Humanism and values in the medical short stories of Arthur Conan Doyle.

In 1894 Arthur Conan Doyle published 15 medical short stories under the title of Round the Red Lamp, a red lamp being the symbol for a physician's office in Victorian England. These 19th-century vignettes do not indulge in scientific descriptions of diseases, their processes, or their treatment. Instead, they are based upon the effects of illness on the lives, sentiments, and emotions of the afflicted, their families, and their physicians. The stories are suffused with romance and humor. Conan Doyle's medical fiction of almost 100 years ago constitutes a superbly written and engaging collection that ranges from the comic to the pathetic. They contain universal themes that are especially appropriate today when humanistic elements are being usurped by rampant technology in both medical education and medical practice. These tales can make a significant contribution in related seminars for both students and practitioners.

Osler's brain and related mental matters.

Interest in the relationship between the morphology of the brain and mental and behavioral characteristics was evident in the 18th century; it flourished in the 19th century and waned during this century. This concern has been expressed in several activities. The weight and cortical area and gyral patterns of brains have been measured in detail in prominent and highly intelligent individuals, such as William Osler, Thomas Browne, and Albert Einstein, as well as in "average" individuals and in criminals. Phrenology is based on the assumption that various modalities of behavior are localized to specific morphologic areas of the brain. Little credence is now given to the mental, behavioral, and psychosocial significance of brain weight and gyral patterns. Practices based on such concepts are now considered by most to be a manifestation of quackery, though phrenology is still believed in by some.

Prudent laboratory usage, cost containment, and high quality medical care: are they compatible?

Inappropriate laboratory use by physicians is partly responsible for the rapid rise in health care costs. This use falls into three categories--over-, under-, and misutilization. Overuse creates information overload for the physician and has a detrimental effect on patient care. Abnormal results are frequently obscured by massive amounts of requested information. Studies show that laboratory use is greater for younger physicians and that increased use is not associated with better outcome of care. Overuse ranges from 26 per cent to 98 per cent for selected tests. Unnecessary tests can be eliminated with no adverse effect on quality. Laboratory use can be improved by a variety of approaches including education, feedback, implementation of administrative changes and, finally, financial incentives or disincentives; the last has proven the most effective. All the approaches should be reinforced by cost-conscious clinical settings that foster a "why" rather than a "why not" philosophy. Improving laboratory use may reduce costs and maintain quality.

Teratomas of the tongue present at birth.

A large teratoma of the tongue, present at birth, was successfully removed at 32 h of age. It contained immature neural tissue consisting of a loose neurofibrillary matrix with primitive neurons, rossettes, and papillary tissue. Serum alpha fetoprotein was present at 8 days of age, as reported in some patients with malignant teratomas. Our case, however, had no histologic evidence of malignancy, no serum alpha fetoprotein at 7 months of age, and no recurrence at 1 years. The four glossal tumors reported in the literature, including one with immature neural elements, were all present at birth. In 1 case, another teratoma of the tongue was found 5 months after removal of the congenital one. It may not have been a recurrence, as the mass was located in a different area of the tongue. It appears that congenital teratomas of the tongue do not behave in a malignant fashion, at least in the 5 known cases.

Anomalous coronary artery simulating parachute mitral valve.

Anomalous left coronary artery, arising from the pulmonary valve, may produce a clinical and radiologic picture mimicking parachute mitral valve (PMV). The pathogenesis is related to left myocardial hypoxia and consequent fibrosis. The authors report a patient with such involvement of the myocardium and contiguous anterior papillary muscle. The result was fibrous atrophy with consequent physiologic and radiologic abnormalities that occur in PMV because of the absence of this muscle, and superficial resemblance to its characteristic morphology.

William Osler and Arthur Conan Doyle versus the antivivisectionists: some lessons from history for today.

Reaction against vivisection for research reached its height in the last two decades of the 19th century and the first two of the 20th, and a resurgence began in the 1960s. Antivivisectionism was and is related, in part, to emphasis on humanitarian sentiments. Two humanitarian physicians defended vivisection as essential. Dr. Arthur Conan Doyle in 1886 justified the killing of rabbits to relieve human suffering from hydrophobia. In 1910, he objected to the antihuman campaign of the antivivisectionists. Dr. William Osler reacted similarly to the threat to vivisection. He gave emphatic evidence to investigative committees in the United States in 1900 and in Britain in 1907. Osler also performed vivisection. His experimentation included studies of pig typhoid and tapeworm cysts in pigs and of the fate of india ink injected into the lungs of kittens. Osler and Conan Doyle were but two of the many prominent physicians who helped stem the tide of antivivisection legislation near the turn of the century. A review of the elements that fostered antivivisectionism in the society of their time is relevant in understanding and reacting to similar sentiments in the present era.