HEALTH TRIBUNE Wednesday, January 31, 2001, Chandigarh, India

Healing revolution goes on
Dr J.D. Wig
HE 20th century has been an era of unparalleled success. It has witnessed great developments ever made by man. At the beginning of the new millennium, it seems appropriate to reflect on the past century and to look forward to the future century.

Unquiet workplace and worker’s mind
Ben Summerskill
ORKPLACE stress has become so bad that thousands of workers are presenting themselves for treatment with symptoms similar to those of psychiatric outpatients, according to a major new investigation. "This is not just a minor worry any more, it can be a serious crisis in people’s lives," said Professor John McLeod, who has completed a survey of 10,000 victims of workplace stress across the UK.

Typhoid: prevent it now

Sticking with rice



Healing revolution goes on
 Dr J.D. Wig

THE 20th century has been an era of unparalleled success. It has witnessed great developments ever made by man. At the beginning of the new millennium, it seems appropriate to reflect on the past century and to look forward to the future century.

The Second World War proved to be a watershed that caused medical textbooks to be rewritten. The trauma of the battlefield provided the experience for a leap forward in surgical techniques. Treatments were streamlined and new methods were born out of necessity.

Sepsis, lethal as the bullet, killed thousands in the First World War and would have done the same in the Second World War but for the introduction of miracle drugs — sulphonamides in the thirties and the discovery of penicillin which came later. Miracles of healing took place with this wonder drug. Before penicillin, an open contaminated wound was a ticket to the mortuary via septicaemia. Such wounds healed and people survived following a course of antibiotics. Thousands of lives were saved. Other antibiotics followed.

Air crews dropping from the skies in burning aircraft paved the way for a great advance in the treatment of burns, in particular the covering of the burnt area, by grafting. The frequent change of dressings inflicted excruciating pain on patients. Immersing these patients in warm saline baths was a new method of treatment. The burned areas were cleaned, dusted with antibiotic powder and dressed. This was a less painful way to treat burns. Plastic surgeons were becoming skilled at replacing damaged parts of the body with grafts.

The evolution of blood transfusion is a fascinating story. The modern era of blood transfusion was initiated in 1900 with the demonstration of A,B and O isoagglutinins in serum. The development of blood banking in the third quarter of the 20th century has been phenomenal. A large number of blood group systems are now recognised. This expansion of knowledge has been reflected in the enhancement of the safety of blood transfusion. The storage of blood has been prolonged by the development of newer blood preservative solutions. The procurement of platelets and granulocytes for transfusion has been facilitated.

The safety of transfusion has been greatly enhanced through the advent of serological testing for the hepatitis virus. A most significant expansion of the horizons of blood banking was the advent of the plastic transfusion equipment. The use of plastic equipment facilitated the advent of blood component therapy, primarily a development of the 1950s and 1960s.

Advances in technology led to new sophisticated radiological procedures — US, CT, MRI have made the human body virtually transparent; intervention in areas previously inaccessible is now a reality. The introduction of screening programmes for the apparently healthy has helped in detecting cancer at a non-palpable stage.

Experiments conducted in Mayneord's laboratory in the UKin 1952 were amongst the first to show that ultrasound had diagnostic potential. Medical ultrasound is now a mature technology. Microscanning has immediate applications in molecular biology and drug studies. Its power to expand the horizons of clinical radiology is immense. Robotics and computer-assisted medical intervention have emerged as a rapidly evolving area of research and development with immense potential for improving clinical outcomes and reducing patient morbidity.

The heart-lung machine makes possible the repair of complicated heart defects. The first successful open heart operation was performed in 1953. Coronary bypass grafting for the treatment of coronary insufficiency was introduced in 1967.

Immunology has revolutionised the approach to disease. The discovery of immunosuppressive drugs have given a new lease of life to patients with failing kidneys and fatiguing hearts.

Cancer, a fearful disease, may now be tackled by immuno-modulation which stimulates the body's own defence mechanism to fight the cancer cells.

The first successful kidney transplant was performed in 1954 by Joe Murrary who received the Nobel Prize 36 years later. Once immunosuppressive drugs became available, kidney transplant became a reality. The Starzl research group (in 1962) developed techniques for liver transplant.

The vascular tree was opened to surgical repair. Dacron grafts were developed for the repair of blood vessels in 1954. Techniques were developed for the replacement of the entire aorta.

Laparoscopic surgery, introduced in 1985, is now firmly established as the method of choice for gallbladder removal. Other applications such as hernia repair, appendecectomy and splenectomy are promising and hopeful ways.

Medical research has progressed to a point where the human genetic map is known and genetic manipulation to alter the disease process is not far away.

Robotics (engineering science concerned with devices that are able automatically to execute tasks usually performed by humans) and computer-assisted medical intervention have emerged as rapidly evolving areas of research and development with immense prospects for improving the outcome while also reducing patient morbidity and the cost of health-care.

The medical community seems to have become sensitive to the dependence of its progress on the products of science and engineering. We have just entered the new millennium. One can only wonder about what the future holds in store for this rapidly changing field. We find ourselves having entered the new era with a hope for the future but a firm footing in the past. Our knowledge of the past and present experiences will direct our research and guide our clinical practice by making others feel good. Procedures and techniques have changed and evolved. We understand much more now than we did years ago. In spite of all these advances, we should continue to be compassionate and caring (and not detached and dispassionate) physicians and surgeons and embrace these advances and incorporate them into our practice.


Unquiet workplace and worker’s mind
Ben Summerskill

WORKPLACE stress has become so bad that thousands of workers are presenting themselves for treatment with symptoms similar to those of psychiatric outpatients, according to a major new investigation. "This is not just a minor worry any more, it can be a serious crisis in people’s lives," said Professor John McLeod, who has completed a survey of 10,000 victims of workplace stress across the UK. "The problem is definitely no longer linked only to management occupations. It now includes ordinary office workers and manual workers too."

In the private sector, employees are suffering from the requirement to deliver higher and higher productivity per person. In the public sector, the beleaguered staff are often being asked to bear greater degrees of responsibility with fewer resources.

"Among groups such as teachers, social workers and police officers, 25 per cent are now suffering from serious stress symptoms," said McLeod.

"In other occupations, we’re finding between 10 and 15 per cent of workers with problems." Undiagnosed anxiety conditions now cause more lost days from work than complaints such as backache, hangovers and stomach upset.

Miriam West, from Swanage, Dorset, in the south of England, said: "I worked for 15 years and was very successful but two years ago I began to feel almost frozen at work. I didn’t know what it was. I hated the idea of going in to the office. I would just sit at weekends and in the evening doing almost nothing.

"When I was at work I constantly chastised myself for not doing enough.

In retrospect, I was over-performing. I was setting standards for myself which I couldn’t reach. My bosses were staggered when I decided to leave. They hadn’t realised that the chaotic atmosphere they created was putting pressure on everyone else.

"But I only made the final decision to re-assess my career after seeing a counsellor. He encouraged me to work out exactly what was creating the pressure and how I could address it."

Almost 1,000 major British firms already provide free stress counselling services to employees. The staff are referred for three to six sessions in the first instance.

"However much we try to minimise sources of stress in the workplace and however much we work to improve employee resilience to pressure, we have to acknowledge that there’ll always be some people who need help," says Dr Marian Roden, corporate medical director of SmithKline Beecham. "The provision of counselling services ensures our staff always have somewhere to turn. Whether the primary source of stress lies within or outside the workplace, early resolution facilitates a rapid return to productivity."

Mike Doig of Chevron Europe, an arm of the US oil company and another provider of workplace support, said: "The evidence not only demonstrates the positive emotional outcomes of help, but also makes a first-rate business case. For every one dollar we spend, we have saved between six and ten dollars."

The report suggests workplace counselling can reduce the incidence of office stress by 50 per cent. Efficiency savings include higher performance and lower levels of sickness and unexplained absence. Substance — abuse from alcohol to serious drugs — also falls among staff who have received help.

Dr Michael Reddy, whose company ICAS provides workplace counselling to businesses in Britain, said: "It’s not just a question of shopfloor versus management, as trade unions have often suggested. In this cost- and corner-cutting culture we are all in the stress firing line. Managers who work 16-hour days are as misguided as lorry drivers who fall asleep at the wheel."

Miriam West insists that workplace counselling transformed her life.

She has left the financial services industry and is setting up a landscape gardening business. "I won’t earn quite so much, but I’m immeasurably happier. One regret I do have is that I didn’t take advice earlier. I think if I had seen someone five years ago, I might have found it much easier to change things at work. I might still be there, but happier." McLeod, of Abertay University, Dundee, Scotland, says British reserve might be preventing us from admitting how awful our working lives are. "American employees tend to be more positive about being counselled for workplace problems. Consequently they tell their mates. In British organisations, that admission is much less likely. If people were more willing to acknowledge that they had seen a workplace stress counsellor it would make it much easier for others to go." — ONS

A fuller version of Dr K.C. Kanwar’s article on bloating and beleching will appear next week.



Typhoid: prevent it now

Q What is typhoid?

A Typhoid is a potentially fatal infectious disease caused by bacterium Salmonella typhi (S. typhi). The name of the illness is derived from the Greek word "typhus" meaning a fever.

Although the typhoid fever is now rare in most industrialised countries, it remains a serious health problem in much of the developing world. The World Health Organisation estimates that about 16 million cases of typhoid fever occur annually in the world causing more than 600,000 deaths.

Q How is typhoid transmitted?

A Humans are the sole reservoir of S. typhi infection as well as the only natural host. Typhoid is transmitted by food or water that has been contaminated by affected individuals, a patient in convalescence, or individuals who harbour the typhoid bacteria.

The fever remains endemic in most of the less-developed areas of the world, where poor conditions of sanitation and food hygiene prevail.

An important property of S. typhi is its ability to survive in the environment, such as in snow, water and food. In some instances, this survival may be as long as several months. The hardy nature of the organism has permitted it to cause epidemics that are unexpected because no apparent recent cause for the contamination was found.

Q What are the symptoms of typhoid?

A The symptoms of the disease vary from case to case but often include intermittent fever, headache, tiredness and weakness, changes in behaviour, and abdominal discomfort with constipation in the early stages of the disease followed by diarrhoea later.

The most severe complications of typhoid are intestinal bleeding and perforation.

Intestinal bleeding occurs in about 5% of typhoid cases. It occurs during 2-3 weeks after infection with sudden deterioration developing malaise, fall in blood pressure, fall in temperature and increased pulse rate.

Perforation occurs in about 4-5% of typhoid cases wherein the ulcerated intestine perforates and the gut content leaks into the abdominal cavity causing infection.

Q What are the main sources of infection?

A Faecal matter is the most common contaminant. Others include saliva, vomitus or other body fluids. Human hands or flies may also spread the contamination.

To be concluded



Sticking with rice

  •  Why should you lose more than just pounds when you avoid carbohydrates?

  • Plus, dietary remedies for cancer and stress?

Jane Clarke answers these questions from London.

AT this time of the year, members of the dieting industry vie with each other to advertise their new "wonder diet". Gone, it seems, are the days when sensible eating habits made the headlines. At the moment, celebrities seem to be falling over each other to trumpet the number of pounds they have shed through following high-protein, low-carbohydrate diets.

Some practitioners have even been recommending a potentially dangerous variation on the theme — the protein and citrus-fruit diet, which also includes injections of substances that are thought to contain diuretics and drugs that stimulate the metabolic rate.

I suspect that high-protein diets are so popular because many people find that eating too many concentrated carbohydrates (such as bread, rice and pasta) makes them feel heavy, bloated and lethargic, and that when they cut out such foods their energy levels rise dramatically.

It is possible to compromise with a diet that helps you both to lose weight and feel healthier, while also protecting your bones and metabolism. Avoiding carbohydrate-rich foods for a few days may give you rapid results, but I advise incorporating a little carbohydrate into your diet to prevent your body from producing ketones. You can derive your daily requirement of 100g of carbohydrate by eating 200g of baked potato, spaghetti or rice, as well as a few pieces of fruit, such as bananas. Pulses, which contain some carbohydrate as well as protein, along with root vegetables and non-watery fruits such as pineapples, mangoes and dried fruits with no added sulphur dioxide (SO2), are equally good dietary staples.


The curcuma cure: a tradition lives on

Pharmaceutical companies are continually investigating traditional remedies in the hope of finding treatments for illnesses. One of the latest studies focuses on a tonic derived from the oils of the Curcuma shrub, a plant used by the inhabitants of Irian Jaya in Indonesia for digestive ailments that is now thought to play a potential role in the prevention of bowel cancer. Although current research indicates that regular exercise and having a diet rich in vegetables and low in fat, meat and alcohol helps to ward off cancer of both the colon and rectum, watch this space: the Curcuma plant may soon yield some vital information.

Q: I have been suffering from increased stress at work and wonder if any foods could help me to deal with it. I should also mention that I smoke. — Alicia Frith, St Albans

A: If you have moved up a gear in response to stress, your body starts to use up nutrients at an increased rate. Unless you increase your intake of nutrients, you will soon feel run down and be more likely to succumb to illness. It is therefore vital that you try to maintain healthy eating habits.

Because smoking increases your vitamin C requirement, start by taking a daily dose of 2,000mg, either in one hit or over time. Snack on plenty of vitamin C-packed fresh fruit during the day; bananas are especially nourishing and calming, while even dried fruits (with no added SO2) will provide you with a source of slow-release energy.

Hold off from biscuits, chocolates and other foods that contain rapidly absorbed sugar, as these will send your blood-sugar and energy levels, as well as your emotions, on a stressful roller-coaster ride. If you are highly stressed, eating fatty foods may also prompt your stomach to produce excessive quantities of acid, causing indigestion and heartburn. Opt for lighter foods, such as a pasta or risotto dish, or simply cooked fish.

Because excess caffeine increases the amount of adrenaline that your body generates in response to stress, restrict your coffee, tea or hot chocolate intake to a couple of cups a day, and drink more water and herbal teas instead. This may sound painful (which it literally may be for the first day or so), but so many patients feel far less agitated and aggressive when they can break the caffeine-dependency cycle that it’s definitely worth giving it a try. — Observer News Service