Funtabulously Frivolous Friday Five 098: Comebacks

FFFF isn’t dead. It just smells funny. Incredibly it has returned from its shallow grave for the 98th edition. And this time we celebrate – the comeback. Come again? Exactly.

Question 1.

st-thomas

Caravaggio’s depiction of the greatest comeback of all time. But which modern-day emergency manoeuvre is being demonstrated by St Thomas Aquinas?

  • The finger thoracostomy.
  • Finger thoracostomy has been used by HEMS at the Royal London for a couple of decades. The procedure is a quick and reliable method of chest decompression in cases of tension pneumothorax and haemothorax. Most practitioners restrict its use to ventilated cases, allowing positive pressure ventilation to drive air or blood out of the hole.
  • Some advocate periodic re-fingering – really it depends on whether or not you went to a British public school.

Simple thoracostomy avoids chest drain insertion in prehospital trauma.
Deakin CD, Davies G, Wilson A.
J Trauma. 1995 Aug;39(2):373-4.

 

See comment from Mark Putland below

Question 2

Spores

From which microbial disaster did the Scottish Island of Gruinard make a comeback in 1986?

  • Anthrax
  • During ghastly research into biological warfare in 1942, a flock of sheep was brought to Gruinard, immobilised in crates, and bombed with a variety of devices that dispersed anthrax spores.
  • The experiment worked excellently, in that all the sheep died and the island was rendered uninhabitable for the best part of 50 years. Gruinard then attracted the unfortunate sobriquet of “Anthrax Island“.
  • The island was decontaminated (mostly) in 1986, with 280 tonnes of formaldehyde.

Question 3

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What is this nasty little creature, and why did it come back to the forefront of plastic surgery?

  • The medicinal leech
  • Surgeons have been mucking about with Hirudo medicinalis for over 2 millennia. The first documented example of its use was in the 6th century BC by Sushruta, a pioneering Ayuvedic surgeon:

“Leeches should be applied where the patient would be found to be old or imbecile, or a woman, or an infant, or a person of an extremely timid disposition, or a person of a delicate constitution.”

The Sushruta Samhita, Chapter XIII: Leeches and of how and which to use.

  • In the modern era the medicinal leech is used by plastic surgeons, because it is excellent at decreasing venous engorgement after microsurgical replantation.
  • Recombinant hirudin (lepirudin) was used for a few years as an alternative to heparin in cases of heparin-induced thrombocytopenia, and attracted interest as a potential treatment for coronary thrombosis, but production ceased in 2012.

Question 4

To whom does this piece of court evidence belong – and how did it enable him to come back?

  • John Wayne Bobbitt
  • Exhibit A is his severed penis, which was famously amputated by his wife in 1993, using a kitchen knife, before being thrown out of a moving car. In an astonishing sequence of crime scene investigation and microsurgery, it was found on the roadside and successfully reattached by microsurgeons.
  • John Bobbitt’s penis continued to make an exhibit of itself, in the 1996 movie entitled Frankenpenis.

Question 5

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Which WWI affliction made an unwelcome comeback at the Glastonbury Festival in 1998?

  • Trenchfoot.
  • Trenchfoot is an immersion syndrome which occurs when feet are cold and damp for hours at a time, resulting in ischaemia, maceration and ultimately gangrene. It was first described in the Napoleonic era, but came to prominence with the advent of trench warfare in WWI.
  • Trenchfoot returned for the wet Glastonbury weekends of 1998 and 2007: the festival’s medical team now includes over a dozen podiatrists.
  • Widespread tissue necrosis was also induced at Glastonbury 2005, following the reappearance of Chas ‘n’ Dave.

 

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Comments

  1. says

    Great post. I’d been meaning to find out why plastic surgeons used leeches.

    However, I think Carvaggio has painted St Thomas the Apostle there doing the finger thoracostomy. St Thomas Aquinas was a 13th century theologian, philosopher and priest.

    Sorry to be a pedant.

    Actually I’m not. I love being a pedant.

  2. Navin Naidoo says

    Great post

    Knew about the leeches from ancient India; don’t know whether the Kama Sutra covered the fingering bit before the great Thomases!

Comments