A short history of providing medical history within the British medical undergraduate curriculum.

This article aims to discuss the history of medical history in the British medical undergraduate curriculum and it reviews the main characters and organisations that have attempted to earn it a place in the curriculum. It also reviews the arguments for and against the study of the subject that have been used over the last 160 years.

Drosophila melanogaster: a fly through its history and current use.

Drosophila melanogaster, the common fruit fly, has been used as a model organism in both medical and scientific research for over a century. Work by Thomas Hunt Morgan (1866-1945) and his students at Columbia University at the beginning of the twentieth century led to great discoveries such as sex-linked inheritance and that ionising radiation causes mutations in genes. However, the use of Drosophila was not limited to genetic research. Experimentation with this model organism has also led to discoveries in neuroscience and neurodevelopment, including the basis of circadian rhythms. Its complex nervous system, conserved neurological function, and human disease-related loci allow Drosophila to be an ideal model organism for the study of neurodegenerative disease, for which it is used today, aiding research into diseases such as Alzheimer's and Parkinson's, which are becoming more prevalent in today's ageing population.

Causes of blindness at Nkhoma Eye Hospital, Malawi.

PURPOSE: The majority of blindness in Sub-Saharan Africa is treatable. This hospital-based study was undertaken in order to investigate the etiology of blindness at Nkhoma Eye Hospital, Malawi. METHODS: One ophthalmologist examined 2082 consecutive new patients who presented to the outpatient department at Nkhoma Eye Hospital, Malawi in 2006. Data recorded included age, sex, visual acuity and diagnosis. Patients were classified as blind if their best corrected visual acuity was <3/60 in one eye (unilateral) or two eyes (bilateral). RESULTS: The most common diagnosis in new outpatients was cataract (52.8%), followed by glaucoma (8.1%), corneal pathology (7.2%), uveitis (4.5%) and maculopathy (3.2%). There were 742 (35.6%) patients with unilateral blindness and 331 (15.9%) patients with bilateral blindness. Unilateral blindness was present in 37.4% of males and 26.5% of females. The most common causes of unilateral blindness were lens pathology (57.8%), followed by glaucoma (12.1%), corneal pathology (10.0%) and uveitis (6.1%). Bilateral blindness was present in 12.5% of males and 16.8% of females respectively. The most common causes of bilateral blindness were lens pathology (54.4%), followed by glaucoma (19.9%), retinopathy (3.6%), maculopathy (3.6%), uveitis (3.6%) and corneal pathology (3.3%). CONCLUSIONS: Cataract is the most common cause of blindness in Nkhoma. Resultantly, cataract management is preferentially targeted in the Nkhoma VISION2020 Programme. Training of auxiliary eye personnel in cataract diagnosis and surgery may assist in this approach.

The effect of the First World War (1914-1918) on the development of British anaesthesia.

One of the greatest but also most unfortunate ironies in life is how modern medicine owes some of its existence to the deadly cancer of war. For those whose image of armed conflict is one of disease, death and destruction, this will no doubt be a surprise. However, these very conditions have allowed military surgeons and physicians unparalleled opportunities to experiment and develop using large and dependent populations of potential patients. The catalyzing effect of war has seen the ambulance, the hospital, plastic surgery, preventative medicine and penicillin as just a few products whose history is linked to war. This paper examines whether anaesthesia, and in particular British anaesthesia, can be added to this list when focussing on the First World War (1914-1918). The anaesthesia that was being practiced at the outbreak of the First World War had not drastically altered from that of the mid-nineteenth century. Old anaesthetics given via basic facemasks could be performed by many doctors; specialists were rare. This situation, however, altered during the First World War. This is because the vast number of wounded in the war demanded the introduction of casualty clearing stations to help triage and treat the wounded quickly and efficiently. The workload of these 'mini hospitals' created specialist anaesthetist posts within the military. Once in place, the anaesthetists were able to help develop the relatively new concepts of blood transfusion and resuscitation. These were recognized to be vital against shock, something that had previously not been well researched or understood. While at the casualty clearing stations, Geoffrey Marshall readdressed this by studying the effects of different anaesthetic agents in varying amounts of shock. This work led to the popularity of nitrous oxide, ether and oxygen, which in turn stimulated interest in anaesthesia machines. Finally, the treating of facial wounds in casualties at the Queen's Hospital for facial and jaw injuries at Sidcup, highlighted the possibility of endotracheal intubation, a technique that had a drastic effect on the administration of anaesthetics. Although there were no new wonder anaesthetics, something which would not occur until the neuromuscular blocking drugs of the 1940s, many of these concepts moved into civilian anaesthesia and enabled British anaesthesia to be at the forefront of anaesthesia development for much of the twentieth century.

Military influence upon the development of anaesthesia from the American Civil War (1861-1865) to the outbreak of the First World War.

The American Civil War (1861-1865) helped cement the place of anaesthesia in American medical practice and offered new insights into the specialty. The advantages that ensued were to offer long-term security to anaesthesia but the short-term gains were negligible. The Franco-Prussian War (1870-1871) exerted a negative influence upon nitrous oxide and oxygen research through the loss of leading civilian scientists to military duty. Later, the Boer Wars (1899-1902) helped stabilise the popularity of chloroform after the Hyderabad Commissions but were of little experimental value to anaesthesia. In the early 20th Century, the military continued to be operational without either specialist anaesthetists or an interest in developing military anaesthesia. However, the lack of anaesthetic development was largely due to problems with economics and academic infrastructure rather than to simple military neglect.

The influence of the military on civilian uncertainty about modern anaesthesia between its origins in 1846 and the end of the Crimean War in 1856.

Examination of primary and secondary sources suggests that the military did not significantly help establish the position of modern anaesthesia in society until evidence and experience from the Crimean War was obtained and disseminated.