First archaeological evidence for ginger consumption as a potential medicinal ingredient in a late medieval leprosarium at St Leonard, Peterborough, England.

Leprosy was one of the most outwardly visible diseases in the European Middle Ages, a period during which leprosaria were founded to provide space for the sick. The extant documentary evidence for leprosy hospitals, especially in relation to diet, therapeutic, and medical care, is limited. However, human dental calculus stands to be an important source of information as it provides insight into the substances people were exposed to and accumulated in their bodies during their lives. In the present study, microremains and DNA were analysed from the calculus of individuals buried in the late medieval cemetery of St Leonard, a leprosarium located in Peterborough, England. The results show the presence of ginger (Zingiber officinale), a culinary and medicinal ingredient, as well as evidence of consumption of cereals and legumes. This research suggests that affected individuals consumed ingredients mentioned in medieval medical textbooks that were used to treat regions of the body typically impacted by leprosy. To the authors' knowledge, this is the first study which has identified Zingiber officinale in human dental calculus in England or on the wider European continent.

Leprosy in England and Wales 1953-2012: surveillance and challenges in low incidence countries.

OBJECTIVE: To review all notified cases of leprosy in England and Wales between 1953 and 2012. DESIGN: National surveillance study of all reported cases. SETTING: England and Wales. OUTCOME: Number and characteristics of reported cases. RESULTS: During this period, a total of 1449 leprosy cases were notified. The incidence fell from 356 new cases notified between 1953 and 1962 to 139 new cases between 2003 and 2012. Where data were available, leprosy was more common in men, 15-45 year olds and those from the Indian subcontinent. There was considerable undernotification in 2001-2012. CONCLUSIONS: The high level of under-reporting indicates a need for improved surveillance in the UK. Public Health England, in collaboration with the UK Panel of Leprosy opinion, has revised the UK Memorandum on Leprosy in order to provide updated guidance on diagnostic procedures, treatment, case management, contact tracing and notification.

The life and times of Francis Geach MD, FRS (1730-1798), Senior Surgeon to the Royal Naval Hospital, Plymouth (1778-1798).

Francis Geach MD, FRS was surgeon to the Royal Naval Hospital, Plymouth from about 1765 until he died in 1798. The son of a sail maker, he was born and raised in Plymouth. He was apprenticed to a surgeon in 1745 and probably undertook some medical training in London but he spent his professional career in Plymouth as a naval surgeon and in private practice. Geach had a particular interest in trauma and skin disease and was highly respected as a diagnostic physician, notably of inflammatory disorders, but he also had an interest in local issues including the cause of Devonshire colic. He was noted for the recognition of the skin disease of Francis Beaufort, later Admiral Sir Francis, as Greek leprosy (psoriasis) and for the recognition and support he gave to Sir William Knighton, physician and private secretary to the Prince Regent, later George IV. This article summarises Francis Geach's genealogy, medical and academic practice, his breadth of interests and his contribution to Devonshire life in the 18th century.

An international multicenter study on quality of life and family quality of life in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) has severe impact on the quality of life (QoL) of children suffering from the disease and their families. The infant's dermatitis quality of life index (IDQoL) and the dermatitis family impact questionnaire (DFI) were designed to study this impact. AIMS: To compare the impact of AD on children and their families in different countries. METHODS: 419 children with AD from six countries representing three continents under the age of 4 years were included into the study. English, Ukrainian, Czech, Portuguese, and Korean versions of the IDQoL and the DFI and Dutch version of the IDQoL questionnaires were used. RESULTS: The highest scored items for the IDQoL and the DFI were rather similar. The IDQoL and the DFI results were well correlated with parental assessment of disease severity and between each other in all countries. Some differences mostly in the IDQoL assessment were found. CONCLUSION: Despite some reported peculiarities, parents in different counties assessed QoL and family QoL of their AD children in a similar way. The IDQoL and the DFI may be reliable initial measures for international studies. International study on the influence of the same treatment methods on the IDQoL and the DFI assessments is important.

[Prof. Masao Ota was interested in Kaisyun Hospital of Kumamoto].

From among the materials of Masao Ota, in the Library of Tokyo University, a letter (1931) was found from Isamu Miyake, prof. of Dermatology, Kumamoto Medical College. Its contents was some information on Kaisyun Hospital (The Kumamoto Hospital of the Resurrection of Hope, leprosy hospital), A calendar (the 1930s) of Kaisyun Hospital was also found in Riddell & Wright's Memorial Museum. This calendar was written in English, and it was to ask for the British and American sponsors to contribute. It includes a lot of articles related to leprosy like Riddell's article. Some new findings related to leprosy at that time were recognized from this calendar.

Two pre-Willan descriptions of psoriasis.

Accurate descriptions of skin lesions, and in particular of those of what we now call osiriasis vulgaris, are rare before the book of Willan's On Cutaneous Diseases at the very beginning of the 19th century. Here we present two instances in which such clinical descriptions are given. Benjamin Franklin wrote about his own skin lesions and their evolution. Dr. Willam Falconer, physician in Bath, England, presents the clinical symptoms and his results with 83 patients with 'lepra graecorum' (the name used at that time) treated between 1772 and 1775. One can wonder why such a now frequent, obvious and distinctive disease had not attracted more attention.

[Sir Arthur Conan Doyle, Sherlock Holmes and infectious diseases]. / Sir Arthur Conan Doyle, Sherlock Holmes y las enfermedades infecciosas.

Besides a pleasant author of best sellers, Sir Arthur Conan Doyle was a medical doctor, writing excellent short stories about the exercise of his profession in England. However, even he mentions The British Medical Journal and The Lancet in the Sherlock Holmes's stories, when in the plot introduces infectious diseases, Conan Doyle ignores important discoveries in the field of tetanus. Anyway, the appearing of infectious diseases in the adventures of the detective are rare: one mention of tetanus, another of leprosy and- the most analyzed in medical literature a case of murder by inoculation of bacteria, probably the agent of melioidosis. Also he makes his hero discovers the toxic actions of a medusa and a transplant of solid organ. Little for a physician and less for an author who also wrote science fiction: it seems that the history of the great medical discoveries at the end of nineteenth century and beginning of the twentieth has passed by his side.., and he just couldn't see it.

Sir Arthur Conan Doyle, Sherlock Holmes y las enfermedades infecciosas / Sir Arthur Conan Doyle, Sherlock Holmes and infectious diseases

Sir Arthur Conan Doyle, además de ameno escritor de best sellers, era médico y escribió excelentes cuentos sobre el ejercicio de su profesión en Inglaterra. Sin embargo, a pesar de mencionar The British Medical Journal y The Lancet en sus historias de Sherlock Holmes, al introducir enfermedades infecciosas en sus tramas, ignora descubrimientos importantes ya realizados en su época en el campo del tétanos. En todo caso, las apariciones de las enfermedades infecciosas en las historias del detective son escasas: una mención del tétanos, otra de la lepra y -la más analizada en la literatura médica- un caso de asesinato realizado mediante la inoculación de una bacteria, probablemente del agente de la melioidosis. También hizo a su héroe descubrir las acciones tóxicas de una medusa y de un trasplante de órganos. Poco para un médico y poco para un autor que también escribía ciencia ficción: pareciera que la historia de los grandes descubrimientos médicos de fines del siglo XX y comienzos del XXI pasó por su lado... y no la vio.

Besides a pleasant author of best sellers, Sir Arthur Conan Doyle was a medical doctor, writing excellent short stories about the exercise of his profession in England. However, even he mentions The British Medical Journal and The Lancet in the Sherlock Holmes’s stories, when in the plot introduces infectious diseases, Conan Doyle ignores important discoveries in the field of tetanus. Anyway, the appearing of infectious diseases in the adventures of the detective are rare: one mention of tetanus, another of leprosy and- the most analyzed in medical literature -a case of murder by inoculation of bacteria, probably the agent of melioidosis. Also he makes his hero discovers the toxic actions of a medusa and a transplant of solid organ. Little for a physician and less for an author who also wrote science fiction: it seems that the history of the great medical discoveries at the end of nineteenth century and beginning of the twentieth has passed by his side… and he just couldn’t see it.

Managing type II and type IV Lauge-Hansen supination external rotation ankle fractures: current orthopaedic practice.

INTRODUCTION: Differentiating supination external rotation (SER) type II and IV ankle injuries is challenging in the absence of a medial malleolar fracture or talar shift on radiographs. The accurate differentiation between a stable SER-II from an unstable SER-IV injury would allow implementation of the appropriate management plan from diagnosis. The aim of this study was to ascertain the practice of orthopaedic surgeons in dealing with these injuries. MATERIALS AND METHODS: A postal survey was undertaken on 216 orthopaedic consultants from three regions. RESULTS: In the presence of medial-sided clinical signs (tenderness, swelling, ecchymosis), 22% of consultants would perform surgical fixation. 53% would choose non-operative treatment and the majority would monitor these fractures through serial radiographs. The remaining 25% of consultants would perform an examination under anaesthesia (EUA; 15%), request stress radiographs (9%) or an MRI scan (1%). Without medial-sided signs, 85% would advocate non-operative treatment and, of these, 74% would perform weekly radiographs. Interestingly, 6% would perform immediate surgical fixation. Stress radiographs (6%) and EUAs (2%) were advocated in the remaining group of consultants. Foot and ankle surgeons utilised stress radiographs more frequently and were more likely to proceed to surgical fixation should talar shift be demonstrated. CONCLUSIONS: Clinical practice is varied amongst the orthopaedic community. This may lead to unnecessary surgery in SER-II injuries and delay in diagnosis and operative management of SER-IV injuries. We have highlighted the various investigative modalities available that may be used in conjunction with clinical signs to make a more accurate diagnosis.

75th Anniversary of the Stiles-Crawford Effect(s): a celebratory special symposium, October 23, 2008; Rochester, New York.

There are rather few articles which, so-to-speak, serve to change the landscape in a scientific field. One of those was the discovery of the "directional sensitivity of the retina" by Walter Stanley Stiles and Brian Hewson Crawford (first reported in 1933). Subsequently, their findings were subdivided by Hansen into two logical components, "the Stiles-Crawford Effects of the First and Second Kinds, (SCE- 1 and SCE-2)." The former (SCE-1) dealt with aspects of their research which addressed alterations in perceived brightness of a visual stimulus; the second (SCE-2) was associated with the perceived hue and saturation of these visual stimuli. These discoveries arose out of a failed attempt by W.S. Stiles and B.H. Crawford to measure properly the areas of the entrance pupils of their experimental subjects as part of a research program which addressed problems of glare, e.g., disability glare, in illuminating engineering. Their research was conducted at the National Physical Laboratory (NPL), which is located in Teddington, Middlesex, England. These two fine scientists properly deduced the reason for the failure of their experimental design, and they effectively described and defined a new feature of the visual system which was largely ascribed to the retina. In time, it was realized that this phenomenon was associated in large measure with the waveguide/fiber-optics properties of photoreceptors, and that this was a feature shared by virtually all vertebrate species. This paper is divided into two parts. In the first part, Enoch describes, as best he can, the culture and working conditions at NPL during 1959/60 when he served as a post-doctoral fellow with W.S. Stiles. And in the second part of this paper, the authors describe the findings of W.S. Stiles and B.H. Crawford at the time of their discovery. Today, we celebrate the 75th Anniversary of that research. The organizing committee for this program (alphabetically) is David Atchison, Jay M. Enoch, Vasudevan Lakshminarayanan, and Pieter Walraven. Our group of speakers today will follow with discussions of aspects of subsequent work which has evolved from the initial discoveries made by the late W.S. Stiles and B.H. Crawford.

Association of spinal cord compression seen on magnetic resonance imaging with clinical outcome in 67 dogs with thoracolumbar intervertebral disc extrusion.

OBJECTIVES: To determine whether there is an association between the degree of transverse spinal cord compression detected by magnetic resonance imaging following thoracolumbar Hansen type 1 intervertebral disc disease in dogs and their presenting and postsurgical neurological status. METHODS: Medical records of 67 dogs with surgically confirmed Hansen type 1 intervertebral disc disease (2000 to 2004) were reviewed to obtain the rate of onset of disease, duration of clinical signs and presurgical and postsurgical neurological grade. Percentage of spinal cord compression was determined on transverse T2-weighted magnetic resonance images. Linear regression was used to examine the association between spinal cord compression and each of the above variables. Chi-squared tests were used to examine associations among postsurgical outcome and presurgical variables. RESULTS: Eighty-five per cent (57 of 67) of dogs were chondrodystrophoid. Mean spinal cord compression was 53 per cent (sd=219.7, range 14.3 to 84.9 per cent). There was no association between the degree of spinal cord compression and the neurological grade at presentation, rate of onset of disease, duration of clinical signs or postsurgical outcome, with no difference between chondrodystrophoid and non-chondrodystrophoid dogs. CLINICAL SIGNIFICANCE: The degree of spinal cord compression documented with magnetic resonance imaging in dogs with thoracolumbar Hansen type 1 intervertebral disc disease was not associated with the severity of neurological signs and was not a prognostic indicator in this study.

Leprosy in Britain: 50 years experience in Liverpool.

BACKGROUND: Leprosy is a chronic infection that presents with varying dermal and neurological symptoms, and which can lead to extensive disability and morbidity, often with accompanying social stigma. AIM: To review the patients presenting to the Liverpool School of Tropical Medicine (LSTM) between 1946 and 2003, looking specifically at country of birth and of infection, details of clinical presentation, diagnosis, management and reactions. DESIGN: Retrospective record review. METHODS: We retrieved all available clinical records for patients seen between 1946 and 2003 (n = 50), consisting of letters, hospital and LSTM casenotes, and some radiographs and photographs. Any history of tuberculosis or diabetes was recorded. RESULTS: Most patients (64%) were born in the Indian subcontinent, and most were thought to have contracted the disease there (62%). Features at presentation included anaesthetic skin lesions in 19 (36%), hypopigmentation in 15 (30%), and peripheral nerve enlargement in 25 (50%). Diagnoses were made by a combination of clinical data and biopsy (60%), and slit skin smears were positive for acid-fast bacilli in 61% of multibacillary patients. Initial presentation was with a leprosy reaction in five cases (10%), and reactions were documented in 42% of all patients. Treatments were varied, progressing from traditional Eastern medicine to the WHO-approved multidrug therapy in use today, with prophylaxis for children and close contacts. DISCUSSION: Leprosy remains an important diagnosis to consider in patients with a history of work or travel in the tropics, and is a diagnosis with far-reaching medical, social and emotional consequences.

Leprosy in Britain: 50 years experience in Liverpool

BACKGROUND: Leprosy is a chronic infection that presents with varying dermal and neurological symptoms, and which can lead to extensive disability and morbidity, often with accompanying social stigma. AIM: To review the patients presenting to the Liverpool School of Tropical Medicine (LSTM) between 1946 and 2003, looking specifically at country of birth and of infection, details of clinical presentation, diagnosis, management and reactions. DESIGN: Retrospective record review. METHODS: We retrieved all available clinical records for patients seen between 1946 and 2003 (n = 50), consisting of letters, hospital and LSTM casenotes, and some radiographs and photographs. Any history of tuberculosis or diabetes was recorded. RESULTS: Most patients (64%) were born in the Indian subcontinent, and most were thought to have contracted the disease there (62%). Features at presentation included anaesthetic skin lesions in 19 (36%), hypopigmentation in 15 (30%), and peripheral nerve enlargement in 25 (50%). Diagnoses were made by a combination of clinical data and biopsy (60%), and slit skin smears were positive for acid-fast bacilli in 61% of multibacillary patients. Initial presentation was with a leprosy reaction in five cases (10%), and reactions were documented in 42% of all patients. Treatments were varied, progressing from traditional Eastern medicine to the WHO-approved multidrug therapy in use today, with prophylaxis for children and close contacts. DISCUSSION: Leprosy remains an important diagnosis to consider in patients with a history of work or travel in the tropics, and is a diagnosis with far-reaching medical, social and emotional consequences.

Bio-cultural effects in medieval populations.

Male skeletons from medieval archaeological sites are analysed to assess differences in stature and body proportions related to the bio-cultural environment, such as social, economic, and health factors. Environmental factors, such as climate change in the course of the Middle Ages, did not have statistically significant effect on body proportions in these samples. The results show a relationship between bio-cultural factors and physique in the analysed populations that indicate stunted growth in height and weight in a leprosarium population with a low socio-economic and health status. A high-status monastic population is characterised by a stocky build, i.e., increased weight for height and relatively shorter limbs, while a medieval parish population has a linear build, i.e., relatively long limbs for height and decreased weight for height. These characteristics, relative weight for height and relative limb length, changed during the course of the Middle Ages, as did stature.

Hertfordshire medieval hospitals.

All Hertfordshire's hospitals were small, although some had considerable endowments, e.g. St Julian's Hospital at St Albans. Most were in decline by the late 15th Century, or had ceased to function.

John Updike on psoriasis: At war with my skin, from the journal of a leper.

BACKGROUND: In recent years patients have become more involved in the impact, description, diagnosis, and management of their own disease. OBJECTIVE: This article will briefly record the personal observations of John Updike, a highly regarded, perceptive twentieth-century American writer, on how moderately severe psoriasis has affected his life and also his thoughts about his disease and its treatment. CONCLUSION: Updike's description of his psoriasis gives a valid insight into a patient's view of psoriasis.

Leprosy in England and Wales.

This paper reviews cases of leprosy notified in England and Wales to the Central Leprosy Register since its inception in 1951. Leprosy remains a rare condition in England and Wales, with fewer than ten cases notified on average in recent years. No definite case of indigenously acquired leprosy has been reported since the disease became notifiable. Although only a small number of patients present each year, leprosy remains a debilitating disease, and the unfamiliarity of clinicians with this condition can lead to delays in diagnosis and undernotification.