A Doctor's Journal
The New Plague
By MILES HOWARD Another example of a new plague threatening us now, in much the same way as cholera and typhoid used to in the past, is injury and death from accidents. . . . Accident death rates are not actually rising, except among the young men and the elderly; but they are not going down anything like quickly enough, and thus are becoming proportionately more and more im- portant. Death and injury from motor vehicles particularly is now very nearly public health problem number one. The snag is that it does not lend itself easily to investigation. To begin with, the whole subject is fraught with emotion; people get terribly upset if you start asking them if they drive after having a drink or-two-----nearly as touchy as when you talk to them about smok- ing and lung cancer.
rinxis very apt comment by Professor Maurice Backett about the emotional charge attach- ing to attempts at inquiry applies not only to road accidents and lung cancer, but to many of the other epidemic disorders of our time—the emo- tions of the listener are involved, because emotions are the principal causative factor in a number (perhaps the majority) of the illnesses that are now becoming relatively more common. So a dis- course on the origins of asthma, or of indigestion, may stray outside the limits of rational thought, and turn into a heated and non-rational bickering.
At the conference on dyspepsia, run by the Col- lege of General Practitioners recently, I was glad to observe how much of the discussion was sen- sible, down to earth, and constructive. The pre- liminary findings of a group of five family doctors on 'indigestion,' as they encountered it in practice, were presented, and I was not surprised to hear that the proportion of stress disorders, among the various types of illness under the heading of dyspepsia, was more than 50 per cent, in all five practices. This is a conclusion one might have expected, but it has not been shown by a field survey (as far as 1 know) before. A general surgeon, Mr. Daintree Johnson, who has wide experience in this field, gave an excellent paper on the surgical management of indigestion : he made it clear to us all how the surgeon decides when, and when not, to operate, with some amusing, and revealing, asides. The level of debate at this conference demonstrated yet again what enormous scope there is for clinical research in general practice. It is encouraging to see how the College has given its blessing to the exploratory activities of its members, and I hope we shall have many more projects of this kind.
Subject for a medical inquiry: the health of professional models. Of late, I do admit, they are looking better—but last year, one couldn't open a copy of Vogue without perceiving a procession of ladies in the last stages of emaciation. They were Mostly very pale, and disposed in the most curious attitudes, reminiscent of the patient with a dislo- cated hip. They seldom smiled, but wore a serious, haughty expression, which barely concealed a pro- found depression. Is this (I was prompted to wonder) the folk-image of the lady of fashion, 1957? And why must she seem so ill? Is it not smart to look cheerful? To be fair, I've never encountered, in real life, anyone who appeared nearly as gaunt as the model in the picture. Per- haps the tide has now turned, and buxomness is coming back into vogue (and Vogue).
In the' earlier years of this century, syphilis used to be called 'the great imitator,' because its manifestations were so protean that they could be, and were, mistaken for all kinds of other diseases. Now syphilis is coming under the con- trol of the antibiotics, and the results of chronic infection are rarely seen. As a successor to its title, one could, I think, name epilepsy. Apart from the major fit, which is easy to recognise, there are many varieties of minor seizure, and these may masquerade as faints, or mental illness, or inattention.
A recent paper by Neil Gordon cites the mani- fold disturbances caused by seizure discharges in the temporal lobe of the brain : for instance, the experience of a strange smell or taste, attacks of panic and feelings of strangeness; in a child, these last may give the impression to the observer that the patient is idly dreaming. The sufferer from temporal lobe epilepsy is especially prone to dis- orders of emotion and behaviour; nowadays, when much more interest is (very properly) being taken in mental disharmony as a cause of illness, it is well to remember that the electrical discharges of epilepsy in the brain may be the cause of mental symptoms. Of course, there is a good deal of evidence that the 'trigger' for seizures is very often an emotional upset, but the tendency to react to stress with seizures could be an inherited trait.
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