A retired senior nurse of great experience sent me a very fine alphabetical collection of medical terms, some very old, that have been recorded on death certificates.
I have not come across it before, and I'll bring you some here today that were new to eyes that thought they had seen it all. You may have heard of barrel chest – a particular shape of ribcage sometimes seen in emphysema patients – but I had never heard of barrel fever, which is, apparently, a vomiting or illness caused by excessive consumption of alcoholic drinks. Black canker is suggestive of what we would now call meningococcal meningitis, with its dark rash. Diphtheria – which claimed lives in my own family a long way back – was sometimes recorded as black throat, or, indeed, bladder-in-throat, referring, perhaps, to the grey membrane that covers the tonsils and throat in the condition. And diarrhoea is an often misspelled, but fairly familiar term to all. But I have never heard or seen it described as bowel hives before. The red diarrhoea of dysentery was described as bloody flux. The word illegitimate is not a nice one to label anybody with, but, in times past, it was even worse. Doctors used the term "baseborn". Syphilis, the venereal disease, was once recorded on death certificates as "bad blood", and the word bealed was sometimes used to describe something that was infected. Enough for one day. But I think that we may be hopping back to this fascinating list when we get through the remainder of the Bs!
When a correspondent signs himself Itchy Dan on the bottom of his correspondence, it merits extra attention from the doctor. I had an email from this ninetysomething-year-old nursing-home resident, who is plagued with a condition called generalised pruritus. He itches all over, and has done so for three or four years now. It is not only very debilitating and sleep-disrupting, but it also causes him great embarrassment, affecting his sociability. The first step in cases like this is to take the problem to the GP. Current medicines need to be reviewed to see if they could be contributing, especially pain-relieving ones. The next step is a complete physical examination to rule out common skin conditions, like eczema or scabies, which both follow particular geographical and rash patterns on the body. Examination of the skin is not enough, though. A head-to-toe physical is the correct examination – an underlying medical condition can be at the heart of as many as half the cases of generalised pruritus. This should be followed by blood tests on the kidneys, liver, thyroid, as well as a full count of blood cells; all are essential. Should no cause show up, and symptoms are as severe as Itchy Dan describes, I think a further consultation with a skin specialist (consultant dermatologist) should be high up on the agenda. A cause will not always be found and, sometimes, a term like xeroderma (which means drying out of the skin) is used, or simple pruritus of old age. It's a fact that this condition is more common in advanced years, but it always needs investigation, and there's no need to despair. Even if no cause is found, a good specialist will not tire of trying new strategies to cope.
I was writing recently about hospital signage, and Liam has been in touch about a general hospital in the south east of the country. A few years ago, he recalls seeing three hospital signs on a grass verge (one placed on top of the other) that ran: Kitchen Supplies Mortuary. Just as well, says Liam, they weren't the other way round: Mortuary Supplies Kitchen. It might well put patients off their dinner.
A few more medical malapropisms this week. A reader working in a unit for older people in the Midlands recalls one resident, who was hard of hearing, telling a visiting relative that she had a urinary cat infection (urinary tract infection). But my witty correspondent tells me she had a purrfect outcome and was feline fine after the antibiotics. And a blow-in to Limerick tells me that, when he arrived there in the 1970s, he met a lady who said her husband had chronic vertical. The husband worked as a typesetter, and my friend thought this was, perhaps, a reasonable diagnosis and occupational hazard of such a job. It was not until some years later that he realised she meant to say chronic vertigo. It sounds less serious than chronic horizontal.
A retired nurse, mother to a posse of nurses, wrote recently to tell me that much of the fun seems to have gone from health services. Today's nurses, she says, feel undervalued and suffer from low morale. Contrary to what unions may tell us, she tells me this is not an Irish phenomenon, but one that is worldwide, as her offspring have worked around the globe. She finds it so sad being the mother of nurses who really love their vocation, and wouldn't do anything else. I wrote recently about the importance of hearing your bowel sounds getting going again after an operation, and she remembers a surgeon called Mr Henley, in swinging 1960s London, who had a lovely old saying: "Sounds that would shock a duchess are music to a surgeon's ear." The perfect gentleman, he would explain to his patients that his job, bowel surgery, was really very straightforward plumbing. My retired correspondent also recalls a Cork surgeon, who would draw the most intricate diagrams for his patients, especially those undergoing bowel surgery, and it had the effect of making them less stressed before theatre. Should the job of reorganising the curriculum ever fall in my lap, art classes would be as compulsory as hand-washing at medical school.
Dr Maurice Gueret is editor of the ‘Irish Medical Directory’ www.imd.ie
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