Dr James Le Fanu: 13 December
George Orwell, writing in the December issue of Tribune in 1946, commended Christmas for sanctioning overindulgence with its ‘platefuls of turkey, flaming plum pudding and Christmas cake with almond icing an inch thick’, even at the cost of ‘peevishness the next morning and castor oil the day after’.
For researchers, the Christmas meal provides the rather different opportunity of an experimental situation for investigating the physiological effects of a large calorie intake on the human organism. John Hampton, former Professor of Medicine at Nottingham University, in a classic study of six healthy volunteers, investigated the strain imposed on the heart by a typical Christmas lunch (a standard festive meal of turkey, mince pies and wine).
He found that the amount of work done by the heart – the cardiac output – increased by a third, ensuring increased blood ow to the stomach to facilitate digestion. This increase in cardiac output could have potentially lethal consequences in those with narrowed coronary arteries.
‘I have noticed full stomachs in several people who died of an acute heart attack,’ observed a pathologist in a letter to The Lancet. ‘Such patients are de nitely at risk following a large meal, the danger being compounded by alcohol, which further raises the cardiac output.’
Christmas lunch is thus clearly a hazardous affair, though there can be few more pleasant ways to go than passing out on the sofa and then shuffling on to the next world, having enjoyed one last meal in the bosom of the family.
In a further experiment relevant to the traditional dilemma of whether it is best to sleep o a heavy Christmas lunch in front of the fire, or burn it off by taking the dog for a brisk jog, the 13th-century Holy Roman Emperor Frederick II ‘caused two condemned criminals to be given a good meal’ after which one was allowed to rest and the other compelled to perform strenuous exercise. A former professor of physiology at London University reports that, subsequently at the autopsy following their execution, ‘the rested man’s stomach was found to be empty (he having obviously digested his meal) while that of the man who was forced to exercise was still full’.
Further investigations have added little to the obvious inference from Frederick’s experiment that exercise inhibits the emptying of the stomach, slowing the digestion to cause nausea and discomfort. Nonetheless, doctors at Guy’s Hospital back in the 1950s found this only applies to vigorous exercise, whereas ‘amicable walking and talking’ actually enhanced stomach emptying.
The several further dangers associated with Christmas festivities are illustrated by the man admitted to Greenwich Hospital on Christmas Day with acute obstruction of the gut, which proved at operation to be due to a large balloon stuck in his duodenum. He made an uneventful recovery, as did an 86-year-old woman who developed peritonitis on Boxing Day and from whose abdomen the surgeon retrieved the plastic robin used to decorate the Christmas cake and whose beak had perforated her gut wall.
Cocktail sticks, too, have their dangers as with the man in his late 30s admitted to Birmingham’s Selly Oak ‘pale, confused and with no recordable blood pressure’. Attempts at resuscitation failed and at necropsy a cocktail stick was found to have perforated through the oesophagus into the main blood vessel – the aorta – running behind it. At the inquest, his wife stated that on Christmas Day they had been eating sausages wrapped in bacon secured with a cocktail stick. These were diff¡cult to see and she had found one in her mouth and removed it. Her husband jokingly commented that he must have swallowed his – as indeed he had.
These hazards of Christmas aside, few would dispute George Orwell’s stirring conclusion to his Tribune article: ‘One celebrates a feast for its own sake – so let there be no gloomy voices of vegetarians or teetotallers to lecture us about what we are doing to the lining of our stomachs.’
This week’s medical query comes courtesy of a lady from Suffolk, who for the past eight years has been troubled by a twitch in her right eye that has become much more marked over the past few months. ‘I have extreme blinking. Now both my eyes close and it’s diff¡cult to open them,’ she writes.
This makes her everyday activities very diff¡cult as she can no longer drive and reads only ‘very little’. Her doctor has done various tests that were normal, other than evidence of a slightly underactive thyroid.
The long duration of these symptoms would suggest this is a condition known as benign essential blepharospasm (uncontrolled muscle contractions of the eyelids). The cause is unknown, though it can certainly be exacerbated by fatigue and stress, or may be a side effect of drugs used for the treatment of Parkinson’s. The most favoured treatment is three-monthly injections of botulinum toxin (Botox), which induce a paralysis of the relevant muscles and permit most of those a ected to lead a relatively normal life.
Email drjames@lady.co.uk
For researchers, the Christmas meal provides the rather different opportunity of an experimental situation for investigating the physiological effects of a large calorie intake on the human organism. John Hampton, former Professor of Medicine at Nottingham University, in a classic study of six healthy volunteers, investigated the strain imposed on the heart by a typical Christmas lunch (a standard festive meal of turkey, mince pies and wine).
He found that the amount of work done by the heart – the cardiac output – increased by a third, ensuring increased blood ow to the stomach to facilitate digestion. This increase in cardiac output could have potentially lethal consequences in those with narrowed coronary arteries.
‘I have noticed full stomachs in several people who died of an acute heart attack,’ observed a pathologist in a letter to The Lancet. ‘Such patients are de nitely at risk following a large meal, the danger being compounded by alcohol, which further raises the cardiac output.’
Christmas lunch is thus clearly a hazardous affair, though there can be few more pleasant ways to go than passing out on the sofa and then shuffling on to the next world, having enjoyed one last meal in the bosom of the family.
In a further experiment relevant to the traditional dilemma of whether it is best to sleep o a heavy Christmas lunch in front of the fire, or burn it off by taking the dog for a brisk jog, the 13th-century Holy Roman Emperor Frederick II ‘caused two condemned criminals to be given a good meal’ after which one was allowed to rest and the other compelled to perform strenuous exercise. A former professor of physiology at London University reports that, subsequently at the autopsy following their execution, ‘the rested man’s stomach was found to be empty (he having obviously digested his meal) while that of the man who was forced to exercise was still full’.
Further investigations have added little to the obvious inference from Frederick’s experiment that exercise inhibits the emptying of the stomach, slowing the digestion to cause nausea and discomfort. Nonetheless, doctors at Guy’s Hospital back in the 1950s found this only applies to vigorous exercise, whereas ‘amicable walking and talking’ actually enhanced stomach emptying.
The several further dangers associated with Christmas festivities are illustrated by the man admitted to Greenwich Hospital on Christmas Day with acute obstruction of the gut, which proved at operation to be due to a large balloon stuck in his duodenum. He made an uneventful recovery, as did an 86-year-old woman who developed peritonitis on Boxing Day and from whose abdomen the surgeon retrieved the plastic robin used to decorate the Christmas cake and whose beak had perforated her gut wall.
Cocktail sticks, too, have their dangers as with the man in his late 30s admitted to Birmingham’s Selly Oak ‘pale, confused and with no recordable blood pressure’. Attempts at resuscitation failed and at necropsy a cocktail stick was found to have perforated through the oesophagus into the main blood vessel – the aorta – running behind it. At the inquest, his wife stated that on Christmas Day they had been eating sausages wrapped in bacon secured with a cocktail stick. These were diff¡cult to see and she had found one in her mouth and removed it. Her husband jokingly commented that he must have swallowed his – as indeed he had.
These hazards of Christmas aside, few would dispute George Orwell’s stirring conclusion to his Tribune article: ‘One celebrates a feast for its own sake – so let there be no gloomy voices of vegetarians or teetotallers to lecture us about what we are doing to the lining of our stomachs.’
This week’s medical query comes courtesy of a lady from Suffolk, who for the past eight years has been troubled by a twitch in her right eye that has become much more marked over the past few months. ‘I have extreme blinking. Now both my eyes close and it’s diff¡cult to open them,’ she writes.
This makes her everyday activities very diff¡cult as she can no longer drive and reads only ‘very little’. Her doctor has done various tests that were normal, other than evidence of a slightly underactive thyroid.
The long duration of these symptoms would suggest this is a condition known as benign essential blepharospasm (uncontrolled muscle contractions of the eyelids). The cause is unknown, though it can certainly be exacerbated by fatigue and stress, or may be a side effect of drugs used for the treatment of Parkinson’s. The most favoured treatment is three-monthly injections of botulinum toxin (Botox), which induce a paralysis of the relevant muscles and permit most of those a ected to lead a relatively normal life.
Email drjames@lady.co.uk