By V. Delazar. Pacific University.

While resources are poured into projects that use health to enhance social control buy 10mg hydroxyzine free shipping anxiety reduction techniques, real health needs—especially those of the elderly— are neglected buy 25 mg hydroxyzine free shipping anxiety symptoms in your head. In the following chapters we will be looking more closely at different aspects of the medicalisation of society, including both the widening range of medical intervention and at its greater penetration into the personal life of the individual. This is a process with adverse consequences for the individual and for society. Despite the fact that more people enjoy better health, the intense awareness of health risks means that people feel more ill. This results in an increasing 10 INTRODUCTION burden of demand on the health care system that every Western society experiences growing difficulty in meeting. In the penultimate chapter we turn to examine the current crisis of medicine and the medical profession—a set of issues which may appear unconnected to the process of medicalisation. Indeed, early critics of the medicalisation of society depicted this as a process driven by medical authorities and anticipated that it would lead to a further growth in medical prestige and power (Zola 1972). In fact, though, doctors have made a substantial contribution to the medicalisation process, as a profession they can scarcely be regarded today as its beneficiaries. The new millennium finds the medical profession in an unprecedented crisis of confidence, with its leaders expressing a beleagured and inward-looking mentality and its ordinary members preoccupied with stress. Through surveying the evolution of the crisis of medicine we can examine the contribution of both internal factors (the specific difficulties of post-war medical science) and external factors (the influence of the social and political events of recent decades). From this perspective, the trend towards medicalisation may be seen as both a consequence of the wider problems of medicine and as a factor exacer-bating them. The relentless politicisation of health under New Labour, which gathered momentum when the prime minister assumed personal responsiblity for the modernisation of the NHS in early 2000, is destined to intensify the process of medicalisation—and the problems of the medical profession and the health service. The key problem is that, just as the role of medicine in society has expanded, the NHS is called upon to play an ever wider role in the life of the nation. When most other institutions that once inspired popular loyalty are now, like the Royal Family, widely scorned, and attempts to foster a collective spirit around Britpop and the Dome have proved a big disappointment, New Labour is left with that great standby of Old Labour politicians, the ‘jewel in the crown’ of the post-war welfare state—the NHS. The NHS serves as a focus for New Labour’s populist gestures to the consumer culture which it believes to be the authentic voice of today’s Britain: hence NHS Direct and walk-in GP surgeries. It is also a key target of Tony Blair’s modernising zeal as he takes on those whom he has designated the ‘forces of conservatism’ in the crusade for quality, transparency and accountability. The NHS is also expected to help in the government’s drive to foster new bonds of community, through encouraging collaboration in the name of health among different agencies and professionals. New Labour 11 INTRODUCTION hopes to take advantage of the prestige of the NHS to advance its project of revitalising the institutional framework of British society and restoring the links between the individual and the state. Even though the government has allocated more funds to the health service, its wider policies are imposing a burden of expectations that will be almost impossible to fulfil, but will have far reaching consequences for our ability to live our lives as we choose. It had a profound effect on society and accelerated changes in the relationships between the state and the individual, and between doctor and patient, that had been proceeding more gradually over the previous decade. A phenomenon of much wider significance than the novel viral infection on which it was based, the panic was both a product of the peculiar insecurities of the historical moment in which it emerged and a force which intensified them. While the panic provoked private fears of a deadly disease, it also fostered new institutions embodying new forms of solidarity and promoted, in the form of the safe sex code, a new moral framework. It encouraged an already growing preoccupation with health or, to be more precise, with disease. The contemporary obsession with illness and death, with morbidity and mortality, so powerfully reinforced by the Aids crisis, increased the dependence of patient on doctor and strengthened the authority of the state over the individual. My first encounter with the Aids scare followed the death of Rock Hudson in 1985, before the panic had really taken off. This former matinee idol had died soon after the devastating impact of Aids had led to the public confirmation of both the nature of his illness and his homosexuality. A middle aged woman—a former fan, who had closely followed the news-story—went into a panic attack when she realised that she had shared a coffee cup with a gay man at work and came rushing in to the surgery. I heard several similar stories after the panic proper took off towards the end of 1986, and then again after the death of pop singer Freddie Mercury in 1992, and again with each upswing in the level of popular anxiety.

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It may also be seen with infarcts in the contralateral thala- mocapsular region order hydroxyzine 10 mg visa anxiety symptoms nail biting, posterior limb of the internal capsule (anterior choroidal artery syndrome) cheap 25 mg hydroxyzine amex anxiety yawning, red nucleus, and the paracentral region (anterior cerebral artery territory). Sensory loss is an indicator of cap- sular involvement; pain in the absence of other sensory features of thalamic involvement. Stroke 1998; 29: 2549-2555 Cross References Ataxia; Hemiataxia; Hemiparesis; Pseudochoreoathetosis - 43 - A Ataxic Nystagmus Ataxic Nystagmus - see INTERNUCLEAR OPHTHALMOPLEGIA; NYSTAGMUS Athetosis Athetosis is the name sometimes given to an involuntary movement dis- order characterized by slow, sinuous, purposeless, writhing movements, often more evident in the distal part of the limbs. Athetosis often coex- ists with the more flowing, dance-like movements of chorea, in which case the movement disorder may be described as choreoathetosis. Indeed the term athetosis is now little used except in the context of “athetoid cerebral palsy. Athetosis and William Alexander Hammond, a founder of American neurology. London: Imperial College Press, 2003: 413-416 Cross References Chorea, Choreoathetosis; Pseudoathetosis; Pseudochoreoathetosis Atrophy Atrophy is a wasting or thinning of tissues. The term is often applied to wasted muscles, usually in the context of lower motor neurone pathology (in which case it may be synonymous with amyotrophy), but also with disuse. Atrophy develops more quickly after lower, as opposed to upper, motor neurone lesions. It may also be applied to other tissues, such as subcutaneous tissue (as in hemifacial atrophy). Atrophy may sometimes be remote from the affected part of the neu- raxis, hence a false-localizing sign, for example wasting of intrinsic hand muscles with foramen magnum lesions. Cross References Amyotrophy; “False-localizing signs”; Hemifacial atrophy; Lower motor neurone (LMN) syndrome; Wasting Attention Attention is a distributed cognitive function, important for the opera- tion of many other cognitive domains; the terms concentration, vigi- lance, and persistence may be used synonymously with attention. It is generally accepted that attention is effortful, selective, and closely linked to intention. Impairment of attentional mechanisms may lead to distractibility (with a resulting complaint of poor memory, better termed aprosexia, - 44 - Auditory Agnosia A q. The neuroanatomical substrates of attention encompass the ascending reticular activating system of the brainstem, the thalamus, and the prefrontal (multimodal association) cerebral cortex (especially on the right). Those adapted to “bedside” use all essentially look for a defect in selective attention, also known as working memory or short term memory (although this does not necessarily equate with lay use of the term “short term memory”): Orientation in time/place Digit span forwards/backward Reciting months of the year backward, counting back from 30 to 1 Serial sevens (serial subtraction of 7 from 100, = 93, 86, 79, 72, 65). In the presence of severe attentional disorder (as in delirium) it is difficult to make any meaningful assessment of other cognitive domains (e. Besides delirium, attentional impairments may be seen following head injury, and in ostensibly “alert” patients, for example, with Alzheimer’s disease (the dysexecutive syndrome of impaired divided attention). Attention and executive deficits in Alzheimer’s disease: a critical review. Amsterdam: John Benjamins, 2002: 43-63 Cross References Aprosexia; Delirium; Dementia; Disinhibition; Dysexecutive syn- drome; Frontal lobe syndromes; Pseudodementia Auditory Agnosia Auditory agnosia refers to an inability to appreciate the meaning of sounds despite normal perception of pure tones as assessed by audi- ological examination. This agnosia may be for either verbal material (pure word deafness) or nonverbal material, either sounds (bells, whistles, animal noises) or music (amusia, of receptive or sensory type). Cross References Agnosia; Amusia; Phonagnosia; Pure word deafness - 45 - A Auditory-Visual Synesthesia Auditory-Visual Synesthesia This name has been given to the phenomenon of sudden sound- evoked light flashes in patients with optic nerve disorders. This may be equivalent to noise-induced visual phosphenes or sound-induced photisms. Archives of Neurology 1981; 38: 211-216 Cross References Phosphene; Synesthesia Aura An aura is a brief feeling or sensation, lasting seconds to minutes, occurring immediately before the onset of a paroxysmal neurological event, such as an epileptic seizure or a migraine attack (migraine with aura, “classical migraine”), “warning” of its imminent presentation, although auras may also occur in isolation. Auras are exclusively subjective, and may be entirely sensory, such as the fortification spectra (teichop- sia) of migraine, or more complex, labeled psychosensory or experien- tial, as in certain seizures. Epileptic auras may be classified into subgroups: ● Somatosensory: for example, paresthesia. References Bien CG, Benninger FO, Urbach H, Schramm J, Kurthen M, Elger CE. Brain 2000; 123: 244-253 - 46 - Automatism A Lüders H, Acharya J, Baumgartner C et al. Neurology 1992; 42: 801-808 Cross References “Alice in Wonderland” syndrome; Déjà vu; Fortification spectra; Hallucination; Illusion; Jamais vu; Parosmia; Seizure; “Tunnel vision” Automatic Obedience Automatic obedience may be seen in startle syndromes, such as the jumping Frenchmen of Maine, latah, and myriachit, when a sud- den shout of, for example, “jump” is followed by a jump. Although initially classified (by Gilles de la Tourette) with tic syndromes, there are clear clinical and pathophysiological differences.

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How fortu- 14 Who’s Who in Orthopedics nate it was that he lived long enough to dedicate five full decades to this discount 25mg hydroxyzine with amex anxiety natural treatment. Alan’s internationally famous “Pyrford Post- graduate Course discount hydroxyzine 10 mg on-line anxiety vitamins,” held twice each year, was attended by well over 5,000 orthopedic trainees and surgeons from the UK and countless other countries. It may be less well known that he organized and lectured at annual satellite courses for 18 years in New York and for 15 years in Toronto. Having yearned to be an actor, he did have some theatrical training, and his presenta- tions at home and abroad reflected this flair. His dramatic delivery gave clarity and impact, which was seasoned with a delightful sense of humor. He served in this capacity in seven universities in the United States, four in Christopher George Canada, four in Australia and 22 in other coun- tries throughout the world. His internationally acclaimed textbooks have 1922–1979 been used by hundreds of thousands of students and orthopedic surgeons worldwide. It is under- Born in 1922 into a medical family, Christopher standable that he became a legend in his own Attenborough was first educated at Marlborough time, and is entirely appropriate that the sixth and College and then went to Trinity College, Cam- seventh editions have been coauthored by Louis bridge, followed by King’s College Hospital, Solomon as Apley’s System of Orthopedics and qualifying in 1944. He has been facile soon posted to the East Indies fleet, where he princeps, easily the first, and his magnificent con- served as a surgeon lieutenant in destroyers, tributions as a teacher will live on through his including HMS Vigilant when it went into inspiring books. Singapore at the end of the war, and he was in the detachment that released the prisoners of war from Changi Prison. His exceptional hospital for 6 months before returning to England ability with written and spoken words displayed in 1947, continuing his training at King’s College a clear and well-ordered mind, which enabled him Hospital under Sir Cecil Wakeley and others. Anyone year at the Metropolitan Hospital as orthopedic who worked closely with him in any of his many registrar preceded his appointment in January distinguished roles soon became aware of these 1952 as first assistant to the orthopedic and acci- remarkable qualities. He could extract the essence dent department of the London Hospital under from a paper or a discussion, pick out the salient Sir Reginald Watson-Jones and Sir Henry points, and give a fair and unbiased opinion, Osmond-Clarke. When Christopher published an article it was He will also be remembered for his innate an event. He never wrote “pot boilers” but con- sense of humor, which made him a wonderful fined his publications to important contributions companion. Thus in 1953 he pub- a committee, in a large or a small group, at work lished in The Journal of Bone and Joint Surgery or at play, it was always fun to be with him. In 1966 he 15 Who’s Who in Orthopedics described his operation for severe congenital enjoyed drawing and gardening, he was captain talipes equinovarus, which still maintains a great of the bell ringers in his village church, and he influence on the treatment of that condition. Nevertheless, in the He was appointed orthopedic consultant to the seclusion of his Sussex home he did many hours Bromley Group of hospitals in 1956. His years in of painstaking research, notably into better Bromley were extremely busy so that he was not designs of joint replacements and in modifying able to get about to meetings, nor did he have those already produced, because—being a per- much time for research. He took on a great burden fectionist—he was never satisfied that he had of children with chronic diseases in particular, achieved the final design. He Christopher’s career written in terms of techni- attended the Cheyne Hospital and the Sydenham cal or orthopedic success is insufficient, because Children’s Hospital. He had to build up the ortho- his real greatness was as a leader and a colleague. He was on his own in those if he was displeased by its quality, he was pre- days and his duties held him to his work. This criticism, always being just About 1967, seeing his wife Sheila put up some and fair, increased the respect of those concerned net curtains on curtain springs, he decided to and made them more determined than ever to adapt springs to surgery and had them made in rectify matters and achieve the improvement stainless steel. In a very short time he had bosacral fusion, for which, to those who use this become internationally famous for his work on method, there is no better way of achieving early arthroplasty, particularly of the knee. Soon the springs constant demand for lectures, both at home and became used for the stabilization of other condi- overseas, and his company was sought after by all tions, such as the fractured olecranon, to give only who knew him. An example of courage is an edification to us In 1970 Christopher moved to Hastings and all, and so when Christopher Attenborough died was at once at home, both clinically and mechan- on June 13, 1979, at the age of 56 after a long ically. He made excellent use of the orthopedic illness, he left behind a great sense of achieve- workshop, wherein he designed his knee prosthe- ment and an uplifting respect. It was not only the illness he made a determined recovery; against knee that attracted his attention, for he was inter- all difficulties he returned to his clinical duties ested in replacement of other joints and his elbow and to operating, including his total knee re- prosthesis was under trial; he was working on placements. This epitomizes Christopher’s life, finger, wrist and ankle prostheses up to the time because no problem or difficulty was too great to of his death. He had evolved the very important overcome; throughout his career he was a stead- concept of a stabilized and gliding joint replace- fast courageous surgeon on whom others could ment and was applying this to the other joints lean for advice, encouragement and strength. It is a tragedy that many patients will be denied the better prostheses that his inventive- ness would have undoubtedly produced in the future.

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