Genetic and phenotypic diversity of methicillin-resistant Staphylococcus aureus among Japanese inpatients in the early 1980s.

To trace the linkage between Japanese healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) strains in the early 1980s and the 2000s onward, we performed molecular characterizations using mainly whole-genome sequencing. Among the 194 S. aureus strains isolated, 20 mecA-positive MRSA (10.3%), 8 mecA-negative MRSA (4.1%) and 3 mecA-positive methicillin-susceptible S. aureus (MSSA) (1.5%) strains were identified. The most frequent sequence type (ST) was ST30 (n = 11), followed by ST5 (n = 8), ST81 (n = 4), and ST247 (n = 3). Rates of staphylococcal cassette chromosome mec (SCCmec) types I, II, and IV composed 65.2%, 13.0%, and 17.4% of isolates, respectively. Notably, 73.3% of SCCmec type I strains were susceptible to imipenem unlike SCCmec type II strains (0%). ST30-SCCmec I (n = 7) and ST5-SCCmec I (n = 5) predominated, whereas only two strains exhibited imipenem-resistance and were tst-positive ST5-SCCmec II, which is the current Japanese HA-MRSA genotype. All ST30 strains shared the common ancestor strain 55/2053, which caused the global pandemic of Panton-Valentine leukocidin-positive MSSA in Europe and the United States in the 1950s. Conspicuously more heterogeneous, the population of HA-MRSA clones observed in the 1980s, including the ST30-SCCmec I clone, has shifted to the current homogeneous population of imipenem-resistant ST5-SCCmec II clones, probably due to the introduction of new antimicrobials.

Inpatients at the St. John's General Hospital: Morbidity in Late 19th-Century Newfoundland and Labrador.

This research analyzes the role of the St. John's General Hospital in late nineteenth-century Newfoundland and Labrador using extant admission and discharge records from 17 May 1886 to 30 December 1899. Most individuals were discharged from the hospital as "cured" or "convalescent." Trauma, musculoskeletal issues, and respiratory diseases were the most common reasons for admission, with males significantly more likely to seek care for trauma, sexually transmitted infections, and kidney/bladder issues. Female inpatients were significantly more likely to be admitted for tumours/cancers, anemia, digestive issues, and issues concerning the female anatomy. Notable were the short hospital stays for tuberculosis, indicating the General played an important role before the founding of the St. John's Sanatorium. A snapshot of late nineteenth-century morbidity reveals the complex risks facing citizens of St. John's and beyond who sought care at the General, which played a key role in the rapidly modernizing medical ecosystem.

'As syllable from sound': the sonic dimensions of confinement at the State Hospital for the Insane at Worcester, Massachusetts.

As the first state hospital in the USA, the Worcester State Hospital for the Insane at Worcester, Massachusetts (est. 1833), set a precedent for asylum design and administration that would be replicated across the country. Because the senses were believed to provide a direct conduit into a person's mental state, the intended therapeutic force of the Worcester State Hospital resided in its particular command over sensory experience. In this paper, I examine how aurality was used as an instrument in the moral architecture of the asylum; how the sonic design of the asylum collided with the day-to-day logistics of institutional management; and the way that patients experienced and engaged with the resultant patterns of sound and silence.

Los espacios de la locura en la Toscana del siglo XVIII: estrategias y negociaciones para enfrentar la enfermedad mental / The spaces of madness in Eighteenth-Century Tuscany. Strategies and negotiations to deal with mental afflictions

Este trabajo estudia los diferentes espacios en que aparece registrada la locura en el Gran Ducado de Toscana durante el siglo XVIII. A partir de la revisión de expedientes de interdicción por incapacidad mental, archivos de justicia criminal, archivos de policía y registros hospitalarios, propone una aproximación a la historia de la locura basada en el análisis comprensivo de las vinculaciones entre las distintas instancias en que se debatió sobre sus características, se evaluaron sus consecuencias y se elaboraron estrategias para hacerle frente. Este enfoque revela que las alternativas existentes para sobrellevar la enfermedad mental funcionaban como respuestas temporales y flexibles que constituían una red de instancias que podían ser recorridas de distintas maneras. Sugiere que el estudio de estos itinerarios, sus actores y lenguajes resulta fundamental para comprender en toda su magnitud la forma en que fueron concebidas y enfrentadas las perturbaciones mentales en el siglo XVIII. En particular, sostiene que su funcionamiento dio pie a un debate social sobre los indicadores y significados de la locura que serviría de insumo para la sistematización del conocimiento psiquiátrico

This study explores the different spaces where madness was recorded in the Grand Duchy of Tuscany during the eighteenth century. Drawing from interdiction procedures, criminal records, records of the police and hospital records, it proposes an approach to the history of madness based on a comprehensive analysis of the connections between the different spaces where people debated about the characteristics and consequences of madness and developed strategies to deal with it. This analytical strategy discloses that the mechanisms for dealing with madness were temporary and flexible responses that functioned as a network that could follow different courses. The study suggests that these itineraries, its agents and languages are essential to fully grasp how mental afflictions were conceived and managed in the eighteenth century. Particularly, it argues that the way they functioned gave origin to a social debate about the indicators and signs of madness that contributed to the systematization of psychiatric knowledge

O "retrato" do hospital da Misericórdia de Vila Viçosa (Portugal) em 1870 / The "portrait" of the hospital of the Misericórdia de Vila Viçosa (Portugal) in 1870

O nosso estudo analisa o hospital da Misericórdia de Vila Viçosa em 1870 com base na descrição elaborada pelo administrador do concelho nessa data. Os elementos fornecidos procuram conhecer a instituição a que está ligado -a Misericórdia-, e contribuir para uma melhor administração. Com base nesta fonte é possível conhecer o hospital, bem como a política seguida pela confraria no tocante à saúde. O seu estudo dá a conhecer o funcionamento da instituição, desde os seus espaços aos doentes, apresentando um hospital Municipal de traça quinhentista, embora adaptado às necessidades do século XIX. Integra ainda as sugestões do administrador do concelho, embora estas não sejam implementadas devido à escassez de receitas com que o hospital se debatia, as quais eram as responsáveis pelo estado de degradação em que alguns dos seus espaços se encontravam, mas sobretudo pelo corte no internamento de doentes e da assistência aos que se curavam em suas casas

Our study analyzes the hospital of the Misericórdia of Vila Viçosa in the 1870, based on the description made by the county administrator in that date. The elements given provided seek to know the institution in which is connected - the Misericórdia -, and to contribute to better administration. Based on this source is possible to know the hospital, as well as the politic pursued by the brotherhood in regards to the health. Its study makes known the functioning of the institution, from its spaces to the sick people, presenting a Municipal hospital of fifths hundred traces, although tailored to the needs of the XIX century. It also integrates the suggestions of the municipal administrator, although these are not implemented due to the lack of revenue that the hospital was debating, which were responsible for the state of degradation in which some of its spaces were located, but especially for the cut in hospitalization and the care of those who were cured in their homes

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Through a glass darkly: patients of the Illinois State Hospital for the Insane at Jacksonville, USA (1854-80).

The State Hospital for the Insane at Jacksonville, Morgan County, Illinois, was the first public hospital of its kind to be established in the state and among the earliest to be built on the 'Kirkbride Plan'. It opened for patients in 1851. We describe the background to the establishment of the hospital and, so far as is possible from publicly available sources, its catchment area, the nature of the patients held there up to 1880, its mechanisms of discharge, and supposed causes of death. We end with a plea that after over 150 years, the release of hospital casebooks and similar records in digital form would be of considerable benefit to historians of psychology, scientific biographers, genealogists and demographers.

Development of psychotherapy as a method of mental disorders treatment at the Jagiellonian University and in Kraków before World War I.

This article presents the origins of Polish psychotherapy with a special focus on psychotherapy development in Krakow and at the Jagiellonian University. The history of Krakow psychotherapy starts with the foundation of the Psychiatry and Neuropathology Clinic of the Jagiellonian University in 1905. Doctors working in the Department of psychotherapy developed their skills through contacts with the Zurich University Psychiatric Clinic Burgholzli. At the same time psychotherapy, and psychoanalysis in particular, were raising more and more interest in Poland. The most dynamic development of psychoanalysis reflected in the number of scientific publications, occurs in the years leading to the outbreak of War World I. This article presents brief portraits of the first Polish psychoanalysts ( Ludwik Jekels, Herman Nunberg, Ludwika Karpinska, Stefan Borowiecki, Jan Nelken, Kraol de Beaurain). Many of them worked in Psychiatry and Neuropathology Clinic of the Jagiellonian University. Their scientific achievements and contribution to the development of the international psychoanalytic movement are described, as well as relationships with leading psychoanalysts of this period (Freud, Jung). With the outbreak of World War I the research on and treatment of war neurosis was initiated in the Psychiatry and Neuropathology Clinic. Professor Piltz, the director of the clinic, together with his assistants (Borowiecki, de Beuarain, Artwinski) devised a unique in European psychiatry and highly efficient method of post-traumatic disorders treatment, in which psychotherapy was of key importance.

Evidências para o uso da avaliação nutricional subjetiva global nos pacientes com doença arterial periférica / Evidence for use of subjective global assessment of the nutritional status of patients with peripheral arterial disease

A desnutrição é uma doença extremamente prevalente em pacientes internados, chegando a acometer 50% deles, 47% dos pacientes cirúrgicos e entre 39 e 73% dos portadores de doença arterial periférica, com grande impacto na morbimortalidade desses pacientes. A desnutrição possui grande relevância no desfecho clínico desses pacientes durante a internação, estando associada a maior incidência de infecções, demora na cicatrização das feridas, diminuição do status de deambulação, maior tempo de internação e mortalidade. Entretanto, o diagnóstico de desnutrição ou risco nutricional desses pacientes tem sido um desafio. A avaliação nutricional subjetiva global revelou-se, até o momento, o padrão ouro como método de triagem de pacientes cirúrgicos internados devido à sua praticidade e acurácia. O objetivo deste trabalho é revisar métodos utilizados na avaliação do estado nutricional e da triagem nutricional de pacientes internados e caracterizar a importância dessa avaliação nos desfechos clínicos dos pacientes com arteriopatias.

Malnutrition is an extremely common disease among hospitalized patients, with prevalence rates as high as 50% overall, 47% among surgical patients and from 39 to 73% among patients with peripheral arterial disease. It has a major impact on morbidity and mortality among these patients. Malnutrition is very relevant to these patients’ clinical outcomes and is associated with a higher incidence of infections, slower wound healing, lower rates of mobility, longer hospital stays and greater mortality. However, diagnosing malnutrition or nutritional risk in these patients has proven to be a challenge. To date, subjective global nutritional assessment remains the gold standard screening method for use with hospitalized surgical patients because of its practicality and accuracy. The objective of this study is to review methods used for assessment of nutritional status and for nutritional screening of hospitalized patients and determine the importance of these assessments to the clinical outcomes of patients with arteriopathies.

[The daily life of patients at the Hôtel-Dieu in Lyon in the nineteenth century]. / La vie quotidienne des patients à l'hôtel-Dieu de Lyon au XIXème siècle.

In 1802 the Hôtel-Dieu in Lyons was incorporated in the so-called Hospices Civils de Lyon. This allowed the expansion and renovation of buildings, as well as the improvement of the conditions of hygiene and comfort of the patients. This hospital was devoted only to the most severely ill or injured adults. 1100 patients were treated by seven doctors, a main surgeon and his deputy, residents and sisters. Broadly speaking the evolution of surgery can be divided into two periods: that of before anesthesia and septic surgery and that of antiseptic and aseptic surgery. We have to mention Gensoul and the resection of the maxillary before anesthesia, Bonnet and Ollier who were devoted to osteo-articular surgery (Ollier's disease), Poncet who built the first aseptic theater, Jaboulay and the resident Carrel who were transplantation's pioneers, Bouveret (paroxysmal tachycardia and Bouveret syndrome), Destot who did the first medical use of X-rays in 1895.

[Chance meeting of psychiatry and art on the "dissecting table"]. / Pszichiátria és müvészet találkozása a boncasztaton.

This paper shows one of many aspects of the history of the Hungarian psychiatry between the two world wars. The data were collected from the "Hungarian Museum of Mind" opened for the public in 1931. It focuses on the collecting policy and the research topics of Hungarian psychiatrists working in the asylums in those days. In 2007 Lipotmezo (the Hungarian Psychiatric and Neurological Institution the biggest Hungarian asylum since its foundations in 1868) was closed. Its art collection was rescued by the Hungarian Academy of Science. From 2007 this collection has been named The Psychiatric Art Collection of the HAS, maintained by The Research Centre for the Humanities of the Hungarian Academy of Science. The artistic objects and documents are properly stored and available for research. Two art historians are in charge of curating the exhibitions and leading the research on the psychiatric art in the context of history, psychiatric history and contemporary culture. This work follows the well established practice of the eighties and nineties when the art historian Edit Plesznivy expert in this subject listed the pieces of this historical collection, and through the context of outsider art and art therapy she channeled it into the field of art institutions. Leaving the hospital environment and having been introduced to the academic world the research is looking toward the collection has been changed and new perspectives have been opened. Beside the art works of the patients living as inmates in mental hospitals, the collecting work and therapeutic practices of the mental physicians became a significant research topic also. Arpad Selig as an assistant physician at the Mental and Neurological Clinic in Lipotmezo started to collect the patients' works of art in the first decade of twentieth century. During the 1920s he was appointed the director of Angyalfold Asylum found in 1883. Selig died in 1929 and the Museum of Mind named after its enthusiastic founder Selig was registered in the official list of museums in 1932. In the 1930s Istvan Zsako the physician director of Angyalfold Asylum took care of the collection. He enriched it with further historical documents on the institution, bibliographies, press cuts, tableaux and photographic albums referring to the institution and the research practiceses of the physicians. After Zsako was appointed the director of Lipotmezo the collections of Lipotmezo and Angyalfold were joined. The collection suffered during the World War II and this period is can be viewed as a caesura in the practice of collecting. Later, from the late fifties, the physician Fekete Janos, head of the nurse training in Lipotmezo was in charge of the collection. He focused on sorting and installation of the remnants and also collected new works of the inpatients. During the seventies the psychotherapy was inaugurated and in the eighties the art therapy exercises began. However, through the reconstruction of the therapeutical and collecting practices show that these evolving art therapy practices partly rooted in the work of psychiatric treatment in the twenties and thirties. Psychiatrists, who lived in the asylums too, supported the so called "noble entertainments" - including artistic drawing, painting, reading and playing musical instruments - and as a part of the daily routines of these mental institutions they formed a locally particular modus operandi of therapy. The inmates of the asylums, the physicians and patients cooperated to enrich the collection which was a venue to represent the life of the institution and to demonstrate the research of the physicians. Despite of the significant differences between the pre- and postwar periods concerning the sociocultural and political structures there is a well defined connection between "curing and curating".

[A campaign against the law of 1838 governing the status of the mentally ill. Hector Malot, Léopold Turck, Théophile Huc -- a writer, a doctor, a lawyer]. / Une campagne contre la loi de 1838 régissant le statut des aliénés. Hector Malot, Léopold Turck, Théophile Huc, un romancier, un médecin, un juriste.

When Napoleon the 3d's government turned to its liberal phase, dissatisfactions felt free to become visible, among which the problems engendered by the law of 1838 about the situation of mental patients; during the 60s, a novelist, Hector Malot; a doctor, Léopold Turck; a jurist, Théophile Huc, tried to amend it.

[Research and treatment of war neuroses at the Clinic for Nervous and Mental Diseases at the Jagiellonian University in Krakow before World War II in the context of psychiatry in Europe]. / Badania i leczenie nerwic wojennych w Klinice Neurologiczno-Psychiatrycznej Uniwersytetu Jagiellonskiego w Krakowie przed II wojna swiatowa na tle psychiatrii europejskiej.

The aim of this article is to offer an overview of the research into diagnosis and treatment of war neuroses at the Clinic for Nervous and Mental Diseases at the Jagiellonian University in Krakow before the outbreak of World War II. It also includes a profile of the work of Prof. Jan Piltz, the then director of the Clinic, and his major scientific achievements. The publications cited in the article date in the main from the period of World War I, and comprise clinical analyses of the consequences of stress suffered at the front as well as a description of the ways in which they were treated. These are presented alongside other major findings related to war neuroses being made in Europe at the time. The article draws attention to the very modern thinking on treatment of war neuroses, far ahead of the average standards of the day, evinced by Prof. Piltz and his team. The most important innovative elements of their treatment of these conditions were the fact that they perceived the cause of the neurosis to lie in previous personality disorders in the patients, their recommendation of psychotherapy as the main method of treatment, and their emphasis on the need for further rehabilitation following the completion of the course of hospital treatment. They also paid significant attention to the importance of drawing up individual therapy plans for each patient.

A biosketch of William Richard Gowers with a new review of his inpatient case history notes.

William Richard Gowers (1845-1915) spent his career working at the National Hospital for the Relief and Cure for the Paralyzed and Epileptic at Queen Square, in London, United Kingdom, and at the nearby University College Hospital. His "Manual of the Diseases of the Nervous System" and many published lectures were based almost entirely on his own clinical observations meticulously recorded in shorthand. In this paper, we have focused on an analysis of his inpatient case records from 1878 to 1911 preserved in the archives at the National Hospital for Neurology and Neurosurgery, Queen Square. We reviewed all 42 volumes and analyzed 2,478 patients. Between 1897 and 1909, a mean of 129.7 cases per year were admitted to the hospital under Gowers' care. We grouped the diagnoses in 12 different categories. Epilepsy (16.5%), followed by spinal cord diseases (10.3%), cerebrovascular diseases (9.5%), and functional disorders (7.9%) were the most common diagnoses.

A biosketch of William Richard Gowers with a new review of his inpatient case history notes / Resumo biográfico de William Richard Gowers com uma nova revisão das notas de pacientes hospitalizados

William Richard Gowers (1845–1915) spent his career working at the National Hospital for the Relief and Cure for the Paralyzed and Epileptic at Queen Square, in London, United Kingdom, and at the nearby University College Hospital. His “Manual of the Diseases of the Nervous System” and many published lectures were based almost entirely on his own clinical observations meticulously recorded in shorthand. In this paper, we have focused on an analysis of his inpatient case records from 1878 to 1911 preserved in the archives at the National Hospital for Neurology and Neurosurgery, Queen Square. We reviewed all 42 volumes and analyzed 2,478 patients. Between 1897 and 1909, a mean of 129.7 cases per year were admitted to the hospital under Gowers' care. We grouped the diagnoses in 12 different categories. Epilepsy (16.5%), followed by spinal cord diseases (10.3%), cerebrovascular diseases (9.5%), and functional disorders (7.9%) were the most common diagnoses.

William Richard Gowers (1845–1915) passou sua vida profissional trabalhando no National Hospital for the Relief and Cure for the Paralyzed and Epileptic e no University College Hospital na Queen Square, em Londres, Reino Unido. Seu livro Manual of the Diseases of the Nervous System, assim como suas várias aulas publicadas foram baseadas quase inteiramente em suas próprias observações clínicas, anotadas meticulosamente em estenografia. Neste artigo, o objetivo foi a análise das notas de casos clínicos de pacientes hospitalizados entre 1878 e 1911 armazenadas nos arquivos do National Hospital for Neurology and Neurosurgery, na Queen Square. Foram revisados 42 volumes e analisados 2.478 pacientes. Entre 1897 e 1909, uma média de 129,7 casos foram admitidos ao ano no hospital sob supervisão de Gowers. Os diagnósticos foram agrupados em 12 categorias diferentes. Epilepsia (16,5%), seguida de doenças da medula espinhal (12,7%), doenças cerebrovasculares (9,5%) e transtornos funcionais (7,9%) foram os diagnósticos mais encontrados nas notas dos casos clínicos.

Inventing the medical portrait: photography at the 'Benevolent Asylum' of Holloway, c. 1885-1889.

In 1885, Holloway Sanatorium, an asylum for the 'mentally afflicted of the middle classes' opened in Egham, Surrey, 20 miles outside London. Until 1910, photographs of about a third of the patients--both those 'Certified Lunatic by Inquisition' and the 'Voluntary Boarders' who admitted themselves--were pasted into the asylum's case books. This paper analyses the photographs that were included in the very first of these, when there was a great uncertainty as to how to represent these patients, or whether to represent them at all. The photographs are unlike any other institutional images of the period, and raise critical questions about the imagined incompatibility between documentary photography and personal agency.

Narrative survival: personal and institutional accounts of asylum confinement.

This essay has been conceptually eclectic in that we have integrated concepts from genre theory and discourse analysis. In our interpretation of Merivale and Marshall's narratives, we have also drawn upon Frye's Anatomy of criticism, a canonical text in literary genre theory. Such an eclectic approach seems warranted by both the contextual and textual features of Merivale's and Marshall's narratives, and in particular by Merivale's use of Mennipean satire with its encyclopedic detail. In our discussion of Merivale and Marshall's Admissions Records we have drawn on speech act theory to suggest that the Order (to admit a patient), the two medical certificates that follow, and finally, the notice to admit a patient constitute a constellation of texts, a genre suite, with a powerful illocutionary force. These texts are the prelude to and the means of confinement; they are both act and process. At the heart of our comparison of the asylum records of Merivale and Marshall with their "survivor narratives" is our analytic conclusion that the Ticehurst case histories can be said to constitute a linear "chronicle" of what Hayes Newington, the writer of the two case histories observed and inferred about his two patients. As chronicles, the Ticehurst Asylum case histories are linear representations or realistic accounts. As such, these archival documents provide a genuine insight into the "ways that that reality offers itself to perception". The institutional accounts exist in--and mark a--"flat time," equalized by each dated entry depicting the writer's mechanical act of observing/noting in brief, stereotypical sentences, e.g., "Patient is better [or, conversely, no] better today." We dubbed this metronomic time: beating regularly and evenly, flattening out the individual trajectories of each patient's illness. Metronomic time is normative. Each beat is calculated precisely to be the same as next. The dispassionate nature of clinical observations and the metronymic rhythms of the asylum fit with this flat, regular, uniform view of time. Once metronomic, institutional time is set in motion by the precipitating event of the certificates of insanity, entries are logged with regularity and observations are made in a formulaic, abbreviated, and predictable manner. By contrast, the passage of time recorded in both Merivale's memoir and Marshall's oral account is irregular, unpredictable, marked by acute catastrophes and long anxious periods of waiting for a resolution, by peaks of conflict and turmoil alternating with valleys of dazed stupor or inaction. Time in their accounts is also recursive; events are re-lived, sometimes more than once, as the patients recount their feelings about their confinement. Time for Merivale and Marshall (and presumably other patients as well) acquires a symphonic pattern: recursive, with dramatic highs and lows, unfolding multiple variations of a central theme-in both of these cases, denial of insanity. Both metronome and symphonic time have similar rhythmic "deep structures," but while one is simply a repetitive drumbeat of the quotidian, the other takes off into richer, more elaborate arrangements invested with personal meaning.

Hospital bodies: the genesis of Italian National Health Service.

Hospital public bodies were instituted in Italy in 1968. Their creation represents a fundamental step forward in the evolution of the national healthcare system and has allowed improvements in social equity in hospitals. The lack of independent funding beyond the insurance-type healthcare system existing at the time, hindered its success. The hospital body has however left a trace in the modern national healthcare system with the introduction of the hospital corporation.