterial colonization of the ventilator circuits, lungs, and endotracheal tube. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. Exposure to allogeneic plasma and risk of postoperative pneumonia and/ or wound infection in coronary artery bypass graft surgery. Transfusion and postoperative pneumonia in coronary artery bypass graft surgery: effect of the length of storage of transfused red cells.

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Head lice infection is very com- extreme cases injected nerve-block medication or mon and easily acquired by coming in close contact surgery generic seroquel 300 mg on-line. Symptoms of head lice infestation include a headache generic seroquel 300 mg otc, febrile A headache associated with tickling feeling of something moving in the hair, fever. Because febrile headache can sometimes indi- itching caused by an allergic reaction to the bites, cate serious conditions such as inflammation of the irritability, and sores on the head caused by scratch- brain (encephalitis), a person who is suffering from ing. Although lice are very small, they can be seen a febrile headache should immediately seek med- on the scalp when they move. Treatment involves a com- bination of topical insecticidal medication and man- headache, migraine See migraine headache. Often a rebound health care proxy An advance medical directive headache occurs right after the medication wears in the form of a legal document that designates off. Treatment involves using the medication less another person (a proxy) to make health care deci- frequently or switching to a different pain reliever. The health care headache, sinus A headache caused by pressure proxy has, in essence, the same rights to request or within the sinus cavities of the head, usually in con- refuse treatment that the person would have if he or nection with sinus infection. The sufferer has pain she were capable of making and communicating and tenderness in the sinus area, discharge from the decisions. Treatment involves treating the underlying condition, which is health outcomes research Research that meas- often an allergy, and using nasal vasoconstrictors ures the value of a particular course of therapy. Hearing aids contain a microphone, in the back of the neck, on the scalp, and sometimes amplifier, and speaker. The term tension-type headache is now preferred, reflecting the fact that research has shown heart The muscle that pumps blood received from that these headaches may not be related to muscle veins into arteries throughout the body. Although the cause is unknown, they are positioned in the chest behind the sternum (breast- believed to be related to the levels of neurotransmit- bone); in front of the trachea, esophagus, and aorta; ters in the brain and are possibly complicated by and above the diaphragm. Stress, lifestyle changes, and the size of a closed fist and weighs about 298 grams changes in sleep patterns are among many possible or 10. Two-thirds of the heart lies in the left side of the chest, with the balance headache, thunderclap A sudden and excruci- in the right side of the chest. Some physicians feel that of specialized cardiac muscle, and it is four-cham- in the absence of a known headache disorder, such bered, with a right atrium and ventricle, and an as migraines, a thunderclap headache may some- anatomically separate left atrium and ventricle. A blood flows from the systemic veins into the right person who experiences this type of headache atrium, thence to the right ventricle, from which it is should immediately seek medical attention. The heart is thus headaches felt to involve abnormal sensitivity of the functionally composed of two hearts: the right heart blood vessels (arteries) in the brain to various trig- and the left heart. The right heart consists of the right gers, resulting in rapid changes in the artery size atrium, which receives deoxygenated blood from the due to spasm (constriction). Other arteries in the body, and the right ventricle, which pumps the deoxy- brain and scalp then open (dilate), and throbbing genated blood to the lungs under low pressure; and pain is perceived in the head. Migraine headache is the left heart, which consists of the left atrium, which the most common type of vascular headache. Not infrequently, this leads to the death of a physician while he or she listens to the chest with part of the heart muscle due to its loss of blood sup- a stethoscope. Typically, the loss of blood supply is caused by a never treated, sometime the condition it represents complete blockage of a coronary artery by a blood may require treatment. The interruption of blood flow is usually caused by arteriosclerosis, with narrowing of the heart rate The number of heartbeats per unit of coronary arteries, the culminating event being a time, usually per minute. Death of the heart muscle often the number of contractions of the ventricles (the causes chest pain and electrical instability of the lower chambers of the heart). Electrical instability of the heart too fast (tachycardia) or too slow (bradycardia). The pulse is often taken at the brain damage and death can result from heart wrist to estimate the heart rate. That portion of the septum resuscitation) within 5 minutes of the onset of ven- that separates the right and left atria of the heart is tricular fibrillation. When paramedics arrive, med- termed the atrial, or interatrial, septum, whereas the ications and/or electrical shock (cardioversion) to portion of the septum that lies between the right and the heart can be administered to convert ventricular left ventricles of the heart is called the ventricular, or fibrillation to a normal heart rhythm. All four is not uncommon and is detected with an electro- heart valves are one-way valves, permitting forward cardiogram. Blood enter- or scarring of the electrical pathways in the heart ing the heart first passes through the tricuspid valve, muscle, either naturally or as a result of disease. After returning from Heart block typically requires no treatment, but can the lungs, the blood passes through the mitral be a factor in the decision of whether or not to put (bicuspid) valve and leaves the heart via the aortic a pacemaker in a heart that is failing or irregularly valve to pass through the aorta. A heart murmur is created by and warmth that occurs in waves, rising up behind blood flow through a heart valve, by blood flow the breastbone (sternum) and moving toward the through a narrowed chamber, or by an unusual neck. It connection between the chambers, as seen with is usually due to gastroesophageal reflux, the return congenital heart disease. See also gas- mur does not represent any disease or condition troesophageal reflux disease. There are many forms of heart murmurs heart-lung machine A machine that does the representing a variety of heart conditions. Each type work both of the heart and of the lungs: pumping of murmur is characterized by its location, timing, and oxygenating blood.

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Emergent threats such as the Nipah virus in Malaysia in 1998–1999 further add to the differential diagnosis for returning travelers with encephalitis (89) generic seroquel 100 mg free shipping. An open-label trial reported a 36% reduction in mortality for acute Nipah virus encephalitis when treated with intravenous ribavirin (90) purchase 50 mg seroquel visa. The travel and exposure history will greatly assist in the inclusion/exclusion of parasitic etiologies. Acute Abdomen Returning travelers presenting with an acute abdomen are most likely to have common conditions seen in nontravelers such as appendicitis, cholecystitis, diverticulitis, or peptic ulcer with perforated viscus (92). Two common diseases in indigenous populations, enteric fever and amebic liver abscess, occur occasionally in immigrants and less commonly in naive travelers (92– 94). Both of these diseases may present with an acute abdomen secondary to severe abdominal pain from uncomplicated disease or as a result of complicated disease such as cyst rupture in 330 Wood-Morris et al. Risk factors for intestinal perforation in typhoid fever were a short duration of symptoms (within 2 weeks of illness onset), inadequate antibiotic therapy, male gender, and leukopenia in a case-control study in Turkey (95). Enteric fever is most commonly due to Salmonella typhi, but also can be caused by S. A larger proportion (69%) has been imported during foreign travel especially from Mexico and India (98). Confirmatory diagnosis of typhoid fever requires blood culture isolation that is positive in approximately 80% of cases or approximately 90% with bone marrow culture (97,101). Stool and urine cultures are occasionally positive, 37% and 7%, respectively, but do not constitute definitive evidence of systemic infection. Adjunctive therapy with high-dose corticosteroids has been shown to decrease mortality in severely ill typhoid fever patients with delirium, obtundation, coma, or shock (104). The majority (95%) of amebic liver abscesses will present within the first two to five years after leaving the endemic region (93,105,106). The differential diagnosis must also include bacterial liver abscess, echinococcal cyst, and hepatoma. Therapy with parenteral metronidazole results in mortality rates of <1% in uncomplicated liver abscesses (93). However, complicated amebic liver abscesses with extension into the thoracic cavity, peritoneum, or pericardium have case-fatality rates of 6. Dysentery and Severe Gastrointestinal Fluid Losses Dysentery is characterized by a toxic appearance, fever, lower abdominal pain, tenesmus, and frequent small-volume loose stools containing blood and/or mucus with large numbers of fecal leukocytes on microscopic exam. Etiologies of dysentery can be divided into amebic (Entamoeba histolytica) versus bacillary [Shigella spp. Shigellosis is the most common etiology and is associated with fatality rates as high as 9% in indigenous populations in endemic regions and 20% during S. Predictive factors associated with increased risk of death in shigellosis (age older than one year, diminished serum total protein, thrombocytopenia, and altered consciousness) reflect the importance of sepsis in shigellosis-related deaths (108). Diarrhea-related mortality in noninflammatory diarrhea has been significantly reduced globally with the institution of oral rehydration therapy. Dysentery-related deaths have not been significantly reduced and require antimicrobial therapy and supportive intensive care in addition to appropriate rehydration (106,107,109,110). Noninflammatory diarrhea due to cholera may present in a returning traveler with life- threatening dehydrating illness with profound fluid and electrolyte deficits (111). Imported Vibrio cholerae is rare in the United States; however, an appreciation of regional risks of epidemic strains (El Tor in South/Central America and Africa, non-O1 V. Fulminant Hepatitis Fulminant hepatitis manifests as severe acute liver failure with jaundice and hepatic encephalopathy (112). Hepatitis B accounts for 30% to 60% with coinfection with delta virus in 30% to 40% that has been demonstrated to increase disease severity (116). Hepatitis C association with fulminant non-A, non-B hepatitis has been reported in Japan but is very uncommon in Western countries (117,118). Hepatitis E, a virus transmitted via an enteric route, has an increased fatality rate in pregnant women (119). Early indicators of a poor prognosis and the potential need for liver transplantation in viral hepatitis include age <11 years or >40 years, duration of jaundice before onset of encephalopathy less than seven days, serum bilirubin >300 mmol/L, and prothrombin time >50 seconds (120). Early diagnosis of acute hepatitis is important, given evidence of specific benefit from antiviral therapies including lamivudine in acute Hepatitis B and interferon therapy for Hepatitis C (121–125). Other less common causes of fulminant hepatitis include Yellow fever virus and leptospirosis. A resurgence in yellow fever in Africa and South America emphasize the continued threat from this agent for unvaccinated travelers (126). Severe yellow fever is fatal in >50% of cases and continues to be a cause of deaths in returning travelers (127–130). Leptospirosis has widespread distribution and is usually transmitted to humans through contact with surface water contaminated with urine from infected animals (131). Travelers returning with leptospirosis typically present with a mild or moderate illness. A recent randomized controlled trial demonstrated equal efficacy of seven-day intravenous therapy with ceftriaxone (1 g daily) and penicillin G (1.

Multiple metastatic lesions from individual patients were analyzed along with 22 paired pretreatment and posttreatment samples cheap seroquel 200 mg online. In the paired primary and relapse cohort purchase seroquel 200mg fast delivery, they observed a greater degree of genomic change in tumors from patients that were initially sensi- tive to chemotherapy and had longer progression-free interval compared with tumors from patients that were resistant to primary chemotherapy. Mapping the mechanisms that confer resistance may enable prediction of whether some women are likely to respond to a certain drug or not, and find ways of reversing resistance. Pathway Targeted Therapies for Ovarian Cancer Mouse ovarian epithelial tumor cell lines that contain various combinations of genetic alterations in the p53, c-myc, K-ras and Akt genes have been used as model for the molecular characterization of pathway-targeted therapy. Response to a par- ticular anticancer drug can be related to the signaling pathway involved. Rapamycin effectively inhibits the growth of tumors that rely on Akt signaling for proliferation, whereas tumors in which Akt signaling is not the driving force in proliferation are resistant to rapamycin. The introduction of activated Akt to the rapamycin-resistant cells does not render the cells susceptible to rapamycin if they can use alternative pathways for survival and proliferation. Therefore, the rapamycin-sensitive tumors develop resistance to rapamycin when presented with alternative survival pathways, such as the mitogen-activated extracellular kinase signaling pathway. These findings indicate that mammalian target of rapamycin inhibitors may be effective in a subset of tumors that depend on Akt activity for survival but not effective in all tumors that exhibit Akt activation. Tumors with alternative survival pathways may require the inactiva- tion of multiple individual pathways for successful treatment. These results have significant implications for the use of pathway-targeted therapy in advanced human ovarian cancers, which typically display numerous genetic alterations that are likely to require impairment of multiple molecular pathways for successful treatment. Universal Free E-Book Store Personalized Management of Cancers of Various Organs 323 Interruption of multiple specific biochemical pathways may be a promising therapeutic strategy in ovarian carcinomas that exhibit resistance to an individual targeted therapy. This strategy may be useful for developing personalized therapies for ovarian cancer. Resistance to platinum therapy is a major obstacle that needs to be overcome in the treatment of ovarian cancer patients. These findings indicate that targeting the Notch pathway significantly increases tumor sensitivity to platinum therapy. Both platinum-resistant and platinum-sensitive relapses may benefit from such an approach as clinical data suggest that all relapses after platinum therapy are increas- ingly platinum resistant. A catalogue of molecular aberrations that cause ovarian cancer is critical for developing and deploying therapies that will improve patients’ lives. Overall, these discoveries set the stage for approaches to the treatment of high-grade serous ovarian cancer in which aberrant genes or networks are detected and targeted with therapies selected to be effective against these specific aberrations. Targeting Hematogenous Metastasis of Ovarian Cancer Ovarian cancer has a clear predilection for metastasis to the omentum, but the underlying mechanisms involved in ovarian cancer spread were not well under- stood. These results highlight hematogenous spread as an important mode of ovarian cancer metastases and use of this knowledge to design better strategies for prevention and treatment. An estimated 80 % of platinum-resistant ovarian cancer patients have been found to have folate receptor-positive disease, and ~40 % express the receptor, as detected by etarfola- tide, in all of their target tumor lesions. Compared to patients who do not express folate receptors on their tumors, folate receptor-positive patients have been shown to have a poorer overall prognosis. Vintafolide is a conjugate of folic acid (vitamin B9) linked to an anticancer agent, the potent vinca alkaloid desacetylvinblastine hydrazide. Since cancer cells Universal Free E-Book Store Personalized Management of Cancers of Various Organs 325 generally consume higher levels of folate than normal cells to fuel their growth, some cancer cell types, including ovarian, have high concentrations of the folate receptor on their surface. Vintafolide is designed to selectively target the folate receptor to deliver the anti-cancer agent to the cancerous tissue. Tumors that have high concentrations of the folate receptor are identified by etarfolatide, a non- invasive imaging diagnostic agent. Intravenous folic acid is used with 99m Tc- etarfolatide for the enhancement of image quality. Future research needs to identify factors that correlate with response (or lack of one) and the underlying genotype-phenotype relationship that dictates this response. Likewise, elevated levels of p16 in a tumor were not especially informative on their Universal Free E-Book Store 326 10 Personalized Therapy of Cancer own, though they did correspond to better oropharyngeal cancer survival when found together with positive blood tests for E6 and E7. Personalized Management of Hematological Malignancies Myeloproliferative disorders include several pathologies sharing the common fea- ture of being clonal hematopoietic stem cell diseases. Hematological malignancies are highly heterogeneous in the matter of molecular mechanisms related to their development and progression. A considerable heterogeneity can be further observed within the same disease at the interindividual level as reflected by different clinical outcomes and responses to treatment in different patients. Considerable work has been done on molecular cytogenetics of hematological malignancies and a number of diagnostics and therapies are available or under development. Such a recurrent and unique Universal Free E-Book Store Personalized Management of Cancers of Various Organs 327 mutation leading to a tyrosine kinase deregulation would make a suitable target for the development of specific therapies. That being so, by potentially highlighting inter-individual dif- ferences that may play a role in the differential success of diverse therapeutic inter- ventions, they promise to be crucial for selecting the most appropriate medical treatments.

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Norbert Guterman) Old persons are sometimes as unwilling to die as tired-out children are to say good night and go to bed buy 50 mg seroquel otc. Walshe in Teachers of Medicine Bodies devoid of mind are as statues in the market Jean Fernel – place buy seroquel 100mg on line. Paris trained physician to Catherine de Medici Electra  The physician today seems athirst for blood. For they which share one father’s blood shall oft Blood-letting, like wine-drinking, is right enough By many a bodily likeness kinship show. Electra  Treatise,  (quoted in The Endeavour of Jean Fernel, Pt ) A weary thing is sickness and its pains! Anatomy is for physiology what geography is for Hippolytus  the historian: it describes the scene of action. Sickness poses only one problem for the patient, but for the Magister Ferrarius th century nurse it involves both mental agony and hard physical work. I would very much rather stand three times in the front of – battle than bear one child. Pollak) Henry Fielding – Sir Grimley Evans – English novelist Professor of Clinical Gerontology, Oxford, England It hath been often said, that it is not death, by The aging of an organism is a progressive loss of dying, which is terrible. When such distempers are in the blood, there is never any security against their breaking out; and that often Margaret Jane Evans – on the slightest occasions, and when least Paediatric pathologist suspected. He that dies before sixty, of a cold or consumption, Hospital Doctor  August (), in response to the reaction dies, in reality, by a violent death. They were started for the punishment of the spirit and have ended in the After two days in hospital I took a turn for the punishment of the body. Fischerisms Howard Fabing and Ray Marr () Attributed The first rule to proper diet? African-born Christian apologist Fischerisms Howard Fabing and Ray Marr () Everyone should bear in mind that the union of Whenever ideas fail, men invent words. Archbishop of Canterbury Fischerisms Howard Fabing and Ray Marr () Consultant specialists are a degree more remote The greatest discoveries of surgery are (like bishops! Fischerisms Howard Fabing and Ray Marr () Lancet :  () The heart is the only organ that takes no rest. All human science is but the increment of the Fischerisms Howard Fabing and Ray Marr () power of the eye, and all human art is the All the world is a laboratory to the inquiring increment of the power of the hand. One cannot ignore the enormous importance of Fischerisms Howard Fabing and Ray Marr () early detection of an appendix which may burst. Lecture to Boston Medical Society, June () When he lacks mental balance without the pneumonia, he is pronounced insane by all smart doctors. Fischerisms Howard Fabing and Ray Marr () The Crack-up ‘Sleeping and Walking’ An insane man is a sick man. Sir Alexander Fleming – Fischerisms Howard Fabing and Ray Marr () British microbiologist A man who cannot work without his A good gulp of hot whisky at bedtime – it’s not hypodermic needle is a poor doctor. Fischerisms Howard Fabing and Ray Marr () Where there is sunshine no doctors are wanted. English lexicographer and translator System einer vollständigen medizinischen Polizei Vol ii () Patience is the best medicine. French anatomist Poor Richard’s Almanack () In vain we shall penetrate more and more deeply the secrets of the structure of the human body, we A ship under sail and a big-bellied woman, shall not dupe nature; we shall die as usual. Are the handsomest two things that can be seen Dialogues des Morts Dialogue V common. We anatomists are like the porters in Paris, who Poor Richard’s Almanack () are acquainted with the narrowest and most In general, mankind, since the improvement in distant streets, but who know nothing of what cookery, eats twice as much as nature requires. Poor Richard’s Almanack () Attributed Nothing is more fatal to Health, than an over Care Sir John Forbes – of it. Scottish physician and editor Poor Richard’s Almanack () In a large proportion of cases treated by He’s the best physician that knows the physicians, the disease is cured by nature, not by worthlessness of the most medicines. Poor Richard’s Almanack () Cyclopaedia of Practical Medicine Be temperate in wine, in eating, girls, and sloth, or Henry Ford – the Gout will seize you and plague you both. If you are healthy, you don’t The patient may well be safer with a physician need it: if you are sick, you shouldn’t take it. Poor Richard’s Almanack () The trouble with the human body as compared with the car is that the exhaust is too near the He that lives upon hope will die fasting. The Way to Wealth Attributed Quacks are the greatest liars in the world except Nicholas J. Contemporary Lecturer in Sociology, Department of Attributed General Practice, University of Sheffield Three elements of surgery define it as different Girolamo Frascastoro – from almost all other clinical specialties: the Italian physician, Verona degree of invasiveness, the use of anaesthetic techniques and its emphasis on sterility. Mothers and fathers, peasants and rulers, children The Social Meaning of Surgery p. Open University Press and greybeards, stood mingled together; all () tortured in soul and foul in body, with scabby skin from which matter oozed.