New to Meducation?
Sign up
Already signed up? Log In

Category

10
1
78

Focus On: Treatment of Epistaxis

Epistaxis is one of the most common ear, nose, and throat emergencies, with an estimated 60% lifetime incidence rate for an individual person.  
American College Of Emergency Medicine
over 9 years ago
29747
3
462

Cerebellar Neuroanatomy

Introduction Examination of the cranial nerves allows one to "view" the brainstem all the way from its rostral to caudal extent. The brainstem can be divided into three levels, the midbrain, the pons and the medulla. The cranial nerves for each of these are: 2 for the midbrain (CN 3 & 4), 4 for the pons (CN 5-8), and 4 for the medulla (CN 9-12). It is important to remember that cranial nerves never cross (except for one exception, the 4th CN) and clinical findings are always on the same side as the cranial nerve involved. Cranial nerve findings when combined with long tract findings (corticospinal and somatosensory) are powerful for localizing lesions in the brainstem. Cranial Nerve 1 Olfaction is the only sensory modality with direct access to cerebral cortex without going through the thalamus. The olfactory tracts project mainly to the uncus of the temporal lobes. Cranial Nerve 2 This cranial nerve has important localizing value because of its "x" axis course from the eye to the occipital cortex. The pattern of a visual field deficit indicates whether an anatomical lesion is pre- or postchiasmal, optic tract, optic radiation or calcarine cortex. Cranial Nerve 3 and 4 These cranial nerves give us a view of the midbrain. The 3rd nerve in particular can give important anatomical localization because it exits the midbrain just medial to the cerebral peduncle. The 3rd nerve controls eye adduction (medial rectus), elevation (superior rectus), depression (inferior rectus), elevation of the eyelid (levator palpebrae superioris), and parasympathetics for the pupil. The 4th CN supplies the superior oblique muscle, which is important to looking down and in (towards the midline). Pontine Level Cranial nerves 5, 6, 7, and 8 are located in the pons and give us a view of this level of the brainstem. Cranial Nerve 6 This cranial nerve innervates the lateral rectus for eye abduction. Remember that cranial nerves 3, 4 and 6 must work in concert for conjugate eye movements; if they don't then diplopia (double vision) results. The medial longitudinal fasciculus (MLF) connects the 6th nerve nucleus to the 3rd nerve nucleus for conjugate movement. Major Oculomotor Gaze Systems Eye movements are controlled by 4 major oculomotor gaze systems, which are tested for on the neurological exam. They are briefly outlined here: Saccadic (frontal gaze center to PPRF (paramedian pontine reticular formation) for rapid eye movements to bring new objects being viewed on to the fovea. Smooth Pursuit (parietal-occipital gaze center via cerebellar and vestibular pathways) for eye movements to keep a moving image centered on the fovea. Vestibulo-ocular (vestibular input) keeps image steady on fovea during head movements. Vergence (optic pathways to oculomotor nuclei) to keep image on fovea predominantly when the viewed object is moved near (near triad- convergence, accommodation and pupillary constriction) Cranial Nerve 5 The entry zone for this cranial nerve is at the mid pons with the motor and main sensory (discriminatory touch) nucleus located at the same level. The axons for the descending tract of the 5th nerve (pain and temperature) descend to the level of the upper cervical spinal cord before they synapse with neurons of the nucleus of the descending tract of the 5th nerve. Second order neurons then cross over and ascend to the VPM of the thalamus. Cranial Nerve 7 This cranial nerve has a motor component for muscles of facial expression (and, don't forget, the strapedius muscle which is important for the acoustic reflex), parasympathetics for tear and salivary glands, and sensory for taste (anterior two-thirds of the tongue). Central (upper motor neuron-UMN) versus Peripheral (lower motor neuron-LMN) 7th nerve weakness- with a peripheral 7th nerve lesion all of the muscles ipsilateral to the affected nerve will be weak whereas with a "central 7th ", only the muscles of the lower half of the face contralateral to the lesion will be weak because the portion of the 7th nerve nucleus that supplies the upper face receives bilateral corticobulbar (UMN) input. Cranial Nerve 8 This nerve is a sensory nerve with two divisions- acoustic and vestibular. The acoustic division is tested by checking auditory acuity and with the Rinne and Weber tests. The vestibular division of this nerve is important for balance. Clinically it be tested with the oculocephalic reflex (Doll's eye maneuver) and oculovestibular reflex (ice water calorics). Medullary Level Cranial nerves 9,10,11, and 12 are located in the medulla and have localizing value for lesions in this most caudal part of the brainstem. Cranial nerves 9 and 10 These two nerves are clinically lumped together. Motor wise, they innervate pharyngeal and laryngeal muscles. Their sensory component is sensation for the pharynx and taste for the posterior one-third of the tongue. Cranial Nerve 11 This nerve is a motor nerve for the sternocleidomastoid and trapezius muscles. The UMN control for the sternocleidomastoid (SCM) is an exception to the rule of the ipsilateral cerebral hemisphere controls the movement of the contralateral side of the body. Because of the crossing then recrossing of the corticobulbar tracts at the high cervical level, the ipsilateral cerebral hemisphere controls the ipsilateral SCM muscle. This makes sense as far as coordinating head movement with body movement if you think about it (remember that the SCM turns the head to the opposite side). So if I want to work with the left side of my body I would want to turn my head to the left so the right SCM would be activated. Cranial Nerve 12 The last of the cranial nerves, CN 12 supplies motor innervation for the tongue. Traps A 6th nerve palsy may be a "false localizing sign". The reason for this is that it has the longest intracranial route of the cranial nerves, therefore it is the most susceptible to pressure that can occur with any cause of increased intracranial pressure.  
Neurologic Exam
almost 9 years ago
Img0
7
188

Upper Respiratory Tract. The Pharynx

This a tutorial outlining the basics of the the pharynx and other elements of the upper respiratory tract.  
Mr Raymond Buick
almost 8 years ago
Preview
2
141

ENT Examination

Guide to doing a clinical exam on the ears, nose and throat by the clinical skills tutors at the University of Liverpool  
Mary
about 7 years ago
Preview
1
36

Gonorrhoea

Gonorrhoea (aka the clap) Nisseria Gonorrhoae (aka Gonococcus, GC)is a Gram-negative intracellular diplococcus. It only infects humans, and likes moist areas, typically infecting the genitourinary tracts, retum, pharynx and conjunctiva. It is particularly intolerant to a dry environment.  
almostadoctor.com - free medical student revision notes
over 5 years ago
Preview
2
60

Different types of Inhaler

There are loads of types of inhalers! You need to be able to tell a patient how to use each type, and what type of drugs can go in each type.   With all inhalers, the amount of drug deposited on the mouth and pharynx is very high. Generally it is about 85% (even with good technique). This can improve to about 75% with different types of inhaler.   How a spacer works  
almostadoctor.com - free medical student revision notes
over 5 years ago
Preview
1
31

Upper Respiratory Tract Infections

Upper Respiratory Tract Infections These account for up to 80% of all RTI’s in children. They can involve the ears, nose, throat and sinuses. They are rarely serious and will not often require hospitalisation. They can become an issue when: A very young child has an RTI that causes a severely ‘blocked nose’ as this can affect feeding. This may result in hospitalisation. There are associated febrile convulsions The RTI causes an exacerbation of asthma  
almostadoctor.com - free medical student revision notes
over 5 years ago
Static.www.bmj
1
36

Hoarseness in a 79 year old woman

A 79 year old woman was referred to our ear, nose, and throat outpatient clinic with a history of hoarse voice. This symptom had been present for around three months. It initially fluctuated in severity but eventually became constant. There was no associated pain, weight loss, cough, dysphagia, odynophagia, or other upper airway symptoms. She had not recently had surgery or experienced trauma. Her medical history was of chronic obstructive pulmonary disease, and she was an ex-smoker.  
bmj.com
over 5 years ago
Preview
1
70

Tonsillitis

Epidemiology and Aetiology 70% viral 30% bacterial 90% will recover within a week without treatment Common in children age 5-10 and young adults age 15-25 Caused by Group A streptococcus. This is carried in normal healthy throats in the general population. Rates of carriage decline with age, from about 10% of under 14’s to  
almostadoctor.com - free medical student revision notes
over 5 years ago
Preview
1
29

A 68 year old woman with deteriorating hearing

A 68 year old woman presented to the ear, nose, and throat (ENT) clinic with gradually worsening bilateral hearing loss over at least the past five years. This was associated with some non-intrusive tinnitus but no other otological symptoms, history of vertigo, or associated systemic problems. She found that she was increasing the TV volume to a level that her family found uncomfortable, and she had started to avoid social situations because she struggled to hear conversation among the background noise. Her medical history was unremarkable except for well controlled hypertension, for which she was taking amlodipine. She also had no history of excessive noise exposure, no previous otological problems, and no family history of note.  
bmj.com
over 5 years ago
Preview
1
28

A 68 year old woman with deteriorating hearing

A 68 year old woman presented to the ear, nose, and throat (ENT) clinic with gradually worsening bilateral hearing loss over at least the past five years. This was associated with some non-intrusive tinnitus but no other otological symptoms, history of vertigo, or associated systemic problems. She found that she was increasing the TV volume to a level that her family found uncomfortable, and she had started to avoid social situations because she struggled to hear conversation among the background noise. Her medical history was unremarkable except for well controlled hypertension, for which she was taking amlodipine. She also had no history of excessive noise exposure, no previous otological problems, and no family history of note.  
bmj.com
over 5 years ago
Preview
1
59

A 68 year old woman with deteriorating hearing

A 68 year old woman presented to the ear, nose, and throat (ENT) clinic with gradually worsening bilateral hearing loss over at least the past five years. This was associated with some non-intrusive tinnitus but no other otological symptoms, history of vertigo, or associated systemic problems. She found that she was increasing the TV volume to a level that her family found uncomfortable, and she had started to avoid social situations because she struggled to hear conversation among the background noise. Her medical history was unremarkable except for well controlled hypertension, for which she was taking amlodipine. She also had no history of excessive noise exposure, no previous otological problems, and no family history of note.  
bmj.com
over 5 years ago
Preview
3
109

ANATOMY; RESPIRATORY SYSTEM; PART 1; Upper Tract; Nose, Pharynx & Larynx; by Professor Fink

This is Part 1 of 2 Anatomy Video Lectures on the Respiratory System by Professor Fink. In this Video Lecture, Professor Fink describes the Functions of the ...  
YouTube
over 5 years ago
Preview
1
64

ANATOMY; RESPIRATORY SYSTEM; PART 1; Upper Tract; Nose, Pharynx & Larynx; by Professor Fink

This is Part 1 of 2 Anatomy Video Lectures on the Respiratory System by Professor Fink. In this Video Lecture, Professor Fink describes the Functions of the ...  
YouTube
about 5 years ago
Www.bmj
1
20

An unusual finding on a pelvic radiograph

A 74 year old man presented to the ear, nose, and throat department with breathlessness on exertion, intermittent voice hoarseness, and a sensation of catarrh in his throat. After a laryngoscopy with biopsy was performed, he was diagnosed as having a low grade chondrosarcoma of the larynx. Before surgical debulking of the lesion was carried out he underwent computed tomography of the chest, abdomen, and pelvis. This confirmed the presence of a subglottic mass in the larynx but also showed a mixed lytic and sclerotic expansile lesion (5.8 cm (longitudinal)×1.6 cm (axial)×4.5 cm) in the left iliac blade of the pelvis. The pelvic lesion was well corticated, with internal ossified septae and calcification. Expansion of the left iliac wing was noted, with no breach in the cortex.  
bmj.com
over 4 years ago
Www.bmj
1
11

A persisting puzzling pneumonia in a young man

A 23 year old immunocompetent man with a history of childhood asthma was referred to the respiratory physicians with a four week history of productive cough, painful throat, fever, rigors, generalised myalgia, and vague discomfort in his left chest. He also had slight abdominal tenderness in the left upper quadrant.  
bmj.com
over 4 years ago
Preview
1
173

Duke Anatomy - Lab 22: Retropharyngeal space

In the last lab you examined many of the structures on the anterior surface of the neck, and looked briefly at the retropharyngeal space and its contents while moving them aside, but you have not yet dissected those structures in detail. Today you will explore the prevertebral area and the back of the pharynx (retropharyngeal space) in much more detail. In order to do this the head must be detached from the vertebral column to allow a posterior approach to the cervical viscera. This is a challenging and labor-intensive dissection.  
web.duke.edu
over 4 years ago
Foo20151013 2023 sql3pi?1444774098
10
924

The NHS needs to learn a lesson from the Military MDT approach

I have recently spent a few days following around registrars on military ward rounds. It has been a fantastic experience for learning about trauma care and rehab, but more importantly it has shown me just how vital team spirit is to modern health care! The military ward round is done once a week. It starts with a huge MDT of almost 40 people, including nurses, physios, registrars and consultants from all of the specialities involved in trauma and rehab. The main trauma ward round team then go to speak to all of the patients in the hospital. The team normally consists of at least one T+O consultant, one plastics, two physios, two nurses, 3 registrars and a few others. This ward round team is huge, unweildly and probably very costly, but those military patients receive a phenomenal level of care that is very quick and efficient. Having then compared this level of care with what I have experience on my 4th year speciality medicine placement, I now feel the NHS has a lot to learn about team work. I am sure that everyone working in healthcare can relate to situations where patients have been admitted under the care of one team, who don’t really know what to do with the patient but struggle on bravely until they are really lost and then look around to see who they can beg for help. The patient then gets ping-ponged around for a few days while management plans are made separately. All of the junior doctors are stressed because they keep having to contact multiple teams to ask what should be done next. The patient is left feeling that their care wasn’t handled very well and is probably less than happy with the delay to their definite treatment. The patient, thankfully, normally ends up getting the correct treatment eventually, but there is often a massive prolongation of their stay in hospital. These prolonged stays are not good for the patient due to increasing risks of complications, side effects, hospital acquired infections etc. They are not good for the health care staff, who get stressed that their patients aren’t receiving the optimum care. The delays are very bad for the NHS managers, who might miss targerts, lose funding and have to juggle beds even more than normal. Finally, it is not good for the NHS as a hole, which has to stump up the very expensive fees these delays cause (approximately £500 a night). There is a simple solution to this which would save a huge amount of time, energy and money. TEAM WORK! Every upper-GI ward round should be done with the consultant surgeon team and a gastroenterologist (even a trainee would probably do) and vice versa, every Gastroenterology ward round should have a surgeon attached. Every orthopaedic ward round should be done with an elderly care physician, physio/rehab specialist and a social worker. Every diabetic foot clinic should have a diabetologist, podiatrist, vascular surgeon and/or orthopaedic surgeon (even trainees). Etc. etc. etc. A more multi-disciplinary team approach will make patient care quicker, more appropriate and less stressful for everyone involved. It would benefit the patients, the staff and the NHS. To begin with it might not seem like an easy situation to arrange. Everyone is over worked, no one has free time, no one has much of a spare budget and everyone has an ego. But... Team work will be essential to improving the NHS. Many MDTs already exist as meetings. MDTs already exist as ED trauma teams, ED resus teams and Military trauma teams. There is no reason why lessons can’t be learnt from these examples and applied to every other field of medicine. I know that as medical students (and probably every other health care student) the theory of how MDTs should work is rammed down our throats time after time, but I personally still think the NHS has a long way to go to live up to the whole team work ethos and that we as the younger, idealist generation of future healthcare professionals should make this one of our key aims for our future careers. When we finally become senior health care professionals we should try our best to make all clinical encounters an MDT approach.  
jacob matthews
about 6 years ago
Foo20151013 2023 37skir?1444774198
2
105

Biohacking - The Brighter Side of Health

2014 is already more than a month old (if you can believe it) and with each passing day, the world we live in is speeding towards breakthroughs in every sphere of life. We're running full tilt, wanting to be bigger and better than we were the day or the hour before. Every passing day reinvents the 'cutting edge' of technology, including medical progress and advancement. Gone are the medieval days when doctors were considered all knowing deities, while medicine consisted of leeches being used to drain 'bad blood'. Nowadays, health isn't just about waiting around until you pick up an infection, then going to your local GP to get treated; in today's world it's all about sustaining your wellbeing. And for that, the new kid on the block is biohacking. Biohacking is the art and science of maximizing your biological potential. As a hacker aims to gain complete control of the system he's trying to infiltrate, be it social or technological; similarly a biohacker aims to obtain full control of his own biology. Simply put, a biohacker looks for techniques to improve himself and his way of life. Before you let your imagination run away with you and start thinking of genetic experiments gone wrong, let me assure you that a biohack is really just about any activity you can do to increase your capabilities or advance your wellbeing. Exercising daily can be a biohack. So can doing the crossword or solving math sums, if it raises your IQ by a few points or improves your general knowledge. What characterizes biohacking is the end goal and the consequent modification of activities to achieve that goal. So what kind of goals would a biohacker have? World domination? Not quite. Adding more productive hours to the day and more productivity to those hours? Check. Eliminating stress and it's causes from their lives? Check. Improving mood, memory and recall, and general happiness? You bet. So the question arises; aren't we all biohackers of sorts? After all, the above mentioned objectives are what everyone aspires to achieve in their lives at one point or the other. unfortunately for all the lazy people out there (including yours truly), biohacking involves being just a tad bit more pro active than just scribbling down a list of such goals as New Year resolutions! There are two main approaches to selecting a biohack that works for you- the biggest aim and the biggest gain. The biggest aim would be targeting those capabilities, an improvement in which would greatly benefit you. This could be as specific as improving your public speaking skills or as general as working upon your diet so you feel more fit and alert. In today's competitive, cut throat world, even the slightest edge can ensure that you reach the finish line first. The biggest gain would be to choose a technique that is low cost- in other words, one that is beneficial yet doesn't burn a hole through your pocket! It isn't possible to give a detailed description of all the methods pioneering biohackers have initiated, but here are some general areas that you can try to upgrade in your life: Hack your diet- They say you are what you eat. Your energy levels are related to what you eat, when you take your meals, the quantity you consume etc. your mood and mental wellbeing is greatly affected by your diet. I could go on and on, but this point is self expanatory. You need to hack your diet! Eat healthier and live longer. Hack your brain- Our minds are capable of incredible things when they're trained to function productively. Had this not been the case, you and I would still be sitting in our respective caves, shivering and waiting for someone to think long enough to discover fire. You don't have to be a neuroscientist to improve your mental performance-studies show that simply knowing you have the power to improve your intelligence is the first step to doing it. Hack your abilities- Your mindset often determines your capacity to rise to a challenge and your ability to achieve. For instance, if you're told that you can't achieve a certain goal because you're a woman, or because you're black or you're too fat or too short, well obviously you're bound to restrict yourself in a mental prison of your own shortcomings. But it's a brave new world so push yourself further. Try something new, be that tacking on an extra lap to your daily exercise routine or squeezing out the extra time to do some volunteer work. Your talents should keep growing right along with you. Hack your age- You might not be able to do much about those birthday candles that just keep adding up...but you can certainly hack how 'old' you feel. Instead of buying in on the notion that you decline as you grow older, look around you. Even simple things such as breathing and stamina building exercises can change the way you age. We have a responsibility to ourselves and to those around us to live our lives to the fullest. So maximise your potential, push against your boundaries, build the learning curve as you go along. After all, health isn't just the absence of disease but complete physical, mental and social wellbeing and biohacking seems to be Yellow Brick Road leading right to it!  
Huda Qadir
almost 6 years ago
Foo20151013 2023 1nftkgk?1444774218
4
300

Gin & Tonic Anyone?

It was a Saturday, about tea-time in the quaint village of Athelstaneford, East Lothian. Mrs Alexandria Agutter sat in her cottage, enjoying the delights of the late-summer evening with a glass of gin and tonic. She listlessly sipped from the rather generous pick-me up, no doubt chewing over the happenings of the day. Blast! The taste was much too bitter to her liking. She stood up. And promptly crumpled to the floor in a dizzied heap. It had not been five minutes when a fiery pain gripped her parched throat and in her frenzied turn she watched the bleary room become draped in a gossamery silk. How Dame Agatha would approve. But this is no crime novel, on that fateful day, 24th August 1994, poor Mrs Agutter immortalised herself in the history books of forensic medicine; she was the victim of a revered toxin and a vintage one it was too. She had unwittingly imbibed a G&T laced with a classic poison of antiquity. A clue from the 21st century: do you recall the first Hunger Games film adaption? Those inviting purple-black berries or as Suzanne Collins coined them ‘Nightlock’; a portmanteau of hemlock and Deadly Nightshade. True to the laters’ real life appearance those onscreen fictional fruits played a recurring cameo role. Deadly Nightshade is a perennial shrub of the family Solanaceae and a relative of the humble potato (a member of the Solanus genus). It is a resident of our native woodland and may be found as far afield as Europe, Africa and Western Asia. The 18th century taxonomist, Carl Linnaeus gave the plant an intriguing name in his great Species Plantarum. The genus Atropa is aptly named after one of the three Greek Fates, Atropos. She is portrayed shearing the thread of a mortal’s life so determining the time and manner of its inevitable end. The Italian species name belladona (beautiful woman) refers to the striking mydriatic effect of the plant on the eye. The name pays homage to Pietro Andre Mattioli, a 16th century physician from Sienna, who was allegedly the first to describe the plant’s use among the Venetian glitterati - ladies of fashion favoured the seductive, doe-eyed look. Belladona is poisonous in its entirety. It was from the plant’s roots in 1831, the German apothecary Heinrich F. G. Mein isolated a white, odourless, crystalline powder: it was (surprise, surprise) atropine. Atropine is a chiral molecule. From its natural plant source it exists as a single stereoisomer L-atropine, which also happens to display a chiral potency 50-100 times that of its D-enantiomer. As with many other anaesthetic agents it is administered as a racemic mixture. How strange that atropine now sits among the anaesthetist’s armamentarium, its action as a competitive antimuscarinic to counter vagal stimulation belies its dark history. It was a favourite of Roman housewives seeking retribution against their less than faithful husbands and a staple of the witch’s potion cupboard. Little wonder how belladona became known as the Devil’s plant. Curiouser still it’s also the antidote for other poisons, most notably the organophosphates or nerve gases. On account of its non-selective antagonism, atropine produces a constellation of effects: the inhibition of salivary, lacrimal and sweat glands occurs at low doses; dry mouth and skin are early markers. Pyrexia is a central effect exacerbated by the inability to sweat. Flushing of the face due to skin vessel vasodilatation. Low parasympathetic tone causes a moderate sinus tachycardia. Vision is blurred as the eye becomes dilated, unresponsive to light and accommodation is impaired. Mental disorientation, agitation and ataxia give the impression of drunkedness or a delirium tremens like syndrome. Visual hallucinations, often of butterflies or silk blowing in the wind, are a late feature. It was then that Mr Agutter, seemingly untroubled by the sight of his wife’s problematic situation, proceeded to leave a message with the local practitioner. How fortunate they were to have the vigilant locum check the answering machine and come round to the Agutter’s lodge accompanied by an ambulance crew. The attending paramedic had the presence of mind to pour the remainder of Mrs Agutter’s beverage into a nearby jam jar, while Mr Agutter handed over what he suspected to be the offending ingredient: the bottle of Indian tonic water. As it soon transpired there were seven other casualties in the surrounding countryside of East Lothian – all involving an encounter with tonic water. In fact by some ironic twist of fate, two of the victims were the wife and son of Dr Geoffry Sharwood-Smith, a consultant aneasthetist. Obviously very familiar with the typical toxidrome of anticholinergic agents, he was quick to suspect atropine poisoning. Although for a man of his position with daily access to a sweetshop of drugs, it was not something to draw attention to. Through no small amount of cunning had the poisoner(s) devised the plan. It was elegant; atropine is very bitter. So much so that it can be detected at concentrations of 100 parts per million (0.001%). Those foolish enough to try the berries of belladonna during walks in the woods are often saved by the berry’s sour taste. They are soon spat out. But the quinine in the tonic water was a worthy disguise. The lethal dose for an adult is approximately 90-130mg, however atropine sensitivity is highy variable. In its salt form, atropine sulfate, it is many times more soluble: >100g can be dissolved in 100ml of water. So 1ml may contain roughly tenfold the lethal dose. There ensued a nationwide scare; 50 000 bottles of Safeway branded Indian tonic water were sacrificed. Only six bottles had been contaminated. They had all been purchased, tops unsealed, from the local Safeway in Hunter’s Tryst. Superficially this looked like the handiwork of a psychopath with a certain distaste for the supermarket brand, and amidst the media furore, it did have some verisimilitude: one of the local papers received a letter from 25 year old, Wayne Smith admitting himself as the sole perpetrator. The forensic scientist, Dr Howard Oakley analysed the contents of the bottles. They all contained a non-lethal dose, 11-74mg/litre of atropine except for the Agutter’s, it contained 103mg/litre. The jam jar holding Mrs Agutter’s drink bore even more sinister results, the atropine concentration was 292mg/L. It would appear Mrs Agutter had in some way outstayed her welcome. But she lived. A miscalculation on the part of the person who had added an extra seasoning of atropine to her drink. According to the numbers she would have had to swallow a can’s worth (330ml) to reach the lethal dose. Thankfully she had taken no more than 50mg. The spotlight suddenly fell on Dr Paul Agutter. He was a lecturer of biochemistry at the nearby University of Napier, which housed a research syndicate specialising in toxicology. CCTV footage had revealed his presence at the Safeway in Hunter’s Tryst and there was eye witness evidence of him having placed bottles onto the shelves. Atropine was also detected by the forensic investigators on a cassete case in his car. Within a matter of two weeks he would be arrested for the attempted murder of his wife. Despite the calculated scheme to delay emergency services and to pass the blame onto a non-existent mass poisoner, he had not accomplished the perfect murder. Was there a motive? Allegedly his best laid plans were for the sake of a mistress, a mature student from Napier. He served seven years of a twelve year sentence. Astonishingly, upon his release from Glenochil prison in 2002, he contacted his then former wife proclaiming his innocence and desire to rejoin her in their Scottish home. A proposition she was not very keen on. Dr Agutter was employed by Manchester University as a lecturer of philosophy and medical ethics. He is currently an associate editor of the online journal Theoretical Biology and Medical Modelling. We will never know the true modus operandi as Dr Agutter never confessed to the crime. Perhaps all this story can afford is weak recompense for the brave followers of the Dry January Campaign. Oddly these sort of incidents never appear in their motivational testimonials. Acknowledgements Emsley J. Molecules of Murder. 2008, Cambridge, RSC Publishing, p.46-67. Lee MR. Solanaceae IV: Atropa belladona, deadly nightshade. J R Coll Physicians Edinb. March 2007; 37: 77-84. Illustrator Edward Wong This blog post is a reproduction of an article published in the The Medical Student Newspaper January issue, 2014 http://www.themedicalstudent.co.uk/  
James Wong
almost 6 years ago