Dr King Research Articles

Pelvic inflammatory disease.

Preview Pelvic inflammatory disease (PID) and its long-term sequelae exact a staggering toll in human suffering, not to mention treatment costs. To curb this escalating problem, the primary care physician needs answers to the following questions: Which pathogens cause PID? What clinical criteria and techniques are of most value in diagnosis? How is uncomplicated PID best treated? Dr King provides this critical information.

'How Do You Do, Miss Manners.... I'm Dave, Your Doctor'

To the Editor.— The editorial in the July 12th issue by Dr King 1 left me a bit perplexed. His opening statement, How should a physician address his patients? was answered in his final paragraph by if you are a mature patient and your doctor calls you by your first name, then in return address him by his first name. The question posed seems addressed to his physician audience; however, the reply seems addressed to the physician's patients. In considering the question of how to address patients, a recent column by Miss Manners is notable ( Minne apolis Star and Tribune , April 24, 1985, p 15DX). In it, columnist Judith Martin attacks the unauthorized use of first names in impersonal situations as, for example, by doctors and nurses who have the mistaken notion that this makes patients feel better. The following day, the Minneapolis Star and Tribune commented on this position

Business, Trades, and Professions

To the Editor.— In his recent editorial, Dr King 1 concludes that medicine is both a profession and a trade. He also concludes that it no longer stands out from innumerable other professions. It is understandable that he might reach these conclusions because of the criteria he uses in defining a profession. My favorite definition of a profession was set forth by Justice Brandeis 2 : (1) A profession is an occupation for which the necessary preliminary training is intellectual in character, involving knowledge and to some extent learning, as distinguished from mere skill. (2) It is an occupation that is pursued largely for others and not merely for one's self. (3) It is an occupation in which the amount of financial return is not the accepted measure of success. Even though Brandeis stated this concise definition over 70 years ago, I believe it is valid today and if adhered to

Business, Trades, and Professions

To the Editor.— One must admire Dr King's 1 recent endeavor to sort out the semantic issues implicit in the title, Medicine—Trade or Profession? One dictionary 2 lists nine definitions for the word and even this doesn't do justice to all the nuances of meaning that have arisen from using the term in multiple disparate contexts. For example, the role of physician is quite different from that of professional dry cleaner. Asking whether medicine is a trade or profession seems most often to be addressing the issue of personal motivation. One is assumed to engage in trade primarily out of self-interest (making money). The rule of caveat emptor applies, and the tradesperson is considered to have no affirmative responsibility for the purchaser's well-being. The professional, by contrast, is assumed to be trust-worthy and controlled by an ethical system that focuses on the interests of others.

Hospitals, infection and antibiotic use

Medical Journal of AustraliaVolume 140, Issue 1 p. 19-22 Conference Report Hospitals, infection and antibiotic use Kathleen King BSc (Hons), MB, ChB, MRCPath, MASM, Kathleen King BSc (Hons), MB, ChB, MRCPath, MASM Deputy Editor The Medical Journal of AustraliaSearch for more papers by this author Kathleen King BSc (Hons), MB, ChB, MRCPath, MASM, Kathleen King BSc (Hons), MB, ChB, MRCPath, MASM Deputy Editor The Medical Journal of AustraliaSearch for more papers by this author First published: 01 January 1984 https://doi.org/10.5694/j.1326-5377.1984.tb103839.xCitations: 2 Reprints: Dr King. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume140, Issue1January 1984Pages 19-22 RelatedInformation

Prevention of Injuries to Children-Reply

In Reply.— I strongly agree with Dr King's thoughtful emphasis on the primary need for better programs of injury prevention, but I hope he does not mean as opposed to these... remedies but rather along with these... remedies! Physicians should lead the way toward control of drunk driving, handguns, flammable fabrics, and caustic and toxic substances, but an informed, concerned must demand the enforcement. Along the way, better systems of tertiary care for trauma victims will decrease morbidity and mortality from this disease of modern society until will enable us to have a higher rate of prevention. I wholeheartedly join Dr King in his suggested programs for decreasing the number of childhood injuries.

Provocative Neutralization-Reply

In Reply.— The study of Mabray et al1was not included in my report because it had been published in May 1982, which was too late for my review. It was concerned with the use of subcutaneous neutralization with progesterone to relieve dysmenorrhea, premenstrual syndrome, midcycle pain, and nausea and vomiting during pregnancy. Thirty-two patients were studied with the single-blind technique and were reported to be able to select a progesterone dilution as their visualizing end point as compared with placebo. In view of the lack of scientific evidence to support progesterone allergy and the failure to use a double-blind trial to evaluate subjective symptoms, I do not believe that this study would have warranted inclusion in my review, which focused predominantly on inhalant and food sensitivities. The remaining four articles referred to by Dr Podell deal principally with sublingual provocative testing and desensitization. The article by Dr King

'CSF Viral Cultures'-Reply

<h3>In Reply.—</h3> Dr King's data are most interesting and reemphasize the need for rapid viral diagnosis if patient management is to be affected. In most cases, antibiotic therapy can be discontinued when bacterial cultures have been negative for 48 to 72 hours. It is sometimes necessary, however, to continue antibiotic therapy because of a questionable Gram stain of CSF, the contamination of CSF or blood cultures, or the presence of multisystem disease with disseminated intravascular coagulopathy. We also agree that the clinical relevance of viral cultures is largely a function of the viral diagnostic laboratory and the clinicians' use thereof. Appropriate specimens handled in an optimal manner will result in better patient care.

Medical Thinking: A Historical Preface

This is a scholarly statement of the ingredients of medical progress made, sometimes slowly, over man's written history. It is no mere recounting of alleged milestones in any popular sense. Rather, it is an analytical and carefully documented account of man's attempt to meet the recurrent diagnostic problems posed by patients from historic times to the present. Instead of denigrating the efforts of early physicians in this regard, Dr King, a highly qualified pathologist and teacher, holds up for all to see the imaginative and innovative theories that have tried to account for major disease entities. In this elegantly produced volume, the reader will find just the right mix of the personal history of the discoverers or contributors of the past along with a clear statement of the problems addressed. An excellent feature of the treatise is the clarification for today's readers of the descriptive terms used by earlier writers.

Why Not Say It Clearly: A Guide to Scientific Writing

When I received this book, my first reaction was a query: Should the title have a question mark? When I noted the author's name, I concluded that the title must be correct. Long respected as an editor, author, medical historian, and philosopher, Dr Lester King has written a book that reflects his many capabilities. Why Not Say It Clearly contains practical points for any writer, novice professional. Fortunately, this is more than a how to book, whose shortcoming would have been emphasis on technique at the expense of perspective. As Dr King observes, the problem in medical publication is not simply the lack of clarity, but the dearth of value. A helpful friend or a good editor can salvage a poor paper if it has an original idea or important data. That the content of so many journals comes from papers given at meetings ensures a flood of material

The Philosophy of Medicine: The Early 18th Century

This is an important book, not only for its superb treatment of the philosophical bases of 18th century scientific and medical thought, but for its uncanny ability to force its 20th century reader to face his own medical-scientific assumptions. It is a rare experience to enjoy a historical treatment of our discipline that is so provocative for modern thought. Dr King has done far more than lay before us the philosophical basis of 18th century medicine. He has properly reached back in time to lay its foundations in Neoplatonic and Galenic medicine and has demonstrated the variations played on these themes until medieval theories were forced to face the new world of scientific observation. Equally interesting are his discussions of the attempts to relate past theory and new knowledge, both by accommodation by reinterpretation and by rejection of one or the other. But beyond the interplay of conflicting philosophical constructions,

Concluding remarks

The idea of this meeting came to the organizers from the type of considerations set out by Dr Kelly in his opening remarks, namely that we see many apparent similarities between phenomena of large scale in geophysics and phenomena of small scale in metallurgy and we would like to understand their significance. Dr Kelly mentioned triple junctions between tectonic plates and between metal grains. Another example, which goes back many years, is that structures in mountains can be simulated by flow in materials such as plasticine, and Dr King has showed us how patterns of faulting look much the same over a wide range of scales. Yet another, by now well known, example is that lunar impact craters look almost indistinguishable over a range of sizes from a few micrometres up to hundreds of kilometres. Dr Kelly remarked to me this morning that the similarity between geophysics and metallurgy extends to terminology, for the geophysicist has his fault and the metallurgist his defect.

Examination of Visual Fields

To the Editor.— Dr King (235:908, 1976) quite correctly pointed out the importance of performing careful examination of visual fields by confrontation, as part of the ordinary neurologic and ophthalmic examination. This is a simple diagnostic technique requiring no special equipment. It has often been poorly taught. Finger wiggling in the far periphery, which is still taught in most medical schools, is the crudest of tests and will pick up only absolute field defects. When done carefully, the confrontation technique is as sensitive a way of getting basic information about the visual fields as formal perimetry with a tangent screen or a Goldmann perimeter—and it is a lot quicker and cheaper. It is useful to think of the confrontation test as consisting of three steps. The patient, with one eye well patched, is seated comfortably, facing the examiner, and is asked to fixate on the examiner's nose. The examiner watches

Examination of Visual Fields

To the Editor.— The technique of visual field testing described by Dr King has been advocated for many years by neurologists at the National Hospital for Nervous Diseases in London. To the advantages of the method already described must be added one other: the detection of visual inattention. The phenomenon of inattention or extinction is one in which the patient is able to appreciate on only one side bilateral stimuli that are presented simultaneously. Depending on the nature of the stimulus used, the condition may be described as tactile or visual inattention. This form of cortical sensory deficit is characteristic of a parietal lobe lesion. Testing for visual fields in the manner recommended by Dr King ensures that visual inattention, when present, will be detected; this important finding cannot be appreciated with unilateral visual field testing.

Diagnostic Ultrasound

The medical applications of diagnostic ultrasound have developed dramatically in the past two decades. The diversity of the usefulness of the tool has stimulated the interest of various medical specialties. It is perhaps this rapid development and diversification that has, up until this current text, eliminated the availability of literature that adequately encompassed all aspects of the uses of ultrasound in medicine. Dr King, by carefully editing a text based on a series of lectures given at Columbia University, was able to incorporate the essentials of the various areas of development of ultrasound. This was done with relatively little duplication or redundancy. Certain areas of the text have a particular sophistication, which can create problems for the novice who is interested in developing some understanding of the medical use of ultrasound. This is particularly true of the second chapter on physical and technical principles. The physics was presented in a

Domesday Book and Anglo-Norman Governance

Domesday Book stands accused of isolation and its historians stand convicted of isolated devotion to Domesday studies. The isolation is not entirely splendid. ‘An inestimable boon to a learned posterity but a vast administrative mistake’ was the brief verdict of Mr Richardson and Professor Sayles in their treatment of the governance of England from the Norman Conquest to Magna Carta. Reviewing recent Domesday studies Dr King judged that research ‘in so arid a climate’ has maintained the gap between Domesday Book and its use in eleventh-and twelfth-century government, and made ‘the inquiry into the resources of the tenants-in-chief look rather more lonely than before, and rather less necessary’.

Geomagnetism and the tropospheric circulation (Reply)

DR KING REPLIES—It is widely believed that long term changes in the circulation of the lower atmosphere will be accompanied by climatic variations. The causes of these changes have not yet been established and at the present time, therefore, they are not predictable. I and other workers (see ref. 1) have suggested that the Earth's magnetic field may influence, through some unknown mechanism, the behaviour of the lower atmosphere at high latitudes in winter. Examples showing the type of evidence on which this suggestion is based are shown in Fig. 1; further evidence will be published elsewhere. I pointed out that such magnetometeorological evidence “cannot be construed as proof that the Earth's magnetic field and the average tropospheric pressure patterns are related, but it does suggest that more work on this problem should be undertaken.”

Toleration, Choice and Liberty

DR KING AND PROFESSOR CRICK ARE BOTH MAINLY CONCERNED TO discuss the concept of tolerance as the deliberate acceptance of what is disapproved. They wish to reserve the use of the word ‘toleration’ for a variation upon this general idea, but their proposals are not quite the same. Dr King wants to use ‘toleration’ as ‘a label for those ideas, doctrines, ideologies or movements’ which have opposed specific types of intolerance. The dictionary label for this is ‘tolerationism’. Toleration is what the ideas, doctrines, etc. advocate; it is not a label for the ideas and doctrines themselves. Professor Crick, at the beginning of his paper, says that he too will use the word ‘toleration’ for ‘theories or doctrines’ which advocate a form of tolerance. But his actual usage later on suggests that he did not intend the word to mean the theories or doctrines; rather that he proposed to say a doctrine was a doctrine of toleration if it advocated a certain kind of tolerance. His distinction between ‘tolerance’ and ‘toleration’ is intended to restrict ‘toleration’ to tolerance in general, tolerance of wide classes of action, and not to use it for tolerance of one specific type, e.g. tolerance of religious worship (which is how it is in fact used in the Act of Toleration and in Locke's Letter Concerning Toleration).

Social and Moral Tolerance

1 SHALL ARGUE THAT TOLERANCE IS CENTRALLY A MORAL CONCEPT (although it is also used in a variety of non-moral ways). My differences with the two papers, with which I in many ways agree, derive from this observation. I shall argue that the definition they use must be extended to allow for claims to legitimacy characteristic of cases of tolerance, and I shall further argue (against Dr King) that tolerance characterizes social groups in a less formal sense than he allows, and (against Professor Crick) that tolerance is primarily a social rather than a political phenomenon.

The Open Society and Utility

I HOPE I SHALL OFFEND NEITHER PROFESSOR CRICK NOR DR KING if I do not discuss their papers in detail. With almost all they say I have no disagreement; and to what they say I think I have little to add. The first thing I wish to do is pursue a point which Crick makes early on in his paper and then drops. Crick says there that one aspect of toleration is ‘putting up with’ whatever it might be; to say that the weather, one's colleagues, or last night's party were ‘tolerable’ amounts to saying that one could put up with them. Of course, as he and King agree, to call any of these tolerable certainly implies that we did not actually like or enjoy it or them; whatever we regard with favour we do not simply tolerate. Crick thinks there is not much to be done with the notion of ‘putting up with’ something; but I shall try to show that we can get further than he thinks.