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YOUR HEALTH Dr James Le Fanu: 14 September

The steep rise – and decline – in the incidence of appendicitis, post-shingles pain relief and the benefits of banana skin

Written by Dr James Le Fanu
There are times when doctors must be firm, no matter how inconvenient their advice, as happened on 24 June 1902, two days before Edward VII's coronation, when Britain's most distinguished surgeon, Sir Frederick Treves was urgently summoned to the palace.

Earlier that evening, the king had hosted a dinner party for his guests (a mere eight courses accompanied by seven wines and brandy) but was now laid low by severe abdominal pain. Sir Frederick's examination revealed a tender mass in the royal pelvis, characteristic of acute appendicitis, and he urged an immediate operation.

The king, who had already waited until he was 59 before ascending the throne on his mother's death, demurred. 'I must keep faith with my people and go to the Abbey,' he remarked. To this, his surgeon replied: 'Then, sir, you will go in your coffin.' As indeed he might well have done, for the operation revealed an abscess the size of an orange arising from his appendix. The king recovered and the coronation took place two months later, on 9 August.

Perhaps surprisingly, appendicitis was a relatively 'new' disease at the time. None of the great physicians of earlier times mentioned it, and it was not until 1886 that an American surgeon described its unmistakable symptoms. Subsequently, its incidence rose steeply, taking in King Edward VII along the way, before reaching a peak in the 1950s when a young trainee surgeon would reasonably expect to remove a couple of appendices a week. Since then, it has been in steep decline and he (or she) would be lucky to perform the operation once a month.

There are two theories for this. The first is dietary, which implicates the relatively low-fibre diet common in Western countries. Appendicitis is rare in Africa and the Far East, where the high consumption of vegetable matter produces a loose and generous stool. This theory, however, fails to account for the initial rise in incidence, which is attributed to the improvements in hygiene following the introduction of domestic water supplies – and baths and water closets into Victorian homes. As a result, people were less exposed to infectious organisms, which in turn changed their pattern of immunity.

This week's medical problem comes courtesy of a lady from Leeds writing on behalf of her husband, who contracted shingles nine months ago; it was promptly diagnosed and treated appropriately with the antiviral drug Acyclovir. But he is still in a lot of pain at the site of the rash (known as post-herpetic neuralgia), despite taking generous amounts of painkillers, the use of a TENS machine and acupuncture. What else, she asks, might help?

This persistence of post-herpetic neuralgia, despite optimal treatment, is quite common. Her husband might consider discussing with his doctor the possibility of taking a small dose of morphine – MST Continus – which influences the perception of the intensity of the pain. Symptoms are often exacerbated by clothing – some find relief by interposing a layer of plastic (or cling film) over the area. Others report the homeopathic remedy hypericum to be very helpful.

drjames@lady.co.uk


TOP BANANAS

The value of rubbing a wart with the inside of a banana skin has featured in this column before, but it is interesting to hear it may also benefit those with eczema – as described by a Cambridge reader who has been troubled since childhood with the condition on her face and ears. 'I always have a banana with my supper, so I took to smearing the inside of the skin on my face and applying it in my ears with a cotton bud,' she writes. 'The effect has been dramatic.'



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