Funtabulously Frivolous Friday Five 246

It is the doplr physician’s pulse watch.

• Pulsometer: As the second hand passes the 12 o’clock mark, take the pulse and count 15 beats. Read the corresponding number on the dial at the 15th beat.
• Asthmometer: As the second hand passes the 6 o’clock mark, count five breaths and read the corresponding number on the dial at the fifth breath.

Robert Graves (1796-1853) had long been heralded as the uncredited inventor of the second-hand on watches. However his role was only to extol the virtues of the second hand in the accurate assessment of the pulse in the clinical setting…

It was English physician Sir John Floyer (1649-1734), in 1707 who invented the pulsometer watch and therefore the seconds hand. Floyer was renowned for his work on the study of the pulse and believed understanding a patient’s pulse was fundamental to elucidating a diagnosis. He developed the pulsometer watch with London watchmaker, Samuel Watson. It enabled him to become the first physician to study the pulse in his clinical practice. He published The Physician’s Pulse-watch Volume I 1707, Volume II 1710.

The Doplr Pulse Watch (2017) is the physician designed modern day medical equivalent.

Sir John was a little eccentric. He held many strong convictions regarding cold bathing and was able to persuade ‘worthy and obliging gentlemen‘ to contribute towards erecting a cold bath at Lichfield.

‘Physicians oft find it a difficult task to conquer the aversions of nice patients and to persuade them to use those medicines to which they have not been accustomed, until they have first convinced them that their medicines are both safe and necessary. I expect to find the same aversion to cold bathing.’ Floyer 1702

Appendectomy 

William Henry Battle (1855-1936) was an English surgeon, who noted some patients developed hernias post appendicectomy and therefore modified the site of incision

… incision 1.5 inches to the inside of the line semilunaris, and divided the aponeurosis of the external oblique with the sheet of the rectus. The rectus muscle was then drawn to the inner side, and the posterior layer of the sheath and transversals fascia exposed, the inner incision not corresponding to the external

He later responded that “this incision did absolutely prevent hernia”

Battle 1904

Immune hyperthyroidism (more commonly referred to as Graves disease or Parry disease.)

In March 1840, Karl Adolph von Basedow (1799-1854), described an association of exophthalmos, tachycardia, and goitre in four cases (Madamme F, G, C and Herr M) monitored over periods of 2, 5, 10 and 11 years. Described locally as the ‘Merseburger Triad‘ the condition was eponymised in 1858 as Basedow disease by Hirsch 1858;2:224-225

Von Basedow outlined the symptoms of hyperthroidism including intolerance to heat, profound sweating, diarrhea and weight loss in the presence of increased appetite.

Madame G and Madame F presented with symptoms of florid hyperthyroidism and exophthalmos and during the course of the disease, both were deemed to have become insane with Madame F admitted to a lunatic asylum.

There appeared an eminent protrusion of the eye balls, which by the way were absolutely healthy and had a completely full sight. In spite of this the sick woman was sleeping with open eyes and had a frightening appearance.’

Basedow 1840 (Madame G)

Herr M, was a 50-year-old man who in 1832 began feeling malaise and having diarrhoea. He suffered from ‘a heat of the blood‘, intense sweating, and oppression of the chest. He had a pale puffy countenance with protruding eyes (‘prominent like a crayfish’s eyes‘); the thyroid was enlarged; the patient was emaciated in spite of good appetite and continued to suffer from loose bowels.

Von Basedow described the connection between these symptoms and tried to explain the pathophysiological mechanisms. He proposed that the exophthalmos was due to an increase of the tissue behind the eye. He hypothesized that ‘dyscrasia of the blood‘ (i.e. mediated via the circulation) caused this tissue swelling and also the goitre. He described pretibial myxedema in two patients with thickened lower legs consisting of a ‘plastic brawn‘ not being impressible and not releasing fluid by puncture. Finally he described pregnancy as a most suitable cure! With symptom amelioration during, and exacerbation following pregnancy recorded in all of his three female patients.

In 1848, Basedow proposed the name Die Glotzaugen-cachexie [Goggle-eyed cachexia] for the constellation of symptoms he first described in 1840.

Her heart was restarted with a direct current shock after 20 minutes.

The Rev. Mr Sowdon and Mr Hawes, apothecary, reported on the surprising effects of electricity in a case report of recovery from sudden death, published in the annual report of the newly founded Humane Society now the Royal Humane Society. The Society had developed from ‘The Institution for Affording immediate relief to persons apparently dead from drowning’. It was “instituted in the year 1774, to protect the industrious from the fatal consequences of unforseen accidents; the young and inexperienced from being sacrificed to their recreations; and the unhappy victims of desponding melancholy and deliberate suicide; from the miserable consequences of self-destruction.”

A Mr Squires, of Wardour Street, Soho lived opposite the house from which a three year old girl, Catherine Sophia Greenhill had fallen from the first storey window on 16th July 1774. After the attending apothecary had declared that nothing could be done for the child Mr Squires, “with the consent of the parents very humanely tried the effects of electricity. At least twenty minutes had elapsed before he could apply the shock, which he gave to various parts of the body without any apparent success; but at length, upon transmitting a few shocks through the thorax, he perceived a small pulsation: soon after the child began to sigh, and to breathe, though with great difficulty. In about ten minutes she vomited: a kind of stupor, occaisioned by the depression of the cranium, remained for some days, but proper means being used, the child was restored to perfect health and spirits in about a week. [Reference]

It is somewhat doubtful that the electricity resulted in ROSC as the child was likely unconscious from a head injury, that is unless she had commotio cordis.

A general rule of thumb is that if the tattoo-to-tooth ratio (TTR) is greater than or equal to one, your patient is indestructible.

The higher the TTR score, the lower the likelihood of a terminal outcome.

A patient with a TTR of just two could be run over by a truck after being shot twice in the back outside of the bar in which he drank six-fifths of whiskey, and shortly after admission to the emergency department he would be demanding cigarettes and sexual favours from any nearby persons.