By W. Gamal. Rosemont College.
A recent report from the Institute of Medicine claims that some thirty new diseases have cropped up since the mid-1970s purchase nizagara 100 mg line, causing tens of millions of deaths purchase nizagara 25mg with amex. New microbes continually come into being and old ones can mutate or evolve rapidly, which challenges our immune systems’ ability to resist them. Serious, sometimes lethal, infec- 14 Becoming Your Own Medical Detective tious diseases such as various strains of inﬂuenza, acquired immunodeﬁ- ciency syndrome (AIDS), and new drug-resistant strains of tuberculosis spread rapidly around the world, often from developing countries to indus- trialized nations. We’re frequently beset by new strains of ﬂu that set physi- cians on a hunt for ways to diagnose and treat them while researchers scramble to develop effective ﬂu vaccines. For instance, we are seeing fre- quent cases of West Nile virus popping up. Most recently, while severe acute respiratory syndrome (SARS) was dominating headlines, a virulent strain of avian ﬂu in Belgium and the Neth- erlands quietly emerged, wiping out entire chicken farms, jumping from poultry to pigs and then to people. The victims began showing up in emer- gency rooms with eye inﬂammation and respiratory illness, which in eighty- three cases resulted in death. Airplanes and cruise ships pump recir- culated air, which may be harboring microscopic monsters, to their passengers. Natalie Angier writes in the New York Times Magazine, “Today diseases as common as the cold and as rare as Ebola are circling the globe with near telephonic speed. Microbes travel by land, sea, air, nose, glove, love, sewage, steerage, rat backs, hat racks, uncooked burritos, overlooked mosquitoes. Nowadays, a mosquito infested with the malaria parasite [or West Nile virus] can be buzzing in Ghana at dawn and dining on an airport employee in Boston at cocktail hour. But there is no standard way to exchange up- to-the-minute information with researchers in other countries in spite of the existence of such organizations as the World Health Organization. As yet, no central symptom-based database exists in this country or in the world, though many experts are working to correct this deﬁciency. Local governments are even being encouraged to harness computers for the task of identifying and tracking disease outbreaks (as reported in the The Diagnosis Dilemma 15 June 2003 issue of Governing, a magazine designed for states and localities). Clearly, though, we are still only in the infancy stages of gathering and exchanging data. It is easy to see how many diseases simply have not yet been identiﬁed and can be diagnostic mysteries. The Immeasurable Effects of the Environment The increase in mystery ailments may be related to factors we encounter in the environment, ranging from chemicals to microorganisms whose growth may be stimulated by changing climatic conditions. For instance, toxic mold can cause serious illnesses that not all doctors know how to recognize. They might expect to ﬁnd such diseases in those who live in substandard hous- ing but fail to ask pertinent questions of their well-heeled patients. There are many unanswered questions about environment-related dis- eases and many aspects that must be researched, and without clear cause- and-effect statistics, physicians may be reluctant to link mysterious symptoms to such exposures. Even so, it is now estimated that forty million people have some form of environmental illness due to allergic or toxic reac- tions to hundreds of thousands of chemicals contained in our air, food, water, homes, workplaces, and schools. But until more studies are con- ducted, it is diagnostic guesswork at best. Kathy, a hard-working executive secretary, had a complex of symptoms that started insidiously with ﬂulike signs—chills, joint pain, and breathing difﬁculties—which ultimately landed her in the hospital emergency room gasping for breath. But no one could diagnose her condition until she found one smart doctor who was willing to look beyond the usual. He found that Kathy was suffering from a malady known as hypersensitivity pneumoni- tis—also known as farmer’s lung or cheese lung—and more recently iden- tiﬁed as a form of “sick building syndrome. It is also found in hay stored in barns and in the fermentation process at cheese factories.
This invaluable war experi- ence crystallized his interest in the surgery of injuries discount 25mg nizagara overnight delivery. Although trained as a general surgeon and accredited as such by the American Board of Surgery discount nizagara 50 mg on-line, interest, opportunity, and circumstances gradually led him into the ﬁeld of musculoskele- tal trauma. Quigley was associated with the Department of Thomas Bartlett QUIGLEY Hygiene and Athletics at Harvard University, 1908– eventually becoming head of the department. He once stated that “the care of these young men Thomas Bartlett Quigley was born on May 24, occupied one-third of my time; and constituted 1908 in North Platte, Nebraska, the son of Dr. He prepared at Omaha opportunity to study injuries under ideal circum- Central High School and then moved East to stances. Although istrative demands of committees and professional there had never been much doubt in his mind societies. For more than 30 years he revived, about a career in medicine, he ﬂirted with the mended, and befriended countless Harvard theater during the summer of 1928. However, he athletes, thus earning the nickname “doctor of has never regretted his choice of medicine. Needless to led to the production of more than 172 publica- say, a rented cut-away was hardly suitable attire tions during his career, mainly devoted to the for such an interview; the Dean thought he was a surgery of trauma. His writings have always been “playboy” who had little to offer the profession. He was, however, accepted by the medical school He has had relatively little time for hobbies, and on graduation in 1933, he felt that he had been but has always enjoyed the sea life, particularly in Boston for long enough, and therefore applied ﬁshing and sailing near his summer home on for an internship in New York. Quigley has had an academic appointment Parker Hospital in New York City. He has Brigham Hospital, where he received his post- also been a consultant to many of the major hos- graduate education in surgery and remained as a pitals in Boston. Furthermore, he has served on member of the staff until his retirement in 1974. In 1978, he was editor of the Year Book 285 Who’s Who in Orthopedics of Sports Medicine. He received an honorary membership in the American Orthopedic Associ- ation for Sports Medicine in 1976, and was cited as “Sportsman of the Year” in 1978. During the period from 1977 to 1978, he was president of the Harvard Medical Alumni Association. Quigley has made numerous contributions to the art and practice of orthopedic surgery, but his approach to the management of the frozen shoulder and the development of a procedure to stabilize the knee utilizing the popliteal muscle deserve special attention. Quigley has served as a role model for students and residents for more than four decades. He has been a superb teacher, perhaps in part owing to his acting talents, but also because of his knowledge and surgical abilities. REYNOLDS especially athletes, students, and residents, and he has encouraged the scholarly activities of numer- 1908–1986 ous surgical and orthopedic residents. He enrolled Whether on rounds or in the operating room, in Washington University in 1926 and received a Dr. Quigley has evidenced the ability to recognize Doctor of Medicine degree in 1934. In surgical house ofﬁcer at Barnes Hospital under the care of patients, the education of students and the supervision of Dr. In 1942, Fred entered active duty with the References United States Army and in 1943 was transferred to England. Quigley TB (1954) Checkrein shoulder: A type of General Hospital in 1944, he met Lieutenant “frozen” shoulder.