We all know, by watching Sweeney Todd, that barbers got up to some very odd things in the past. From about 1000 AD to well into the 1800s, they were not just hair choppers but well-known surgeons. They’d do everything from pulling teeth to blood letting to castration. But why?
Once upon a time, these preserved human and animal brains were once lovingly studied by Soviet-era neuroscientists. But when the lab was abandoned — perhaps in a hurry — these lonely brains were left behind.
There are few details on this abandoned neuroscience lab, so we’ll have to take the photographer’s word that it’s the real deal. Supposedly, this former Soviet laboratory sits in Moscow, where it was operated by the army. Some time after the lab was hastily abandoned, it was sealed off. But civilians who venture inside will see skinned animal heads, slides depicting brain cross-sections, and lots and lots of actual brains amidst the more mundane dirty dishes and glassware. Head over to the Russian blog brusnichka for more macabre photos from the lab.
Feast your eyes on a gruesome “wound man” from London’s Wellcome Library’s collection of medieval anatomy diagrams. This above wound man hails from the 1400s and offers all sorts of valuable advice on how to remove swords from his torso and extremities. And here are a few more of his colleagues from 1420-1430s Germany, 1675 Austria and South Germany (note the terrifically unsympathetic dog), 1678 England, and the 1530s.
I’ve been rather busy with my Internal Medicine clerkship as of late, but I thought I’d write a post on the importance of a History & Physical Exam (H&PE) in medicine. There are several basic pieces of information that can be joined to establish the proper diagnosis by us.
- History (which must be accurate, skillfully elicited, carefully interpreted, and coherently expressed).
- Physical Examination (which should build on the existing information and provide clues for obtaining additional history).
- Ancillary data (routine and special studies, consultations, etc.).
- Observations of the course of the illness (usually less expensive and more rewarding than extensive excursions in the use of ancillary studies, e.g., lab).
Our basic thesis is that the vast majority of clinical problems should and can be resolved by the effective use of the H&PE. In most cases the history should be and is the most productive. You will find this conclusively and objectively demonstrated when dealing with patients about whom no history can be obtained.
To put it another way, the diagnosis should be clear based on the present illness and related points of the history most of the time. In fact, if the diagnosis is not apparent at the end of the history and the physical examination, there is little likelihood that such will emerge by the use of ancillary data/or special studies.
Laboratory studies should be viewed and used primarily to confirm a diagnosis rather than make one. Furthermore, experience has taught us that thoughtful observation of the patient and his or her illness can be the most effective tool of complex, particularly chronic, problems.