Dundra, G. Porphyria and the folkloric vampire. BMJ, 1999, pp. 319–335.
2 LEPROSY: A PIECE OF HISTORY, OR STILL A THREAT?
LEPROSY IS A DISEASE known to us since biblical times. But have you known or known of anyone with this disease?
Are there still leper colonies?
In the Bible (Luke 17: 11-19), Jesus encounters ten men known as “lepers.” Historically, lepers were forbidden entry to towns and were required to ring a bell, announcing their contact risk. Jesus cures the men, and the priests in the town certify them as “clean.” Only one man, however, returns to thank Jesus.
Leper colonies, or quarantine houses, were common in the Middle Ages, often run by religious missionaries. Leprosy was greatly feared because of the disfigurement and disability that it causes.
Despite its biblical descriptions, leprosy is not highly contagious. It is most likely transmitted by the respiratory route from untreated individuals, usually over long-term contact. While the disease usually starts with a characteristic skin rash, it goes on to damage the nerves in the fingers and toes. The lack of sensation leads to skin damage and numbness, resulting in tissue loss. It also leads to paralysis of small muscles.
Leprosy is today known as Hansen’s Disease, named after Armauer Hansen, a Norwegian doctor who in 1876 first observed under a microscope the bacterium Mycobacterium leprae that causes the disease.
The cure came in 1950. Dr. Vincent Barry, in Trinity College, Dublin, while working on medications to counter tuberculosis, stumbled on Dapsone, an antimicrobial that was discovered to be effective against the leprosy bacterium. That discovery was to save 15 million lives. Dapsone, in combination with other anti-TB drugs, is still used to treat leprosy.
Spinalonga in Crete was one of the last leper colonies to close, in 1957. However, if we reflect on the fact that HIV has been largely contained, and that 65 percent of people with cancer now beat it, it is incredible to learn that leprosy is still infecting people. United States has 100 new cases of leprosy each year. In 2013, in the state of Maharashtra, India, 35 new cases presented to one clinic alone in a one-week period. In the same state, it is documented that 5,000 people have been cured of the disease and now live on in relatively good health.
So, while it’s a myth that leprosy has been eradicated, it is also a myth that it untreatable and irreversible. Leprosy can now be cured.
REFERENCE
Yadav, N., S. Kar, B. Madke, D. Dashatwar, N. Singh. Leprosy elimination a myth busted. Journal of Neurosciences in Rural Practice, vol. 5, suppl. 1, 2014, pp. 28–32.
3 DIVINE INTERVENTION: CAN PRAYER EFFECT MEDICAL OUTCOMES?
MANY OF US HAVE family or friends who have faith that praying at a time of misfortune, surgery, or life-threatening illness will improve the outcome. Some researchers have attempted to find if this is actually the case.
Difficulties arise when scientific analysis is compared with theological arguments. The scientist first needs to assume or prove that God exists, that prayer can travel through space to reach God, and that God is responsive to prayer and can influence the outcome for the better. Theological arguments will be based instead on certainty that God exists, is receptive to prayer, and has omnipotent ability to influence outcomes through a mechanism unknown to science.
To study the efficacy of prayer, medical science would require performing trials that were randomized and double-blinded. Subjects would be picked at random, and the patients would have to be unaware of whether they were being prayed for or not. Then, for a further period, the roles would have to be reversed, with the original group proceeding without prayer while the other group was prayed for, at a time of great medical concern. Not an easy job to do, and for sure no one has done it.
However, studies have been done in randomized fashion, and ten of these studies were analyzed by the Cochrane Review to report on what evidence could be found. The Cochrane Review is an international organization that reviews human research and reports in an evidence-based fashion. In 2009 the review looked at ten randomized trials which it felt tested the hypothesis that “praying to God can help those who are prayed for.” The conclusion was that the methodology of these trials can scarcely allow outcomes to be presented as proof. They also beg the question as to whether God would intervene in case A and ignore the plight of case B.
The studies fail as well to address the controversy as to whether death is necessarily always a negative outcome. For instance, if a very elderly person has a debilitating stroke, perhaps that person should be allowed to depart this world and not linger in pain.
Some of the prayers in the studies were actually retroactive, with prayers coming after the event. (Analysts pointed out that there was no time in heaven.)
One trial showed a small reduction in deaths from sepsis (blood infections) in those who were prayed for. Another study found an actual increase in surgical complications in the prayed-for group, but only if they knew that they were being prayed for.
One study in Korea at an IVF clinic reported that prayer could be related to success rates in pregnancy. The prayed-for group had a better pregnancy rate. However, the prayers were exclusively Christian, and many in the study were Catholics, whose church is opposed to IVF. Is this outcome therefore a positive one?
In summary, the Cochrane Review felt that the mixture of science and theology was unsound in all ten studies and that much additional research was needed.
Perhaps it would be better to have atheists conduct these studies to remove bias. Certainly, a science-based model is needed before we can conclude whether the claim of improved outcomes from prayer for the sick is a myth.
However, this is not to say that prayer and religious faith do not benefit persons diagnosed with serious disease. Researchers looked at coping strategies in elderly women recently diagnosed with breast cancer. They concluded that 91 percent reported that religious faith provided emotional support; 70 percent reported strong emotional support; and 60 percent felt that religion now brought meaning to everyday life.
These effects could of course be related to faith and social support rather than divine intervention. So … come back in 30 years!
REFERENCES
Jørgensen, K.J., A. Hróbjartsson, P.C. Gøtzs. Divine intervention? A Cochrane Review on intercessory prayer gone beyond science and reason. Journal of Negative Results in Biomedicine, 2009, p. 7.
Feher, S., and R.C. Maly. Coping with breast cancer in later life: The role of religious faith. Psycho-oncology, vol. 8, no. 5, 1999, pp. 408–416.
4 EPILEPSY: OLD DEMONS OR NEW UNDERSTANDINGS?
MY DOCTOR, MY FRIEND, my neighbour, my favourite musician, and my local police officer all have it. Add to the list Charles Dickens, Vincent Van Gogh, Alfred Nobel, Richard Burton, Julius Caesar, and Sir Isaac Newton, and you may realize how pervasive this condition is. Today there are some 50 million people with epilepsy worldwide.
One seizure does not constitute epilepsy. Epilepsy is a disease involving recurrent seizures. The origin or cause of these neurological episodes is unknown in the majority of cases, rendering it a primary disorder (a condition not known to be related to other medical pathology).
Epilepsy may be the most misunderstood and stigmatized condition in human medicine. In the twenty-first century, the lore and beliefs of our past seem hard to change. Even the term epilepsy comes from the Greek verb epilambeneim, meaning to be seized, or taken by surprise.
As historically all diseases were regarded as a form of punishment, this condition was regarded as a form of retribution. Sufferers were believed to be possessed by demons. The ailment was thought to be infectious, and thus isolation was employed. The first enlightenment came with Aristotle, who felt it was an organic disorder. It wasn’t until 1875 that an English neurologist described it as a disruption in electrical activity in the brain. In 1930, a device called the electroencephalogram first recorded electrical activity from the brain and allowed objective diagnosis.
The first anti
convulsant (bromide) came to us in 1875. Now dozens of such medications control seizure activity and allow for a more normal life. However, one-third of patients still have poorly controlled (refractory) epilepsy.
And not all persons who experience seizures are only mildly impaired. Persons with neurological disorders have a higher incidence of seizures — for instance, 25 percent of children with cerebral palsy have accompanying seizures. Many of these seizure patterns can be severe, depending on the degree of neurological damage.
But a large number of healthy functioning children and adults have not been permitted to take part in mainstream society as a result of mythology. Some of this stigmatization is compounded by inaccurate portrayals of epilepsy in the media:
Demonic possession. (Remember The Exorcist?)
Foaming at the mouth. This rarely happens in a seizure and is merely a stereotype.
An object must be placed in the patient’s mouth to stop them swallowing their tongue. This is not the right thing to do, and no one can swallow their tongue.
People become violent in a seizure. Patients are unconscious and unable to demonstrate violence.
It is also sometimes believed that persons with epilepsy have lower IQs. This myth is based on the fact that school leavers with epilepsy often demonstrate poor academic achievement. However, this may relate to several factors other than IQ. For instance:
Confusion and memory loss are common after a seizure.
Absence seizures (petit mal) may be mistaken for daydreaming.
Drug therapy: Many anticonvulsants slow cognitive function and interfere with short-term memory.
Children with seizures may miss more school or be stigmatized by seizures in the classroom.
The stigma of epilepsy is often more disabling than its neurological effects. I quote Orrin Devinsky, a landmark American neurologist: “For persons with epilepsy, fighting the stigma of cultural bias is followed in life by educational underachievement, low self esteem, restricted opportunities for social activities, poor employment opportunities, and problems with intimate relationships.” These negative attitudes to epilepsy can lead to difficulty in finding employment and developing relationships. Vulnerability in social situations, where a seizure can occur without warning, leads to withdrawal from society, further compounding the problem.
Equal-opportunity employment bodies and epilepsy societies have done Trojan work in advocating for persons with epilepsy. Increasing awareness among employers, schools, and career guidance officers has moved this cause forwards.
Up to now, people with epilepsy have been reluctant to disclose their condition when applying for jobs. However, employers and colleagues might well consider learning what to do in the event of a seizure. Epilepsy also affects what insurance is available for the employee and the employer. Clearly there are some jobs that will not be open to people with epilepsy in the interest of safety. For instance, in Ontario one needs to be seizure free for six months to drive a car. In the United States, one needs to be ten years’ seizure free (without medications) to have a commercial driver’s licence.
However, being employed gives people a sense of identity and self-worth and provides structure in their day, while helping them to be viewed as valued members of society. It can be hard when these doors are closed.
The fact that society in general is 50 years behind the times in awareness of epilepsy truths is a fixable problem. Consider this: the year I entered medical school in 1970 was the year that the UK law prohibiting marriage of persons with epilepsy was repealed. That would hardly have done a lot for intimate relationships in former years!
When we consider the opinion of a neurological surgeon, Dr. Joseph Price, who stated in 1892 that the causes of seizures lay in “debauchery, chocolate, coffee, excessive lust, and amorous love songs,” I suppose we have come a long way.
REFERENCES
Baxendale, S., and A. O’Toole. Epilepsy myth alive and foaming in the 21st century. Epilepsy and Behaviour, vol. 2, no. 2, 2007, pp. 192–196.
Price, J. The surgical treatment of epilepsy. JNervMent Dis., 1892, pp. 396–407.
Maria, S.L., and O. Devinsky. Epilepsy and behaviour: A brief history. Epilepsy and Behaviour, vol. 1, no. 1, 2000, pp. 27–36.
Voskuil, P.H. The illness of Vincent Van Gogh. J HistNeurosci, vol. 14, 2005, pp. 169–175.
5 THE ROD OF CADUCEUS: ONE SNAKE OR TWO?
THE SYMBOL ON THE LEFT above is probably familiar to you as the symbol of medicine or healing. It is common to see this symbol in North America, since the Caduceus was adopted by the U.S. Army’s Medical Department at the beginning of the twentieth century.
The rod stands for power, the serpents stand for wisdom, and the two wings represent diligence and activity. However, this emblem is actually the symbol of Hermes, the Greek god who is protector of merchants — and tricksters and thieves!
The symbol on the right, the Rod of Asclepius, is the true symbol of medicine and healing. It is the symbol adopted by the World Health Organization and all national medical organizations. Unlike the Rod of Caduceus, it has only one snake and no wings.
Asclepius was a Greco-Roman god of healing, worshipped as the son of Apollo. Historians have traced his existence to the sixth century BC. He was perceived as a patron of physicians and as the origin of the rod of physicians. His daughters are Hygieia, goddess of hygiene and cleanliness, and Panacea, goddess of remedies.
The origin of this symbol is also fraught with myths. One story tells of Asclepius treating a patient who was threatened by an approaching snake. He killed the snake with his staff and retained it as a symbol of healing.
So, how much do most doctors, nurses, or medical students know about this symbolism of their profession?
In 2014, a study was undertaken of 200 doctors and 100 medical students to assess their knowledge of medical symbols, among them the emblem of healing. Only 6 percent of doctors were aware of the rod of Asclepius as the true emblem of healing.
Humans are fond of symmetry, and so many may simply find the symmetrical Caduceus more attractive than the Asclepius. Many institutions continue to use the Caduceus rather than the Asclepius as their symbol, and that is unlikely to change.
REFERENCE
Shetty, A., S. Shetty, O. Dsouza. Medical symbols in practice: Myths vs. reality. Journal of Clinical Diagnostic Research, vol. 8, no. 8, 2014, pp. 12–14.
6 FEVER THROUGH THE CENTURIES
PROBABLY NO OTHER medical topic is as fraught with myth as fever, particularly fever in children. Partly to blame is that the causes of fevers may range from inconsequential to life-threatening.
Even the definition of fever varies widely. Fever is generally agreed to be an elevation in body temperature above the normal range. But what is a normal body temperature? In general, you could take 37 degrees Celsius as a normal body temperature and 38 degrees as a fever. However, this range varies over the journey from the cradle to the seniors’ home.
It isn’t valid to report a temperature based on a flushed infant with a warm forehead. Temperatures are measured at many body sites. Generally speaking, core body temperature, measured in the rectum, is 0.5 degrees higher than a measurement taken peripherally, such as under the armpit. Some medical practitioners may even ask for a correction for the time of day, believing the afternoon body temperature to be 0.5 degrees higher than one taken later in the day.
Most people do not have baseline measurements of their own normal body temperatures. As these vary, it might be possible to entertain different definitions of fever for given individuals.
Fevers account for 30 percent of children’s medical visits and 20 percent of all emergency room visits. These figures demonstrate the magnitude of the clinical problem. It is
unlikely that any other single issue reaches the significance or volume of this complaint. “Fever phobia” is ascribed to parents who are unduly anxious about the possible outcomes of fever in their children. However, fever phobia is also found in nursing staff
and medical staff.
Fever anxiety is usually related to adverse experiences of children with fevers, or reports they’ve heard about negative outcomes. Dismissing fevers would be foolhardy. Fever in an infant under two months of age is more likely to be a manifestation of serious bacterial infection than fever in a six-year-old. Also, fever in an unimmunized child requires a different set of considerations from those of a regular fever visit.
So, armed with this introduction, let’s look at some of the myths that have developed over the centuries, many of which are still around.
Does serious infection always manifest as fever?
While fever is a common manifestation of infection, not all serious infections will have a fever at examination. The most sinister example is a child in septic shock. In this condition, bacteria invade the bloodstream in large numbers and cause a clinical state of shock. The result is low blood pressure and poor blood supply to the skin and vital organs. In this scenario, the temperature measurement will actually be low, not high — a state called hypothermia. This condition is fatal unless treated quickly and aggressively. Even with treatment, morbidity and mortality are significant. This outcome is probably the number 1 reason for fever phobia and for the enormous number of visits to doctors and emergency rooms. The infection may start with fever, but in the shock stage there will be no temperature elevation.
The higher the fever, the sicker the child?
One of the most benign conditions in pediatric medicine is called roseola. This is a viral illness caused by human herpes virus type 6. The infant will usually have an extremely high temperature, often 40 degrees, but no other findings are evident, and all X-rays and blood tests are normal. Then, after three days, a characteristic rash declares itself, and all is well again. However, the rash does not appear until after the three days of high fever.
Of Plagues and Vampires: Believable Myths and Unbelievable Facts from Medical Practice Page 2