- Email: [email protected]
Netherlands CONTROL OF MALARIA
971 reaction to that war I saw riots and demonstrations that closed schools and businesses, disenchantment and flight to Canada, and an overall anguish in society that continues to reincarnate. A boyhood chum was killed during the Tet offensive (friendly fire? drug overdose? a hero?) and a cousin committed suicide after reluming from Nam. Approaching my eighteenth year with trepidation and anger at the military-industrial complex, events conspired in an unusual pattern for me. My lottery number kept me in college and assured of not getting drafted. I escaped the military-but wait. Because of high medical-school costs and limited financial options, I joined the Army. The Uniformed Services Health Professions Scholarship Program was the bait and I the hungry fish. Not only would the military support my tuition and books but also I would be paid$400 a month while attending medical school. My payback obligation was to serve in the Army for three years after
residency. The Army experience was good. I completed medical school and didn’t owe a dime. I received excellent postgraduate training in an Army medical centre. Subsequently, I experienced two challenging and productive utilisation tours. During my six years’ active duty I had feelings of ambivalence about wearing the uniform. I was proud to serve my country, but, imprinted by the TV evening news of my youth, I had come to feel that the uniform symbolised the infliction of pain and suffering. Not consistent with my oath as a physician. Time is slowly beginning to heal some of the deep lacerations of Vietnam. Today the draft-age youth looks to the military as a good economic start (like I had), though in a neutral moral environment. When my obligation was complete, I had to take off the uniform, though the Army was good to me, wanted me to stay with a promotion, and would have been a rewarding career. The images of the 1960s and early 1970s remained too vivid for me. However, my strident distaste for anything perpetrated by our Government has softened to a more analytical, less emotional relationship. I am older but hopefully not selling out. I hope that the Vietnam lessons have truly been learned. Our country and the world need more people training for peace and preparing to fight the battles of hunger, hatred, disease, illiteracy, and pollution. This warfare should be the medical well as all people’s active mission.
profession’s
as
Netherlands CONTROL OF MALARIA
Q-Now! was the title of a recent symposium on the use of quinine and quinidine in malaria, organised in Amsterdam by the Association Institute for Tropical Medicine Rotterdam-Leiden. It gathered some 150 physicians, pharmacologists, botanists, parasitologists, pharmacists, and industrial chemists. The programme ranged from the historical aspects of the discovery of the Peruvian bark, through methods of harvesting the precious natural product at modern plantations of cinchona in Africa, to clinical uses of its main alkaloids in severe falciparum malaria, in cardiology, in muscular, neurological, protozoan, or helininthic diseases, and in veterinary medicine. The problem of resistance of Plasmodium falciparum to most of the synthetic antimalarial compounds and the incipient resistance to quinine in some parts of the tropical world revealed how narrow is our present margin of safety in chemotherapy and chemoprophylaxis of malaria. The value of exchange transfusion and the new knowledge of pharmacokinetics of quinine drew much attention. Finally, some exciting prospects of biotechnology in the cultivation of cinchona plants under laboratory conditions and the possibilities of genetic engineering of the sources of alkaloids were unveiled. The advantages and disadvantages of such revolutionary advances that may threaten the three centuries of the domination of Jesuit bark in the treatment of malaria were given a fair appraisal. The papers presented
Leyderma.
at
the
symposium
will be
published
in Acta
In
England Now
My daughter is a sister in the busy accident department of a London hospital. Enter one day a burly policeman leading an elderly man and woman who were badly scratched about the face and hands. The story was that their docile and pampered tom-cat-fed on smoked ham at 95p a quarter pound from the delicatessen-had suddenly gone berserk and attacked them ferociously and repeatedly, so that they had had to retreat into the bedroom, where fortunately there was a phone to contact the police. The officers forced an entry, killed the cat, released the terrified couple, and then threw the corpse into a convenient skip. Immediate treatment was straightforward but my daughter was worried about rabies. She also had a vague recollection of something called cat-scratch disease. So she rang up the police station and asked them to find the body. The desk sergeant was incredulous. "Are you pulling my leg, Miss?" he asked. Sister denied it. So with heavy emphasis he went on: "Look, Miss, do you seriously expect me to go round rubbish-tips looking for a pussy-cat? A dead
pussy-cat?" She did, and eventually he did, and the vet did a postmortem. The verdict was expressed simply as "encephalitis". The couple’s outward injuries healed, but not their heartache. They found it bad enough to have lost their pet: the hardest fact to live with was that he had turned against those who loved him. *
*
*
AMONG my many faults an inability to spell must rank high. This did not matter, at one time, because I wrote everything by hand and a vague squiggle (or, in an emergency, a blot) could conceal my uncertainties if not my unknowing errors. This all changed a year or so back, when I was lured into buying a word processor. It has been very useful and I would not be without it-but the neatly printed text does show me up. Recently, therefore, I have invested in a spelling-checking program which runs alongside my wordprocessing software and not only checks my spelling but also suggests alternatives for words it does not recognise. Being innocent of much medical jargon, the machine has uttered some entertaining suggestions-and sometimes so apposite as to make one wonder if it can really think. My first effort was a letter to Mr X, our unit general manager, to complain about the latest effects of Griffiths on the NHS. I found that Mr X (UGM) became Mr X (Ugly), whilst Griffiths changed to Gruffness and NHS into NAG. I had talked of writing to the Secretary of State, but when I found him turned into Mr Fouler my nerve deserted me. Then I tried writing to one of our surgeons about someone who had attended his outpatients ("outdated" the machine would have it). The man had had a barium enema, and anyone who has experienced one will appreciate the change to "baring enemy". I went on to discuss his inguinal hernia, vaguely wondering what the surgeon would make of "infemal hermit". By now I was really getting into the swing of it, so I wrote to our local professor of obstetrics and gynaecology, who came out as professor of obituaries and gymnasium. This started me going through the titles of all my colleagues. That a paediatrician should become "patriarchal" seemed apt, the translation of our endocrinologist into "endearing" I was not so sure about. I felt sorry for our orthopaedic surgeon who, at the touch of a computer key, became an orphaned surgeon, whilst I did not doubt that our consultant in neurology would smile wryly if he discovered his metamorphosis into "consultant in neuroses". I suppose it is a comment on our times that much psychiatric
terminology was in the program’s dictionary; schizophrenia, paranoid psychosis, addiction, it recognised the lot. But it made a very appropriate job of addressing our senior psychiatrist, possessor of a doctorate and a fellowship: Dr Z, MD, FRCPsych, became Dr Z, MAD, FRANTIC.
residency. The Army experience was good. I completed medical school and didn’t owe a dime. I received excellent postgraduate training in an Army medical centre. Subsequently, I experienced two challenging and productive utilisation tours. During my six years’ active duty I had feelings of ambivalence about wearing the uniform. I was proud to serve my country, but, imprinted by the TV evening news of my youth, I had come to feel that the uniform symbolised the infliction of pain and suffering. Not consistent with my oath as a physician. Time is slowly beginning to heal some of the deep lacerations of Vietnam. Today the draft-age youth looks to the military as a good economic start (like I had), though in a neutral moral environment. When my obligation was complete, I had to take off the uniform, though the Army was good to me, wanted me to stay with a promotion, and would have been a rewarding career. The images of the 1960s and early 1970s remained too vivid for me. However, my strident distaste for anything perpetrated by our Government has softened to a more analytical, less emotional relationship. I am older but hopefully not selling out. I hope that the Vietnam lessons have truly been learned. Our country and the world need more people training for peace and preparing to fight the battles of hunger, hatred, disease, illiteracy, and pollution. This warfare should be the medical well as all people’s active mission.
profession’s
as
Netherlands CONTROL OF MALARIA
Q-Now! was the title of a recent symposium on the use of quinine and quinidine in malaria, organised in Amsterdam by the Association Institute for Tropical Medicine Rotterdam-Leiden. It gathered some 150 physicians, pharmacologists, botanists, parasitologists, pharmacists, and industrial chemists. The programme ranged from the historical aspects of the discovery of the Peruvian bark, through methods of harvesting the precious natural product at modern plantations of cinchona in Africa, to clinical uses of its main alkaloids in severe falciparum malaria, in cardiology, in muscular, neurological, protozoan, or helininthic diseases, and in veterinary medicine. The problem of resistance of Plasmodium falciparum to most of the synthetic antimalarial compounds and the incipient resistance to quinine in some parts of the tropical world revealed how narrow is our present margin of safety in chemotherapy and chemoprophylaxis of malaria. The value of exchange transfusion and the new knowledge of pharmacokinetics of quinine drew much attention. Finally, some exciting prospects of biotechnology in the cultivation of cinchona plants under laboratory conditions and the possibilities of genetic engineering of the sources of alkaloids were unveiled. The advantages and disadvantages of such revolutionary advances that may threaten the three centuries of the domination of Jesuit bark in the treatment of malaria were given a fair appraisal. The papers presented
Leyderma.
at
the
symposium
will be
published
in Acta
In
England Now
My daughter is a sister in the busy accident department of a London hospital. Enter one day a burly policeman leading an elderly man and woman who were badly scratched about the face and hands. The story was that their docile and pampered tom-cat-fed on smoked ham at 95p a quarter pound from the delicatessen-had suddenly gone berserk and attacked them ferociously and repeatedly, so that they had had to retreat into the bedroom, where fortunately there was a phone to contact the police. The officers forced an entry, killed the cat, released the terrified couple, and then threw the corpse into a convenient skip. Immediate treatment was straightforward but my daughter was worried about rabies. She also had a vague recollection of something called cat-scratch disease. So she rang up the police station and asked them to find the body. The desk sergeant was incredulous. "Are you pulling my leg, Miss?" he asked. Sister denied it. So with heavy emphasis he went on: "Look, Miss, do you seriously expect me to go round rubbish-tips looking for a pussy-cat? A dead
pussy-cat?" She did, and eventually he did, and the vet did a postmortem. The verdict was expressed simply as "encephalitis". The couple’s outward injuries healed, but not their heartache. They found it bad enough to have lost their pet: the hardest fact to live with was that he had turned against those who loved him. *
*
*
AMONG my many faults an inability to spell must rank high. This did not matter, at one time, because I wrote everything by hand and a vague squiggle (or, in an emergency, a blot) could conceal my uncertainties if not my unknowing errors. This all changed a year or so back, when I was lured into buying a word processor. It has been very useful and I would not be without it-but the neatly printed text does show me up. Recently, therefore, I have invested in a spelling-checking program which runs alongside my wordprocessing software and not only checks my spelling but also suggests alternatives for words it does not recognise. Being innocent of much medical jargon, the machine has uttered some entertaining suggestions-and sometimes so apposite as to make one wonder if it can really think. My first effort was a letter to Mr X, our unit general manager, to complain about the latest effects of Griffiths on the NHS. I found that Mr X (UGM) became Mr X (Ugly), whilst Griffiths changed to Gruffness and NHS into NAG. I had talked of writing to the Secretary of State, but when I found him turned into Mr Fouler my nerve deserted me. Then I tried writing to one of our surgeons about someone who had attended his outpatients ("outdated" the machine would have it). The man had had a barium enema, and anyone who has experienced one will appreciate the change to "baring enemy". I went on to discuss his inguinal hernia, vaguely wondering what the surgeon would make of "infemal hermit". By now I was really getting into the swing of it, so I wrote to our local professor of obstetrics and gynaecology, who came out as professor of obituaries and gymnasium. This started me going through the titles of all my colleagues. That a paediatrician should become "patriarchal" seemed apt, the translation of our endocrinologist into "endearing" I was not so sure about. I felt sorry for our orthopaedic surgeon who, at the touch of a computer key, became an orphaned surgeon, whilst I did not doubt that our consultant in neurology would smile wryly if he discovered his metamorphosis into "consultant in neuroses". I suppose it is a comment on our times that much psychiatric
terminology was in the program’s dictionary; schizophrenia, paranoid psychosis, addiction, it recognised the lot. But it made a very appropriate job of addressing our senior psychiatrist, possessor of a doctorate and a fellowship: Dr Z, MD, FRCPsych, became Dr Z, MAD, FRANTIC.