Biographies of eminent Scottish physicians: Professor Sir Ian Hill.
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Biomedical subjects
Publications and source records attributed to D Emslie-Smith.
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After Harvey's visits to Scotland with Charles I the formation of a united Caroline University in Aberdeen was thwarted by the Civil War. In Oxford Harvey instituted a group of medical scientists, forerunners of the Royal Society, who almost explained the physiology of respiration. Harvey had several things in common with Dr Samuel Johnson. Johnson's medical knowledge and contacts are emphasised, examples of 17th and 18th century health regimens are given and Johnson's friendship with Scottish medical men and some others connected with the Royal College of Physicians and the Harveian Society of Edingburgh are described.
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In a study of 45 cases of ventricular pre-excitation, 19 were classified as type A and 20 as type B according to Rosenbaum's criteria, which depend on the polarity of the major deflections in the right praecordial leads and not, as is commonly thought, on the direction of the delta vector. Six cases that could not be classified as type A or type B were termed intermediate. Vectorcardiograms were recorded from 29, and these showed a wide but continuous range of values for both the delta and the main QRS vectors in all three planes. Any classification based on these features must, therefore, depend on arbitrary quantitative data. Three patients in this series had associated right bundle-branch block. A review of the published reports on the association of pre-excitation and bundle-branch block failed to provide a rational basis for the classification of pre-excitation. It is emphasized that Rosenbaum's classification is empirical and its validity is questioned.
A prospective study was made of 80 patients during typical clinical episodes of acute myocardial infarction with biochemical and scalar electrocardiographic confirmation. Nine patients had bundle-branch block and 12 had had previous episodes of myocardial infarction. Serial electrocardiograms and vectorcardiograms were recorded during the first week in hospital. The most striking finding was that in more than half the cases there was disagreement between the electrocardiogram and vectorcardiogram in the localizationof infarction. The earliest evidence of infarction in the electrocardiogram is often restricted to ST and T changes though in the corresponding vectorcardiograms evidence of infarction may be present in the QRS loop. In those cases in which both electrocardiogram and vectorcardiogram show QRS abnormalities these are frequently detected earlier in the vectorcardiogram, but the converse is rare.
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The photomotogram (P.M.G.) of the Achilles tendon reflex was studied in 26 patients with hypothermia (rectal temperature 33.3 degrees C or less), 10 of whom also had myxoedema (serum protein bound iodine 2.8 mug/100 ml or less). No reflex could be elicited in eight (31%) of these patients, including three of those with myxoedema. Hypothermia increases both the contraction and the relaxation times of the reflex, the relaxation phase being particularly prolonged in those with myxoedema. In those patients from whom the reflex was elicited the ratio of the contraction time to the "half-relaxation time" in the P.M.G. was less than unity in six of the seven with myxoedema, and considerably greater than unity in eight of the 11 (73%) who were euthyroid. Thus, analysis of the Achilles tendon reflex P.M.G. correctly predicted the thyroid status in 14 of the 18 hypothermic patients in whom the Achilles tendon reflex was present (78%). The wider use of this rapid test of thyroid function would allow a more rational use of thyroid hormones in hypothermic patients and so lead to a better assessment of their value.
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