The laryngoscope and nineteenth-century British understanding of laryngeal movements.

The source of the human voice is obscured from view. The development of the laryngoscope in the late 1850s provided the potential to see the action of the vocal folds during speaking for the first time. This new instrument materially contributed to the understanding of vocal fold neuroanatomy, neurophysiology, and neuropathology. The laryngoscope led to elaborated understanding of disorders that previously were determined by changes in sound. The objective of this paper is to detail the consequences of this novel visualization of the larynx, and to trace how it aided in the development of understanding of the movements of the vocal folds. This is demonstrated through an examination of the activities and practices of a group of London clinicians in the second half of the nineteenth century.

Features of serial cranial ultrasound detected neuropathology in very preterm infants.

BACKGROUND: The purpose of this study was to identify the pattern and factors associated with changes in cranial ultrasound (CUS) -detected findings in infants born at or less than 28 weeks of gestation. METHODS: We compared readings of CUS performed at the end of the first week of life and at 4-5 weeks of age. Alteration of CUS findings was classified as: (i) unchanged, if no deviation was detected (Group 1); (ii) worsening, if there were new findings (Group 2); and (iii) improvement, if there was normalization or reduction in severity (Group 3). Descriptive statistics, multivariate controlled logistic regression, and kappa (k) statistics with 95% Confidence Interval (95% CI) were reported. RESULTS: Among 510 studied infants, 82.3% (95% CI 78.8-85.4) were in Group 1, 10.0% (95% CI 7.7-12.9) in Group 2, and 7.7% (95% CI 5.7-10.3) in Group 3. Overall agreement between the two scans was moderate (k 0.62; 95% CI 0.55-0.69). Worsening of CUS findings was associated with neonatal morbidities independently from gestational age and birth weight. The probability for worsening of CUS findings was higher in infants with an initial diagnosis of intraventricular hemorrhage (IVH) grade 2, than in those reported as no pathology/IVH grade 1 (Odds Ratio 5.79; 95% CI 2.42-13.91) or IVH grade 3-4 (Odds Ratio 3.81; 95% CI 1.10-13.21). CONCLUSIONS: In very preterm born infants, the initial CUS findings in combination with neonatal morbidities can help predict the brain lesions that are seen at the end of the first month of life and could be useful in their clinical management.

Between the Mind Twist and the Brain Spot. The Material Dimensions of Psychopathology in the Work of Elmer Ernest Southard .

This paper explores the material and visual practices that defined studies of psychopathology in early twentieth-century American medicine, through a close look at the work of neuropathologist Elmer E. Southard (1876­1920). As a discipline sitting at the intersection between laboratory and clinical practice, neuropathology has received little attention from historians of the brain sciences. Unlike the neurologist, who was interested in treating patients and saving lives, the neuropathologist often encountered patients following death, and studied the brain for signs of pathology during autopsy. Trained in a German tradition of laboratory pathology, Southard has been cast as a somaticist with respect to psychopathology. By examining Southard's medical and philosophical writings, I present a more nuanced analysis of the role of brain pathology in Southard's vision of disease etiology, his views on the foundations of psychiatry, as well as a more vivid picture of the sorts of material practices that defined the work of the neuropathologist.