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 231.
You find yourself on holiday in Africa helping out with a dermatology clinic (yes, your forte as an emergency physician). In the queue is a young boy who describes a papular “raspberry-like” lesion which appeared on his arm, then healed after 8 weeks. He now has widespread dissemination of smaller skin lesions. Beside him is his mother whom you note has unusual shaped shins. What is the diagnosis?
- Yaws, (the name is believed to originate from “yaya,” which in the indigenous Caribbean language means sore), is a chronic, contagious, nonvenereal infection caused by the spirochete Treponema pallidum.
- There is a primary disease usually a solitary lesion “the mother yaw” which heals with time and then further lesions erupt on the skin indicating secondary disease.
- The mother has a saber shin deformity (an abnormality of the tibia characterized by marked anterior bowing of the lower leg) from tertiary disease. Other signs would include: soft tissue destruction jointly with severe skin ulceration and painful hyperkeratosis on palms and soles, leading to gross deformities of the legs, skull, nose, palate, and upper jaw, with consequent irreversible disabling and disfiguration.
- Direct skin-to-skin contact is the main route for transmission, together with breaks in the skin caused by injuries, bites, or excoriations. It can be treated with penicillin, tetracycline, doxycycline, or erythromycin. [Reference]
- This letter provoked a postmortem examination at which Dr John Henry Bell (1832-1906) was present. Bell reasoned that the deaths could not be due to fibers, dust, or hair because the woolsorters did not suffer more than others from cough, and the deaths were sudden. A colleague who had been visiting European bacteriologic laboratories suggested that the disease might have some connection with the splenic fever of sheep and cattle, which was caused by the anthrax bacillus.
- Dr Bell inoculated animals with blood from a fatal case. They all died, and he found anthrax bacilli in their blood. “I will not enter into the particulars as to its cause, nature, and symptoms (these are more suited for the medical press), except to say that it is produced by the inhalation of living organisms derived from the fleeces of animals that have died from anthrax. It may readily be communicated from man to animals, and their blood when examined after death abounds with bacteria (bacillus anthrax) like caterpillars without legs—millions in a drop.”
- In May 1880, a man named Samuel Firth contracted the disease and died. Bell attended the man and wrote on the death certificate that the man had died from woolsorters’ disease as a result of his employer’s neglect. The ensuing court case led to a series of voluntary guidelines. These were reaffirmed and expanded in 1884 and were continued by voluntary compliance until 1899, when they were adopted as official policy by the British Home Office.
- The woolsorters recognised Dr Bell’s contributions by presenting him at a public dinner with a gold watch and chain. [Reference]
- Oral rehydration solution (ORS)
- Originally used in India by NF Pierce and N Hirschhorn in tertiary paediatric centres some years earlier. Dilip Mahalanabis was witness to the cholera outbreaks every monsoon season which had a 30% mortality rate due to lack of IV fluids. He thought it would be worth trialling this fluid in the dire circumstances.
- Mortality dropped from 30% to 1%. Of course the medical community was sceptical until a WHO cholera specialist visited and confirmed the results. [Reference]
What did Thomas Hodgkin die of in 1866?
- Dysentery – perhaps some ORS may have helped?
- Moses Montefiore met Hodgkin in 1823 through his brother, who briefly was Hodgkin’s patient but fired him. However, Moses Montefiore and Hodgkin became close friends, and Hodgkin served as personal physician for Moses Montefiore and his wife. Their journeys together were philanthropic purposes and on his trip to Palestine in 1866 Hodgkin became ill with a dysenteric-like disease and died on April 4. He was buried in Jaffa. [Reference]
- In February I76I, Dr David Bayford was present for an autopsy where an emaciated woman of 62 died of ‘obstructed deglutition’ of many years’ standing. Dr Lucas performing the autopsy could find no cause.
- “Bayford, with the optimism and enthusiasm of youth and an enquiring and prepared mind, reviewed the autopsy findings and was successful in detecting the cause of the obstruction as being an aberrant right subclavian artery which arose from the left side of the arch of the aorta, its last branch passing, on its way to the right upper extremity, between the trachea and the front of the oesophagus, compressing its lumen to cause the obstructed deglutition“. [Reference]
- The term comes from the Latin, lusus naturae, meaning “prank of nature”.
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