What’s Your Poison?

What’s yours? A question asked in bars around the country; whisky, gin, beer. In another context, the question is not asked, because most of us are not interested, but the answer is given at length. What’s your disease?

There is no one so proud as the, now recovered, person describing how baffling and serious their disease has been. ‘None of the doctors knew what it was; I even saw the professor and he did not know.’

I eavesdropped on one such conversation at a drinks party. The man described his symptoms well and insisted that the disease was a mystery. I interrupted and asked, did he suffer from diarrhoea and vomiting about two weeks before the illness started? How did I know? He had not realised that this was the start of the illness.

Before I could be accused of being the smart Alec, I told him that George Guillain and Jean Alexander Barré were not the only ones to have described his disease in 1916 but André Strohl, a contemporary had been left out. Precedence should go to Jean Baptiste Landry who gave the first description in 1859. It should be called Landry-Guillain-Barré-Strohl disease if we allow a disease to be named after those who described them.

Eponymous Diseases

Then we got to a discussion of diseases named after the physicians who first described them. We are all familiar with James Parkinson, George Huntington, Alois Alzheimer, Thomas Hodgkin, and Hans Asperger. Thomas Addison should be mentioned as it was probably his disease that carried off our Hampshire Heroine, Jane Austen.

James Parkinson was involved in the popgun plot, an alleged assignation plot on King George III in 1794. Parkinson disappeared for a while to avoid prosecution but returned to write his monograph ‘The Shaking Palsy’ in 1817. He was also a palaeontologist and a social reformer and supporter of the French revolution.

Geographical Names

The World Health Organisation has recently concerned itself with the naming of disease especially as names sometimes seem to attach blame. The French Disease was the English name for Syphilis but in France, it was called The English Disease. Spanish ‘flu was called Naples Soldier disease in Spain as the Spanish did not want the blame for it. That form of ‘flu, which killed more people than World War I, probably started among soldiers in France but army camps in Kansas also have a claim. Flu epidemics have also been attributed to Hong Kong, China and Mexico.

Why should the little town of Lyme be forever associated with tics?

We cannot blame legionnaires for Legionnaires’ disease. It was they that suffered the first brunt of it. Marburg disease and Ebola are very similar and to avoid attaching the disease to a place, the WHO has proposed calling them Filovirus-associated Haemorrhagic Fever types 1 and 2 but I can’t see that catching on except in official reports.

International and Interspecies

Disease is international and interspecies. Infections crossing species, like ‘flu, are called zoonoses and the interplay of viruses between pigs, birds and man is important in working out the dynamics of epidemics. The WHO has several initiatives to combat insect born disease. We are learning that changes in agricultural practices can facilitate the spread of some. Malaria is the most important disease spread by insects.

It was many years before I discovered that a fellow student at medical school was the grandson of Ronald Ross, the man who discovered that the malaria parasite is carried by mosquitos. My friend inherited his grandfather’s car from the 1930’s. I cannot remember the make, but it had a pre-selector gearbox which kept breaking down. My connection with one of the great men of medicine is that I rode in Ronald Ross’s car.

In my office in the Cambridge Military Hospital in Aldershot I reported results of tests done in Hong Kong on Gurkhas serving in the British Army who were suspected of having Japanese Encephalitis. You cannot get much more international than that.

Many years ago, I had a patient in my clinic called Angelman. I learned that he was a retired doctor. Did he know that there is a rare children’s disorder known as Angelman’s syndrome? ‘Yes,’ he said, ‘that was me.’ As I examined him, he told me the story:

It was purely by chance that nearly thirty years ago (e.g., circa 1964) three handicapped children were admitted at various times to my children’s ward in England. They had a variety of disabilities and although at first sight, they seemed to be suffering from different conditions I felt that there was a common cause for their illness. The diagnosis was purely a clinical one because in spite of technical investigations which today are more refined I was unable to establish scientific proof that the three children all had the same handicap. In view of this, I hesitated to write about them in the medical journals. However, when on holiday in Italy I happened to see an oil painting in the Castelvecchio Museum in Verona called … a Boy with a Puppet. The boy’s laughing face and the fact that my patients exhibited jerky movements gave me the idea of writing an article about the three children with a title of Puppet Children. It was not a name that pleased all parents but it served as a means of combining the three little patients into a single group. Later the name was changed to Angelman syndrome. This article was published in 1965 and after some initial interest lay almost forgotten until the early eighties.

[Angelman, quoted by Williams, Charles. “Harry Angelman and the History of AS”. Stay informed. US: Angelman Syndrome Foundation. Archived from the original on 2011-06-30.]

He went on to explain that he would have liked to keep up with all the scientific advances in the genetics of the disease but his job as a general paediatrician in Warrington kept him busy and his holiday time was spent studying paintings in Italy.

Diseases have amusing descriptive names: Break bone fever, Chikungunya, Barber’s rash, Bloody flux, Black death, St Vitus dance and one I do not have now, Scrivener’s palsy (writer’s cramp). I am sure you can think of some others.

Abbreviations

Then there is the Doctors’ black humour, more about the patients than their disease, often expressed in abbreviations in the notes.

PFO – pissed, fell over. The commonest condition in A & E on Saturday night.  PGT – pissed, got thumped is a variation.

A & W – Alive and well. Usually, a patient faking illness.

BUNDY – But unfortunately not yet dead. A lost cause.

EtOH – Alcohol (drunk)

FLK – Funny looking kid. Children’s’ faces often give a clue to a diagnosis, eg Angelman’s.

GANFYD – Get a note from your doctor. Bain of GPs clinics clogged with patients told to GANFYD by some authority.

TTFO – Told to go home.

TATT – Tired all the time.

NFP – Normal for Portsmouth. Justified or not Portsmouth has a reputation for young women requiring multiple abortions.

NAD – Test result, Nothing Abnormal Discovered; or is it Not Actually Done?

ANDIER – Heart sink patient. ‘I’ve got this pain here, and here, and…’

TRO – applies to us all eventually. Time Ran Out.

Here’s to a healthy 2020.