NEJM 22 Mar 2007

In England they used to be known as firemen, even when this invited confusion with the stokers of steam locomotives, but now they are usually called by the more heroic name of firefighter, after the American practice. A few months ago, after the death of a British firefighter in the course of duty, I was surprised to learn that this is a very rare event. It seems from this US study that during emergency duty a greater risk may be death from coronary heart disease, but this also remains uncommon and overall their firefighters are fitter than the general population.

Ah, another case of hand foot and mouth disease.

Call the registrar round, look for spots on the bottom too: no, it’s nothing to do with cattle, yes, it’ll get better on its own in a few days. Ah, but will it? Did you know that enterovirus 71 infection can be neurotropic? That it can affect the pons and the cerebellum, and even the medulla causing neurogenic pulmonary oedema which can be fatal? This paper reports the long term sequelae of hand, foot and mouth disease complicated by encephalitis in the massive Taiwanese epidemic of 1998. Few had lasting neuropsychological impairment except those who had suffered cardiopulmonary failure. But the experience of poliomyelitis in the last century warns us that these enteroviruses have a nasty habit of becoming more infectious and more neurotropic without warning (see the perspective piece).

Claudicatio n. limping (Cicero). So “intermittent claudication