On ‘the biology of war’

The Biology of War is an ardent anti‐war treatise as well as a scientific work, written in Germany in 1915 by the then famous Berlin cardiologist Georg F. Nicolai. In the book, which he wrote in prison, Nicolai opposes the social Darwinist apology for war of the time, and discusses the biological basis of bellicosity wherein he stresses the central role of a ‘tribal instinct*. This view is here considered in relation to modern sociobiology. Fighting, almost alone, against the authorities and a public opinion which—folly of the day—glorified war as a ‘struggle for existence’, Nicolai stands as an example for medical peace activities of today—the folly of our time being the threat of nuclear omnicide.     

The cowards’ war: Landmines and civilians

Landmines are designed to be undetectable and are usually deployed randomly, remotely and in vast numbers so as to be indiscriminate in their effects. Main victims are rural civilians in poor Third World countries. Main suppliers of landmines are in Europe, Britain, the United States, and ex‐Soviet Union. Landmines kill civilians long after the war is over; two die for every one surviving injury. About 75 per cent of survivors require amputation; in Cambodia one person in every 236 of the population is a mine‐amputee. Mine injuries divert scarce resources from programmes to improve public health in these countries. They also prevent recultivation of large areas of land, so contributing to the breakup of subsistence economies, migration and further increased morbidity and mortality. Mine location and clearance remains time‐consuming and hazardous, because companies have concentrated instead on developing ‘better’ mines. But experience in Europe after World War II shows that with sufficient commitment large areas of heavily mined land can be cleared and reused. Many major mine‐producing countries such as Britain have not ratified the 1981 Inhumane Weapons Convention, which seeks to protect civilians from the indiscriminate use of mines. Improvement of this legislation, to prioritize clearly civilian protection over military necessity, and with monitoring and adjudication mechanisms, is required. Many non‐governmental organizations are now coordinating to form an international campaign against landmines, with several initial successes achieved.     

How to Recognize ‘Athlete's Heart’

Chronic endurance exercise inbrief duces various cardiac adapta- JHHHM tions, including an enlarged left ventricular cavity and an appropriate increase in wall thickness (eccentric hypertrophy), greater ability to increase stroke volume during exercise, and bradycardia at rest. Strength athletes have thicker left ventricular walls with no increase in cavity size (concentric hypertrophy). In the past, chest x-rays and ECG have suggested some of these changes, however, echocardiograms have clearly established the syndrome of the athlete's heart. In addition, these adaptations seldom exceed the range of normal variation seen in the general population. Understanding these alterations helps distinguish healthy adaptations to exercise from signs of disease.     

The ‘Isolated’ Posterior Cruciate Ligament Injury

In brief: This case report describes the mechanism of injury of an isolated posterior cruciate ligament tear. This injury was videotaped during a soccer game and was followed by an immediate physical examination and surgical and arthroscopic documentation of the isolated avulsion. Three other cases supported the videotaped mechanism of injury. The athlete was injured as he received a violent blow to the anterior surface of the tibia during knee flexion while attempting to slide-tackle an opponent.     

Skier's Knee: The ‘Cruciate Connection’

In brief: The authors have seen an increase in anterior cruciate ligament injuries in recent years. In a study of 3,074 Alpine skiers at the Killington Mountain Clinic and the Rutland Regional Medical Center in Vermont, there were more anterior cruciate ligament injuries than tibial fractures. The outcome for the skier with anterior cruciate ligament disruption depends on early, accurate diagnosis of the injury in its acute state. Often this injury is misdiagnosed. The authors have found that the modified Lachman test, in which the patient is sitting rather than lying supine, makes diagnosis of anterior cruciate ligament injuries easier. In addition, the modified version is easier to teach and perform than the standard Lachman test.     

The Brundtland report: ‘Our common future’

The World Commission on Environment and Development presented its report to the world at a press conference in London, England on 27 April 1987. The report examines the critical issues of environment and development, suggests concrete and realistic proposals for dealing with them, and proposes far‐reaching changes for implementing the proposals at national and international levels.     

The Pittsburgh Marathon: ‘Playing Weather Roulette’

Weather conditions during last May's Pittsburgh Marathon helped set the stage for a staggering number of heat-related injuries. Here's the inside story on why the race was run and the alternatives that could have been chosen.     

The phenomenon of ‘tired moly-99Mo’

The phenomenon of tired moly-⁹⁹Mo results in poor yields of ^99mTcO ₄ ^- obtained from ⁹⁹MoO ₄ ^2- . The solvated electron has been conceived to explain this phenomenon, especially when it occurs in highly alkaline media as obtained in the solvent extraction type of separation system.     

Diphtheria – ‘The strangling angel’ of children

Diphtheria, an acute infectious condition caused by Corynebacterium diphtheriae, was once a major killer of children. Although the mortality rates dropped dramatically in the mid-twentieth century, due to a combination of improved standards of living and immunization programs, outbreaks are still occurring. Two children, aged four and five years respectively, are reported to demonstrate characteristic features of lethal cases. Death in case 1 was due to an extensive upper airway pseudomembrane causing acute respiratory failure. The diagnosis of diphtheria was only made at postmortem. Death in case 2 was due to acute cardiac failure with heart block complicating diphtheria. Other mechanisms in fatal cases involve disseminated intravascular coagulation, renal and endocrine failure. Declining levels of immunity among adults has resulted in a change in the epidemiological pattern of the disease with an older age of victims in recent outbreaks. As a result of population shifts and failure to immunize children it is likely that forensic pathologists may see more cases of diphtheria in the future. Due to the rarity of cases in Western communities and atypical presentations, the diagnosis may only be established at autopsy.     

The Differential Response of the Skin in Young and Old Rats to a Combination of X-rays and ‘Wet’ or ‘Dry’ Hyperthermia

Summary

The left hind feet of groups of female rats aged 7, 14 and 52 weeks were irradiated at three dose levels of X-rays (20, 25 or 30 Gy). Hyperthermia (42·5°C for 1 h) was carried out immediately following irradiation using either ‘wet’ or ‘dry’ heat, achieved by immersion in either water or fluorocarbon liquid.

The results demonstrated that ‘wet’ heat produced a consistently greater enhancement of the irradiation damage than ‘dry’ heat. The thermal enhancement ratio for irradiation plus ‘wet’ heat was approximately 1·5 and for irradiation plus ‘dry’ heat it was in the range 1·17 to 1·39. Immersion of the feet in fluorocarbon liquid at 37°C did not significantly modify the irradiation response of the skin. The lower thermal enhancement ratios obtained using immersion in fluorocarbon liquid at 42·5°C are close to those obtained in large animal studies and also similar to the limited amount of data from clinical studies where microwave or ultrasound heating techniques were used.

It has been demonstrated that there are large age-related differences in the response of the rat foot skin to irradiation alone. It has also been shown in the present study, using rats of the same age, that the response to irradiation plus hyperthermia was less age dependent. This finding may reflect the differing methods by which damage occurs in tissue after irradiation or hyperthermia.