Abstract
Before embarking on a discussion of the various problems connected with bleeding intracranial arterial aneurysms, I should like to remind the reader of a general problem: how much can be spent on these patients, whose active treatment demands both intellectual and manual performance of a high order? The answer varies with the affluence of the country and with the availability of medical manpower. In a country with a high per capita income it is reasonable to spend resources on improving the chances of survival of one small group by 10–20 per cent; such expenditure cannot be afforded in a country where famine is a regular visitor. Aneurysm surgery must be viewed in the perspective of the country where it is practised. At the moment of writing there is about one neurosurgeon to 100,000 inhabitants in the United States; in Finland, one neurosurgeon to 650,000 inhabitants. In addition Finland is experiencing a severe shortage of nurses, and specialties like neurosurgery, cardiovascular surgery and gynaecology and obstetrics have been particularly hard hit. So, in spite of having the highest incidence of subarachnoid haemorrhage in the world (24/100,000 inhabitants a year; Aho 1974) and being sixteenth on the list of the industrialized nations, in neurosurgery Finland is at the moment forced to adopt many of the attitudes of developing countries.
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References
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Troupp, H. (1976). The Management of Intracranial Arterial Aneurysms in the Acute Stage. In: Krayenbühl, H., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 3. Springer, Vienna. https://doi.org/10.1007/978-3-7091-7080-9_2
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