MJM Wardrounds - Lister

This week’s two minute tutorials were in support of a choice of antibiotics/drugs for an emergency…including our first input from a pharmacist. I need to speak to Dr Jones, to get the marks, before announcing the winner. The various drug choices are listed in the comments for last week’s wardround post, except Dr Tuck’s which is in the trichotillomania comments. (Bad aim Claire, have you been posting comments half asleep?).

I enjoyed the exercise of choosing the 5 antibiotics and five other drugs. It was interesting that several of us ran into the same problem: finding that only 4 non-antibiotics were needed. That 10th drug proved to be a problem, I think, not because it was not needed but because it opened up so many possible disorders for consideration. Hopefully you found the exercise useful.

The choices were backed up by sound argument and support from sources such as the Red Cross. There did seem to be, perhaps unsurprisingly, many broad areas of agreement: antiseptics, cover for tetanus (be it with anti-tetanus Ig or clindamycin), antibiotics to provide broad cover for G+, G-, anaerobes, protozoa etc. Most of you chose to take rehydration fluids (oral or IV), opiate analgesics and oxygen. I had not thought of activated charcoal but on reflection I quite like the idea. I will look at the Red Cross site again (Thank you to Naveen Mohan for pointing it out to me.)

I suggested a tree of woes exercise for each of you. For my part I would now ditch Anti-tetanus Ig and diclofenac for clindamycin and activated charcoal.


This week’s reading was On the antiseptic principle in the Practice of surgery. Joseph Lister. Lancet 1867, Sept 21, 90 (2299) 353-356

This is a landmark paper without any doubt, describing what must be one of the most important advances in the practice of medicine. The effects of the work are shown in Lister’s last paragraph….

"There is, however, one point more that I cannot but advert to-namely, the influence of this mode of treatment upon the general healthiness of an hospital. Previously to its introduction, the two large wards in which most of my cases of accident and of operation are treated were amongst the unhealthiest in the whole surgical division of the Glasgow Royal Infirmary… But since the antiseptic treatment has been brought into full operation, and wounds and abscesses no longer poison the atmosphere with putrid exhalations, my wards, though in other respects under precisely the same circumstances as before, have completely changed their character; so that during the last nine months not a single instance of pyaemia, hospital gangrene, or erysipelas has occurred in them. As there appears to be no doubt regarding the cause of this change, the importance of the fact can hardly be exaggerated."



The reading for next week is:
The case for an all-female crew to Mars. William J. Rowe. Journal of Men’s Health and Gender. 2004 Dec Vol 1 (No.4) 341-344

If you prefer it as a PDF, click here and you should be able to get the file with your Athens password. Is this for real or is it a spoof? How do you assess the credibility of a paper like this? And what can you learn from it?

Interesting problems this week:

Small joint inflammatory arthritis in polymyalgia rheumatica, tell me more
Miller-Fisher syndrome. What is anti GQ1B?
Stent thrombosis, tell me more
Tarsal tunnel syndrome, what are the symptoms?
Dressler’s syndrome after pacemaker insertion, tell me more
Hypomagnesaemia, tell me more
Pacemaker Syndrome, what’s that?


Don’t forget your two minute tutorials…make them concise and precise.

If anyone would like to submit two minute tutorials for the podcast, or make a suggestion for future topics, just leave me a note in one of the comments.

MJM