A New Scientific Humanism

1. A Narrative Future for MedicineMeyerChildren’sHospital, Firenze 18-19th February 2016 Brian Hurwitz King’s College London A New Scientific Humanism

2. Case Report The pretty young virgin daughter of Nerius was twenty years old. She was struck on the bregma by the flat of the hand of a young woman friend in play. … she became blind and breathless, and went home when fever seized her... her head ached, and there was redness about the face. On the seventh day foul smelling pus came out around the right ear, reddish …she was prostrated, depressed, speechless; the right side of her face was drawn up. On the ninth day she died. Hippocrates. Epidemics V in Smith WD (Tr) Epidemics II and IV-VII. Cambridge, MA: Harvard University Press, 1994.

3. Case Report The pretty young virgin daughter of Nerius was twenty years old. She was struck on the bregma by the flat of the hand of a young woman friend in play. … she became blind and breathless, and went home when fever seized her... her head ached, and there was redness about the face. On the seventh day foul smelling pus came out around the right ear, reddish …she was prostrated, depressed, speechless; the right side of her face was drawn up. On the ninth day she died. Hippocrates. Epidemics V in Smith WD (Tr) Epidemics II and IV-VII. Cambridge, MA: Harvard University Press, 1994.

4. Case Report The pretty young virgindaughter of Nerius was twenty years old. She was struck on the bregma by the flat of the hand of a young woman friend in play. … she became blind and breathless, and went home when fever seized her... her head ached, and there was redness about the face. On the seventh day foul smelling pus came out around the right ear, reddish …she was prostrated, depressed, speechless; the right side of her face was drawn up. On the ninth day she died.

5. Case Report The pretty young virgin daughter of Nerius was twenty years old. She was struck on the bregma by the flat of the hand of a young woman friend in play. … she became blind and breathless, and went home when fever seized her... her head ached, and there was redness about the face. On the seventh day foul smelling pus came out around the right ear, reddish …she was prostrated, depressed, speechless; the right side of her face was drawn up. On the ninth day she died.

6. Case Report Eumelus of Larissa grew rigid in his legs, arms, and jaws. He could not extend them or bend them unless someone else extended or bent them, nor open his jaws unless someone opened them. But no other symptoms..

7. Case Report Eumelus of Larissa grew rigid in his legs, arms, and jaws. He could not extend them or bend them unless someone else extended or bent them, nor open his jaws unless someone opened them. But no other symptoms. He had no pain and he did not eat, except barley cakes, and he drank honey water. On the twentieth day he fell backwards while sitting and severely struck his head on a stone, and darkness poured over him.

8. Case Report Eumelus of Larissa grew rigid in his legs, arms, and jaws. He could not extend them or bend them unless someone else extended or bent them, nor open his jaws unless someone opened them. But no other symptoms. He had no pain and he did not eat, except barley cakes, and he drank honey water. On the twentieth day he fell backwards while sitting and severely struck his head on a stone, and darkness poured over him. Shortly later he stood up and was better. All was relaxed except that when he wakened after sleep his joints were slightly bound. He was then twelve or thirteen. He was troubled for three or four months. Hippocrates. Epidemics V in Smith WD (Tr) Epidemics II and IV-VII.

9. Case Report Eumelus of Larissa grew rigid in his legs, arms, and jaws. He could not extend them or bend them unless someone else extended or bent them, nor open his jaws unless someone opened them. But no other symptoms. He had no pain and he did not eat, except barley cakes, and he drank honey water. On the twentieth day he fell backwards while sitting and severely struck his head on a stone,and darkness poured over him. Shortly later he stood up and was better. All was relaxed except that when he wakened after sleep his joints were slightly bound. He was then twelveor?thirteen. He was troubled for three or four months. Hippocrates. Epidemics V in Smith WD (Tr) Epidemics II and IV-VII.

10. On Head Wounds So, in addition to your visual inspection of what may be seen in the bone, you must also inquire about all these matters – for these are indications of a patient’s being injured to a greater or lesser degree –

11. On Head Wounds So, in addition to your visual inspection of what may be seen in the bone, you must also inquire about all these matters – for these are indications of a patient’s being injured to a greater or lesser degree – and inquire whether the patient was stunned and darkness poured over him and whether he had vertigo and fell down. Hippocrates. On Head Wounds 11.8. Hanson M (Tr). Berlin: Akademie Verlag, 1999, 77.

12. A Girl, three Years old, who remained a quarter of an Hour under Water without drowning May 6 1737 Rebecca Yates of Market Bosworth in Leicestershire, had a Daughter about three Years of Age that fell into the Mill dam near to the water Mill-Wheel; and by force of the stream, was drawn under the water to the Wheel, with her legs forwards; one of her legs went under the Mill-Wheel; …the Child’s leg stopped the said Wheel from moving at all. The sudden stopping of the Mill so much surprised the Miller that he went immediately and let down the shuttle….. The First Word she spoke was Help me, repeating this three times. For God’s sake help me out if you can………

13. A Girl, three Years old, who remained a quarter of an Hour under Water without drowning May 6 1737 Rebecca Yates of Market Bosworth in Leicestershire, had a Daughter about three Years of Age that fell into the Mill dam near to the water Mill-Wheel; and by force of the stream, was drawn under the water to the Wheel, with her legs forwards; one of her legs went under the Mill-Wheel; …the Child’s leg stopped the said Wheel from moving at all. The sudden stopping of the Mill so much surprised the Miller that he went immediately and let down the shuttle….. The First Word she spoke was Help me, repeating this three times. For God’s sake help me out if you can………

14. She spoke very briskly after she was put to bed…But the Mill Wheel had tore away all Skin, Muscles, Sinews and Tendon of her leg quite to the Bone. Child lived Monday to Friday then died of her wounds and bruises; otherwise in all Appearance, she might have lived to have made a fine Woman. The whole Time of her being under Water depth 41/2 feet was near 15 minutes. Green J. Philosophical Transactions 1739 (July-Oct) 166-8.

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17. Jan P Vandenbroucke

20. BMJ | 17 FEBRUARY 2007 | Volume 334

21. BMJ | 17 FEBRUARY 2007 | Volume 334

32. Current Concepts in the Management of Pain in Children in ERs • Pain a feature of 78% of child visits to emergency rooms • Fractures, headache, earache, sore throat, abdominal pain. ‘Early aggressive treatment of pain is recommended, because uncontrolled or severe pain stimuli can lead to hyperalgesia – an enhancement of the pain response.’ Krauss BS, Calligaris L, Green SM, Barbi E. Lancet 2016;387: 83-92.

33. Current Concepts in the Management of Pain in Children in ERs ‘Early aggressive treatment of pain is recommended, because uncontrolled or severe pain stimuli can lead to hyperalgesia – an enhancement of the pain response.’ Krauss BS, Calligaris L, Green SM, Barbi E. Lancet 2016;387: 83-92.

34. ‘Recognition and assessment of pain in infants can be difficult because these patients cannot verbalise their pain experience. Spinal reflex responses are exagerated, but facial expression is a weak indicator. … excessive crying, irritability, poor feeding, position and movement of the arms and legs, and sleep disturbance can indicate pain. Altered facial expression is also suggestive.

35. ‘Recognition and assessment of pain in infants can be difficult because these patients cannot verbalise their pain experience. Spinal reflex responses are exagerated, but facial expression is a weak indicator. … excessive crying, irritability, poor feeding, position and movement of the arms and legs, and sleep disturbance can indicate pain. Altered facial expression is also suggestive. Tools to grade children’s pain are widely recommended, including physiological methods, observational and behavioural measures (grading of facial expression, leg movements, activity crying), self-reporting meaures, and parents’ report. In older children most physicians regard patients’ self-reporting of pain as the gold standard.’ (83)

41. Tim Matthews

43. Narrative ‘… a representation of events which is shaped, organized and coloured, presenting those events, and the people involved in them, from a certain perspective or perspectives, thereby creating narrative structure: • coherence • meaningfulness • evaluative and emotional significance.’ Goldie P. The Mess Inside. Oxford: Oxford University Press, 2012, 8.

44. Narrative ‘… is a representation of events which is shaped, organized, and coloured, presenting those events, and the people invoved in them, from a certain perspective, thereby giving narrative structure – coherence, meaningfulness, and evaluative and emotional import – to what is narrated.’ Goldie P. The Mess Inside. Oxford: Oxford University Press, 2012, 8.

45. … a young Soviet prisoner in my ward … was moribund and screaming... . I examined him. He had an obvious severe pleural rub. I thought this was the cause of the pain and the screaming. I had no morphine, just aspirin, which had no effect. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. Cochrane A.L., Blythe M. One Man’s Medicine: an Autobiography ofProfessor Archie Cochrane. London: British Medical Journal, 1989.

46. … a young Soviet prisoner in my ward … was moribund and screaming... . I examined him. He had an obvious severe pleural rub. I thought this was the cause of the pain and the screaming. I had no morphine, just aspirin, which had no effect. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. Cochrane A.L., Blythe M. One Man’s Medicine: an Autobiography ofProfessor Archie Cochrane. London: British Medical Journal, 1989.

47. … a young Soviet prisoner in my ward … was moribund and screaming... . I examined him. He had an obvious severe pleural rub. I thought this was the cause of the pain and the screaming. I had no morphine, just aspirin, which had no effect. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. Cochrane A.L., Blythe M. One Man’s Medicine: an Autobiography ofProfessor Archie Cochrane. London: British Medical Journal, 1989.

48. … a young Soviet prisoner in my ward … was moribund and screaming... . I examined him. He had an obvious severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect.I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. Cochrane A.L., Blythe M. One Man’s Medicine: an Autobiography ofProfessor Archie Cochrane. London: British Medical Journal, 1989.

49. … a young Soviet prisoner in my ward … was moribund and screaming... . I examined him. He had an obvious severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying. Cochrane A.L., Blythe M. One Man’s Medicine: an Autobiography ofProfessor Archie Cochrane. London: British Medical Journal, 1989.

50. … a young Soviet prisoner in my ward … was moribund and screaming. I examined him. He had obvious …. severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect. I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying.I was ashamed of my misdiagnosis and kept the story secret. Cochrane A.L., Blythe M. One Man’s Medicine: an Autobiography ofProfessor Archie Cochrane. London: British Medical Journal, 1989.