Learning about Bodies

SCIF Study 2 - Susan Hardy

Learning about BodiesBy the 18th C, university anatomical teachings were declining in quality whilst private anatomy schools were set up as money-making ventures. In London, the Scottish Hunter Brothers were the archetypal medical entrepreneurs.William Hunter was the face, having two entrepreneurial ideas: being a fashionable physician (respect by middle-classes, more upper-class than typical physicians, well-dressed), and starting an Anatomy School for paying students (future physicians and surgeons). He became a man-midwife, which they claimed were better as they had technology (forceps - put under babies head), publication (anatomical atlases - showed position of baby in uterus) and practice.John Hunter was less articulate (strong accent) but liked making things and was a brilliant anatomist (whilst William was the face), and did drawings and hands-on demonstrations. He collected animal skeletons from all around the world in the Hunterian Museum by boiling down the animals, which he used for comparative anatomy. They called the bodies subjects, one of which was the Irish Giant (the Hunters were interested in freaks - fat, thin, tall, short, deformities; sent men to stalk him and paid for dead body) which was an attraction for students. However their results were practical (e.g. discovered popliteal aneurism - blowing out of blood vessel in leg, could lead to haemorrhage, which occurred in coach drivers knees) to which they could apply a treatment (in this case conservative surgery which conserves the limb by cutting out the aneurism, collecting blood vessels and relying on collateral circulation).Bodies from hanged felons were given to unis (by a 17th C royal decree - dissection was seen as an extra punishment), but not anatomy schools, which instead made deals with condemned prisoners families for money (although not often), or body snatchers - deals with poor law hospitals and gravediggers for the bodies, which left the poor at risk as bodies were not considered legal property. However popular press fuelled middle class panic.

In the 1820s, Dr. Robert Knoxs Anatomy School in Edinburgh was popular but also expensive as it had a good supply of bodies, which came from William Burke and William Hare from accidental mass murders, which started off by ones wife owning a boarding house and dead bodies were sold to Dr. Knox. Lead to murder by burking (smothering and breaking neck) which was done on the poor, possibly those going to die soon. There was no police force, only informants/witnesses. They became careless and were caught, and Hare explained everything and dobbed Burke in, and was pardoned (Kings Evidence) whilst Burke was hung in a large crowd and dissected by Professor Monro from a uni, and a mask of his face was made. There were copy cat murders in London, which resulted in dishonoured surgeons (others outraged against stigma) and The Anatomy Act of 1832 (pushed by Jeremy Bentham; body preserved) which basically made taking unclaimed, destitute dead bodies legal (but now requires approval). Thomas Wakleys The Lancet (surgical knife) was the first medical journal which encouraged people to be critical, stopped medicine being ridiculous.

Learning more about Bodies: Post-Mortems and VivisectionsMurders for bodies were somewhat pointless as they didnt know if the patient was well, ill, lifestyle, diet, only gave some structure, not function. In the 19th C, Paris was the hub for cutting edge teaching and experience in medicine and surgery for European and American students, and the Hotel Dieu was the generic French name for hospitals meaning House of God (shows religious influence). The symbol of the doctor changed from a flask of urine to a stethoscope.

In 1789 the French revolution (liberty, equality, fraternity) saw the monarchy (church) fall, leading to a secularisation (loses religious significance) of the state and mass executions of aristocrats (nobles and Church) by guillotine (humane - originally used by physician for vitalisitic experiments: checking if body moved, eyes fluttered to see if still living). It also led to a rise in secular middle class professionals, allowing a proliferation of physicians and surgeons (as before couldnt do anything without approval or patronage of monarchy, now achievements based on ability). Hospitals had Schools of Health that focussed on practice (and order and reason), not theory alone.Larger hospitals had poor patients, and the patients life stories were communicated to the doctors (although not always reliable). Extensive examination was used for patients: inventum novum (percussion of the chest; tapped it, listened for things like tuberculosis where there was fluid in the chest cavity; idea from tapping beer barrels to determine emptiness) and immediate auscultation (listening directly to heart and chest), however there were social and moral/ethical issues.Rene Laennec (1781-1826; died of tuberculosis) invented the stethoscope to overcome intimacy (idea from rolling up paper) using mediate auscultation, which was more efficient. However treatments were still Hippocratic (blood letting and purging). Patients were also studied from bedside examinations (first stage) right until post-mortem dissections (second stage), to compare and correlate the body and disease, showing how disease worked in a person.Medical research also began at the tissue level (French for fabric; histology). 21 types were identified, and pathological changes (like internal lesions) were noted. The large number of bodies allowed for a comparison between the normal and abnormal, and they began to think of specific diseases (not just a diseased body). However without microscopes this was all based on the senses.

Claude Bernard (1813-1876) was a uni professor without patients who was famous for the repeatability of his experimental methods in vivisection. Wrote Introduction to the Study of Experimental Medicine in 1865 which looked at milieu interieur (internal environment), believed internal body stable and resistant to external environment unless affected by physiological disturbances like miasmas or poisons. He lacked the students to share his work.German Rudolph Virchow (1821-1902) held conjoint uni and hospital positions and wrote Cellular Pathology in 1858, which supported Bernards findings. Believe looking microscopically also became necessary for medical research. He was also popular with students (a good lecturer).This didnt necessarily result in treatment. Emperor Frederick of the newly united Germany (son-in-law of Queen Victoria) had a sore throat and eventually lost the ability to speak, and a tissue sample was taken for cellular diagnosis, however he died (son Kaiser started WWI) which didnt give doctors a good reputation.

There were many reactions to vivisection (which was done on animals). It was not approved of as the West came to treat animals with nobility and sentimentality, and animal rights and womens rights became a conjoint movement with female activists like Frances Power Cobbe who founded the BUAV. David Ferrier (1843-1928) showed work on neuroscience to an international conference with his experimental subjects (dogs, monkeys) to which there was outrage. The Vivisectionists Wife was Bernards wife, and she and his daughter opposed his work and supposedly free animals in his cages.Microbe HuntersInitially diagnosis and explanations were stories, often with supernatural interventions (gods displeased with you change behaviour/offering), an imbalance of humours caused by lifestyle (environment, diet, exercise), miasmas (state of bad air, swamps and malaria, bad smells), lesions in tissues in the body, and eventually the ideas of specific diseases caused by invasion of the body (contingent (subject to chance) contagionism). Before the 19th C, illnesses like leprosy and smallpox couldnt be explained by stories as they were passed from person-to-person, but not all followed this pattern and there was no elaboration on the means of transmission. In the 16th C, there was the great pox (syphilis). Many blamed connections between native populations from New World voyages and warfare and the explorers, and it was transferred back to Europe in a virulent form (in comparison there was small pox, so apparently this was much worse). However bones from the 11th-12th C had these lesions in Europe, so it may have been an old contagion that happened to pick up around then that happened to pick up around then.

Diagnosis was done by symptoms (rashes, pustules), however this may have confused it with other diseases, and it was referred to as the "French/Spanish/Italian/English disease" as it was unpleasant, unsightly and unwanted. Its name was coined in the 19th C after Girolamo Fracastorio's (1484-1530; physician, poet and philosopher) protagonist in a poem about a shepherd with syphilis. He also wrote De Mortis Cortis, (About the Contagion of Death) in Latin. Fracastorius suggested it could be caused by imperceptible particles". At the time it was cured with mercury ointment (cheap but nasty - similar to cauterisation; hid so others didn't know they were sick) or guaiac bark (expensive as it had to be imported so only the rich could afford, steamed or soaked in powder, less nasty). Fuggers (a Swiss firm) had a pharmaceutical monopoly on the ales bark.

Spectacles were already being manufactured in Low Countries (western coast of Europe) however there was a greater need for magnifying technology. Antoni van Leeuwenhoek (1632-1723) manufactured and experimented with his own equipment, seeing "animalcules" (could have been sperm, blood, cells or microbes. By the 19th C microscopes improved (following Virchow's push to look microscopically).

French Louis Pasteur (1822-1895) was a chemist trying to stop wine going off for the wine industry, and in his swan-necked flask experiments he found there was no fermentation or putrefaction in the absence of biological entities, believing germs (seeds of disease) had floated and caused these processes. Diseases began to be thought of as entities with specific symptoms and specific microbes invading the body and creating a manifestation by specific internal and external symptoms. There was a move from physiological explanations to bacteriological, like typhoid which was originally described as the state of a body, now a specific entity.

In the 1840s, surgery took off with anaesthesia being brought into city hospitals, resulting in more and slower operations (which often resulted in more infections). In the 1860s, Joseph Lister suggested the use of carbolic acid as a means of antisepsis, applied as a spray.

Robert Koch (1843-1910) hunted and named microbes by staining and fixing them in petri dishes, then examining them under a microscope. He believed each disease was caused by a different microbe, and this set off mass microbe hunting (as many wished to have a microbe named after them). In the 19th C in cities and during WWI there was another epidemic of syphilis, and whilst the microbe was found and diagnosable, there was no cure at the time.

The Hunt for the Magic Bullet

The term "magic bullet" comes from the 1840s German Opera about Caspar the Hunter where he hunts with a gun (which would have been dangerous in those times as unreliable), but he isn't successful so he makes a deal with the devil to always hit, but there will always be the devil's bullet which may come at anytime and hit anyone. Now magic bullets are often antibiotics, as they are fired into the body to kill microbes whilst leaving the body unharmed. Developments include microscopy, microbe hunting in animal fluids, fixing and staining, and Koch's Postulates (injecting to see if same symptoms result).

Many ideas are pursued as they are needed at the time, such as venereal diseases like syphilis (altered facial structures as bone became brittle (primary stage), shameful affliction with stigmata (spots/lesions; secondary stage), and general paralysis of the insane (GPI; tertiary stage)), which lead to a demand for a cure. Arsenic was the 19th C drug of choice as it was unregulated, easily obtainable, and could be claimed for other uses like killing rats, a face wash, a stimulant or used in paint/wallpaper. Arsenic compounds were then researched as small quantities had been to known to be cured. Erlich and Hata found Salvarsan 606, which they produced industrially. In WWI, there was not enough so propaganda was used to warn against consorting with prostitutes, mercury used for treatment if low supplies.

Alexander Fleming (1888-1955) discovered the first real magic bullet at St. Mary's Hospital, London in the late 1920s. He had been working on war wounds, and mould spores landed on his petri dishes which resulted in bacterial inhibition. He turned this into "mould juice" which treated infectious boils, abscesses and carbuncles topically (without side effects), and in 1928 wrote a paper on penicillin, however there was little further work done on it as it was difficult to produce and was unstable.Howard Florey and his team at the Dunn School of Pathology, Oxford isolated and purified the active ingredient and tested it on mice (producing it in milk churns, lemonade bottles, bedpans and baths as they had little funding as it was being spent on WWII). His wife Dr. Ethel Florey administered it and found it was generally successful, surprising at the time for people to come back from the dead, sounded almost religious. Florey went to the US to mass produce (as there was no war there at the time, but despite the US being neutral until 1943 it was only supplied to British allies). This was a sae and effective broad-spectrum antibiotic, however it couldn't help with viruses and some were allergic to the antibiotic. Meanwhile Fleming becomes a wartime propaganda media personality, despite having not much to do with it. It raised many ethical problems like who could get it as production of limited (soldiers vs. children), whether it would encourage/condone immoral behaviour, whether Fleming or Florey should get the fame (both + Ernst Chain - main supporting member - got 1945 Nobel Prize), and the effects of overuse of antibiotics (people wanted it even if didn't need, however resistance was built which compromised immunity).

A new plague returned, AIDS, which may have come from Africa and appeared to be prevalent in the west amongst haemophiliacs (blood transfusions), intravenous drug users (hypodermic syringes) and the homosexual community (sexual freedom). In terms of drugs (Panacea) there was no cure, only management, whilst information/education on healthy living (Hygiea) was used, often through fear campaigns (Grim Reaper posters, ancestral memory of plague).Smallpox (the speckled monster) in Europe and AustraliaRhases (860-932 CE) from Persia wrote Treatise on Smallpox (spoke about disease with bumps, we believe it was smallpox), in which he believed it was caused by putrefying and fermenting of the blood which caused pustules/lesions on the skin, and found it was common in the young. Cures mainly came from the West included placement in closed, heated rooms to sweat out the ferments or humours, however this was not affordable for the poor. Variola minor became variole major (more abundant) in 16th C, as it was refreshed by people that hadnt been in contact with it before (New World exploring). Preventions mainly came from the East, where children were exposed to mild cases (as it was noted a person never gets it again), and dried matter from pustules was blown up nostrils, and later inserted through surface scratches (scarifying with matter) for a mild, localised reaction. The monster also defied class barriers, as Englands Queen Mary died (1694), however Frances King Louis XV (1757) survived.In the early 18th C, the east met west, as Lady Mary Wortley Montague brough news of Eastern practices, and had her own children inoculated (through scarifying), and they ran a controlled trial in England, reporting results at a meeting of the Royal Society in London in 1714 where they appeared reasonably successful. By the 1740s, inoculation was improved with shallowed scratches and a greater chance of a localised, mild reaction, administered by common people advertised in the local press (physicians were a bit posh for commoners, grass roots campaign). However whilst this did some good, it also spread the disease.

In the 18th C, the poor crowded in cities, and the failure of Panacea meant the rediscovery of Hygiea and an attempt to clean the environment. However the upper and middle classes saw them as a threat of disease. They had higher expectations of health, and were more rational than providential (religious), and use patches (small dots) and makeup to hide disease. Both syphilis and small box were stigmatising and ruined reputations and beauty (scarred horribly afterwards), so in prostitution girls fresh from the country were often used as they were less likely to have been in contact with these diseases. It was noted that women from the countryside (pretty milkmaids) werent affected by smallpox, and using this grass roots wisdom cowpox was used as a variole vaccinae (vaccus is Latin for cow).Dr. Edward Jenner (1749-1823) was a country practitioner and pupil of John Hunter who asked him, Why not try the experiment? and he immunised using the weaker strain in cows (not an original idea), which he wrote about in his book, The Cow Pox. However many didnt like the idea of putting animal matter into humans, contamination occurred (as no sterilising and shared between people), had side effects (as the strain wasnt always mild), and the poor were least likely to be vaccinated whilst being at greatest risk, remaining a threat to others.

It came to Australia by ship, and a vaccine institute was set up in Sydney in the 1840s. The contagion spread throughout the Aboriginal population from coast-to-coast and back (although some dont believe to be as detrimental as first thought). In 1881-2 there was a revival of smallpox (but only 154 cases confirmed with 25.9% death rate), so premier Sir Henry Parkes set up the Board of Health with the power to disinfect residences by ordering 3000 gallons of carbolic acid. There was fear, panic and xenophobia (racism), and patients were isolated in their own homes (with no means of wage) or sent to North Head Quarantine Station (miserable conditions, forced, no wage, pres claimed poor were stealing taxes in doing so when they didnt even want to go). The Coast Hospital at little Bay (now Prince Henry Hospital) was established as another isolated area. By 1966 there were mass smallpox vaccinations by the WHO, and it was declared eradicated by 1974 (with the last death in 1978 with a lab worker in Birmingham, UK).In Australia there is no smallpox and infectious diseases are at a lower rate in the general population. Some say better lifestyle (although polio broke out in 1950s despite good hygiene), whilst others believe due to immunisation (1.5% of children under 7 not vaccinated due to vaccine refusal). There are questions as to whether it is an individual decision, or whether direct (goaling) or indirect (not allowed to attend school) compulsion is needed. We also rely on herd immunity, but natural immunity (if we lead healthy lives we dont need poison to fight poison) is also something fought for.The Medicalisation of MadnessInitially there was a supernatural approach, in which they were believed to be possessed by Gods or the devil. Some were believed to be saints (spoke in tongues, had strange dreams). Experts were priests who used exorcism (attempted to drive out the spirit) which was much like current psychology (spoke calmly, touch/contact). According to some sources in worked in some instances.

The natural approach was that everyone was different and madness was just part of lifes rich tapestry, however many were outcast as freaks, monstrosities (many of whom had to join a circus for work) or the village idiot (acceptance was hard is people were aggressive or disruptive). Up until the 19th C many hid mad relatives in attics (if rich house was large enough, had servants to care for them) as they didnt want to lower the status of the family.

The punitive approach was supported by the British 1714 Vagrancy Act (similar acts in Europe), where anyone behaving in a violent or disruptive manner in the streets (even just shouting, throwing things, being rude or sleeping on the street) were locked up as towns were supposed to be more organised. This led to the 18th C penal code (many laws to protect people and their property from madmen, even in minor offences), resulting in overcrowded prisons and hulks (shacks on the river) as America had become independent so they were sent to the Australian colonies. Many were set free, and whether mad or driven mad (many claimed due to sunstroke in NSW), some went to institutions within hospitals and hospitals just for mad people, the first being Gladesville. By the 18th-19th C, there was a trade in lunacy where unwanted relatives (even if not mad, just irritating) could be placed if committed, and they were placed in The York Retreat (run by religious group Quakers where if they behaved well they were treated like ladies and gentlemen) and Bedlam (which had a private section for the wealthy).There were many theories to these causes (which focussed on the workings of the body), including an imbalance in the four humours, chemical ferments that disordered the brain (16th-17th C), then in the later 17th C nerves thought of as a hydraulic system of hollow pipes with fluid under pressure allowing the mind to control the body, and eventually nerves were like wires with electrical impulses, and short circuiting was the cause of madness.In diagnosis, there was mania which occurred in men, hysteria in women (Greek for uterus or womb), or melancholia (gender neutral).

Treatments include bloodletting until the 18th C (cutting vein, letting blood out, you feel lighter). Trepanning (drilling/digging holes in skulls, but not brain, only shallow, let out some bad substances, almost Hippocratic) was also used. For mania they could also be calmed by having a plainer diet or constricted physically like straight jackets with no vision to limit stimulation (as they were overstimulated), whilst in melancholia they were under-stimulated and hence given red wine and red meat or swung around. By the 19th C it was more medicalised, and Pinel (who did autopsies after the French revolution on monarchy) believed they werent criminals but patients, taking away their shackles and putting them in beds to be examined. Later in the 19th C, French doctor Charcot researched the workings of the brain, and displayed his patients (nearly always female) to students (male), however many claimed they were hired actors which he admits to as sometimes reality wasnt dramatic enough. His pupil Sigmund Freud advocated for the talking cure whilst the patient was on a couch in the late 19th C in Vienna.After WWI neurasthenia (war-related shell shock or PTSD; some thought it just to be the effects of the sound) occurred in men and women (however their brain fever occurred from the pace of modern life). By the 20th C, drugs and surgery (frontal lobotomy: cut front of brain, makes less violent, however often did more damage as in the case of JFKs sister) had been developed to alter consciousness and mood, as well as electro-convulsive therapies (ECT). However in the Chelmsford Private Hospital, Sydney in the 1960-70s, patients (afflicted mainly with schizophrenia, but also obesity, depression and addition) were treated with deep sleep: barbiturates + ECT, which put patients in a vegetative state so they could control levels of stimulation, however there were 26 deaths reported and a Royal Commission Investigation, with many cases only being resolved recently.In the 20th-21st C there was de-institutionalisation as they realised it wasnt good for people as many were crowded, how lower standards than those expected and were expensive. The 1970s saw an anti-psychiatry movement where everyone was seen in a naturalistic approach and madness was just one place on the continuum of human behaviour. The mad were led back into communal homes.Forensic MedicineForensic (Latin for in the forum/public domain/trial) medicine is the application of medical science (technological and laboratory methods). By mid-19th C in most countries med students had to go through standardised exams and qualifications. Qualified med graduates were put on medical registers, however they werent always up-to-date (as doctors were busy attending patients), so signing death certificates, treating patients and use in legal cases may have been done by those other than the ones qualified. Doctors became the expert witnesses in murder trials, considering physical evidence at the scene of crime (although not always there), looking for physical matches (connections between murderer and victim), and usually were local GPs.

In 1807 the first chair of Forensic Medicine at Edinburgh University was elected (although they didnt do much, but the fact it existed was noteworthy), and in 1813 Mathiew Orfila became a professor of forensic chemistry in Paris. His textbook Treatise on Toxicology reflected the main 19th C method of murder (poison). Arsenic was often used as it was easily obtainable and commercially produced (for rat poison, womens cosmetics to whiten skin, dyes and wallpaper, and for arsenic eaters as a stimulant), and its symptoms were confused with cholera (as it produced almost identical gastrointestinal problems). The first female serial killer , Mary Ann Cotton, killed husbands and children in the mid-19th C after insuring their lives to reap money, and moved around the country doing so.

In 1832 the Marsh test for arsenic was first used in a jury trial, which Marsh later described in 1846 in the Edinburgh Philosophical Journal, however sometimes there were contamination problems as was case with Dr. Alfred Taylor, which gave it a bad name, Forensic examination was considered the cinderella of medicine, requiring no formal training but rather using morbid anatomy and pathology. It was considered the beastly science, horrible and looked down up, and unfortunate errors and erratic experts didnt help. Physiognomy (early profiling by judging character from their face) was instead viewed as the better forensic science, however it may have even complicated the Jack the Ripper murders in 1888 (as they may have done some actual detecting if not focussed upon this), and in the case of Lizzie Borden she was accused of murdering her parents with an axe however despite evidence against her was let go because she looked respectable.Sir Bernard Spilsbury (1877-1947) was the first celebrity expert witness and rescued forensic medicine, being an Assistant Resident Forensic Pathologist at St. Marys Hospital, London, where by 1905 pathologists were required to perform post-mortems in sudden or unexplained deaths. In the Crippen case, Crippen was hung for chopping up his wife and putting her in the cellar, but recent DNA findings suggest the body may have been wrongly identified (so at the time good, now bad). In the Brides in the Bath case in 1915, George Joseph Smith had been taking new wives during wartime to boarding houses where there were baths and they had mysteriously died (could have been stroke, epilepsy, heat stroke, accidental drownings), so Spilsbury was called in and he noted no visible injuries and baths were too small for spasm, so he experimented at a police station where he found by puling legs the person would drown from the gush of shock (didnt just assume). This case opened the worlds eyes to how crimes could be linked, the freed and recklessness of serial killers, and the media (newspapers, photography, telephone and telegraphs) allowed for better communication, which allowed these similar crimes to be linked. Spilsbury was knighted in 1923, but didnt write a book or train/work with anyone, and he committed suicide during WWII after he lost a son to the war and may have had guilt from knowing some cases were wrong.

REMEMBER: DISCUSS WHY TOPIC IS IMPORTANT IN HISTORY OF MEDICINE

Better Babies

In early times, birth was a rite of passage and secret womens business (those that helped give birth were women - midwives or wise women), wrapped in swaddling bands (bandages) as body is pliable (e.g. believed encouraged babies to grow legs straight). High mortality for women and children in medieval times (not unexpected at time, women wrote letters before death). Focus not just on body but soul, so priest may attend (male) to ensure baby was accepted into the religion (baptism) just in case they died. Before 16th century, lower outward manifestation of love which grew until the 16th C. In 17th C, wise women had herbal medicines and gave spells or incantations for mother to say, however many babies died or were deformed due to malnourished mothers, wise women were blamed (witchcraft). Midwifery was then a less enticing job, so male midwives (physicians looking to open patient base) took over, including the Hunter brothers. Hunter brothers had atlases with drawings of children in utero, aided understanding. Midwives also had technology: The Chamberlen forceps (grabs baby around head; 17-18th C), which was a response to obstructed births (that often lead to deaths) - but they didnt allow other practitioners to see. This mostly appealed to middle-class women who wanted more cutting-edge technology with fashionable man-midwives in their own homes. Moral and ethical problems (male and female interaction), and women moved from birthing stools to bed with covers (not only for decency but also so people didnt see the idea of forceps and steal it), which meant slower births (as gravity couldnt assist).James Simpson (UK physician) used chloroform in 1840s for anaesthesia in birthing, however births also became longer as mothers unable to push, and ethics about religion (childbirth should be in pain). Queen Victoria had a child with anaesthesia and supported the idea.

Poor/destitute for mothers go to Benevolent Asylums (hospitals for birthing), which lead to overcrowded hospitals with diseased, malnourished people which lead to puerperal (childbed) fever from cross-infection, which lead to many deaths of mothers and increased orphans.Ignaz Semmelweis (1818-65), Hungarian in Vienna (minority) looked at students and midwives clinics (many preferred to have birth on street than in students), and found deaths much higher in student doctor places, and Semmelweis found they brought disease from post-mortems (called morbid matter, germs not known). Death of colleague who got a cut on his finger confirms his suspicion. Suggested medical students wash their hands (unpopular, nitpicking).

By late 19th-20th C, surgery is aseptic and childbirth becomes aseptic too. Women are given twilight sleep (asleep, dont remember it, fears it is too sterile, no love/soul). In 20th-21st C, Australia and NZ lead the way in ante-natal (before birth) support. There was improved nutrition for mothers, examinations, tests and scans, return to birthing stool, and choice between home and hospitals. However, there are high standards in developed countries (back to blaming for deformities), and it isnt available in all parts of the world, and it should be.Page 10

Oliver Bogdanovski