The development and evolution of “cerebral thermometry”: Clinical applications of a nineteenth-century approach to cerebral localization and neurological diagnosis

ABSTRACT

Surface thermometers were developed in the latter half of the nineteenth century. In 1877, Broca, already famous for his contributions to the cerebral localization of nonfluent aphasia, presented his first clinical observations on cranial surface temperatures: In two cases, cranial surface temperatures were decreased over a middle cerebral artery infarction, and increased in surrounding areas, which Broca attributed to “compensatory hyperaemia.” As Broca made apparent in a later report in 1879, he had used a “thermometric crown,” an apparatus consisting of six to eight large-reservoir mercury thermometers strapped against the head. Following Broca’s report, American neurologists reported cases in which cranial surface temperatures were increased either locally over a superficial brain tumor or globally with a cerebral abscess. Despite promising anecdotal reports, contemporaries recognized that significant technical and practical problems limited its accuracy, reliability, and clinical utility. Advocates never demonstrated that this technology provided significant marginal benefit to the medical history and physical examination. The technique fell out of fashion before 1900, though some early advocates promoted it into the early twentieth century. It was ultimately replaced by more effective technologies for cerebral localization and neurological diagnosis.     

The assessment of Perkins’ patent metallic “tractors”: Abandonment of an 18th-century therapeutic fad following trials using sham instruments

ABSTRACT

From 1799 to 1801, with the instigation of John Haygarth, physicians in England evaluated the claims of Elisha and Benjamin Perkins that their patented “metallic tractors” could cure a wide variety of disorders. Previous therapies were typically judged based on experience and authority, whereas Perkinism was evaluated using a series of clinical trials of varying methodological sophistication, most employing sham instruments (all but those involving infants or horses), with a variety of trial designs, inconsistent use of contemporary controls, and different approaches to blinding subjects to the treatment administered. Haygarth and his colleagues collectively demonstrated that tractors and sham instruments produced equivalent effects in adults, and, by inference, that the tractors had no special therapeutic properties. Other trials using only genuine tractors demonstrated no effects in infants and horses, subjects who could not reasonably be influenced by suggestion and the imagination. These collective results provided strong support for the rival hypothesis that the observed effects were due to suggestion and the imagination of the subjects. Despite fallacy-laden counterattacks and counterarguments from Benjamin Perkins and his supporters, the trials eroded support for this therapy and led to abandonment of the “Metallic Practice” as a treatment in Britain and elsewhere.     

Pathways to Homelessness: a Comparison of Gender and Schizophrenia in Inner-Sydney

The study compares residential ‘pathways’ into homelessness of a sample of 50 homeless people in inner city Sydney, in an attempt to see whether gender difference or schizophrenia is more important in the determination of mobility patterns leading in and out of homelessness. Three structural processes contributing to the present pattern of homelessness in inner Sydney are identified, providing the context for observed differences in residential histories leading to inner city homelessness. A hypothesis of the study is that women would be likely to experience different factors in the pathway to homelessness such as child raising or partnerships that may influence their residential history. However, after the breakdown of marriage, partnerships appear to play a minor role in the residential mobility of both schizophrenic women and men.     

Old Khotanese synchronic umlaut

This paper has received much beneficial input from R. E. Emmerick and P. O. Skjærvø; final responsibility here is mine. The Social Sciences and Humanities Research Council of Canada funded presentation of this topic at the XXXII International Congress for Asian and North African Studies, 25–30 August 1986, Hamburg.     

Production Skill and Paleoindian Workgroup Organization in the Medicine Creek Drainage,Southwestern Nebraska

Extremely skillful stoneworking is widely cited as an important characteristic of the Paleoindian period in North America. This paper considers differences in finished and unfinished projectile points and bifaces from two Paleoindian sites in the Medicine Creek drainage of southwestern Nebraska with this in mind, arguing that these differences reflect significant differences in the overall level of skill of the stoneworkers who used these sites. Recognizing variability in Paleoindian flintknapping skill has implications for the organization of landuse in the Medicine Creek region and for our understanding of the archaeology of the Paleoindian period in general.     

Development and the Role of Microcredit

Microcredit is a concept that has gained widespread acceptance by international development agencies and major donors. It is viewed as a way to correct both governmental and market failure in Sub-Saharan Africa. Many view microcredit as a method for linking the formal and informal sectors of African economies to increase the reach of the formal sector. Extending the reach of the formal economy through microcredit is possible, and desirable, depending on macroeconomic reforms, respect for traditional financing relationships, and local control of institutions. However, very little has been done to determine the extent to which microcredit programs actually increase economic well-being. The model program, Grameen Bank of Bangladesh, has been studied and evaluated, but replications may not be inherently successful. The literature accepts that microcredit will increase economic well-being, if programs are correctly designed. Program design issues cannot be resolved, however, until economic well-being is measured and associated with specific designs.     

Dr John H. Kenneth

A technique for the detailed assessment of terrain capability is described. The method is used to evaluate the terrain capability of 81 sample farms in North East Scotland. The relevance of the technique is assessed by an analysis to determine the influence of terrain capability on type of farming. Results are also presented to indicate that farmers’ perception of their land type may be different to its actual capability. The need for a flexible approach to terrain capability evaluation is stressed.