Morning Call: pick of the papers

The ten must-read comment pieces from this morning's papers.

1. George Osborne's strivers have a shock in store (Guardian)

The £10bn of extra welfare cuts will hit the strivers the Tories are courting as much as the targeted 'shirkers', says Gavin Kelly.

2. Andrew Mitchell must step down (Daily Telegraph)

The Chief Whip is a walking, talking embodiment of everything with which David Cameron would least like his party to be associated, says a Telegraph leader.

3. The harmful myth of the balanced budget (Financial Times)

Critics of austerity sell themselves short by merely calling for a deceleration in deficit reduction, says Samuel Brittan.

4. The US is buzzing, but it’s a Wasp-free zone (Times) (£)

In 1992 all four presidential candidates were White Anglo-Saxon Protestants, notes Ben Macintyre. That’s four more than this year.

5. Integration? The opposite is true in Jeremy Hunt's NHS (Guardian)

The latest healthcare buzzword means nothing, but growing privatisation is reported to be fragmenting services, writes Polly Toynbee.

6. What Doctors Don’t Tell You: There is something very wrong with our libel laws (Independent)

Our libel law protects the rich and the powerful, writes Simon Singh. It's time for a 21st century re-think.

7. Cameron’s toffs must convince the plebs they’re on their side (Daily Telegraph)

The Andrew Mitchell affair hides the fact that it is the Conservatives who are fighting class inequality, argues Fraser Nelson.

8. High-stakes choices for China’s leaders (Financial Times)

Changes at the top will shape the international order for decades, writes Philip Stephens.

9. Grubby deal that will harm British politics (Daily Mail)

The Prime Minister should think long and hard before allowing 16 and 17-year-olds to vote on Scottish independence, argues a Daily Mail editorial.

10. Gove's centralism is not so much socialist as Soviet (Guardian)

Instead of modernising, British schools stick with the same culture that saw a Nobel winner humiliated in class, writes Simon Jenkins.

 

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear