During my last shift, seven of the first eight patients that I treated had injuries from falls on the ice. Elbow fracture, elbow dislocation, two hip fractures, coccyx (tailbone) fracture, depressed skull fracture, a few back pains … and a partridge in a pear tree.

When it snows out, the snow is slippery. When you compress snow by walking or driving over it, the snow stays slippery. When the sun comes out and turns the top layer of snow kind of a clear color, the snow still stays slippery. If you walk on any of these substances, your feet will slip.

Even Ms. WhiteCoat slipped on the ice and fell on her hip when she was getting groceries out of the truck. Busted her cell phone all to smithereens, but at least she’s OK.

So here’s my suggestion for a good stocking stuffer: Shoe Cleats.

I’m not going to give you any links because I don’t want to be accused of a conflict of interest by the FTC or whatever other blogger police are out there. Go online and use your favorite search engine that doesn’t track all of your online movements [cough cough Scroogle cough hack IX Quick] and do a search for “shoe cleats” or “traction cleats” or “fishing treads.” Some sporting goods stores even have them. Then buy some and put them in your family’s stockings or even give them as an early present – especially your independent elderly family members.

They may look dorky, but the $20 you spend on them is a heck of a lot better than the $20,000+ for surgery and the weeks in rehab that will be needed if someone falls and busts a hip.

Trust me. The operating rooms are overbooked and the ortho docs are talking about all the new cars and vacation villas they’re planning to buy.

There is a run on gastroenteritis in our area.

Lately, it seems as if about half of the patients coming into the emergency department have some combination of nausea, vomiting, diarrhea, and abdominal cramps. School attendance has dropped by 15%.

I cringe when people call gastroenteritis the “stomach flu.”  You can call it whatever you want, but just because the name that you choose to give to your symptoms has the word “flu” in it does not mean that it will get better with Tamiflu. Two different diseases. So demanding Tamiflu for your vomiting and diarrhea will do just about as much good as ingesting artichoke leaves. Only the Tamiflu will set you back about $100. Tamiflu only works for influenza. It does not work for “stomach flu” gastroenteritis.

The most common symptoms in influenza are fever, cough, sore throat, headache and body aches. Yes, some people also have vomiting and diarrhea with influenza, but those symptoms rarely occur in the absence of the others.

Plenty of fluids, medications such as Zofran and Imodium to relieve symptoms, and a bland diet are about all we can do until the disease runs its course. The symptoms usually last a few days and then resolve. Most often, outbreaks of gastroenteritis are caused by Norovirus, but other viruses may also be to blame.

The WhiteCoat household didn’t escape the wrath of the stomach flu this year. Two of my four kids have been home yesterday and today. Even though I felt bad for her, it was kind of funny when my 7 year old daughter came into my office yesterday and made the following statement:

“Dad, I don’t mean to alarm you, but I have pee coming out of my butt.”

No, honey, that’s diarrhea. Let’s go get you some Tamiflu.

Hello all, it’s ERP from Erstories.net. Haven’t done a post here in a while so I thought I’d put up one on a subject I find pretty fascinating.

Having read Dr Grumpy’s fascinating historical posts and being an avid history buff myself, I thought I would give one a try.  I don’t have his encyclopaedic knowledge of military history oddities, but remember reading a great medical-historical story a while back and thought I’d share it with you.

In 1821, “Le petit Caporal” (The Little Corporal) died in Longfellow House on the remote island of St Helena.  Of course The Little Corporal (also known as Boney by the Brits) was Napoleon Bonaparte. Having finally lost at Waterloo to Arthur Wellesley (the First Duke of Wellington) and Coalition forces in 1815, Napoleon was finally banished to the island where he eventually would die 6 years later.   There has been nearly endless amounts of speculation as to the cause of his death since the 1960′s (and likely shortly after his death as well) when sentimental souvenirs of the dead Emperor, locks of his hair, were analysed.  High levels of Arsenic were found leading to historians to question the original cause of death from a cancerous gastric ulcer (as recorded by physicians who performed his autopsy).

Napoleon famously stated in his will that he had been “murdered by the British Oligarchy”. Suddenly, this actually seemed possible.  In a way, they may have, albeit unintentionally – but more on that shortly.   Arsenic is a deadly poison used for centuries to commit murder – but it also had many legitimate medical and commercial uses.  Namely, elemental aresnic is grey  but compounds of it can produce a brilliant green dye – used for centuries until synthetic green dyes were invented at the early part of the 20th century.  Medically, it had been used for a whole host of ailments (and still occasionally is), and when given in small quantities, is not so dangerous and has some positive effects.  Most commonly it was used for psoriasis,haemorrhoids, breathing ailments,  it still can be used in treating certain kinds of leukaemia and trapanosomal infections).  In fact, finding some arsenic in his hair likely would not be that unusual given that many people were prescribed arsenical treatments in the early 19th century.  However, his levels were quite high so some enterprising people set out to prove or disprove this notion.

An interesting phenomenon had been previously discovered – one that explained the notion of “The sick room”.  This was a room that when one spent time in it, felt ill (although the term also means a room where you put people who are sick).  I guess it could have been from the general odouriferousness of one’s company back then, but a better theory is that of Arsine vapour.  When subjected to certain chemical reactions, solid arsenic compounds can be turned into toxic gas (notable trimethyl and dimethyl arsine). This was used to deadly affect during World War I in the form of gas warfare. In fact, the British developed a form of it that they called Lewisite – hence the reason that the antidote for Arsenic poisoning is called BAL or British Anti-Lewisite.   Anyway,  we come to the idea of death by wallpaper.

Wallpaper made in the 18th and 19th centuries often contained toxic compounds to produce the brilliant colours favoured by those with the $$ to decorated their houses with it.   Bright green was created by arsenic compounds (like copper arsenite).  This was normally no big deal (unless you ate the paper) in temperate climates.  However, under certain environmental conditions – notable those with high levels of moisture, organisms can grow in the walls and wallpaper. These moulds can process the arsenic and turn it into arsine gas.   As this accumulates in a small room that may not have good ventilation, those in it can become ill.  This actually has a name – Gosio’s Disease.  In the 1980′s a researcher discovered something amazing; an actual sample of the wallpaper that was in the Longfellow House on St Helena.   A lady in the UK had a scrap book that had been handed down to her through the generations – it catalogued someone’s trip to St Helena in 1823, and amazingly contained a scrap of wallpaper that this souvenir hunter had taken off the wall of Napoleon’s drawing room.   This paper was analysed and found to contain Scheele’s Green pigment – copper arsenite.  The researcher in charge now had evidence as to how Napoleon could have accumulated the arsenic.  He visited the island to confirm his suspicions.    Tiny 6 x 8 mile St Helena is an extremely remote island in the south Atlantic, 700 miles from the nearest land, 1000 miles from Africa and 1000 miles from South America.  It is tropical and  mould of the type that can convert copper arsenite to arsine gas thrives there.   The area of Longwood House is extremely damp and in fact every few years the wallpaper there has to be replaced due to moisture-related damage. Thus, he was not INTENTIONALLY poisoned with arsenic – but rather the Brits who had manufactured the paper (much less dangerous in the British Isles) had unknowingly contributed to the Little Corporal’s demise!  Now, one may ask, how come the other people in his house did not all die from this?  Well, the fact is that as Napoleon aged, and as authorities grew more and more fearful that he might escape, he was largely confined to his drawing room and bed room.  He often kept the shutters closed.   He wrote memoirs and kept to himself.  The others in the house frequently left and thus were not so exposed (although they were noted to again describe a “bad air” and felt ill when they spent prolonged periods at Longwood House).

This does not completely prove that Napoleon died from arsenic poisoning – he probably died WITH arsenic poisoning.  It may have hastened his death but likely did not cause the actual demise.   It certainly helps shoot the theory to pieces that his staff or others intentionally poisoned him.  However, the final cause of death is another interesting story.   From the autopsy report and his known constant upper GI complaints, Napoleon was clearly suffering for a while with gastric ulcers.  Ultimately one became cancerous (as discovered at autopsy) and pushed him down the inevitable road to the great Arc de Triomphe in the sky.  As often is the case in the era before modern medicine, treatments for ailments were often more dangerous than the ailments themselves! Doctors really did unknowingly hasten death (maybe a good thing in some cases), at times killing people who might have otherwise recovered had they been left alone!  Toxic compounds, elixirs, poultices, etc were frequently given – often with the idea to induce vomiting and diarrheoa to “purge” the system of the illness.  Of course this caused at the very least volume depletion and dehydration, but also other problems.   Notably, potassium is lost when one has severe diarrhoea.    The Emperor was in fact treated with tartar emetic and calomel which is made of highly toxic mercuric chloride.  The day before he died, he was given a huge dose of this stuff.  Additionally, he was treated with a Quinine-containing substance called “Jesuit’s Bark”.  This, in addition to arsenic compounds that he had been unintentionally accumulating, cause QT prolongation (a measurement on the EKG between the Q and T waves).  QT prolongation is also caused by electrolyte imbalances such a low potassium and magnesium (both caused by the purgatives he was getting). In this setting,  one can go into the arrhythmia Torsades De Pointes (Twisting around the point), and die very rapidly.

Thus there is good evidence Ole’ Boney would have eventually died from cancer (probably would have just wasted away, unable to eat when the mass caused an obstruction), but was actually killed by both his wallpaper and medical malpractice. Albeit both unintentional.

I originally read about his story in a fascinating book called The Elements of Murder by John Emsley.  He is a Cambridge-based Chemist who talks about the historical use of toxic chemicals to comit murder. There is a whole chapter on all the Arsenic killers as well as ones on Mercury, Thallium, Copper, and others.  I highly recommend it.

Additional references include

“David E. Jones and Ken Ledingham, ‘Arsenic in Napoleon’s wallpaper’, Nature, 1982,. 299: 626-7.”  (this is the researcher who found the wall paper and travelled to St Helena in the 80′s)

This Article describes the possible final cause of the Emperor’s Death by Torsades.