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Brain cells produce minute fluctuations in electric current which can be recorded by placing on various parts of the head small metal discs attached to suitable amplifiers.The numerous electrical impulses which are associated with the living brain tend to produce a particular repetitive pattern. With the eyes closed, alpha rhythm appears, i.e. a rhythm consisting of waves lasting one-tenth of a second; with the eyes opened so that the brain is alerted, this rhythm disappears. Faster rhythms may be seen when the patient is on tranquillizers, and slower (theta) rhythms indicate malfunctions or tumours of the brain.These slower rhythms are also seen in some patients with migraine, particularly during an attack, when they may indicate a transient decrease in circulation. Most patients with migraine have a normal EEG but the abnormalities found consist mainly of slow wave activity, more often over only one temporal lobe. EEG findings are not always conclusive since many different abnormalities can give identical EEG changes. A small percentage of ‘normal’ people without symptoms have EEG ‘abnormalities’ but these occur more commonly in migraine patients and become more pronounced during an attack. The EEG can therefore be a help both in assessing the severity of attacks and in excluding diagnoses other than migraine; patients with hemiplegic migraine particularly tend to have severe persisting EEG abnormalities on the relevant side of the head.During one stage of the EEG examination, the patient is asked to ‘over-breathe’, i.e. to breathe rapidly and deeply; this causes carbon dioxide to be ‘blown off producing a change in the acidity of the blood. Over-breathing can bring out latent abnormalities and, although migraine patients have slightly different responses to over-breathing, the meaning of this is uncertain. It may be that they are more anxious as a group with a greater tendency to over-breathing, i.e. an anxiety response. A more likely explanation is that their blood vessels are unduly sensitive to changes in blood acidity.Another EEG technique to reveal latent abnormalities is the response to & stroboscope, a machine that produces flashing lights (flicker) at different frequencies. In the vast majority of migraine subjects, these responses are made to a much greater range of flash frequencies than in normal subjects but, as a similar phenomenon was observed in people with anxiety and tension who do not suffer from migraine, its significance is uncertain. The EEG changes found in migraine may be very similar to those found in epilepsy, and on the basis of the EEG records it would be difficult to distinguish between the two conditions.The EEG can indicate a structural abnormality but it is not always possible to distinguish one cause of structural abnormality from another; indeed, some deep-seated lesions may cause no EEG abnormality or only minimal generalized changes.The answer to the question of what the EEG does is that it supplies a useful piece of the jigsaw puzzle but rarely gives the whole answer to a diagnostic problem on its own. Rather like the skull X-ray, the EEG will reveal something unsuspected only in some instances, when more extensive investigations are indicated.
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Are there no drawbacks to this program of complete equality? What will become of the children, for example, if women possess economic independence, which can be attained only by working outside of the home? And will there be any home at all? These questions are the stumbling blocks in the elevation of woman from the mere status of cook, housekeeper and nurse-girl to that of a fully developed human being who can be a real companion to her husband. The difficulties are not so serious, however, as conservative people would like to make them out to be. Beyond having to take several leaves of absence from outside work during pregnancy and lactation, there is no reason why a woman should have to neglect her career on account of children.Day nurseries and pre-schools, which can eventually be made part of the public school system, not only enable a mother to pursue her daily work outside the home but are much better for the child than the type of training or lack of training that it receives from most mothers. And the attention which both the father and mother can give to the children in the evening and over week ends will lend all the “personal touch” that is needed. As a matter of fact, with both parents working, with housekeeping done for the most part by specialists in that field, and with most meals eaten in family restaurants instead of laboriously prepared at home, both parents will actually have more time to devote to their children in a constructive way than at present. The improvement too in the relations of husband and wife, which will result from greater equality, will make home-life even more real and pleasant than it has been under the old regime, and both parents and children will be happier.Objection may be raised to woman’s entering industry because this will flood the labor market, reduce wages and throw deserving men out of work. While there may be, and in fact are, some difficulties of this sort, yet they may be regarded as merely transitional. Besides, the entrance of women into industry is quite gradual, and probably, if present tendencies continue, the population will sooner or later be sufficiently reduced to enable both men and women to have employment, with reduced hours and better pay, brought about by the continued improvement in industrial technology and in the greater power of workers to demand their due share of the products of industry. It is beyond the scope of this book, however, to enter into all the intricate economic questions that the proposed equality of the sexes raises. If the ideal is worth attaining, surely it can be made economically practicable.*106\275\8*

The medical care system is large, complicated, overwhelming, and bewildering. Everyone who is a patient in the system has a right to have questions answered. Questions about medical care are best addressed to the medical care providers—the nurse or midlevel practitioner or physician. Questions about the medical system itself are best addressed to a patient representative, a patient advocate now in most hospitals and in many of the larger clinics.     People who become patients in the medical care system have specific rights they should be aware of. The following is an adaptation and amplification of the “Patient’s Bill of Rights” offered at the Johns Hopkins Hospital in Baltimore, Maryland.1. The person should expect medical care regardless of race, color, religion, national origin, source of pay, or medical condition. Specifically, no one can be denied care because of HIV infection. Early in the AIDS epidemic, some hospitals and clinics avoided providing AIDS care, on the grounds that treating people with AIDS might deter other people from using that hospital or clinic. Much of this image problem is now in the past, but people with HIV infection should nonetheless be aware of their right to medical care in hospitals.2.  The person should expect to be treated with respect. He or she should be addressed by proper names and not be treated with undue familiarity. He or she has the right to an appropriate response to questions.3. People should expect privacy and confidentiality in all aspects of their care. This is an especially sensitive issue for people with HIV infection. Privacy and confidentiality have some limits, however. Important diagnoses such as HIV infection or the complications of HIV infection cannot be excluded from the medical record. Moreover, these medical records are available to those who have a justified need to see them, including physicians involved in the person’s care, insurance companies, Medicaid/Medicare, HMOs, and public health officials. Furthermore, all cases of AIDS are reported, by law, to the Centers for Disease Control; and many states require that blood tests that are positive for HIV also be reported to state health departments. Although this is a sensitive issue, we are not aware of a breach of confidentiality that has ever occurred as a result of such reports. And hospitals take seriously their responsibility to protect medical records from people who have no need to see them.4. People should know the physician who is responsible for their care. They have the right to participate in decisions involving their medical care. These decisions should be based on a clear explanation of the medical condition, the proposed procedures, the proposed treatments, and the risks involved.5. People should expect efficient and courteous attention from all hospital personnel. They should also respect the possibility that other patients’ needs might be more urgent.6. People have the right to be interviewed and examined in surroundings that assure privacy. They also have the right to know the role of any observer and to ask observers to leave. People also have the right to restrict visitors and can do this simply by notifying the nurse or physician responsible for their care.7. Mentally competent people have the right to reject any form of proposed treatment or diagnostic test. In particular, many people have profound feelings about resuscitation and life support measures like breathing machines or artificial kidney machines. Uncomfortable as this subject is, decisions about life support measures should not be left until the person is too ill to participate in a rational discussion. Preferences about such issues should be discussed candidly, at the appropriate time, and should be documented in the medical record, in a living will, or by assigning a durable power of attorney for health care. In the event that there are no such provisions, and the person is not capable of making medical decisions, this role is entrusted to a hierarchy of others, starting with a court-appointed legal guardian, then spouse, child over eighteen years, parent, or sibling (brother or sister), in that order.8. People may be asked to participate in research projects called clinical trials. Clinical trials can involve people only with their written consent and with the approval of the person’s physician. Furthermore, once involved in a clinical trial, the person has the right to discontinue participation at any time.9. People have the right to unrestricted communication with anyone. This includes physicians, lawyers, clergy, and representatives of AIDS-advocacy groups.10. People may leave the hospital against the advice of their doctors at any time. They will usually need to sign a form entitled “Discharge Against Medical Advice.” The implication of the form is that the physician will not be responsible for any harm that results from this action. In addition, the refusal of care by the person or the person’s legally authorized representative may, upon appropriate notice, result in termination of the patient-physician relationship. The exception to the discharging-against-advice right is that some states have laws requiring people with certain contagious diseases who are considered potentially harmful to others to remain in the hospital. It is conceivable that this ruling could be applied to people with HIV infection who are known to behave irresponsibly. We are not aware that this ruling has ever been applied in this way.11. People may not be transferred from one facility to another unless they receive a complete explanation of the need for the transfer and the alternatives to the transfer, and unless the receiving facility accepts the transfer. People who desire transfer to another hospital should notify their physicians, who will make the arrangements. Almost all transfers between hospitals are based on discussions between physicians, usually the physicians-of-record of the two facilities. The admitting office of the receiving hospital must also be involved to assure that the source of medical insurance complies with their requirements.12. People who are discharged from the hospital have a right to information regarding continuing health care requirements, including recommendations for medications, nutrition, activity, return to work, and follow-up medical evaluations.13. The person has the right to inquire about any charges by the hospital, the clinic, or a physician, and to be presented with various options for payment.*170\191\2*