Dr James Le Fanu: 21 March
There might seem few things quite as futile as doctors’ uncritical enthusiasm, for the best part of 1,700 years, for blood letting. It started with Galen, personal physician to Marcus Aurelius in the 2nd century AD, who promoted its value in ‘balancing the humors’. It was still widely used in the 19th century with the common practice of applying up to 50 leeches at a time to the skin of patients with pneumonia – their combined e orts removing up to three litres of blood.
It only came to an end when a French physician, Pierre Louis, invoked the novel method of statistical analysis to show that bleeding, whether early or late in the course of the illness, in large or small amounts, had zero effect on whether the patient lived or died.
It is hard to believe bloodletting would have lasted so long if some at least did not feel it was of value, as Sheffield family doctor Ghilam Nahami discovered to his surprise when one of his patients remarked how his migraine headaches were much diminished since he had started to donate blood regularly. An intrigued Dr Nahami went on to interview 2,000 donors while they were enjoying their traditional biscuit and cup of tea. Most felt no better, a few felt worse – mainly due to faintness – but nearly 150 earmarked that they felt ‘refreshed and revitalised’ after a session. Twenty donors con rmed its e cacy in reducing the frequency of their migraines, and a similar number noted that it also prevented nosebleeds.
Several years ago, Surgeon Commander Rick Jolly, senior medical officer in the Royal Navy during the Falklands War, drew attention to a further important effect. Speaking at a conference at the Royal College of Surgeons he described how, prior to hostilities, he had arranged for 900 soldiers to donate a pint of blood. His precautionary measures paid off . Many of the casualties sustained high-energy blast injuries, resulting in large muscle wounds with heavy blood loss.
He was, however, astonished at the ‘speed and vigour’ with which they recovered from their wounds, and the very low mortality rate – less than one per cent – of those requiring major surgery. He attributed these impressive results to the preceding blood-donor session in gingering up the body’s repair mechanisms. Those early physicians, it seems, might have been a lot wiser than we give them credit for.
This week’s medical query comes courtesy of a woman in her early 70s who, since her teenage years, has had eczema of her lower legs – controlled by the standard treatments of moisturising cream and a steroid ointment. Then four months ago, suddenly and unexpectedly, her eczema spread all over her body. ‘It drives me crazy with constant itching, especially at night,’ she writes, and the excessive scratching has caused recurrent attacks of cellulitis. ‘No one seems to have any idea what might have caused this sudden flare-up nor what can effectively relieve it.’
There are several recognised trigger factors that can cause this type of sudden exacerbation of previously mild eczema including, notably, intercurrent infection, a viral illness such as flu, and stress. For most, the underlying cause of their eczema is not known and the same probably applies to such fluctuations in its severity. It certainly sounds as if referral to a skin specialist is warranted but, in the meantime, it would be appropriate to discuss with the family doctor whether a course of oral steroids might help bring it under control.
Email drjames@lady.co.uk
It only came to an end when a French physician, Pierre Louis, invoked the novel method of statistical analysis to show that bleeding, whether early or late in the course of the illness, in large or small amounts, had zero effect on whether the patient lived or died.
It is hard to believe bloodletting would have lasted so long if some at least did not feel it was of value, as Sheffield family doctor Ghilam Nahami discovered to his surprise when one of his patients remarked how his migraine headaches were much diminished since he had started to donate blood regularly. An intrigued Dr Nahami went on to interview 2,000 donors while they were enjoying their traditional biscuit and cup of tea. Most felt no better, a few felt worse – mainly due to faintness – but nearly 150 earmarked that they felt ‘refreshed and revitalised’ after a session. Twenty donors con rmed its e cacy in reducing the frequency of their migraines, and a similar number noted that it also prevented nosebleeds.
Several years ago, Surgeon Commander Rick Jolly, senior medical officer in the Royal Navy during the Falklands War, drew attention to a further important effect. Speaking at a conference at the Royal College of Surgeons he described how, prior to hostilities, he had arranged for 900 soldiers to donate a pint of blood. His precautionary measures paid off . Many of the casualties sustained high-energy blast injuries, resulting in large muscle wounds with heavy blood loss.
He was, however, astonished at the ‘speed and vigour’ with which they recovered from their wounds, and the very low mortality rate – less than one per cent – of those requiring major surgery. He attributed these impressive results to the preceding blood-donor session in gingering up the body’s repair mechanisms. Those early physicians, it seems, might have been a lot wiser than we give them credit for.
This week’s medical query comes courtesy of a woman in her early 70s who, since her teenage years, has had eczema of her lower legs – controlled by the standard treatments of moisturising cream and a steroid ointment. Then four months ago, suddenly and unexpectedly, her eczema spread all over her body. ‘It drives me crazy with constant itching, especially at night,’ she writes, and the excessive scratching has caused recurrent attacks of cellulitis. ‘No one seems to have any idea what might have caused this sudden flare-up nor what can effectively relieve it.’
There are several recognised trigger factors that can cause this type of sudden exacerbation of previously mild eczema including, notably, intercurrent infection, a viral illness such as flu, and stress. For most, the underlying cause of their eczema is not known and the same probably applies to such fluctuations in its severity. It certainly sounds as if referral to a skin specialist is warranted but, in the meantime, it would be appropriate to discuss with the family doctor whether a course of oral steroids might help bring it under control.
DADDY COOL
Cold water can be an invigorating remedy for male infertility as first reported 50 years ago by Doctor HA Davidson – inspired by reading of a curious experiment where scientists, having placed a woolly bag over a ram’s scrotum noticed its sperm count had fallen precipitously. He suggested to three sub-fertile men that they should do the opposite and cold sponge their scrotums twice a day – with the pleasing result that their wives conceived almost immediately.Email drjames@lady.co.uk