YOUR HEALTH Dr James Le Fanu: 14 December
Heretical as it is to say so, smoking can be good for your health. Indeed, the main credit for the worldwide spread of tobacco use must go to the initial enthusiastic advocacy of doctors and two Spanish physicians in particular: Nicolas Monardes and Juan de Cárdenas.
‘To seek to tell the virtues and greatness of this holy herb,’ wrote de Cárdenas in 1578, ‘the ailments that can be cured by it, the evils from which it has saved thousands, would go unto infinity.’
Meanwhile, Dr Monardes cited no fewer than 20 specific ailments, from toothache to cancer, for which tobacco was, he claimed, a useful treatment. Two factors contributed to its popularity in medical circles. Tobacco was conceived of as being ‘hot and dry’, which meant it counteracted a surfeit of illnessinducing ‘wet humours’. Then, tobacco had a pharmacological effect, which is more than can be said for most of the other contemporary herbal remedies. Current scientific research suggests tobacco can be of value in several conditions, including ulcerative colitis, Parkinson’s and Alzheimer’s. Many of those with ulcerative colitis report that smoking improves its main symptoms of pain and diarrhoea. A gut specialist from University Hospital Cardiff describes the case of a 36-year-old woman who had smoked a packet a day for many years before quitting at the age of 32 – only to develop ulcerative colitis a year later. She started smoking again ‘and noticed a marked improvement within a week… since then she has stopped and started on two occasions with the same effect,’ he writes.
Here the precise mechanism of the beneficial effects of smoking is unclear, but in the case of Parkinson’s and Alzheimer’s, there is a plausible explanation, as it increases the number of nicotine-sensitive receptors in the brain, which in turn influences the amount of the brain chemical acetylcholine. Thus smokers, it is estimated, have a markedly reduced risk of developing Alzheimer’s – and the same, but less consistently so, for Parkinson’s.
Further, according to a study from London’s Institute of Psychiatry, injecting small doses of nicotine under the skin in those with Alzheimer’s markedly increases levels of ‘attention and information processing’. To be sure, the overall health hazards of tobacco are very serious, but those who feel their memory is slipping might consider applying a nicotine patch daily to see whether this improves matters.
Royal Confinements
The perennial fascination with all matters Royal would seem as robust as ever. It is difficult to imagine any pregnancy other than that of the Duchess of Cambridge warranting congratulatory messages from the President of the United States, the Prime Minister and the Archbishop of Canterbury – even though it could be another 60 years before her first-born son or daughter is crowned in Westminster Abbey.
The drama of the circumstances surrounding the announcement no doubt heightened public interest still further – while generating so many column inches about hyperemesis gravidarum from medical experts, there can be few who are not now acquainted with the nature, treatment and outlook of the condition.
Pregnancy can be a tricky business, with numerous hazards along the way. Here, a couple of Royal confinements from the past are instructive – not just because of their profound historical and constitutional consequences, but also in the way they influenced two critical events in the rise of modern obstetrics.
The first concerns Princess Charlotte of Wales, the only daughter of the then Prince Regent and future King George IV. In 1816, Princess Charlotte married Prince Leopold of Saxe-Coburg and after two miscarriages became pregnant for the third time with a child who all hoped would be the heir in the next generation to the British throne. Her obstetrician, Sir Richard Croft, kept detailed notes of the progress of her labour, thus providing a harrowing insight into the trauma of childbirth as experienced by so many women down through the centuries.
Four hours after the rupture of the membranes, the princess was still only having weak labour pains and almost a day passed before her cervix was fully dilated. This should have prompted Sir Richard to apply obstetric forceps to facilitate the second stage, but like so many obstetricians of his day, he was opposed to their use. Indeed, it would be another exhausting, incredible 24 hours before the princess was finally delivered of a dead male child.
The inevitable corollary of such a prolonged labour was not long delayed, as 20 minutes after the delivery the princess developed a catastrophic postpartum haemorrhage, from which she soon succumbed. The final episode in this tragedy came three months later when Sir Richard Croft, ravaged with guilt over the consequences of having held so tenaciously to the rules of obstetric practice, shot himself.
The outcome of the death of Princess Charlotte and her son was a display of national emotion on a grand scale – not surprisingly, given her personal charm and crucial role in the process of monarchical succession. Her demise did however prompt obstetricians to use forceps more often in such circumstances.
This cycle of events was repeated 40 years later when Queen Victoria insisted, prior to the birth of her eighth child Leopold, ‘We are going to have this baby, and We are going to have him with chloroform.’
Several years earlier, the Professor of Midwifery at Edinburgh University, James Young Simpson, had pioneered the use of (the newly discovered) chloroform for the relief of labour pains – only to encounter opposition not just from his medical colleagues but also, on scriptural grounds, from leaders of the Church of England, citing the Bible’s admonition to Eve, ‘In sorrow shalt thou bring forth children’ (Genesis 3 v.16). Countering these objections, Simpson also evoked the authority of the Bible but to demonstrate the good book did sanction anaesthesia: ‘…the Lord God caused a deep sleep to fall upon Adam and he slept; and He took one of his ribs and closed the flesh thereof’ (Genesis 2 v.21).
Queen Victoria had her way and the pioneer anaesthetist John Snow sprinkled chloroform on to a handkerchief for her to inhale during each contraction. Describing the experience later the queen wrote how Snow ‘gave that blessed chloroform and the effect was soothing, quietening and delightful beyond measure’. Four years later she received chloroform during the birth of her ninth and last child, Princess Beatrice. ‘Anaesthesia à la reine’ as it was soon known, became fashionable and objections to its use faded away.
These two Royal confinements therefore had a profound influence on the development of modern obstetrics – which, along with the introduction in the 1930s of the antibiotic sulphonamide to treat puerperal fever, would transform childbirth into the (relatively) safe practice it is today.
The Duchess of Cambridge’s bout of hyperemesis may have a similar effect in drawing attention to the potentially serious consequences of excess vomiting in the early pregnancy and the need for its prompt and effective treatment.
drjames@lady.co.uk
Our latest medical query comes courtesy of a lady from Sussex who has what seems to be recurrent bouts of an upper respiratory tract infection three or four times a year. The symptoms are virtually identical each time – she feels cold and shivery, starts coughing and develops a sore throat. This lasts for a couple of days but leaves her feeling ‘really quite ill and exhausted’. She has had all the usual blood tests, which turn out to be perplexingly normal. This is most likely to be the condition known as cyclical neutropenia (literally a fluctuating white cell count) where periodically the precursors of these cells in the brain marrow fail to mature properly – thus compromising the body’s defence mechanism against infection. The diagnosis is made by performing regular blood tests, which should show a fall in the blood count just prior to the onset of symptoms followed by gradual recovery. The cause remains obscure but can run in families and is also very common in grey collie dogs. As can be imagined, it can come as a considerable relief to discover the nature of the problem, which can be minimised by taking a preventive course of antibiotics at the first sign of a further episode.
‘To seek to tell the virtues and greatness of this holy herb,’ wrote de Cárdenas in 1578, ‘the ailments that can be cured by it, the evils from which it has saved thousands, would go unto infinity.’
Meanwhile, Dr Monardes cited no fewer than 20 specific ailments, from toothache to cancer, for which tobacco was, he claimed, a useful treatment. Two factors contributed to its popularity in medical circles. Tobacco was conceived of as being ‘hot and dry’, which meant it counteracted a surfeit of illnessinducing ‘wet humours’. Then, tobacco had a pharmacological effect, which is more than can be said for most of the other contemporary herbal remedies. Current scientific research suggests tobacco can be of value in several conditions, including ulcerative colitis, Parkinson’s and Alzheimer’s. Many of those with ulcerative colitis report that smoking improves its main symptoms of pain and diarrhoea. A gut specialist from University Hospital Cardiff describes the case of a 36-year-old woman who had smoked a packet a day for many years before quitting at the age of 32 – only to develop ulcerative colitis a year later. She started smoking again ‘and noticed a marked improvement within a week… since then she has stopped and started on two occasions with the same effect,’ he writes.
Here the precise mechanism of the beneficial effects of smoking is unclear, but in the case of Parkinson’s and Alzheimer’s, there is a plausible explanation, as it increases the number of nicotine-sensitive receptors in the brain, which in turn influences the amount of the brain chemical acetylcholine. Thus smokers, it is estimated, have a markedly reduced risk of developing Alzheimer’s – and the same, but less consistently so, for Parkinson’s.
Further, according to a study from London’s Institute of Psychiatry, injecting small doses of nicotine under the skin in those with Alzheimer’s markedly increases levels of ‘attention and information processing’. To be sure, the overall health hazards of tobacco are very serious, but those who feel their memory is slipping might consider applying a nicotine patch daily to see whether this improves matters.
Royal Confinements
The perennial fascination with all matters Royal would seem as robust as ever. It is difficult to imagine any pregnancy other than that of the Duchess of Cambridge warranting congratulatory messages from the President of the United States, the Prime Minister and the Archbishop of Canterbury – even though it could be another 60 years before her first-born son or daughter is crowned in Westminster Abbey.
The drama of the circumstances surrounding the announcement no doubt heightened public interest still further – while generating so many column inches about hyperemesis gravidarum from medical experts, there can be few who are not now acquainted with the nature, treatment and outlook of the condition.
Pregnancy can be a tricky business, with numerous hazards along the way. Here, a couple of Royal confinements from the past are instructive – not just because of their profound historical and constitutional consequences, but also in the way they influenced two critical events in the rise of modern obstetrics.
The first concerns Princess Charlotte of Wales, the only daughter of the then Prince Regent and future King George IV. In 1816, Princess Charlotte married Prince Leopold of Saxe-Coburg and after two miscarriages became pregnant for the third time with a child who all hoped would be the heir in the next generation to the British throne. Her obstetrician, Sir Richard Croft, kept detailed notes of the progress of her labour, thus providing a harrowing insight into the trauma of childbirth as experienced by so many women down through the centuries.
Four hours after the rupture of the membranes, the princess was still only having weak labour pains and almost a day passed before her cervix was fully dilated. This should have prompted Sir Richard to apply obstetric forceps to facilitate the second stage, but like so many obstetricians of his day, he was opposed to their use. Indeed, it would be another exhausting, incredible 24 hours before the princess was finally delivered of a dead male child.
The inevitable corollary of such a prolonged labour was not long delayed, as 20 minutes after the delivery the princess developed a catastrophic postpartum haemorrhage, from which she soon succumbed. The final episode in this tragedy came three months later when Sir Richard Croft, ravaged with guilt over the consequences of having held so tenaciously to the rules of obstetric practice, shot himself.
The outcome of the death of Princess Charlotte and her son was a display of national emotion on a grand scale – not surprisingly, given her personal charm and crucial role in the process of monarchical succession. Her demise did however prompt obstetricians to use forceps more often in such circumstances.
This cycle of events was repeated 40 years later when Queen Victoria insisted, prior to the birth of her eighth child Leopold, ‘We are going to have this baby, and We are going to have him with chloroform.’
Several years earlier, the Professor of Midwifery at Edinburgh University, James Young Simpson, had pioneered the use of (the newly discovered) chloroform for the relief of labour pains – only to encounter opposition not just from his medical colleagues but also, on scriptural grounds, from leaders of the Church of England, citing the Bible’s admonition to Eve, ‘In sorrow shalt thou bring forth children’ (Genesis 3 v.16). Countering these objections, Simpson also evoked the authority of the Bible but to demonstrate the good book did sanction anaesthesia: ‘…the Lord God caused a deep sleep to fall upon Adam and he slept; and He took one of his ribs and closed the flesh thereof’ (Genesis 2 v.21).
Queen Victoria had her way and the pioneer anaesthetist John Snow sprinkled chloroform on to a handkerchief for her to inhale during each contraction. Describing the experience later the queen wrote how Snow ‘gave that blessed chloroform and the effect was soothing, quietening and delightful beyond measure’. Four years later she received chloroform during the birth of her ninth and last child, Princess Beatrice. ‘Anaesthesia à la reine’ as it was soon known, became fashionable and objections to its use faded away.
These two Royal confinements therefore had a profound influence on the development of modern obstetrics – which, along with the introduction in the 1930s of the antibiotic sulphonamide to treat puerperal fever, would transform childbirth into the (relatively) safe practice it is today.
The Duchess of Cambridge’s bout of hyperemesis may have a similar effect in drawing attention to the potentially serious consequences of excess vomiting in the early pregnancy and the need for its prompt and effective treatment.
drjames@lady.co.uk
Our latest medical query comes courtesy of a lady from Sussex who has what seems to be recurrent bouts of an upper respiratory tract infection three or four times a year. The symptoms are virtually identical each time – she feels cold and shivery, starts coughing and develops a sore throat. This lasts for a couple of days but leaves her feeling ‘really quite ill and exhausted’. She has had all the usual blood tests, which turn out to be perplexingly normal. This is most likely to be the condition known as cyclical neutropenia (literally a fluctuating white cell count) where periodically the precursors of these cells in the brain marrow fail to mature properly – thus compromising the body’s defence mechanism against infection. The diagnosis is made by performing regular blood tests, which should show a fall in the blood count just prior to the onset of symptoms followed by gradual recovery. The cause remains obscure but can run in families and is also very common in grey collie dogs. As can be imagined, it can come as a considerable relief to discover the nature of the problem, which can be minimised by taking a preventive course of antibiotics at the first sign of a further episode.