DOCSLIB.ORG

The UK Register of HIV Seroconverters: Estimating the Times from HIV Seroconversion to the Development of Aids and Death and Associated Factors from a Cohort of HIV Seroconverters

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The UK Register of HIV Seroconverters: Estimating the Times from HIV Seroconversion to the Development of Aids and Death and Associated Factors from a Cohort of HIV Seroconverters The UK Register of HIV Seroconverters: estimating the times from HIV seroconversion to the development of AIDS and death and associated factors from a cohort of HIV seroconverters This work is presented as a thesis for the degree of DOCTOR OF PHILOSOPHY in Epidemiology at the Faculty of Clinical Sciences by Kholoud Porter From the Medical Research Council HIV Clinical Trials Centre University College London Medical School The Mortimer Market Centre March 1998 ProQuest Number: U642762 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest U642762 Published by ProQuest LLC(2015). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT Knowledge of the distribution of intervals from HIV infection to the development of AIDS and to death, and the factors affecting these intervals is vital to an understanding of the natural history of HIV infection and for making projections of future numbers of AIDS cases. This distribution may have changed since the beginning of the epidemic due particularly to the introduction of anti-retroviral treatment and prophylaxis for Pneumocystis carinii pneumonia. It is likely to be influenced by new advances in the management of HIV infected individuals in the future. Changes in the incubation period distribution could also occur in the absence of changes in available treatments and treatment uptake, due to the evolving distributions of new viral strains. It is therefore important to monitor whether there are changes in the incubation period distribution and, if so, the extent of those changes and factors associated with them. A number of studies have provided estimates for this period in different population groups. Most have tended to focus on one transmission category, e.g. homosexual men, injecting drug users, or haemophiliacs; are small in size; or are no longer recruiting new subjects. This thesis reports on the design, methods and findings from a register of HIV-infected individuals in the UK in whom the date of seroconversion is known with reasonable precision (seroconverters). Baseline and annual follow up information is collected and includes: sex, age, ethnic group, route of HIV transmission, latest CD4 count, details of therapy and prophylaxis, AIDS defining events and vital status. Findings presented in this work are on 2022 seroconverters reported by the end of September 1997, the first 3 years of the Register. Careful documentation of the time that each seroconverter came under unbiased follow up for the purposes of the Register was made so as to minimise any bias resulting from the preferential inclusion of long-term non-progressors and recent seroconverters. Censoring at the end of June 1995, the estimated median time to AIDS from HIV seroconversion was 9.26 years (95% CI= 8.46- 10.39). Censoring at the end of December 1996 the estimated median time from seroconversion to death (from any cause) was 10.79 years (95% CI= 9.81- 11.36 years). Age was found to be highly associated with disease progression with a relative risk of 1.43 (95% CI= 1.19- 1.71) and 1.51 (95% CI= 1.29- 1.78) for each 10-year increase in age to AIDS and death respectively. After adjustment for the effects of other covariates, no evidence of a difference was found between exposure categories, sex or over calendar time. ACKNOWLEDGEMENTS This work was undertaken while I was employed at the MRC HIV Clinical Trials Centre as Project Co-ordinator for the UK Register of HIV Seroconverters. It was never as a one-woman-band and I am deeply indebted to the many friends and colleagues without whose help, support, encouragement and example I could not have completed this work. I would especially like to thank Professor Anne Johnson and Professor Andrew Phillips whom I have been fortunate to have as my supervisors. I am extremely grateful to them for always finding time through their busy schedules to give guidance, encouragement and support, and always with patience and good humour. I am extremely grateful to Professor Janet Darbyshire for her endless support and encouragement throughout my work and study. I am especially thankful to her for being such an approachable and thoughtful person. I am most indebted to Dr Noël Gill for his guidance over many years and for his faith in my abilities. I am particularly indebted to him for arranging CDSC’s funding of this doctorate. So many colleagues at CDSC, SCIEH and the Trials Centre have helped make my job less stressful and more manageable and the goals more achievable. I should like to express my gratitude to them all and in particular: CDSC: Dr Barry Evans, Miss Amanda Wright, Mr Dominic Howitt, Dr Ruth Gilbert, Ms Anna Molesworth, and Mrs Pauline Kaye. SCIEH: Dr David Goldberg, Mr Glen Codere, and Ms Geraldine Bums. Clinical Trials Centre: Ms Charlotte Duff, Ms Joanne Gillett, Mr Patrick Kelleher, Ms Sarah Walker, Dr Abdel Babiker, Dr Malcolm Hooker, Mr Adrian Kimberley, and Mr Robert Manning. This work would not have been possible without the help of clinicians, nurses, database administrators, microbiologists and virologists in a number of centres throughout the United Kingdom. I am very grateful to each of them for their continued help and support. Their names appear in Appendix II to this work. 3 Last, and certainly not least, a special thank you to Tariq and Adam for being the constant source of moral support. CONTENTS Page List of tables 6 List of figures 9 Chapter I Introduction 11 Chapter II A review of publications of HIV seroconverter cohorts 30 Chapter III Methods 68 Chapter IV Methodological issues 81 Chapter V Characteristics of the UK Register cohort 98 Chapter VI Statistical methods and an evaluation of bias 118 Chapter VII Progression estimates from HIV seroconversion to 131 AIDS and to death Chapter VIII A summary of findings and further work 153 APPENDICES 165 I Members of the Executive and Steering committees II Names of collaborators III Definition of an acute seroconverter IV Data collection forms V Time of entry into risk set for each clinical centre VI Epidemiology & Infection publication REFERENCES 189 LIST OF TABLES Table Title Page 1.1 Summary of the 1986 classification system for the clinical 15 manifestations of HIV infection 1.2 Summary of the 1993 classification system for the clinical 16 manifestations of HIV infection 1.3 Diseases included in the current definition for AIDS 18 1.4 Definitive Diagnostic Methods for Diseases Indicative of AIDS 19 1.5 Presumptive Methods for Diseases Indicative of AIDS 20 1.6 AIDS cases and HIV infection reports in the UK: data reported to 22 CDSC and SCIEH to the end of September 1994 1.7 Drugs prescribed in HIV infection 27 2.1 A summary of published studies of HIV progression rates in cohorts of 33 homosexual and bisexual men 2.2 A summary of published studies of HIV progression rates in cohorts of 44 persons with haemophilia 2.3 Estimates of progression to AIDS by age group at seroconversion from 46 the UKHCDO data 2.4 Estimates of progression to AIDS within 9 years of seroconversion by 46 age group for persons in the MCHS 2.5 A summary of published studies of blood transfusion recipients 49 2.6 Progression to AIDS by age group at seroconversion for Swedish 53 transfusion recipients 2.7 A summary of published studies of injecting drug users 55 2.8 A comparison of progression rates to AIDS between haemophiliacs in 61 Western Pennsylvania and homosexual men in the SFCC 2.9 A comparison of progression rates to AIDS between haemophiliacs in 61 MCHS and homosexual men in the 1RS 2.10 Progression rates to AIDS in haemophiliacs and transfusion recipients 64 in Sweden 4.1 Exposure category distribution of seroconverters, reported AIDS cases 83 and HIV infections (to the end of September 1994) and estimated prevalence (at the end of 1993) 4.2 Late entry: number of patients recruited from each of 3 hypothetical 90 clinics 4.3 Late entry: life table of retrospectively identified seroconverters from 90 hypothetical clinics A, B, and C (see Table 4.2) 4.4 Reporting delay for UK AIDS cases reported to CDSC and SCIEH to the 95 end of 1996 5.1 Characteristics of all subjects reported to the Register 100 October 1994 - September 1997 5.2 Total number of all subjects reported, number of AIDS diagnoses, and 104 number of deaths known by 30 September 1997 5.3 Age distribution of all subjects reported to the Register 105 by exposure category 5.4 Age at seroconversion of all subjects reported to the Register by 106 exposure category and sex 5.5 Interval between last negative and first positive HIV antibody tests and 109 proportions with AIDS and who have died 5.6 AIDS cases: Year of diagnosis of AIDS 110 5.7 AIDS cases: AIDS defining diseases and proportion of total diagnoses 112 5.8 AIDS cases: exposure category distribution of all AIDS-defining 113 conditions 5.9 Non-progressors: year of last clinic visit for persons not diagnosed 114 with AIDS 5.10 Deaths : Estimated year of seroconversion by year of death 115 5.11 Persons remaining alive in HIV survival estimates: year last known to 117 be alive 6.1 Documentation of seroconversion
Load more

Recommended publications
  • (Not) Visiting Isolation Hospitals in Mid-Victorian Britain
    7 Infection and Citizenship: (Not) Visiting Isolation Hospitals in Mid-Victorian Britain Graham Mooney Local authority provision for the sequestration of infectious people mushroomed in Great Britain from the mid-1860s. By the First World War, more than 750 isolation hospitals contained almost 32,000 beds for infectious patients, most of whom were children. Trips to an isolation hospital were problematic because visitors might contract infection there and spread it to the wider community. Various strategies sought to minimise this risk or eliminate it altogether. This chapter argues that the management of isolation hospital visitors was typical of Victorian public health’s tendency to regulate people’s behaviour. By granting rights to, and conferring responsibilities on, the relatives of patients, visiting practices enshrined notions of citizenship that sought to govern ‘through’ the family. The isolation of people with infectious disease has attracted an increasing amount of attention from historians. The fundamental rationales for the institutional exclusion of the infected – namely the protection of the wider population, the prevention or stamping out of an epidemic outbreak – are practically self-evident. Yet scrutiny in a variety of metropolitan and colonial contexts also reveals a set of practices that, over the course of the nineteenth century, seemingly were ever more laden with undertones of coercion, moral and physical rehabilitation and normalisation. The removal of biologically dangerous individuals from their community surroundings
    [Show full text]
  • Dr James a Gray Interviewer: Morrice Mccrae Date: August 2003
    Interviewee: Dr James A Gray Interviewer: Morrice McCrae Date: August 2003 Keywords: Leith Hospital World War Two Royal Medical Society RAF Aden Protectorate Levies Dr [James McCash] Murdoch Edinburgh City Hospital Royal Free Hospital Infectious Diseases Edinburgh Postgraduate Board for Medicine Senior Fellows Club MM: James Gray was born in Bristol in 1935. He’s of a medical family; both his father and grandfather were fellows of the Royal College of Physicians of Edinburgh. He was educated at St Pauls School, London and Edinburgh University. As a student, he was a member of the Royal Medical Society and became its senior president in 1958. After graduating he held house appointments in Edinburgh and in Middlesbrough before holding a short service commission in the Royal Air Force. He returned to Edinburgh as a research fellow at Edinburgh Royal Infirmary. He then became registrar at Bristol Royal Infirmary and later senior registrar in the infectious diseases department of the Royal Free Hospital, London. In 1969 he was appointed consultant in communicable diseases at the City Hospital in Edinburgh and from 1976 until 1984 he was assistant director of studies at the Edinburgh Postgraduate Board. MM: James, you were born in March 1935. JG: Correct, that’s right. MM: And that was in Bristol. JG: Correct, yes. MM: But I think you’re of an Edinburgh family, are you not? JG: Very much so, yes. That goes back to certainly my grandfather who was the medical officer of health for Leith and a very successful general practitioner in the Ferry Road and my father, who also studied medicine - both of them are Edinburgh graduates - and then my father got away from general practice and went in to all the laboratory specialities which he was always interested in, particularly microbiology, and he worked with Professor T.
    [Show full text]
  • Proceedings of the British Thoracic Society, Scottish Thoracic Society and Thoracic Society of Australia
    Thorax: first published as 10.1136/thx.42.9.705 on 1 September 1987. Downloaded from Thorax 1987;42:705-752 Proceedings of the British Thoracic Society, Scottish Thoracic Society and Thoracic Society of Australia The 1987 summer meeting held on 1-3 July in the University of Edinburgh. Bronchoscopy in the elderly: helpful or hazardous? mg (two). Bronchoscopists completed questionnaires immediately afterwards, and patients the next day, AJ KNOX, BH MASCIE-TAYLOR, RL PAGE Respiratory returning them promptly by stamped addressed envelope. Medicine Unit, St. James's Hospital, Leeds Recently, After midazolam, fewer patients remembered the nasal doubt has been cast on the safety and desirability of spray (15% vs 36%, p<0.05) or bronchoscope insertion fibreoptic bronchoscopy in the elderly (Grant IBW, Br Med (9% vs 38%, p<0.01); complaints fell from 48% J 1986;293:286-7). To answer this question, we looked at previously to 7%o. Fewer patients were difficult to the safety and acceptability of the procedure in 60 patients, bronchoscope or found it unpleasant after midazolam, aged 80-92 over the four year period May 1982-May 1986. though more needed extra lignocaine; these differences Thirty-four patients were male. Sedation was with atropine, were not significant. Overall, the commonest complaint fentanyl, and diazepam, 2% lignocaine being instilled (32%) was of apprehension about the procedure or results locally over the cords. There was no serious morbidity and but 97%to would have another bronchoscopy, and 74%o no mortality. The diagnostic yield was similar to younger found it better than expected, though 93% appreciated age groups.
    [Show full text]
  • HISTORY Scheinker Syndrome (GSS) Consequence Ofexposure Totheseinfected Individuals
    J R Coll Physicians Edinb 2005; 35:268–274 PAPER © 2005 Royal College of Physicians of Edinburgh Dangerous dissections: the hazard from bodies supplied to Edinburgh anatomists, winter session, 1848–9 MH Kaufman School of Biomedical and Clinical Laboratory Sciences, University of Edinburgh,Scotland ABSTRACT After the 1832 Anatomy Act,all bodies that were to be used by medical Correspondence to MH Kaufman, students for dissection were supplied to Schools of Anatomy based on their needs. School of Biomedical and Clinical During the Winter Session of 1848–9, a high proportion of the bodies supplied to Laboratory Sciences, Hugh Robson the University of Edinburgh, and the majority of those supplied to the Argyle Building, George Square, Edinburgh Square School had died of an infectious disease. Most had died from cholera, while EH8 9XD others had died of typhus, tuberculosis or other infectious diseases. These bodies tel. +44 (0)131 650 3113 were not embalmed before dissection. Therefore, both medical students and their teachers in Departments of Anatomy, in addition to those in the hospitals in which fax. +44 (0)131 650 3711 they had died, would have been at risk of becoming infected or even dying as a consequence of exposure to these infected individuals. e-mail [email protected] KEYWORDS Infected bodies, Schools of Anatomy, cholera, typhus, tuberculosis, bodies not embalmed, risk of infection LIST OF ABBREVIATIONS Creutzfeldt Jacob Disease (CJD), Gerstmann-Straussler- Scheinker syndrome (GSS) DECLARATION OF INTEREST No conflict of interests declared. Shortly after the implementation of the 1832 Anatomy and therefore had relatively little difficulty in obtaining an Act,1 there was considerable concern in the various adequate number for this purpose, this tended to be the extra-mural schools in Edinburgh, all of which were exception rather than the rule.
    [Show full text]
  • Infectious Diseases, Discussion on Isolation And
    Meeting III.?December 3, 1913 Dr William Russell, Vice-President, in the Chair II. Original Communications DISCUSSION ON ISOLATION AND QUARANTINE PERIODS IN THE MORE COMMON INFECTIOUS DISEASES Opened by Claude B. Ker, M.D., F.R C.P., Medical Superintendent, Edinburgh City Hospital It has occurred to me that the time has arrived when we may with profit investigate the rules usually laid down for the isolation and quarantine periods of the more common infectious diseases. Tradi' tions are handed down to us, we accept them, and they not only become the routine of our own practice, but are also regarded as almost sacred by the general public. And yet our views of the infectivity of certain diseases are undergoing modification, and in this subject, as in others, we are surely to -be permitted to criticise the opinions of our predecessors. That is why I think that an occasional stocktaking, if I may call it so, of our regulations regarding infectious diseases might be undertaken with great advantage. But first I wish to make it perfectly clear that, as things are at present, I totally disclaim any desire to find fault with the regula- tions laid down by public health departments and by schools. 1 have had a hand in drawing up many, and I have always felt myself tied by the views accepted by the profession at large. I do not think either a it reasonable to expect public health authority or a school BY DR CLAUDE B. KER 43 *? take the initiative in relaxing generally accepted rules which aPpear to some of us unnecessarily strict or irksome.
    [Show full text]
  • Digest of Research on Drug Use and Hiv/Aids in the Criminal Justice System
    DIGEST OF RESEARCH ON DRUG USE AND HIV/AIDS IN THE CRIMINAL JUSTICE SYSTEM DIGEST OF RESEARCH ON DRUG USE AND HIV/AIDS IN THE CRIMINAL JUSTICE SYSTEM 2008 Edition Published by The European Institute of Social Services University of Kent Keynes College Canterbury CT2 7NP DIGEST OF RESEARCH ON DRUG USE AND HIV/AIDS IN THE CRIMINAL JUSTICE SYSTEM EISS wishes to acknowledge the contribution of Cranstoun Drug Service to the present digest, which is an expansion of the Digest of Research produced till December 2006 under the European Commission funded ENDIPP project, co-managed by Cranstoun Drug Services. The Connections project has received funding from the European Commission under the Public Health Programme 2003-2008. However, the sole responsibility for the project lies with the author and the European Commission is not responsible for any use that may be made of the information contained therein. DIGEST OF RESEARCH ON DRUG USE AND HIV/AIDS IN THE CRIMINAL JUSTICE SYSTEM Digest of Research on Drug Use and HIV/AIDS in Prisons Revised 2008 version TABLE OF CONTENTS A. ABSTRACTS................................................................................................ 4 B. REFERENCES ......................................................................................... 335 C. KEYWORDS............................................................................................ 377 D. COUNTRY INDEX.................................................................................. 381 DIGEST OF RESEARCH ON DRUG USE AND HIV/AIDS IN THE CRIMINAL JUSTICE SYSTEM A. ABSTRACTS 1. PSYCHOACTIVE SUBSTANCE ABUSE AMONG INMATES OF A NIGERIAN PRISON POPULATION The objectives of this study were: (1) to assess the prevalence rate of psychoactive substance abuse and dependence among inmates of a Nigerian prison population within the past month; (2) to highlight how aware these prisoners were, of the various drug abuse; (3) to compare the findings with those of reports from abroad, and general Nigerian population samples.
    [Show full text]
  • Proceedings of the British Thoracic Society
    Thorax: first published as 10.1136/thx.40.9.688 on 1 September 1985. Downloaded from Thorax 1985;40:688-728 Proceedings of the British Thoracic Society The 1985 summer meeting of the British Thoracic Society was held on 3-5 July at the University of York Asthma and indoor mould exposure 95%, W 88%, T 86%, C 48%, P 36%, A 16%, N 13% plus others (panic 11%o, sputum 7%). The symptoms used to ML BURR, J MULLINS, TG MERRET, NCH STOTT MRC judge asthma were B 75%, T 70%, W 52%, C 30%, P Epidemiology Unit, Cardiff; Sully Hospital, Penarth; 30%, A 16%, N 13% plus others (loss of inhaler response RAST Allergy Unit, Benenden; Ely Surgery, 5%, fast pulse rate 4%). Some volunteered that as asthma Cardiff Asthmatics aged 15-60 years, currently receiving worsened C disappeared, others that W disappeared. Apart treatment, were identified from a register maintained by a from B at least half of other symptoms were not group practice in Cardiff. Seventy-two patients were volunteered before specified questioning. Asthma identified and may be taken to represent the spectrum of symptoms and asthma judgment are not consistent but treated asthma in the community. Each patient was highly individual. This has implications for asthma matched with a control, of the same age and sex, registered symptom scoring. Pain should be regarded as a common with the same general practitioners. Patients and controls symptom of asthma. were investigated for evidence of allergy to moulds and copyright. other allergens. Nineteen of the asthmatics (26%o) and nine of the controls (12.501o) reported visible mould on the inside walls of their homes.
    [Show full text]
  • THE DIAGNOSIS and Msftfflbtcl...Gp. BACTERIAL
    THE DIAGNOSIS AND mSftfflBTCL.. .gP. BACTERIAL MflnHHTlS by ROBERT IAMB. B.Sc.fKB . fCh.B.fD.P.EL Physician, The Gateside Hospital for Infectious Diseases, Greenock. Late Registrar in Infectious Diseases, Ruchill Hospital, Glasgow. ProQuest Number: 13838662 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13838662 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 TOIQEi Whilst I was a resident medical officer at Ruchill Hospital ample opportunity *was afforded for a study of the diagnosis and the effects of treatment in the difference types of hacterial meningitis. Most of the cases were, of course, meningococcal and tuberculous meningitis, but pneumococcal and influenzal meningitis cases f o m e d a small but significant proportion. The number and distribution of cases studied in Ruchill Hospital was as follows: - Tuberculous Meningitis., .85 cases Meningococcal Meningitis 100 cases "Pneumococcal Meningitis. .14 cases Influenzal meningitis,., • 9 cases These cases were observed during the period November 1947 until March 1950 when I assumed my present appointment as physician to Gateside Hospital, Greenock, where a further twenty cases of tuberculous meningitis were studied, making the total number of cases of this disease studied 105.
    [Show full text]
  • Surveillance of HIV Infection in Scotland
    Surveillance of HIV Infection in Scotland ( A decade of HIV surveillance at SCIEH: 1984 -1994) Gwendolyn Muriel Allardice, M.Sc. Thesis submitted to the University of Glasgow for the degree of Doctor of Philosophy Department of Public Health February 1996 ProQuest Number: 13832499 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13832499 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 'f&U (o5<$^ Cf)i 6LASS0^7 !UNIVERSL / > TT377 "Y * Abstract The objectives of this thesis are to describe, analyse and evaluate the principal HIV surveillance schemes co-ordinated at the Scottish Centre for Infection and Environmental Health (SCIEH) between 1984 and 1994. Chapter one begins with a brief review of surveillance, including examples of surveillance schemes and their benefits, followed by a detailed statement of the aims of this thesis. The chapter continues with a review of the first reports of AIDS, the discovery of HIV, the transmission of HIV, the immune response to HIV, and the development of a test for HIV antibodies. A brief introduction to the principal HIV surveillance schemes is given, with a description of the role of each scheme in the context of the overall HIV surveillance programme for Scotland.
    [Show full text]
  • MODERN REQUIREMENTS in ISOLATION HOSPITAL
    MODERN REQUIREMENTS In ISOLATION HOSPITAL CONSTRUCTION AND ADMINISTRATION Alexander Taylor Elder, M»B.,Ch«B.,B«Hy. aD#P,H» Assistant Medical Superintendent The Florence Nightingale Hospital, Bnry, ProQuest Number: 13905203 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 13905203 Published by ProQuest LLC(2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 .Hypothesis........ •...Historical Review....... The Major Infections.... ..Constructional Requirements • •......Administration..... ..... The Future Policy..... References.....See Back CHAPTER I, HYPOTHESIS ttThe Art of a thing is, first, its aim, and next, its .manner of accomplishment.11 C.N. BOVEE. Summaries of Thought, Art and Artists. The first conception of a need for the Isolation Hospital was based upon a desire to separate the infected sick from the remainder of the community. This, in the early days of the hospitals, seemed the ideal method of check­ ing the spread of epidemics; how disappointing in their actual effect, in this direction, they proved to be Is well shown by the literature of the end of the nineteenth century. The idea of safeguarding the non-infected was not a new one, dating back to the ninth century, as will be shown subsequently.
    [Show full text]
  • Ijjq.E Tj ~Tottis4 ~Oti.Ety }, O£ T4.E ~Istory of 4'«E~Itin.E
    ijJq.e tJ ~tottis4 ~oti.ety }, o£ t4.e ~istory of 4'«e~itin.e (Founded April, 1948) REPORT OF PROCEEDINGS SESSION 1998 - 99 and 1999 - 2000 OFFICE BEARERS (1998-99) (1999-2000) President DR. J. FORRESTER OR. 1. FORRESTER Vice-Presidents DR. H. T. SWAN DR. H. T. SWAN DR. D. I. WRIGHT OR. O. J. WRlGHT Hon. Secretary DR. J. MacGREGOE. DR. 1. MacGREGOR Treasurer - DR. J. SIMPSON OR. J. SIMPSON Hon. Auditor DR. RUFUS ROSS DR. RUFUS ROSS Hon. Editor OR. O. 1. WRIGHT DR. O. J. WRIGHT Council MRS. AILSA BLAIR MRS. AILSA BLAIR MISS 1. FERGUSON MISS J. FERGUSON MRS. B. GEISSLER MRS. B. GEISSLER OR. E. JELLINEK OR. JAMES GRAY OR. E. LAZENBY DR. E. JELLINEK PROP. R. I. McCALLUM OR. E. LAZENBY MR. ROY MILLER MR. ROY MILLER PROP. T. H. PENNINGTON PROP. T. H. PENNINGTON DR. R. ROSS DR. R. ROSS DR. M. J. WILLIAMS OR. M. J. WILLIAMS mire ~rotth:df ~orietll of tqt ~istoru of 4ffi{tttirint (Founded April, 1948) Report ofProceedings CONTENTS Papers Page (a) Family Planning in Sierra Leone 1-4 Dr Elizabeth Wilson (b) Poverty, Milk and Tuberculosis in Glasgow 1900-1935 5-8 Dr John Burnett (c) Personal Wartime Research Experiences in India and Burma 9-13 Pro! RH Girdwood (d) From Billroth's Gastrectomy to Laparoscopic Gastric Stapling 13-20 Pro! R Van Hee (e) The History of General Anaesthesia 20-23 Miss RJ Gorrigan (f) The History of Tuberculosis 23-28 Mr Hans Sharma (g) A History of the Edinburgh City Hospital 29-34 Dr lames Gray (h) Glasgow's Contribution to New Zealand Medicine 34-43 Dr Derek Dow (i) The Development of Clinical Thermometry 43-45 Dr J.
    [Show full text]
  • An Aetiological Study of Respiratory Infection in Children, Edinburgh City Hospital, 1961-1963
    J. Byg., Camb. (1965), 63, 187 187 Printed in Great Britain An aetiological study of respiratory infection in children, Edinburgh City Hospital, 1961-1963 BY G. E. D. URQUHART,* MARGARET A. J. MOFFAT, MARGARET A. CALDER AND GILLIAN M. CRUICKSHANK Wellcome Laboratory, City Hospital, Edinburgh (Received 21 August 1964) The aetiology of acute respiratory infection in young children is still not fully understood and numerous combined clinical and laboratory investigations have been carried out in an attempt to elucidate this problem (Morrison et al. 1957; Gardner et al. 1960; Holland, Tanner, Pereira & Taylor, 1960; Garrow & Taylor, 1962; Tobin, 1963; Clarke et al. 1964). No such study had been carried out in Edinburgh and a fact-finding survey was therefore planned to provide a picture of the bacterial and viral flora occurring in children admitted to hospital with respiratory infection. In this survey, no effort was made to examine a control group of children but it was hoped that by investigating all cases of respiratory illness certain aetiological patterns might be found to be associated with certain syndromes. Although the sera were tested for antibodies to respiratory syncytial virus no particular attempt was made to isolate this virus; optimum conditions for isolation of the common cold viruses were likewise not provided. The part played by these viruses may be considerable and must not be overlooked when examining the present results. MATERIALS AND METHODS The investigations were carried out during two winter periods; (1) from 1 October 1961 to 30 April 1962; (2) from 1 November 1962 to 31 May 1963. The procedures adopted during the first period are described below; alterations to the protocol made during the second period are listed separately.
    [Show full text]