Medicine

"The ' measures the volume of s compared to the total (red blood cells and ). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. s calculate the hematocrit by multiplying the the red cell number (in millions/mm3) by (MCV, in s). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152)."

"is the packed spun volume of whole that is made up of s and is expressed as a percentage of total . It can be measured or calculated as Hct = (RBC × )/10. Abnormal calculated hematocrit values may occur as a result of interferences that may cause erroneous RBC and MCV measurements which include very high count, high concentration of s, or … An increased hematocrit may be due to or . Decreased values may be due to , , , or . Pregnancy may also cause slightly decreased hematocrit due to an increase in blood volume."

"... The results of the European Cooperative Acute Stroke Study III (ECASS III) ... (ClinicalTrials.gov number, NCT00153036), reported in this issue of the Journal, teach us many lessons, some medical and some political, and clearly provide powerful, persuasive evidence that is safe and effective for patients with acute stroke. … The rationale for ECASS III arose from a pooled analysis of several previous studies that had differing time windows for enrollment. ... Analyses from the resulting pooled sample suggested that thrombolytic therapy could be beneficial even when given more than 3 hours after the onset of symptoms, and ECASS III was designed to confirm this hypothesis. As the authors of this article point out, however, neither their results nor those of the previous pooled analysis suggest that the ideal window for acute thrombolytic therapy is 4.5 hours after the onset of a stroke, because we know that the potential for neurologic rescue declines monotonically with every passing minute. ... I like to pose this scenario to my trainees: a patient presents to you 30 minutes after the onset of a left hemispheric stroke; how long do you have to initiate thrombolytic therapy? The correct answer is 1 minute, not 2.5 hours, and ECASS III does not now justify an answer of 4 hours. From the moment the patient arrives at the door, every minute counts ..."

"(AF) is associated with an increase in mortality and morbidity, with a substantial increase in stroke and systemic . Strokes related to AF are associated with higher mortality, greater disability, longer hospital stays, and lower chance of being discharged home than strokes unrelated to AF."

"Our stroke expert, Sarah Song, MD, MPH, assistant professor of neurology at in Chicago, offers this valuable advice. Act FAST. Being able to recognize the signs of stroke will help you respond faster and get help sooner and may result in less disability, says Dr. Song. "Remember the acronym FAST: Face, Arm, Speech, Time," she says. "The face can droop on one side. The arm can be weak or numb. Speech can be garbled, slurred, or nonsensical. Time is of the essence." If you notice any of these symptoms in yourself or anyone else, call 911 and get to the hospital as quickly as possible. "Treatment for stroke is most effective for patients who arrive at the hospital within four and a half hours of the start of symptoms," says Dr. Song. Always call 911. "Some people think they should drive to the emergency department," says Dr. Song. But stroke units in hospitals across the country now work closely with first responders, she says. EMTs are trained to spot the signs of stroke and can connect patients with stroke doctors quickly to prevent long waits in waiting rooms and emergency triage. "Calling 911 is the single best way to get yourself or someone you love evaluated and treated for stroke," she says."

"... 's part in the has drawn fire as a quixotic quest after the mirage of collective security through the , an allegedly utopian, or "Wilsonian," endeavor that traded vague dreams for harsh realities and derailed a more realistic settlement, which might have lasted. Worst of all, arguments about the political fight at home over the treaty and membership in the League have cast him as a stubborn, self-righteous spoiler who blocked reasonable compromise. That view of him has often overlooked or minimized one glaring fact: in the middle of this fight, he suffered a stroke that left him an invalid for his last year and a half in office. Wilson's stroke caused the worst crisis of presidential disability in American history, and it had a effect on him. Out of a dynamic, resourceful leader emerged an emotionally unstable, delusional creature."

"Stroke versus TIA? s (TIA) occur in approximately 15% of patients before an eventual stroke, with the highest risk in the first days following an event ... While TIAs do not always come to medical attention, their presentation in the acute stroke setting ostensibly complicates the treatment decision in patients who may be exhibiting improvement. The majority of TIAs resolve in less than 60 minutes whereas the majority of true strokes reach peak deficit in the same time frame. A 2009 scientific statement from the / discourages the use of traditional time-based definitions of TIA in favor of a tissue-based definition (i.e. the presence or absence of lesions on diffusion-weighted ) ..."

"What is a stroke? ... how common is it? It is the leading cause of serious disability of adults in the United States. It is the fifth leading cause of deaths in the United States. Moreover, it is the second leading cause of deaths worldwide ... it is characterized by injury to the brain from or rupture of a . There are two broad types of stroke. The first is blockage of a blood vessel — that accounts for eighty percent of strokes ... And there's , which accounts for twenty percent ... due to rupture of a blood vessel."

"Giving Your Medical HistoryThis is often the most important part of the medical visit for you and your doctor. It is necessary in helping the doctor make a correct diagnosis. Depending on how well your doctor knows you, there may be a few questions concerning your recent health and well-being, or it may be necessary to take a complete history starting from the beginning. You may find yourself annoyed by all the questions that allow only "yes" of "no" answers. Being curt may be useful to the doctor for certain parts of the medical history. Still, all the problems in the doctor-patient relationship and communication, which are the subject of so much interest, research, and teaching, do influence how effective the medical history taking will be. On both sides of the equation, good communication skills will result in a better medical history."

"To evaluate the relative importance of the medical history, the physical examination, and laboratory investigations in the diagnosis and management of medical outpatients some physicians recorded their diagnosis and a prediction of the method of management after reading the patient's referral letter, again after taking the history, and again after performing the physical examination. These diagnoses and predictions were compared with the diagnosis and method of management which had been adopted two months after the patient's initial attendance. A diagnosis that agreed with the one finally accepted was made after reading the referral letter and taking the history in 66 out of 80 new patients; the physical examination was useful in only seven patients, and the laboratory investigations in a further seven. In only one of six patients in whom the physician was unable to make any diagnosis after taking the history and examining the patient did laboratory investigations lead to a positive diagnosis."

"Medical editors, however much they may disagree on scientific, social, or economic problems, will agree on one point: papers submitted for publication are, with few exceptions, badly written. The need for better medical writing is a perennial complaint: but what to do about it? One remedy is a book designed for self-study. Almost every year, publishers will bring out one or more volumes of this type, often helpful if used earnestly and critically. ... A second resource for improvement is the workshop or short course in writing. ..."

"Nearly a quarter of a century ago I left the security of a well-paid and well-pensioned position to go on a mission to show doctors how much they — and their patients — would benefit from knowing the simple techniques of effective writing. As an editor on medical magazines for a decade, I had been surprised by much of what I had seen: winding texts of long and pompous words brought together in rambling sentences that obscured any sensible meaning. Here was a great opportunity, I thought, to pass on what I had learnt as a professional writer: that the best way to express clear and well-ordered thoughts was through clear and simple language. I was confident that within a year or two the culture would start to change, and instead of glibly trotting out phrases like Long-term medication is predicated, doctors would start writing: You may have to take these pills for a long time. To my surprise I met fierce resistance. 'You can't use simple words, they are for children'; ' Approximately is a proper scientific word; it would be wrong to write about '; 'Don't put We examined the patient; instead write, The patient was examined '. One exasperated public health doctor went so far as to say: 'We're doctors. We don't necessarily want people to understand what we are writing'."

"Words matter in science that matters. Far too often, however, the words in medical literature are chosen and arranged without enough care. This leads to confusing, jargon-filled writing that is difficult to read, even for medical researchers. Not only is careless writing a barrier to publication, it makes it more difficult for peers to understand and build on other researchers’ work. Poor communication limits the impact of medical research, so clinicians and patients ultimately suffer as well. Vague and ambiguous clinical practice guidelines, for example, have been linked to medical errors and inconsistent interpretation. … Writing about complex medical research in plain language is challenging. Technical terms, acronyms and jargon, although used too frequently, cannot be avoided entirely. But the benefits — improved knowledge translation, less research waste — are too great for needlessly complicated writing to be accepted as inevitable. Medical educators, academic institutions and health care researchers have a duty to improve the quality of written communication to extend the reach of useful medical knowledge."

"There is probably more bad writing in medical journals than in any other kind of periodicals. For this there is a variety of reasons. Medical men are without leisure, and there is so much in medicine about which something may be written, that they lose their way. Besides, it is a common delusion that the mere fact of attendance for four or five years upon lectures in a faculty of a university confers upon a man those qualitiies of aptitude, precision, and harmony, which are commonly called style. On the contrary, the pursuit of a single, dominating interest, as told the students of , limits a man's breadth of outlook and the range of his intellectual curiosity; it dulls his zest and diminishes his eagerness to know and integrate into himself the best that has been thought and written for the enrichment of his mind. In short, it is a bar to the perception of what is good and what is evil in the art of writing."

"Presenting and communicating information effectively in any medical document is of paramount importance. The facts must be presented in such a way that they can be understood as intended. Many medical manuscripts are used for the diagnosis and treatment of patients: if they are misinterpreted, the consequences could be harm to the patient. Far too many errors that occur in medical practice are the result of poorly written documents, which in turn can result in miscommunication of information."

"The ability to endure rejection is a must. I began medical writing in the early 1970s while in small-town private practice. I had some early success in conducting clinical studies and seeing the results in print in respected journals. I also wrote some articles for controlled circulation, advertiser-supported journals, such as Medical Economics. Not everything I wrote was published. I also began writing health books for non-medical people, what the editors call the "lay audience." Here I collected so many rejection letters that I could have wallpapered a room with them. Only when I began writing and editing medical books did my acceptance rate become favorable. However, after 40 years of medical writing experience, I still receive rejections for clinical papers, editorials, and book proposals. And, yes, it still hurts. If you aspire to be a medical writer you will need determination. Being a writer takes a lot of effort and you really need to want to see your work in print."

"Medical writing, like the treatments it describes, can be used to improve health but also has the potential to harm. Rudyard Kipling (Kipling, 1923) wrote that ‘words are, of course, the most powerful drug used by mankind’, reminding us that writing has the power to change behaviours and attitudes. Medical writing therefore carries a heavy burden of responsibility. However, working with a powerful, or potentially dangerous, substance can be exhilarating. Another factor that makes medical writing such an interesting area is that it inhabits a strange boundary zone between science and art. Medical writing, especially reporting clinical trial results must be factual and objective. Certain aspects can undoubtedly be improved by following checklists and guidelines (Plint et al, 2006). Yet formulaic papers that report results dispassionately tend to be dry and uninteresting, while good papers should be inspiring and persuasive. But if the persuasive elements are taken too far or the arguments are not properly grounded in the findings, the report becomes biased and potentially misleading. Writers therefore walk a tightrope along what has been termed ‘the rhetoric of research’ (Horton, 1995; Schriger, 2005). They need to understand both the underlying science and the expressive art and to know where one should stop and the other begin."

"I went to Allah's Messenger (ﷺ) along with a a son of mine whose palate and tonsils I had pressed with my finger as a treatment for a (throat and tonsil) disease. The Prophet (ﷺ) said, "Why do you pain your children by pressing their throats! Use Ud Al-Hindi (certain Indian incense) for it cures seven diseases, one of which is pleurisy. It is used as a snuff for treating throat and tonsil disease and it is inserted into one side of the mouth of one suffering from pleurisy.""

"First, one of the most important – and, for many, confusing – questions: why do some trans people need medical intervention at all? Dysphoria, the antonym of ‘euphoria’, is the clinical term now used to describe the intense feeling of anxiety, distress or unhappiness some trans people feel in relation to their primary sex characteristics (genitals), their secondary sex characteristics (breasts, facial hair, menstruation, face shape, voice) or how these physical traits cause society to interact with them, by perceiving them as a male or female. Previously called 'gender identity disorder' and, before that, 'transsexualism', gender dysphoria is the name given to an experience many trans people struggle with, which can be helped by medical intervention. Although the term is widely used within the community, different trans people can experience dysphoria in very different ways, and so might have different clinical needs."

"It is the "battle of the beliefs": hanging on to your belief that you are who you are despite how others may define you, while also challenging yourself not to compare your insides to other people’s outsides. It's a constant effort to align yourself externally with how you feel internally."

"Dysphoria, it should be said, is not a precondition of being trans. According to some research, as many as 10 per cent of those who positively identify as trans men, trans women, non-binary people and various other terms do so without any feelings of dysphoria. It is sometimes incorrectly assumed that trans men and women experience dysphoria and non-binary people do not, when in fact some non-binary people feel themselves to be in great need of medical assistance, and some trans men and women seek none at all. Nevertheless, most trans people experience dysphoria to some degree."

"Gender dysphoria is a rare experience in society as a whole, affecting about 0.4 per cent of the population, which can make it hard to explain to the vast majority of people, who have not experienced it. To get around this, we often rely on metaphors. The clumsy phrase ‘born in the wrong body’ has become the favoured soundbite in popular media. Clumsy because – and this must be stressed – many trans people do not think this describes dysphoria at all well. To my mind, the trans writer Andrea Long Chu expresses it more accurately: "Dysphoria," she says, "can feel like heartbreak." Heartbreak, its incapacitating grief and the sense of absence and loss which activate the same parts of the brain as physical pain, can be so all-consuming it interferes with your everyday life. So, too, dysphoria. For me, at least, this is a much richer way of describing how many trans people experience distress with their bodies – indeed, how I felt until I medically transitioned."

"In place of such articles as have been condemned, eat fruits, grains, and vegetables. There isa ric variety of these kinds of food, and they are wholesome and unstimulating. Graham flour, oatmeal, and ripe fruit are the indisensables of a dietary for those who are suffering from sexual excesses."

"Those who have studied the nutritional conditions of “primitive” Africans in tropical Africa are unanimous in stating that they show no clinical signs of dietary deficiency. One of the most striking indications of the superiority of indigenous African diet is the magnificent condition of the teeth. One researcher among six ethnic groups in Kenya could not find a single case of tooth decay, not a single deformation of dental arch. But when those same people were transplanted and put on the “civilized” diet available under colonialism, their teeth began to decay at once."

"At last a growing number of physicians, private citizens and even the Federal Trade Commission are beginning to re-examine these long standing and deeply ingrained beliefs in the virtue of cow milk. And even Richard Nixon and John Connally came to realize that cow milk may not be good for you. The fact is: the drinking of cow milk has been linked to iron-deficiency anemia in infants and children; it has been named as the cause of cramps and diarrhea in much of the world's population, and the cause of multiple forms of allergy as well; and the possibility has been raised that it may play a central role in the origins of atherosclerosis and heart attacks."

"Message for My Meat-Eating Friends,"

"I should say in a ten-year period we'd be able to wipe out his debt. We'd be able to help make sure that all those things we need to do child care, elder care, making sure that we continue to strengthen our health care system, making sure that we're able to make every single solitary person eligible for what I've been able to do with the with the Covid, excuse me, with, um, dealing with everything we have to do with, uh. Look, if we finally beat Medicare?"

"'People who don't see you every day have a hard time understanding how on some days‒good days‒you can run three miles, but can barely walk across the parking lot on other days,' [my mom] said quietly."

"'the sense of fatigue is often a very fallacious index of the working capacity of the body … there is not necessarily any correspondence between the subjective feelings of fatigue and the capacity of the muscles to perform work'"

"In the point of view of an Art... Medicine appears to me to have followed a constantly progressive march from its origin to the death of Galen. Then it remained stationary, or even retrograded, at least in Europe, until the end of the fourteenth century... But from this epoch, the Healing Art took a new bound, and acquired, from generation to generation, remarkable perfection. Those who deny the progress of Medicine, have never seriously studied its history."

"Whatever this erudite historian in Medicine may say, doubt is not the last word of science, it is only the commencement of it, the point of departure. It is merely a favorable disposition for acquiring knowledge, certainty, or at least conviction. So taught Aristotle, so proclaimed Descartes, and the intimate sense of each one of us confirms the same. When we undertake the search for truth, it is with the desire and hope of attaining it, and if persuaded in advance that this desire and hope are vain... we would rest in careless repose, rather than uselessly fatigue ourselves in the pursuit of a chimera."

"Celebrated physicians influence the progress of their Science and the value of their Art, not by their writings only, but by their oral teachings, character, and conduct. Their lives offer, often, models for imitation, and sometimes, also, faults and errors to be avoided. Often, too, the early education of a man, and the circumstances in the midst of which he was reared, explain the peculiarity of his genius, and give the key to his successes and reverses. For these reasons, I could not neglect entirely some biographic details relative to the most famous physicians, especially when these details had some connection with the general history of the Art, or embraced some moral considerations."

"Of capital interest in the history of medical theories is, that they are all derived more or less directly, from some system of philosophy; so that only an incomplete idea of them could be obtained if the philosophic sources from which they were drawn were unknown. But too much importance must not be attached to these analogies, nor must the value of medical theories be judged by them... a philosophic system may be false as a whole and yet true in its particular application to Medicine. On the other hand, we may, by false logic, deduce an erroneous medical theory from an irreproachable philosophic system. Thus, then, after having indicated the philosophic ideas with which each medical doctrine may seem to be related, we shall judge this in itself, and relative to its practical consequences."

"Willis combined the physician's expert anatomical sophistication with the fluent use of an interpretive apparatus that see-sawed between novelty and tradition, Galenism and Gassendist , and mechanism."

"The history of medicine from Hippokrates and Galen till the present time has been replete with innovations, new teachers, new schools, new procedures. There has been no one school, no single medical profession, outside of the priesthoods, extending in an unbroken chain from the indefinite Past to our own Twentieth Century. New phases have manifested themselves as regularly almost as those of the moon in the sky. We may not be astonished at Paracelsus for burning the writings of Galen as no longer suitable for the student of the Healing Art. A distinguished physician of Edinburg upon taking charge of the Library of the University, commanded all books of reference that were ten years old to be removed as obsolete. If any would conjure with old names, like Galen, Rhasis, Ibn Sina, or later ones that have been distinguished, the fact is nevertheless unquestionable, that they have had their time. We may profit by their counsel and examples, but we can not be bound to employ their formulas and procedures."

"The earlier faiths of the world which ascribed the origin of mankind to Divinity, also associated the technique of medicine with the offices of religious worship. They named gods as the first physicians; these famous hero-chieftains, gifted men who were instinct with enthusiastic fervor, the Rephaim and giant-minds among the tribes and peoples of the earth. The temples were often hospitals to which the sick resorted for counsel and healing medicines, believing that the means of cure had been revealed there by the guardian divinity of the shrine. The priests were regarded as physicians for disorders of the body; prophets and diviners were consulted for those who suffered from disease, and the wisdom of the philosophers included the knowledge of treating physical maladies. ...Pythagoras, Aristotle, Athenæos, the early Christian teachers, the mystics of later centuries, down to our own times, not only gave instructions to their disciples in arcane, metaphysical and other learning, but also treated the sick and ministered to their bodily injuries."

"Indeed, we may regard it as an axiom, that the knowledge which is anywhere possessed of the art of healing, is the measure of the refinement and civilization to which the people have attained. Man is civilized by virtue of social relations; and refinement is the becoming divested from grossness, vulgarity, and the evil manners which are characteristic and incident to a living for one's self alone. Selfishness is savagery; and a state of society in which self-interest is the ruling element is hardly yet reclaimed from the state of barbarism. It is of little avail to appeal to skill in mechanics, engineering, and other attainments in the plane of material evolution. These are not adequate proof of spiritual advancement. Kindly sentiment toward others, sincere regard for their welfare, charity in will and act, make the only real culture and civilization. The art and technique of healing proceed from these qualities, and cannot flourish apart from them."

"The History of the Healing Art is as old as the history of the human race. The amber of antiquity has not preserved the name or any monument of the benefactor who first ventured upon the attempt to relieve the maladies of his fellow beings. To know so much would be equivalent to knowing the origins of civilization... What is regarded as learning, erudition, or wisdom, is a treasure which others have won and possessed before us. Every great thought has had a precursor, every great man a predecessor. ...We have no Father of Medicine, no Founder of the Healing Art, except in eponym."

"Rome at an early period gave birth to several philosophers and practitioners in the art of healing. Cornelius Celsus['s] ...works on medicine show the advanced state of surgery and medicine during the Roman Empire. ...Of the methods of administration employed in early Roman pharmacy, the malagma was commonly used. It was a kind of soft mass composed of herbs and grass beaten up to the consistency of a thick paste, and applied to the skin. Numerous formulae for malagmas are given, in which pellitory, , resin, s, , , etc., are included. Their malagmas corresponded with our ointments. They also used plasters, of which the of galbanum, pitch, resin, and oil, in an improved form, has survived two thousand years. Troches, for healing wounds, were composed of dry medicines held in suspension by some liquid such as wine or oil. Pessaries (vaginal) were originated by the Greeks, who called them pessi. The ingredients were placed in a piece of wool, and thus used. Powders and snuffs were also common methods of administration. ...The Greeks called their embrocations or ointments euchrista. The catapotia was the method used for internal administration in liquid form, for which many recipes are given by Celsus."

"The history of medicine, of all the branches of that art, is the one to which least attention is devoted by physicians; and yet its study not only possesses great scientific value, but likewise includes an important germ of practical information."

"Medicine and theology, now it would seem irreconcilably at variance, were in their early periods of development most intimately united, like twin sisters in the womb, whom we are unable for a long period to recognize as distinct beings, and of whom even after birth we cannot say which is the elder, since both were born at the same time."

"To the naturalist, it [the history of medicine] teaches how the branches of his science, which lift their heads so proudly to-day, were originally mere offshoots of medicine, and have been only recently planted as independent growths upon a soil of their own."

"An acquaintance with the history of his science is... especially indispensable to the practical physician, if he would thoroughly comprehend and penetrate the secrets of his profession. To him, indeed, it is the bright and polar star, since undoubtedly it alone can teach him the principles of a medical practice independent of the currents, the faith and the superstition of the present. Moreover, it offers him as scientific gain, through the knowledge of the past, the measure for a just and well-founded criticism of the doings of his own time, places in his hand the thread by which he unites past conditions and efforts with those of the present, and sets before him the mirror in which he may observe and compare the past and present, in order to draw therefrom well-grounded conclusions for the future."

"We prize infinitely less the fact that history, among almost all people, presents to our eyes the immortal gods as the authors of medical art, than that it teaches us how mortal men have struggled continually after god-like aims—the prevention, the cure, or at least the alleviation of the woe and suffering imposed as an unavoidable heritage, and in a thousand different forms, upon us created beings—even though to-day, as in the past, these aims have been only imperfectly attained."

"Medicine is a science which hath been... more professed than laboured, and yet more laboured than advanced: the labour having been, in my judgment, rather in circle than in progression. For I find much iteration but small addition. It considereth causes of diseases, with the occasions or impulsions; the diseases themselves, with the accidents; and the cures with the preservations. The deficiencies which I think good to note being a few of many, and those such as are of a more open and manifest nature, I will enumerate, and not place."

"To attempt to isolate the history of medicine, and to comprehend its curious ebbs and flows of doctrine from medical writings only, is like cutting a narrow strip from the center of a piece of tapestry and speculating upon the origin and purpose of the cut threads of patterns that may be found in it."

"When we take an extended view of the progress of medicine, tracing it from its scanty sources, in the most remote periods of society, and observe its course, as gradually augmented by the stores of Grecian and Roman learning, obscured by the darkness of the middle ages, and again bursting forth in the copious and almost overwhelming streams of modern literature, we are naturally led to separate the narrative into three divisions, corresponding to the three great chronological periods. The first of these will comprehend the history of practical medicine, from the earliest records which we possess, to the decline of Roman literature; the second will contain an account of the state of the science, through what are termed the dark ages, until the revival of letters; the third will commence with the establishment of the inductive philosophy, and be continued to the commencement of the nineteenth century."

"The improvement in the healing art has been nearly in proportion to the advancement of the other arts of life, and to the gradual progress of knowledge on all subjects intimately connected with our existence or welfare."

"The probability... is that the priests of the Egyptians were at the same time their physicians. This appears to have been the case among the Jews and the Greeks, who are supposed to have borrowed from the Egyptians many of their institutions; and indeed it seems to be the natural progress of society in its earlier periods, when the priests were generally the depositaries of knowledge."

"The Greeks soon excelled the Egyptians in medicine, so late as the time of Plato, the Pastopheri, or medical division of the hierarchy, are found not altogether to have lost their former celebrity. Some of the distinguished Greek physicians went to Egypt, in order to study medicine under the Egyptian priesthood. The Pastopheri were keepers of the temples, and the sick who resorted there for aid came in the first instance into their hands, and they were thus called upon more frequently than others, both to examine the patient and to prescribe a remedy. That the upper ranks of the hierarchy, the higher orders of the sacred colleges also, attended to medical practice, we have positive proof. Plato and Euripedes, during their residence in Egypt, were both cured of an attack of illness by such."