Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 230.
- Developed by Charles Barbier (1767-1841), after Napoleon commissioned a plan to develop a way for soldiers to communicate silently in the night without a light source. It proved too difficult for the soldiers and was abandoned.
- Braille had blinded himself as a child by accidentally stabbing himself in the eye with his fathers awl (used for putting holes in leather). Having heard about Barbier’s night writing the pair met at the Royal Institute for the Blind in Paris. It took Braille a further 9 years to perfect his system. [Reference]
Beards as we know, can be risky, particularly during bag-valve mask ventilation attempts. The problem has been solved with vaseline and tegaderm with the news spreading via social media. However, there was a mayor of Braunau am Inn on the Austrian-German border in the 16th Century who didn’t have the luxury of twitter. How did he succumb due to his facial hair?
- In 1567, Hans Steininger a popular mayor was known for his 4ft 6 inch beard. On September 28 of that year, there was a large fire in the town that caused a general panic. Steininger usually kept his prodigious beard hair rolled up and stuffed in a pocket, but during the commotion he was running around with it hanging free. In the midst of the chaos, he managed to step on his own beard, sending him tumbling down a flight of stairs and breaking his neck.
- Braunau am Inn is also known of the birth place of Adolf Hitler but for obvious reasons they celebrate Hans Steininger including a statue on the local church, his preserved beard and a tourist tour with its very own Hans Steininger actor. [Reference]
- Relative bradycardia in association with fever (Temperature-pulse dissociation).
- 1859 – Jean-Charles Faget (1818–1884) published a review of the clinical historical accounts of multiple patients suffering from fever in the 1839, 1853 and 1858 Yellow fever epidemics in New Orleans.
- ‘…I think I have arrived, at least for the differential diagnosis of yellow fever and our rural fevers, to a general fact of some importance; I mean the regular decay of the pulse, from the first or second day, to the fourth or fifth day, in the true yellow fever, at least in New Orleans, a regular and rapid decrease of the pulse, according to almost a hundred observations already, we may recognize that this is the true character of this fever. I do not know, indeed, that there is another serious acute illness, whose febrile reaction falls so early, so quickly, and with such regularity.‘ [Faget JC 1859 p84-85]
- Faget sign has been recorded with Salmonella typhi (Typhoid Fever); Yellow Fever (viral hemorrhagic disease); Legionella; C. burnetii (Q Fever); Legionella; Chlamydia; Mycoplasma; Tularemia; Colorado Tick Fever (Coltivirus); Leshmaniasis; Brucellosis; Psittacosis and Dengue Fever. [Reference]
“A previously well 30-year-old woman re-presented to the emergency department complaining of worsening central abdominal pain initially colicky at first presentation 2 days earlier. She was tachycardic at 105 and other vital signs were normal. Her abdomen was peritonitic. At initial presentation, she was thought to have biliary colic, even though ultrasound and hepatobiliary iminodiacetic acid scans were normal. She did not have plain abdominal films. Laboratory studies were normal. CT of the abdomen revealed a metallic wire-shaped foreign body at the mesenteric root of a small bowel volvulus.” What is the diagnosis?
- A laparotomy a mid–small bowel section of ischaemia and adhesions were found related to the perforation of a 7 cm piece of orthodontic wire.
- Most inert ingested objects, if they pass the cricopharyngeal sphincter, will pass spontaneously. The most common site for perforation or obstruction is the ileocaecal valve. The patient made a full recovery and recalled having braces 10 years prior but not of swallowing any wire. [Case of: Orthodontic braces come back to bite]
- When making a diagnosis one should first consider the obvious
- The law is named after Willie Sutton (1901–1980), a bank robber renowned for escaping from prisons. Finally apprehended, Sutton was allegedly asked by a reporter ‘Why do you always rob banks?‘ to which he replied ‘Why, that’s where the money is.‘
- His logic spurred William Dock (1898–1990) in 1960 to coin ‘Sutton’s Law‘ as it pertains to medicine…to ‘go where the money is’. On rounds as a visiting professor at Yale, Dock met a young Puerto Rican woman with an undiagnosed liver disorder despite an extensive series of tests. Suspecting the diagnosis of schistosomiasis he said ‘Why don’t you apply Sutton’s Law?’ i.e. in this particular patient, perform a liver biopsy. The biopsy confirmed ova and the diagnosis.
- 1961 – Yale physicians Robert Petersdorf and Paul Beeson were on that very teaching round and published a paper examining ‘Fever of Unexplained Origin‘ in which Sutton’s Law was first recounted as a footnote. ‘We are indebted to Dr. William Dock for the term Sutton’s Law. It recommends proceeding immediately to the diagnostic test most likely to provide a diagnosis, and deplores the tendency to carry out a battery of ‘routine’ examinations in conventional sequence…’
- Sutton’s Law gained immediate popularity because it reminded physicians to bypass unnecessary, inconclusive, and often expensive studies.
- 1976 – Although Dock was the inventor of the eponym ‘Sutton’s law,’ Sutton himself denied ever saying the phrase. “The credit belongs to some enterprising reporter who apparently felt a need to fill out his copy,” wrote Sutton in his autobiography “I can’t even remember where I first read it. It just seemed to appear one day, and then it was everywhere. If anybody had asked me, I’d have probably said it… Like Dr Dock said, it couldn’t be more obvious. Why did I rob banks? Because I enjoyed it. I loved it!“
- The diagnostic strategy of going for the obvious is referred to as Sutton’s Law. The slip (Sutton’s slip) occurs when possibilities other than the obvious are not given sufficient consideration. [Reference]
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