Mark Corson

A. Mezir. Kennedy-Western University.

Jean Mark Gaspard Itard (1774-1838) generic 25mg hydroxyzine with mastercard, a Parisian asylum doctor 25mg hydroxyzine visa, tried to treat cheap 25 mg hydroxyzine free shipping, 3951 Victor, the twelve year old feral ‘Wild boy of Aveyron’ in 1801, giving up in failure after six years. In British India, from the early 19th century, a policy of repatriation of the mentally ill back to England was used to disguise such vulnerability from the natives. Treating the insane: rotating chair 3949 Friern Hospital from 1937 until it was closed in the 1990s. Hitch wrote to colleagues in England, Ireland and Scotland in 3953 1841 suggesting that an association be formed. The Journal of Mental 3958 Science replaced the Asylum Journal and was itself replaced by the British Journal of Psychiatry since 1963. The Idiots Act of 1886 made the simple distinction between greater (idiot) and lesser (imbecile) degrees of mental handicap. Sutherland of London), and included Conolly (1858), Bucknill (1860), Joseph Lalor (Richmond Asylum, Dublin, 1861) and Henry Monro (Clapton). Duncan [took over from his father at Farnhamm House private asylum, Finglas – he was also vice-president of the College of Physicians] of Dublin (1875), J A Eames of Cork (1885), Conolly Norman of the Richmond Asylum (1894), Oscar T Woods of Cork (1901), W R Dawson of Dublin (1911), and Michael J Nolan of Downpatrick. Patrick’s Hospital, Dublin, (1931) John Dunne (Grangegorman, formerly the Richmond Asylum; 1955), William McCarten of Northern Ireland (1961), Desmond Curran (London, 1963), and Erwin Stengel (Sheffield, 1966). Amariah Brigham 3960 Tom Lynch (1922-2005; see picture) in charge: later Professor of Psychiatry, Royal College of Surgeons, Dublin. Other provisions entertained by the Act included an emergency order of short duration and special inquiries in the case of aristocrats. The same legislation allowed and for uncensored forwarding of certain letters written by inmates and for the relegation of restraint to the status of a specific medical intervention rather than something which any member of staff might apply. In 1879, Dr Abraham Cowles of the McLean Asylum, Massachusetts, started the first training school for attendants of the insane. It is generally held that McNaghten was a paranoiac (delusional disorder) or, favoured by Rollin, (1996) had a schizophrenic disorder. McNaghten was placed in Bethlem Hospital but was eventually moved to Broadmoor Asylum, dying there on 3rd May 1865 aged 52 years. A consequence of this Act was the locking away in asylums for long periods of retarded individuals who had outraged public morals, including girls who had become pregnant. The case of Sir Roger Casement provides an example of how homosexuality was viewed publicly in the early part of the 20th century: following the 1916 rebellion in Ireland, Casement was sentenced to death. Earlier, in the 1860s, Gustav Broun cauterised the clitoris and uterine cavity to reduce masturbation in women. Denial of masturbation was often met with disbelief and guilty depressives often exaggerated their sins. St Thomas Aquinas (1225-1274) stressed that sex was for marriage and only for procreative purposes. In 1708 the Dutch physician Herman Boerhaave (1668-1738) wrote that ‘too lavish’ a discharge of semen led to a wide variety of nervous problems that included convulsions, and dullness of the senses! S A D Tissot, a Swiss physician, published an influential book on the subject in 1758 which contained similar dire warnings. Benjamin Rush of Philadelphia published a book in 1812 in which he mentions masturbation as a cause of madness, impotence, poor sight, amnesia, and death! The effects of masturbation were considered to affect the health of offspring, perhaps an early attempt at epigenetic theorising! He was expelled from the Obstetrical Society in 1867 and his theories about masturbation were contradicted by Henry Maudsley, 3970 although Maudsley had earlier been an adherent of masturbatory insanity himself. Kraepelin, writing in the 1890s, was categorical that masturbation never causes madness. Whilst belief in masturbatory insanity lingered on into the first half of the twentieth century it eventually gave way, in orthodox circles at least, to the view that, apart from religious considerations, the main consequence of masturbation per se was guilt. Males were sometimes subjected to infibulation (wring of the foreskin to prevent its movement)! In 1958, the South African, Joseph Wolpe (1915-97: later worked in Philadelphia), published Psychotherapy by Reciprocal Inhibition, and went on to develop the treatment known as systematic desensitisation. Joseph Wolpe The 1930 Mental Treatment Act allowed for three admission categories, one of which recognised the person who might be admitted voluntarily (and might discharge himself by giving three days notice). The earlier association of asylums with only involuntary care may have branded them as places one sent people to as a final resort. The English Homicide Act of 1957, reflecting a long tradition in Scotland (Walker, 1968), permitted a defence of diminished responsibility to a charge of murder. If successful, the conviction is of manslaughter, allowing the judge wider choice of disposal. The Irish Criminal Law (Insanity) Act 2006 permits a defence of diminished responsibility. Dr J Carse of Graylingwell Hospital, Chichester, started 3972 the ‘Worthing Experiment’ in 1957: a day hospital , out-patient clinic, and domiciliary service reduced admissions from Worthing by 59%. The launch of the National Health Service in 1948 initiated the difficult process of integrating mental health services with the general body of medical services, thus, at least de jure, freeing them from ‘the taint of the Poor Law and lunacy code’. In fact open doors were to be found in Fife and Kinross Asylum in the 1870s under Dr John Batty Tuke, no relation of the York Tukes. Jimmy Carter established a 3973 President’s Commission on Mental Health in 1977 which increased funding for community psychiatry. However, Ronnie Reagan repealed this legislation in 1981, before it could be implemented. A night hospital was situated in the stables, at first operating weeknights but later also at weekends. People found unfit to plead before this legislation could be detained in hospital without any finding as to guilt or innocence.

There is less than normal spontaneity of movement or facial expression buy hydroxyzine 10 mg low price, there is no hypertonia proven hydroxyzine 25 mg, and the patient feels tired generic hydroxyzine 10mg with mastercard, indifferent, sad, or ‘like a zombie’. Sustained contraction of muscles of neck, mouth, tongue, or occasionally other muscle groups that is subjectively distressing and 3728 3729 often painful. Examples are oculogyric crisis , blepharospam, glossopharnygeal 3730 dystonia , tortipelvis, lordosis, scoliosis, opisthotonus, and twisting of mouth or 3731 rotation of neck. Acute first-episode psychotic patients are more likely to develop acute 3732 dystonia if they are relatively young and have negative symptoms. The young male (well muscled) is the classic victim but the association with male sex is questionable. Flecainide, a substituted benzamide and class Ic antiarrhythmic, has been reported to ‘possibly’ cause oro-facial dyskinesia in one case. Reducing the dose of antipsychotic drug may lead to a transient worsening of dystonic movement, but about 50% of the movements will improve or disappear eventually. Median of 5 years exposure to antipsychotic drugs but can occur as early as 3 weeks. Anticholinergic drugs, tetrabenazine, reserpine, clozapine, or stopping the offending drug are all possible management strategies. Thornton & McKenna, 1994) 3730 Dysarthria, dysphagia, breathing problems, cyanosis. Botulinum toxin can be used for circumscribed tardive dystonic syndromes, such as laryngeal dystonia, but injections need to be repeated every 3-6 months. Thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus are surgical approaches to managing refractory cases. Tardive dysbehaviour disorder, the occurrence of increased activity, aggression, screaming, insomnia and so on after stopping long-term antipsychotic drug treatment,(Gualtieri ea, 1984) is another controversial disorder. Akathisia May be responsible for non-compliance with medication, violence or even suicide Occurs in both medicated and unmedicated Parkinsonism Occurs in about 20% (12. There may be subjective and objective components, but the absence of the subjective element (pseudoakathisia) does not negate the diagnosis,(Sachdev, 2004, p. However, the supine case may still show legs crossing and uncrossing, shifting of the position of the trunk, and various other movements. Akathisia was first reported as a complication of antipsychotic medication by Hans Steck (1954) a psychiatrist at Céry-Lausanne. Withdrawal akathisia develops days to weeks after stopping or reducing the dose of an antipsychotic drug. However, akathisia following removal of a drug that suppresses akathisia does not fit this definition. Also, pain or burning in the oral or genital reasons has been included in this category. Pseudoakathisia is an unfortunate term that may mean tardive dyskinesia of the lower limbs or that there is no subjective sensation of restlessness. Hemiakathisia (affects one half of body) and monoakathisia (one limb involved) are curiosities. Although reported in relation to drug therapy, they should lead one to consider a physical cause. Secondary akathisia may be due to Parkinson’s disease, cerebral trauma, damage to the lenticular nucleus or subthalamic nucleus, or encephalitis lethargica. Whilst forward flexion of the spine is typical, some cases may 3738 stand stiff and upright whilst others may even bend backwards. Extrapyramidal rigidity can be lead-pipe (persistent resistance to passive movement) or cogwheel (succession of resistances). Above and below that point these two activities come closer together so that Parkinsonism becomes less at lower and higher doses. This accounts for the well-known clinical phenomenon of an increase in Parkinsonism as the dose of neuroleptic is reduced! Whilst most cases are reversible, some may represent unmasking of idiopathic Parkinson’s disease. The first modern description may have been that of Matthias Schönecker in 1957 (of Essen-Brobeck) and the term ‘tardive dyskinesia’ was proposed by Arild Faurbye (1907-1983) of St Hans Psychiatric Hospital Roskilde (Denmark) and co-workers in 1964. Patients with affective disorders who are given neuroleptics (disputably, depressed patients may be at greater risk than schizophrenic patients – Yassa ea, 1992; Larkin & Gervin, 1998 – but not all studies agree: Twamley ea, 2003, p. In patients of 55 years or older with bipolar affective disorder, the ones with involuntary movements were not distinguished from those without them by past or current exposure to antipsychotic drugs, anticholinergics, or carbamazepine, but they had poorer cognitive function, had fewer major depressive episodes, and had received briefer exposure to lithium. It is more 3741 3742 common with age , anticholinergic drug given in addition , possibly female sex, 3743 depot neuroleptics , and perhaps early Parkinsonism. African Americans), confounding may have occurred due to assignment of ethnicity in a multiracial society, and other factors such as medication choice and dosage, tobacco, 3746 alcohol , diet, and genes must all be taken into account. Withdrawal-emergent dyskinesia may either resolve over some weeks or may not resolve, the latter presumably representing cases that were latent or simply suppressed by D2 blockade. Withdrawal-emergent dyskinesia may follow a change from a typical to an atypical antipsychotic. Adolescents with schizotypal disorder were found to have an excess of movement disorder that progressed with time and that correlated with prodromal psychotic symptoms. The left lentiform nucleus was 11% larger in dyskinetic patients v controls, and the right lateral ventricle-hemisphere ratio was 33% larger in patients without dyskinesia v controls. As controls age the volume of caudate and lentiform nuclei shrink, a pattern not seen in the patients. The authors suggested that dyskinetic patients have striatal pathology, whereas cortical atrophy is more pronounced in non-dyskinetic cases.

Why was Health Watch attacking those therapists and scientists who thought that the destabilisation of our natural environment was making us ill? In this book purchase hydroxyzine 25 mg on-line, I have tried to answer some of these questions buy discount hydroxyzine 10mg online, although even I have to admit that the route to my conclusions seems on occasions tenuous order 10mg hydroxyzine with amex. This is not due to any lack of intellectual rigour on my part, but more to do with the fact that my investigation only scratched the surface of a powerful and extensive underworld spawned by big business. It will be some time before we are able to understand fully and record in detail the present period of crisis and the shifts in paradigm which have thrown up the surveillance, sabotage, harassment and fraud which are increasingly becoming an everyday part of commercial competition. In the last months of writing, three unrelated things affected me, forcing me to focus my mind more sharply on the importance of finishing the book. Clinic employees were made to raise their hands and stand against the wall, while officers covered them. Coincidentally, at around the same time, I received a call from a doctor and research scientist in Europe. Much of his work has concentrated upon chemical food additives and their effect upon the immune system. Anonymous letters to his local tax office falsely claimed that he had assets in Swiss accounts. In a re-run of the charges brought in the sixties against Dr Joseph Issels, the German cancer doctor, Naessens was charged with having caused the death of a woman to whom he gave treatment. His acquittal did not however diminish the terror, suffering or social destruction brought by such cases. I have tried to create a narrative running from beginning to the end, but I realise that in places it is interrupted and is unlikely to engage the attention of many readers from start to finish. Part One looks at the growth of scientific medicine and the history of health-fraud campaigns in America. It lays the basis for understanding the role of Rockefeller interests in defending orthodox medicine and scientific research. The lives of these practitioners are taken up again in Part Five of the book which details attacks upon them after 1989. Part Four traces the historical conflict between orthodox and complementary medicine in Britain, and deals with the beginnings and growth of the London-based Campaign Against Health Fraud. Part Five picks up on the stories of those practitioners whose work was discussed in Part Two. Given the relative complexity of the book, its large number of subjects and lack of continuous narrative, some readers may prefer to read sections separately. I structured the book as I did, because I felt that the information was most accessible when presented in this way. I reasoned that readers would want to become familiar with the individuals and practitioners involved in alternative medicine before they read about the attacks mounted against them. In this book, I have frequently found myself using terms which do not describe what I wish to say. Often this is not however a pure or noble science but a corrupted science, one which serves profit rather than truth. Scientific medicine does not always reflect the highest standards of medicine and is sometimes not at all scientific. On the other hand some of the research carried out into the basis of such things as homoeopathy and acupuncture has been high quality science. Naturally we are all against fraud of any kind, at the least it robs us of our expectations and at worst deprives us of our innocence. We might disagree about the prevalence of fraud in health care, but we are all against it. While investigating and researching this book, I came across very little deliberate health fraud amongst alternative or complementary practitioners. Those practitioners who are not effective in their work are rarely fraudsters, more often they are naive but sincere individuals who would accept regulation if the matter were discussed. On the other hand, very real fraud in science, industry, business and research is increasing. In these areas, the intent of the fraudster is often blatantly criminal and their actions utterly unaccountable. Part of this book is about the British Campaign Against Health Fraud and the American National Council Against Health Fraud. If anything, those whom they tar with the brush of fraud are involved in nothing more than fair competition with orthodox medicine or medical research. Where reference is made to the specific campaigns, readers will just have to bear in mind that I do not think that their titles befit their true aims. As in war or under a totalitarian regime, language rather than verifiable facts has shaped our understanding of the illness. The era of industrial production and the mass society which it created is coming to an end. The evolutionary necessity of the industrial revolution created enormous problems. The new means of production, the factories, belched out pollution and filled the air with chemical toxins. The noisy metal machines imposed upon their operatives the anonymity of yet another part of that machine. The monumentally rewarding ideas which gave birth to it, concepts of rationalism and scientific enquiry which were to free the human body from its travail of work, were twinned with the debilitating effects of the new industry, effects which were inseparable from it. The science which accompanied the industrial revolution was a science which grew from engineering, the making of metal machines. Science re-created a structure of knowledge which was itself based upon knowledge of the machine.

After decontamination may be employed to improve casualty flow though such a system cheap hydroxyzine 25mg. Rescuers that have been operating within the warm or hot zones Cyanides are chemical asphyxiants that inhibit mitochondrial will also require decontamination (Figure 34 cheap hydroxyzine 10mg free shipping. Severe exposure can cause death within minutes buy hydroxyzine 25 mg free shipping, with victims experiencing dyspnoea, hypotension and syncope, followed by cardiorespira- tory arrest. These patients have a significant metabolic aci- dosis due to excessive anaerobic cellular respiration. Symptoms develop over minutes to hours, with ocular involve- ment (pain, irritation) being followed by respiratory symptoms (irritation, inhalational burns, acute lung injury) and then by skin blistering. Pulmonary agents such as chlorine and phosgene damage the cell membranes within the respiratory tract and lungs leading to progressive airway irritation, pulmonary oedema and in severe exposures death. Biological casualties Once stabilized from potentially life-threatening traumatic injuries, patients exposed to radiation should undergo prompt Delayed presentation often complicates the presentation of bio- decontamination to avoid spreading particles of radioactive logical casualties, and it can be difficult to initially discriminate material; once decontaminated, there is minimal risk to healthcare between a few sick patients and a group of victims intentionally providers (who should still, as a matter of course, observe standard exposed to a biological agent. Pure radiation exposure without contact with that are considered to be possible components of biowarfare or any material does not cause a patient to become radioactively bioterrorism plots are also endemic to certain areas of the world dangerous to others. Consequently, a high index of suspicion regarding unusual are not likely to be a significant source of exposure to prehospital clusters of disease or presentations of a disease unusual to the area personnel. A few specific types of radiation sources, when ingested, or in the wrong season is key to identifying a biological agent are amenable to particular antidotal therapies; however, these are exposure and initiating the investigative process. When possible, after immediate life-stabilizing treatment, decontamination can Radiological and nuclear casualties then be performed to minimize spread of radiation and risk to Presentation of radiological casualties can occur any time, from healthcare personnel. Additional debridement and decorporation immediately after an exposure to weeks later depending on the therapy will probably be provided in the hospital setting. Delayed presentations can lead any radiation exposure, the principle of ‘time–distance–shielding’ to challenges in establishing the correct diagnosis. Nuclear casualties, in contrast, themselves by physical barriers when possible (e. Personal dosimeters can help identify and monitor the area of the detonation are also exposed to typical explosive/blast ongoing radiological hazards. Mass casualty triage in the chemical, biological, radiological, or nuclear environment. Sacramento: California Emergency Medical Services Authority, incident sites may require higher-level protection. Medical treatment of radiological precautions are advisable for all multiple casualty responses casualties: current concepts. Medicalstrategiestohandlemasscasualties suspected exposures from the use of biological weapons. Football matches seem 2001 Congo Stampede 50 10 to be of particular concern as many documented disasters having 2001 Ghana Stampede 150 130 occurred over a relatively short period of time (Table 35. Despite these alarming statistics, it is not just football events that carry the risk of developing into a mass casualty incident. Instead, concerts, political gatherings and even religious meetings have been a thorough risk and vulnerability analysis needs to be undertaken. The presence of alcohol as well as recreational with the event organizer and other relevant safety and security role drugs further complicates matters for event organizers and medical players. Many risk factors have been described which have a direct planners of mass gatherings. Medical planning for a mass gathering impact on the number of persons requiring medical intervention is not as simple as just deploying medical personnel on the basis of at a mass gathering. Although the literature • past history of similar events describes events that have an audience younger than 35 years of age • expected number of spectators as being associated with a greater number of patient presentations, • event duration one must not forget that events that attracts predominantly elderly • seasonal considerations people can likewise result in large patient numbers. This has been • proximity to hospitals documented in many descriptive studies, particularly large religious • profile of hospitals gathering such as Papal visits. Past history of similar events Nature of the event The history of previous events of a similar nature, with particular The nature of the event being hosted has been identified as being reference to the type of incidents that occurred and the medical just as an important risk factor as the number of spectators when problems that arose, is an important piece of information to be predicting likely medical requirements. For example: a rock concert considered when planning the medical coverage for an event. Every with the potential of a younger spectator profile and increased mass gathering should add to a database which in turn can aid in potential of alcohol and/or drug abuse is likely to result in more evidenced based planning for similar events worldwide. Is the event being hosted in a purpose built stadium or does the venue consist of temporary structures which may elevate the risk Expected number of spectators profile? Indoor events have been shown to produce lower patient numbers than similar events held outdoors where exposure to the The number of spectators may be one of the easier parameters elements may have a detrimental effect on the spectators. Early consultation and planning in conjunction with the event organizers will aid in determining the expected numbers of persons that will be attending. More often than not, the capacity of the venue will be exceeded when unseated spectators are catered The duration of the event is an important determinant of the for, and this has its own inherent problems. Events of an extended duration add a number Spectator profile of additional risks that need to be considered. Medical staff may need to be deployed in a shift system so as to adhere to legislation The importance of profiling the potential spectators cannot be over that covers the maximum hours that a medical staff member can emphasized. It is also likely that the number of patients presenting for medical attention is likely to increase the longer the event continues. This is especially relevant where alcohol is sold at the venue as well as when the spectators are exposed to environmental elements. The length of time that people are expected to queue to enter a venue should be included in the determining the duration of the event Seasonal consideration Weather is noted to be an important but all too often neglected factor that determines patient presentation rates at mass gatherings. Hot and humid conditions are noted to be associated with a higher patient presentation rate. Be aware that medical staff deployed at these events are also potentially exposed and thus the planning should also include suitable shelter from where the medical staff can operate. This guide provides a way in which to quantify the risk profile of an event based on the factors listed earlier in this chapter (Tables 35.