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Author: Dinah Williams
Title: Lesson from Waterloo for Modern Medicine

The following newspaper clipping is Dinah's contribution:

From the Daily Telegraph 24/11/2004 by Celia Hall, Medical Editor

Lesson from Waterloo for Modern Medicine

The survival rates of soldiers and sailors wounded at the battles of Waterloo and Trafalgar are helping doctors to re-evaluate the body's ability to overcome serious injury.

Prof Mervyn Singer, an intensive care specialist at University College London, told a public lecture yesterday entitled Are we Ignoring the Lessons of Waterloo at our (Patients') Peril?: "Despite the non-existence of antibiotics, blood transfusion, life support machines and other paraphernalia of modern intensive care, most of them recovered.

"Yet with all our technical advances in medicine, mortality rates from conditions such as sepsis [bacterial infection in the blood stream] haven't improved dramatically."

He said that of 52 wounded survivors of the 13th Light Dragoons, injured by sabre, gunfire and cannon, only three died.

"Dr William Beatty, a surgeon on Victory, noted that 57 of the crew were killed at Trafalgar or died soon afterwards from wounds. But among 102 wounded survivors, including 10 amputees and cases of gangrene or tetanus, only six died."

Prof Singer is beginning research into multiple organ failure induced by sepsis.

"We need to ask whether our current interventions may even be injurious to the healing process.

"Modern treatments trigger changes in the patient's inflammatory and immune responses or influence circulatory, hormonal, bioenergetic and metabolic systems in ways we don't appreciate. Even lowering the temperatures of a feverish patient may be counter productive," he said. When people are badly injured, or have septicaemia, the body may shut down vital organs, such as the kidneys. This process, multiple organ failure, kills about a third of patients in intensive care.

Prof Singer and Dr Paul Glynne, of the Institute of Hepatology at UCL, are wondering if multiple organ failure is an extreme method of surviving critical illness by shutting down organs in a way similar to hibernating.

Their studies already indicate that leptin, a hormone that regulates hunger, body weight and metabolism, is linked to multiple organ failure induced by sepsis.

Prof Singer said it was known that when patients survived their injuries and multiple organ failure, the organs were not damaged. Even during failure they appeared to be healthy.