Who's Your Enemy?: Incorporating Stories of Trauma into a Medical Humanities Course.

This article discusses the theoretical and practical experiment of creating, promoting and co-teaching a medical humanities course: Medicine, War and the Arts at a School of Medicine in the United States from the viewpoint of the students who took the class. Specifically, it analyses how three themes emerged in students' responses to the oral, literary and visual stories of war and trauma in the course and how they revealed the subjective and ambivalent nature of all medical encounters with patients. The conclusion is that actively encouraging students to view the role of the physician through the lens of historical and contemporary trauma enables them to contemplate the difficult question, "Who's Your Enemy?" when caring for the sick and themselves.

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.

Clinical characteristics and treatment outcomes of adolescent heroin users.

Heroin use among adolescents is a major social and health problem, and has been increasing over the past decade, but has not been extensively studied. This study compared characteristics of adolescent heroin users (n = 56) to adolescent non heroin users (n = 93) at entry to short-term residential treatment through 12 months posttreatment. The heroin group was comprised of more females, older adolescents, and more Caucasians. At baseline, heroin users reported more days of drug use, days high, days not meeting responsibilities, and had more substance abuse and dependence symptoms. Heroin users also showed greater severity on multiple indicators of functional impairment and psychological distress. Although adolescent heroin users appear to represent a distinct subpopulation with multiple indicators of heightened severity, they respond to treatment with significant reductions in drug use, psychological symptoms, illegal activities, and overall psychosocial impairment. Furthermore, adolescent heroin users respond to treatment in the same remitting/relapsing pattern as non heroin users, yet their higher severity persists over a 12 month follow-up period. Further research is needed to generalize these findings to other settings, and to guide the development and evaluation of treatment options for adolescent heroin users.

Evidence for increased mitochondrial superoxide production in Down syndrome.

Respiring mitochondria represent the major source of superoxide production in most cells, and superoxide anions function as direct precursors of hydrogen peroxide formation within mitochondria. We use a lucigenen-derived chemiluminescence (LDCL) assay to test the hypothesis that intramitochondrial superoxide production is altered in young children with DS. We also measured the levels of two serum markers of lipid peroxidation, lipid peroxides (LOOH), and malondialdehyde as thiobarbituric acid reactive substances (TBARS), to determine if superoxide levels correlate with in vivo measures of lipid peroxidation. A three-group, cross-sectional design was utilized which allowed us to compare young children with DS to children with cognitive impairment (CI) of unknown etiology, and typically developing (Nl) children. Data was analyzed using Pearson's zero-order correlations and multivariate analysis of variance (MANOVA) with Bonferroni correction for multiple comparisons. DS subjects had significantly elevated LDCL signal compared to Nl subjects (p = .03), but did not differ significantly from CI subjects. This study provides new evidence regarding an important source of reactive oxygen species in trisomy 21. The role of the mitochondria in superoxide anion production and the mechanisms underlying its generation in DS deserves further study.

"With much nausea, loathing, and foetor": William Harvey, dissection, and dispassion in early modern medicine.

In early modern England accumulating knowledge of normal and morbid anatomy through dissecting the human body not only led to a better understanding of nature, but also defined the identity of the people who engaged in this activity. This essay analyses the relationship between systemically dismembering the dead and how this pursuit shaped the attitudes and emotions of early modern medical men toward the living. I focus on the most famous anatomist in early modern Britain - the discoverer of the circulation of the blood, William Harvey (1578-1657).