A historical analysis of surgery performed between 1941 and 1942 at the Bangour Maxillofacial and Plastic Surgery Unit, Scotland.

In 1939, Bangour Emergency Medical Services Hospital was built as an annexe to Edinburgh War Hospital. The Maxillofacial and Plastic Surgery Unit opened in 1941, one of the several set-ups built with the support of Sir Harold Gillies, to ensure a service with specialist skills throughout Great Britain. The unit was led by Alexander Burns Wallace, who had to rapidly adapt the service to reflect the patterns of injury reflected by the more modern warfare practiced in the Second World War, while also incorporating techniques that were, at the time, revolutionary. Although much has been written about other units, Bangour's activity revealed through its case histories' highlights that plastic surgery was developing in parallel throughout Britain. The influence of Sir Harold Gillies was clear, and his input to support the fledgling service serves as an important aspect of the newly developing specialty of plastic surgery: collaboration and sharing of knowledge. This paper analyses the work of the Maxillofacial and Plastic Surgery Unit at Bangour General Hospital in Scotland between 1941 and 1942 and demonstrates its historical significance, as well as its relevance to current practice. Ninety-two case notes from the unit recently became accessible. These were analysed and four were selected for review in this study. These cases were selected as they were well-documented with photographs and good examples of the work performed at the unit in order to highlight the innovative, creative and complicated work carried out at the Unit.

Norman Dott (1897-1973) and medical illustration: the importance of art to neurosurgery.

Anatomical information and pathologies have been conveyed through the medium of medical illustrations for centuries. In the formative years of British neurosurgery, Professor Norman Dott (1897-1973) utilised medical illustrations as a means of documenting neurosurgical advances and conveying pathological-anatomical correlation. He commissioned a vast number of medical illustrations over the course of his career, ultimately producing a diverse collection of items, most of which is cared for by Lothian Health Services Archive (LHSA), Edinburgh, Scotland. In this study, the original material from Dott's personal collection was audited. Of 172 stand-alone drawings, 84 were categorised and analysed. The findings are a reflection of Dott's expertise as an academic and a surgeon. Spanning the years 1925-1968, a wide range of pathologies and procedures are depicted including intracranial aneurysms and their ligation, an area in which Dott was renowned for pioneering surgical advances. The collection stands as a testament to Dott's emphasis upon medical illustration to communicate the intricacies and complexities of his field, providing valuable insight into clinical and surgical practice in neurosurgery when the specialty was in its juvenescence. In order to illuminate the connections between biography and specialism that generated an extraordinary visual archive, this study considers the early life and work of Norman Dott and the influence of Harvey Cushing on Dott's prioritisation of visual documentation of surgical practice. It explores the impact of German-American medical artist Max Brödel on the UK, and especially on the artists employed by Dott, before presenting a short review of the medical illustrations they created.

Long-term outcomes of shamanic treatment for temporomandibular joint disorders.

BACKGROUND: Temporomandibular joint disorders (TMDs) are chronic, often refractory, pain conditions affecting the jaw and face. Patients least likely to respond to allopathic treatment have the most marked biologic responsiveness to external stressors and concomitant psychosocial and emotional difficulties. From a shamanic healing perspective, this describes individuals who are thought to be "dispirited" and may benefit from this ancient form of spiritual healing. OBJECTIVE: To report on the long-term quantitative and qualitative outcomes relative to end-of-treatment status of a phase I study that evaluated the feasibility and efficacy of shamanic healing for people with TMDs. METHODS/DESIGN: Participants were contacted by telephone at one, three, six, and nine months after treatment and asked to report pain and disability outcomes and qualitative feedback. SETTING: Portland, OR. PARTICIPANTS: Twenty-three women aged 25 to 55 years diagnosed with TMD. PRIMARY OUTCOME MEASURES: Participants rated their TMD-related pain and disability (on the TMD Research Diagnostic Criteria Axis II Pain Related Disability and Psychological Status Scale) at each follow-up call and were asked to describe their condition qualitatively. RESULTS: Improvements in usual pain, worst pain, and functional impairment reported at end of treatment did not change during the 9 months after treatment ended (p > 0.18). CONCLUSION: Shamanic healing had lasting effects on TMDs in this small cohort of women.

Journey into healing: the transformative experience of shamanic healing on women with temporomandibular joint disorders.

OBJECTIVE: To evaluate participants' perceptions of illness, healing process, and experience of effects from shamanic treatment as reported from in-depth interviews. THEORETICAL FRAMEWORK: Consistent with a whole systems research model, qualitative methods were used to evaluate the outcomes and experiences of clinical trial participants. Quantitative results are reported elsewhere. METHOD: Twenty participants completed five visits with a randomly assigned shamanic practitioner and completed pretreatment and posttreatment in-depth interviews conducted by trained, qualitative researchers. CONTEXT: Some physical and psychological symptoms associated with temporomandibular joint disorders (TMD) may be indicative of the shamanic definition of soul loss. Because this was the first clinical trial of shamanic healing for TMD pain, a mixed-methods approach enabled researchers to capture a wide range of participants' experiences. PARTICIPANTS: Eligible volunteers were women aged between 25 to 55 years, naive to shamanic healing, with a confirmed diagnosis of TMD and a pain level of three or higher on the Research Diagnostic Criteria Axis II questionnaire. DATA COLLECTION: For consistency, interviewers followed a guide that allowed individual experiences to emerge. Interviews lasted about one hour, were recorded, and professionally transcribed. ANALYSIS AND INTERPRETATION: Following standard qualitative analysis procedures, researchers developed and applied thematic codes to transcribed text of interviews. Coded text was reviewed to generate summaries of thematic content. MAIN RESULTS: Although participants described physical changes, three times as much text was devoted to changes in self-awareness, capacity for coping, improvement in relationships, and taking better care of themselves. Their experience describes a process of transformation.

Feasibility and short-term outcomes of a shamanic treatment for temporomandibular joint disorders.

CONTEXT: Temporomandibular joint disorders (TMDs) are chronic, recurrent, non-progressive pain conditions affecting the jaw and face. Patients least likely to respond to allopathic treatment are those with the most marked biological responsiveness to external stressors and concomitant emotional and psychosocial difficulties. These characteristics describe individuals who are "dispirited" and may benefit from shamanic healing, an ancient form of spiritual healing. OBJECTIVE: This phase 1 study tested feasibility and safety of shamanic healing for TMDs. DESIGN: Participants were randomized to 1 of 4 shamanic practitioners and attended 5 shamanic healing sessions. Self-reported pain and disability were recorded at baseline and each treatment visit and at 1, 3, 6, and 9-month follow-ups. Participants also were clinically evaluated at baseline and end of treatment. In-depth interviews, part of our mixed methods design, were conducted at baseline and end of treatment to evaluate acceptability and nonclinical changes associated with treatment. SETTING: Portland, Oregon. PATIENTS OR OTHER PARTICIPANTS: Twenty-three women with diagnosed TMDs. INTERVENTION: Shamanic treatment carried out during 5 treatment visits. MAIN OUTCOME MEASURES: Change from baseline to posttreatment in diagnosis of TMDs by Research Diagnostic Criteria (RDC) exam and participant self-ratings on the "usual" pain, "worst" pain, and functional impact of TMDs subscales of the RDC Axis II Pain Related Disability and Psychological Status Scale. This paper reports on outcomes at end of treatment. RESULTS: This study demonstrated the feasibility and acceptability of clinical trials of shamanic healing. The mean of usual pain went from 4.96 to 2.70, P<.0001; worst pain from 7.48 to 3.60, P<.0001, and functional impact of TMDs from 3.74 to 1.15, P<.0052. Only 4 women were clinically diagnosed with TMDs at the end of treatment.