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Through the action of hormones purchase confido american express prostate cancer 101, blood glucose is normally maintained at about 100 mg/dL (5 order 60 caps confido with mastercard mens health online dating. Hormones that raise the blood glucose level are glucagon discount confido on line prostate cancer immunotherapy, epinephrine, adrenocorticosteroids, growth hormone, and thyroid hormone. Considerable dysfunction of the pancreas must occur before enzyme secretion decreases and protein and fat digestion becomes impaired. Definition of Biliary Terms Cholecystitis: inflammation of the gallbladder Cholelithiasis: the presence of calculi in the gallbladder Cholecystectomy: removal of the gallbladder Cholecystostomy: opening and drainage of the gallbladder Choledochotomy: opening into the common duct 73 Choledocholithiasis: stones in the common duct Choledocholithotomy: incision of common bile duct for removal of stones Cholecystitis Acute inflammation (cholecystitis) of the gallbladder causes pain, tenderness, and rigidity of the upper right abdomen that may radiate to the midsternalarea or right shoulder Associated with nausea, vomiting, and the usual signs of an acute inflammation. Bile remaining in the gallbladder initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are compressed, compromising its vascular supply. Cholelithiasis Gallstones usually form in the gallbladder from the solid constituents of bile Vary greatly in size, shape, and composition. Pain and Biliary Colic If a gallstone obstructs the cystic duct, the gallbladder becomes distended, inflamed, and eventually infected (acute cholecystitis). Jaundice Jaundice occurs in a few patients with gallbladder disease and usually occurs with obstruction of the common bile duct. Changes in Urine and Stool Color The excretion of the bile pigments by the kidneys gives the urine a very dark color. Obstruction of bile flow: also interferes with absorption of the fat-soluble vitamins. The patient may exhibit deficiencies (eg, bleeding caused by vitamin K deficiency) of these vitamins if biliaryobstruction has been prolonged. A fiberopticduodenoscope, with side-viewing apparatus, is inserted into the duodenum. The ampullaof Vateris catheterized and the biliarytree injected with contrast agent. This procedure is of special value in visualizing neoplasmsof the ampullaarea and extracting a biopsy specimen. Unless the patient‘s condition deteriorates, surgical intervention is delayed until the acute symptoms subside. Lithotripsy Surgical Management A chest x-ray, electrocardiogram, and liver function tests may be performed in addition to x-ray studies of the gallbladder. Nutritional requirements are considered; if the nutritional status is suboptimal, it may be necessary to provide intravenous glucose with protein hydrolysatesupplements to aid wound healing and help prevent liver damage. Preparation for gallbladder surgery is similar to that for any upper abdominal laparotomyor laparoscopy. Cholecystectomy In this procedure, the gallbladder is removed through an abdominal incision (usually right subcostal) after the cystic duct and artery are ligated. In some patients a drain may be placed close to the gallbladder bed and brought out through a puncture wound if there is a bile leak. A small leak should close spontaneously in a few days with the drain preventing accumulation of bile. After the stones have been evacuated, a tube usually is inserted into the duct for drainage of bile until edema subsides. Percutaneous cholecystostomy has been used in the treatment and diagnosis of acute cholecystitisin patients who are poor risks for any surgical procedure or for general anesthesia. These may include patients with sepsis or severe cardiac, renal, pulmonary, or liver failure. Bile is aspirated to ensure adequate placement of the needle, and a catheter is inserted into the gallbladder to decompress the biliarytract. Disorders of the Pancreas Pancreatitis (inflammation of the pancreas) is a serious disorder. Typically, patients are men 40 to 45 years of age with a history of alcoholism or women 50 to 55 years of age with a history of biliarydisease. Minimal organ dysfunction is present, and return to normal usually occurs within 6 months. Gallstones enter the common bile duct and lodge at the ampullaof Vater, obstructing the flow of pancreatic juice or causing a reflux of bile from the common bile duct into the pancreatic duct, thus activating the powerful enzymes within the pancreas which leads to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage. Clinical Manifestations Severe abdominal pain is the major symptom that causes the patient to seek medical care. A rigid or board-like abdomen may develop and is generally an ominous sign; the abdomen may remain soft in the absence of peritonitis. Assessment and Diagnostic Findings History of abdominal pain, the presence of known risk factors, In 90% of the cases, serum amylase and lipase levels usually rise in excess of three times their normal upper limit within 24 hours Serum amylase usually returns to normal within 48 to 72 hours. Serum lipase levels may remain elevated for 7 to 14 days Urinary amylase levels elevated and remain elevated longer than serum amylase levels. Fat content of stools varies between 50% and 90% in pancreatic disease; normally, the fat content is 20%. Medical Management Management of the patient with acute pancreatitis is directed toward relieving symptoms and preventing or treating complications. All oral intake is withheld to inhibit pancreatic stimulation and secretion of pancreatic enzymes. Pain Management Adequate pain medication is essential during the course of acute pancreatitis to provide sufficient pain relief and minimize restlessness, which may stimulate pancreatic secretion further. Morphine and morphine derivatives are often avoided because it has been thought that they cause spasm of the sphincter of Oddi; meperidine (Demerol) is often prescribed because it is less likely to cause spasm of the sphincter Intensive care Correction of fluid and blood loss and low albumin levels is necessary to maintain fluid volume and prevent renal failure. The patient is usually acutely ill and is monitored in the intensive care unit, where hemodynamic monitoring and arterial blood gas monitoring are initiated. Antibiotic agents may be prescribed if infection is present; insulin may be required if significant hyperglycemia occurs. Respiratory Care Aggressive respiratory care is indicated because of the high risk for elevation of the diaphragm, pulmonary infiltrates and effusion, and atelectasis. Hypoxemia occurs in a significant number of patients with acute pancreatitis 84 even with normal x-ray findings. Respiratory care may range from close monitoring of arterial blood gases to use of humidified oxygen to intubation and mechanical ventilation Biliary drainage Placement of biliary drains (for external drainage) and stents (indwelling tubes) in the pancreatic duct through endoscopy has been performed to reestablish drainage of the pancreas. Surgical Intervention Although often risky because the acutely ill patient is a poor surgical risk, surgery may be performed to assist in the diagnosis of pancreatitis (diagnostic laparotomy), to establish pancreatic drainage, or to resect or débride a necrotic pancreas. The patient who undergoes pancreatic surgery may have multiple drains in place postoperatively as well as a surgical incision that is left open for irrigation and repacking every 2 to 3 days to remove necrotic debris Post Acute Management Antacids may be used when acute pancreatitis begins to resolve. If the episode of pancreatitis occurred during 85 treatment with thiazide diuretics, corticosteroids, or oral contraceptives, these medications are discontinued. Chronic Pancreatitis is an inflammatory disorder characterized by progressive anatomic and functional destruction of the pancreas. The end result is mechanical obstruction of the pancreatic and common bile ducts and the duodenum. Additionally, there is atrophy of the epitheliumof the ducts, inflammation, and destruction of the secreting cells of the pancreas. Excessive and prolonged consumption of alcohol accounts for approximately 70% of the cases The incidence of pancreatitis is 50 times greater in alcoholics than in the nondrinking population. Long-term alcohol consumption causes hypersecretion of protein in pancreatic secretions, resulting in protein plugs and calculi within the pancreatic ducts. Damage to these cells is more likely to occur and to be more severe in patients whose diets are poor in protein content and either very high or very low in fat.

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If capsulated yeast cells are seen in the microscopial preparations generic confido 60caps on line man health in pakistan, 0 inoculate a plate of sabouraud agar discount 60 caps confido visa mens health 7 day meal. Incubate at 35-37 C for up to 72hours order confido 60caps otc androgen hormone regulation, cheeking for growth after overnight incubation. The term septicaemia refers to a severe and often fatal infection of the blood in which bacteria multiply and release toxins in to the blood stream. In typhoid, salmonella typhi can be detected in the blood of 75-90% of patients during the first 10 days of infection and in about 30% of patients during the third week. Collection and culture of Blood and Borne marrow 9 Blood and bone marrow require culturing immediately after collection, before clotting occurs. Choice of culture media 9 Because septicaemia is such a serious condition, it is essential to use media that will provide the fastest 167 growth and isolation of as wide a range of pathogens as possible. Because the bacteria can be seen growing on the slope, the need to subculture on a solid medium every few days is avoided, thus reducing the risk of contamination. It prevents clotting of the blood and neutralize the natural bactericidal substances in fresh blood. Aminobenzoic acid: This neutralizes the action of sulphonamides should these be present in the blood. Collect and culture the specimen Blood • It should be collected before antimicrobial treatement has been started and at the time the patient’s temperature is beginning to rise. Insert the needle through the rubber line of the bottle cap and dispense 5ml of blood into each culture bottle. Incubate the inoculated media: Thioglycollate broth 0 At 35-37 C for up to 2 weeks, examining and sub-culturing • Look for visible signs of bacterial growth such as turbidity above the red cell layer, colonies growing on top of the red cells (“cotton balls”), haemolysis, gas bubbles and clots. Synovitis means inflammation of the synovial membrane (living of a joint capsule). Arthritis may be caused by bacteria (infective arthritis), rheumatoid arthritis, gout and pseudogout, osteoatrhtitus 3. The term pleural effusion is used to describe a non-purulent serous effusion which sometimes forms in pneumonia, tuberculosis, malignante disease etc Empyema is used to describe a purulent pleural effusion when pus is found in the pleural space. Peritonitis means inflammation of the peritoneum, which is the serous membrane that lines the peritoneal cavity. Ascites refers to the accumulation of fluid in the pentional cary causing abdominal swelling. Commensales No microbial flora Collection is carried out by a medical officer - 2-3ml without anticogulent, to see whether clotting occurs. Staphylococcus warneri • Can readily grow in ordinary media under aerobic and micro- aerophilic conditions • grow most rapidly at 37 0c but form pigment best at room temperature of 20-25 oc • Colonies in solid media are round, smooth, raised and glistening. Peptidoglycan( Mucopeptide): Polysaccharide polymer which provide the rigid exoskeleton of the cell wall. It is important in the pathogenesis of infection like eliciting production of cytokines and opsonic antibodies; chemoattractant for polymorphs;and activate complement 2. Catalase- Produced by staphylococci Converts H202 into H20 and 02 175 Catalase test differentiates staphylococci(catalase-positive) from streptococci(catalase-negative). Coagulase may deposit fibrin on the surface of organism and alter ingestion by phagocytic cells. Clumping factor: A surface compound that is responsible for adherence of the organism to fibrinogen and fibrin Produced by Staphylococcus aureus Determines Invasive potential of the organism. Multiple (A-E, G-I, K-M) soluble heat-stable, gut enzyme resistant toxins which act on neural receptors 176 in the gut to stimulate vomiting center in the central nervous system. Epidermolytic toxin A: Chromosomal gene product and heat stable Epidermolytic toxin B: Plamid mediated and heat labile. Endocarditis and meningitis: Infection of heart tissue and leptomeninges respectively. Characterized by abrupt onset of high fever, vomiting, diarrhea, myalgia, scarlatiform rash,and hypotension with cardiac and renal failure in the most severe disease. Catalaseproducing Bacteria (Staphlococci) No active bubbling…………Non-catalase producing bacteria (streptococci) 2. Serologic specificity of the cell wall group specific substance and other cellwall capsular antigens 3. Partial Greenish discoloration Alpha(α) Viridans streptococci (reduced hemoglobin). None No change Gamma(δ) Enterococci Lancefield grouping of streptococci: Streptococci produce group specific carbohydrates(C carbohydrates) identified using group specific antiserum. Group-specific cell wall antigen Streptococcal cell wall obtained carbohydrate is the basis for serologic grouping of streptococci (Lancefield groups A-H, K-U) 183 2. M protein They are found in hair-like projections of the streptococcal surfaceand determine virulence Major virulent factor for group A streptococci. T substance: Acid and heat labile unlike M protein, and has no relation to virulence of streptococci. R protein Streptococcus pyogenes (Group A β-hemolytic streptococci) The most pathogenic member of the genus It is present as a commensal in the nasopharynx in a variable proportion of healthy individuals. It is an active proteolytic enzyme which lyses fibrin by catalytic conversion of plasminogen to plasmin. Has been given intravenously for the the treatment of pulmonary edema and of arterial and venous thrombosis 2. Streptodornase: Streptococcal deoxyribonuclease 184 Mixtures of streptokinase and streptodornase are used in “enzymatic debridement” 3. Hyaluronidase: Spreading factor It degrades the ground substance of connective tissue (hyaluronic acid) and aids in spreading infectious micro- organoism 5. Hemolysins: Two types Streptolysin O and Streptolysin S Antistreptolysin O antibody titer > 1:200 todd: Supportive evidence for Acute reheumatic fever 2. Erythrogenic toxin: Pyrogenic exotoxins It is responsible for the erythematous rash in scarlet fever. Acute rheumatic fever 185 Immunological damage to the heart valves and muscle following Streptococcal upper respiratory tract infection It clinically presents with fever, malaise, migratory non- sppurative polyarthritis, carditis, erythema marginatum and subcutaneous nodules 2. Post streptococcal acute glomerulonephritis Immunological damage to the kidney following infection of skin with streptococci It clinically manifests with generalized body edema, elevated bloood pressure, protein and blood in the urine, bloood urea nitrogen retention and low complement level. Necrotizing fascitis(Streptococcal gangrene): Extensive and rapidly spreading necrosis of skin and subcutaneous tissue S. Streptococcus mitis Streptococcus mutans Streptococcus salivarius Streptococcus sanguis Clinical features. Grow in ordinary media with shiny or dry colonies with grey-white or colorless appearance. Penicillin + Gentamicin 188 Streptococcus pneumoniae • Fastidious, lancet-shaped gram positive diplococci. Septic arthritis Laboratory Diagnosis: Specimen: Sputum, blood, cerebrospinal fluid, ear discharge and sinus drainage. Look for the appearance of capsule swelling under the 100X objective microscope Treatment: Amoxicillin Chloramphenicol Thid generation Cephalosporins Prevention and control: Pneumococcal conjugate vaccine: Immunization of individuals with type specific polysaccharide vaccine Biochemical reaction to diagnose streptococci.

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Nonetheless discount 60caps confido with amex androgen hormone weight gain, experts now strongly recommend atypical antipsychotic medications purchase confido amex man health malaysia, as a group (with the exclusion of clozapine) buy confido 60 caps fast delivery prostate cancer 5k cincinnati, as the first-line of treatment for schizophrenia, replacing typical antipsychotic medications (McEvoy et al. Some antipsychotic medications are also available in tablets, including dissolvable forms (Mueser & Gingerich, 2006). Antipsychotic medications can additionally be taken in the form of short-acting and long-acting injections. Short-acting intramuscular formulations are typically used in emergency situations to help people who are acutely psychotic to calm down (Mueser & Gingerich, 2006). The practice of administering high doses of high potency antipsychotic medication intramuscularly within 24 hours has not demonstrated any gains in the onset of therapeutic efficacy, when compared to the administration of standard doses, however (Sharif et al. Researchers claim that the practice of administering high doses of 16 antipsychotic medication within a short period of time has been largely discontinued due to a lack of evidence (Sharif et al. Long-acting, depot formulations, administered intramuscularly, once every one to six weeks are also available for some antipsychotic medications (David & Adams, 2001). Long-acting injections are frequently prescribed in cases of poor adherence and for consumers on community treatment orders, which permit the involuntary treatment of some consumers whilst they reside in the community. Community treatment orders are typically granted when consumers are non-adherent and experience frequent symptom relapses that place their own or others’ safety at risk. Long-acting depot formulations work by distributing medication throughout the body on a constant basis over the following weeks and then gradually leave the body after the one to six weeks have elapsed. Thus, the perceived advantage of this method is that it guarantees consistent delivery of the medication (David & Adams, 2001). Whilst the exact mechanism of antipsychotic medications is unclear, it is frequently proposed that they block dopamine receptors, thereby targeting the positive symptoms of schizophrenia (Van Os & Kapur, 2009). Consistently, randomised control trials of medication have shown that the potency of different antipsychotic medications can be explained almost perfectly by the amount of dopamine in the brain that is blocked by that medication (Mueser & Gingerich, 2006). This theory is disputed by research which demonstrates 17 that newer (atypical) medications bind less than older (typical) medications to dopamine receptors, yet are as efficacious (or more so in the case of clozapine) (Jones & Buckley, 2006). Negative symptoms and cognitive symptoms are not consistently improved by antipsychotic medication treatment. Doses below the dopamine binding threshold (approximately 60% dopamine receptor occupancy) are clinically ineffective for treating schizophrenia. The atypical medications, in general, have a wider therapeutic window, meaning that the difference between therapeutic and toxic levels is larger (Jones & Buckley, 2006). Another hypothesis is that the new medications are more selective in the parts of the brain they affect (Weiden et al. For example, there is more than one type of dopamine receptor, and different antipsychotics may have different effects on each type (Mueser & Gingerich, 2006). It was originally termed a ‘major tranquiliser’ due to its calmative effects in addition to dramatically reducing psychotic symptoms amongst agitated patients (Jones & Buckley, 2006; Schulz & McGorry, 2000; Weiden et al. The introduction of Chlorpromazine represented the first effective medical management strategy for schizophrenia and was, thus, deemed one of the great medical advances of the twentieth century (Sharif et al. Typical antipsychotics were breakthrough medications, as they provided therapy for psychosis, which had previously been almost impossible to treat (Conley, 2000). The effectiveness of antipsychotics in reducing the intensity of consumers’ positive symptoms- has permitted the outpatient treatment of schizophrenia and was associated with a dramatic reduction in mental hospital populations (Freedman, 2005; Schulz & McGorry, 2000). The typical antipsychotic medications currently in use include: Haloperidol, Thieridaxine, Thiothixene, Fluphenazine, Trifluoperazine, Chlorpromazine and Perphenazine. Over one hundred clinical trials have demonstrated the effectiveness of typical antipsychotic medications, including a series of double-blind placebo studies (Sharif et al. Research that has not supported the effectiveness of typical medications is generally restricted to poorly designed studies that involved ineffective dosages (Sharif et al. Although typical antipsychotic medications substantially reduce the positive symptoms of schizophrenia in some people, they have been documented as having no appreciable effect on cognitive dysfunction, and as having only a limited effect on, and even worsening, negative and depressive symptoms (Conley, 2000; Jones & Buckley, 2006; 19 Mueser & Gingerich, 2006; Weiden et al. Contradictory evidence exists, however, which points to clinical trials that indicate that all symptoms associated with schizophrenia improve with typical antipsychotic medication although, in general, positive symptoms respond to a greater degree and more consistently than negative symptoms (Sharif et al. Extensive evidence indicates that typical antipsychotic medications are essentially similar in efficacy profiles, however, individual consumers may respond better to one drug than another due to their different side effect profiles (Sharif et al. For example, while Chlorpromazine is quite sedating, Haloperidol is not (Mueser & Gingerich, 2006). The side effects of typical antipsychotic medications are frequently distressing and prominent and in addition to sedation, include: slowed thinking, dizziness, sexual dysfunction and sensitivity to sunlight. Anticholinergic side effects are also associated with typical antipsychotics, which include dry mouth, blurry vision, constipation, difficulty urinating and memory problems (Mueser & Gingerich, 2006). Tardive dyskinesia typically 20 emerges several months after the commencement of treatment and is potentially a lifelong condition (Weiden et al. It usually consists of involuntary movements of the head, tongue, lips, hands and feet and can affect speech, posture and sometimes breathing (Birchwood & Jackson, 2001; Jones & Buckley, 2006; Mueser & Gingerich, 2006). Typical presentations of the conditions involve protruding tongue, facial grimaces, and slow rhythmical movements of the hands and feet, sometimes even without the person knowing it (McEvoy et al. The chances of developing tardive dyskinesia can reportedly be reduced by using the lowest possible effective dose of medication (McEvoy et al. Since the development of the new, atypical antipsychotic medications, indications for typical antipsychotic medications are shrinking. McGorry (1992) posits that typical antipsychotic medications, in low dosages, may still have a role amongst a small proportion of consumers, who demonstrated a positive response to typical schedules including remission and good tolerability. They have also been indicated in the acute management of aggression or violence in some patients in the past (McEvoy et al. Advantages of typical antispychotic medications over atypical antipsychotic medications include greater medication familiarity for some consumers and clinicians and they are less expensive (Weiden et al. The development of atypical antipsychotic medications has also increased the probability of finding a suitable drug for individuals with schizophrenia, as there are now more options available to consumers and practitioners (Janssen et al. The wider choice offered by the advent of atypical medications, in addition to their increased tolerability, have been associated with more sustained adherence to prescriptions (Liberman & Kopelowicz, 2005). Clozapine, the first atypical antipsychotic medication, manufactured in 1959, was first tested in the 1970s and was discontinued due to serious blood reactions (Weiden et al. It was reintroduced for use in 1989 in the United States, followed by the introduction of the other atypical antipsyhotic medications in the 1990s or after 2000 (Weiden et al. The atypical antipsychotic medications currently available are: clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, sertindole, zotepine and amisulpiride. With the exception of clozapine, these atypical antipsychotic medications were developed following years of scientific research aimed at understanding how typical antipsychotic medications work and trying to make more effective medications with fewer serious side effects (Mueser & Gingerich, 2006). Several studies have historically supported, and continue to support, the efficacy of atypical antipsychotic medications for treating positive symptoms of schizophrenia amongst treatment-responsive, recurrent- episode consumers, when compared with placebo (eg; Buchanan et al. A recent systematic review revealed some evidence that olanzapine, 22 ziprasidone and zotepine were more effective at reducing relapse rates over 12 months than placebo (Smith et al. A vast number of double-blind studies comparing the acute treatment effects of atypical antipsychotic medications with typical antipsychotic medications have been conducted.

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Knowles – Message to Congress on Mental Health purchase confido 60caps without prescription prostate cancer xenografts,  February () President confido 60 caps fast delivery man health singapore, Rockefeller Foundation The needs of children should not be made to The American Medical Association operating from wait confido 60caps with amex mens health depression. A proud and resourceful nation can no longer ask Speech to the Institute on Medical Center Problems,  December () its older people to live in constant fear of a serious illness for which adequate funds are not available. Theodor Kocher – We owe them the right of dignity in sickness as Swiss surgeon well as in health. Message to Congress on Problems of the Aged,  February A surgeon is a doctor who can operate and who () knows when not to. Attributed to Kocher, perhaps reflecting his dismay at the effects of total strumectomy (thyroidectomy) on goitre patients Jean Kerr – Sergei S. John Forbes) Attributed Jean de La Fontaine – French poet Frederick James Kottke – Rather suffer than die is man’s motto. Laing – Preface to Krusen’s Handbook of Physical Medicine and Rehabilitation. Saunders () Scottish psychiatrist Schizophrenia is a special strategy that a person invents in order to live in an unlivable situation. Karl Kraus – The Divided Self Austrian writer and satirist Children do not give up their innate imagination, Psychoanalysis is the disease it purports to cure. Charles Lamb – Attributed British essayist How sickness enlarges the dimensions of a man’s Jiddhu Krishnamurti – self to himself. Indian theosophist Last Essays of Elia ‘The Convalescent’ Meditation is not a means to an end. It is both the The first water cure was the Flood, and it killed means and the end. Walsh) Observer  August () It is necessary that a surgeon should have a temperate and moderate disposition... He should be well grounded in natural science, and should René Laënnec – know not only medicine but every part of French physician philosophy; Chirurgia Magna (transl. Walsh) I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and Why is there such a great difference between the the other to my ear, and was not a little surprised physician and the surgeon? The physicians have and pleased to find that I could thereby perceive abandoned operative procedures to the laity, the action of the heart in a manner much more either, as some say, because they disdain to clear and distinct than I had ever been able to do operate with their hands, or because they do not by the immediate application of the ear. Walsh)   ·     Andrew Lang – In truth, the amount of irremediable disease in Scottish man of letters the world is enormous. General Remarks on the Practice of Medicine ‘The Heart and He uses statistics as a drunken man uses Its Affections’, Ch. Attributed General Remarks on the Practice of Medicine ‘The Heart and Its Affections’, Ch. General Remarks on the Practice of Medicine ‘The Heart and It is less important to invent new operations and Its Affections’, Ch. Perfect health, like perfect beauty, is a rare thing; First Congress of Surgery,  April () and so, it seems, is perfect disease. General Remarks on the Practice of Medicine ‘The Heart and Wind is the cause of a hundred diseases. The only exercise I get is when I take the studs out Lectures on Clinical Medicine Lect. Bartlett’s Unfamiliar Quotations Medicine is a strange mixture of speculation and action. The knowledge of the senses is the best The sins of youth are paid for in old age. You cannot be sure of the success of your remedy, Whom fate wishes to ruin she first makes mad. Professor of Pharmacology, University College Hospital, Diseases of the Heart Lect. The choice before doctors is not whether they General Remarks on the Practice of Medicine ‘The Heart and should experiment on their patients, but whether Its Affection’, Ch. General Remarks on the Practice of Medicine ‘The Heart and Clinical Pharmacology p. Churchill Livingstone, Edinburgh ()    ·    Antoine Lavoisier – James Le Fanu French chemist Doctor and medical journalist We must trust to nothing but facts: The map of mental illness, like that of Africa These are presented to us by Nature, and cannot before the Victorian explorers, remains a blank. Robert Kerr) The failure of the two great projects of the last Public usefulness and the interests of humanity two decades – The New Genetics and The Social ennoble the most disgusting work. Metropolitan Life ‘Food for Thought and Vice Versa’ Vladimir Ilyich Lenin – Stanislaw Lec – Russian revolutionary and head of state Polish poet Either socialism will defeat the louse, or the louse Wounds heal and become scars. Every surgeon carries about him a little cemetery, The Spy Who Came In from the Cold in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures. Lecky – La Philosophie de la Chirurgie Foreword Irish historian and philosopher Abortion... Letter to a friend,  September () Armies have been supposed to lose more of their men by sickness than by the sword. Sir Thomas Lewis – A Treatise of the Scurvy Preface British physician and clinical scientist Art Linklater Diagnosis is a system of more or less accurate Contemporary guessing, in which the endpoint achieved is a name. Skin is like wax paper that holds everything in Lancet :  () without dripping. A Child’s Garden of Misinformation () Georg Christoph Lichtenberg – Lin Yutang –? German physicist and satirist Chinese author and philologist How is it that animals do not squint? Is this The Chinese do not draw any distinction between another prerogative of the human species? By the London Post, Massachusetts Medical Society (), quoting his article in the New England Journal of Medicine of Medical practice—where next? Journal of the Royal Society  October () of Medicine :  () It is intellectual and communication skills which Lord Lister – will become the most crucial competency in health care. Journal of the Royal Society Since the antiseptic treatment has been brought of Medicine :  () into full operation my wards, have completely The basic contract of health care has changed changed their character; so that during the last from a private matter between doctors and nine months not a single instance of pyaemia, patients to a more public one between health care hospital gangrene or erysipelas has occurred in providers – epitomized by hospitals – and patients. Journal of the Royal Society British Medical Journal :  () of Medicine :  () On the Antiseptic Principle of the Practice of Surgery    ·    The material which I have employed is carbolic or Liu Kung Cho phenic acid, a volatile organic compound, which Chinese sage appears to exercise a peculiarly destructive The able doctor acts before sickness comes. Professor of Gynaecology, Sydney, Australia British Medical Journal :  () Induced abortion, usually in defiance of the law, is On the Antiseptic Principle of the Practice of Surgery the oldest method of birth control and the most It is our proud office to tend the fleshy tabernacle common method by which women prevent the of the immortal spirit, and our path, if rightly birth of unwanted children. David Lloyd George – Address University of Edinburgh, August () British Liberal statesman The irritation of the wound by antiseptic When they circumcised Herbert Samuel, they irrigation and washing may therefore threw away the wrong bit. Percy Lockhart Mummery – Report of the British Association for the Advancement of Coloproctologist at St. Mark’s Hospital, London Science () Probably more reputations have been damaged by There are people who do not object to eating a the unsuccessful treatment of cases of fistula than mutton chop, yet who consider it something by excision of the rectum or gastroenterostomy. British Medical Journal :  () Presidential Address to the Royal Society of Medicine () The profession to which I have the great honour to belong is, I firmly believe, on the average, the Robert F. The patient should be managed the way the doctor British Medical Journal :  () or a member of his family would wish to be treated if he were that patient in that bed at that time. I regard that all worldly distinctions are as Attributed nothing in comparison with the hope that I may have been the means of reducing in some degree the sum of human misery.