Checking up baby: a doctor cares for a baby in a Paris hospital, 2013. Photo: Getty
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The baby only had chickenpox. But then she suddenly stopped breathing

Dr Phil Whitaker’s Health Matters column. 

It seemed a straightforward visit – a feverish 13-month-old in an outlying village whose mum couldn’t bring her to surgery. I drove out on the lunchtime round and it didn’t take long to ascertain the reason for her daughter’s temperature: the first spots of chickenpox were apparent when I removed her Babygro. I continued my examination, making sure everything else was all right, and was in the middle of listening to her chest when suddenly the child arched her back grotesquely, her body incredibly stiff. Her eyes rolled, leaving just the whites visible, and she stopped breathing.

For a few seconds, my shocked brain refused to think of anything medically useful. Then, two things happened. The little girl’s body began to jerk violently, accompanied by her strangulated efforts to draw breath. And her mother began to scream.

I was inexperienced – this was during my first months in general practice – and I felt a huge surge of adrenalin. In the hospital, where I’d worked up until then, the press of a button would bring colleagues running in seconds and every conceivable drug was to hand. Out here in the middle of nowhere, aside from a stethoscope, a torch and a prescription pad, I had nothing.

The mother was hysterical – it did look for all the world as though an infanticidal poltergeist was choking the life out of her child. I managed to maintain enough presence of mind to put the girl in the recovery position and note the time (seizures that last longer than five minutes may need treatment to terminate them). By insistently and loudly repeating the mother’s name, I eventually broke through her terror and got her to dial 999.

This was almost certainly a febrile convulsion – a seizure associated with a high temperature. Despite the alarming appearances, they are in essence benign. They usually stop spontaneously within a few minutes, as this one did. For a first episode, admission is advised to rule out serious causes of fits such as meningitis, but subsequently, once a child is known to be prone to them, convulsions can be managed at home.

It used to be thought that taking steps to reduce fever must be helpful in preventing their occurrence. For years, doctors told parents to strip their febrile child off, put a fan to blow over them, even sponge them with tepid water. However, measures that cool the outside of the body often result in a reduction in skin blood flow. The skin is the body’s radiator: shut down its circulation and the heat simply remains inside, elevating the core temperature further.

More recently, advice has shifted to paracetamol and ibuprofen (antipyretics) – drugs that can but don’t always reduce fever. Many doctors and nurses exhort parents to monitor their children’s temperature, dose them up frequently and seek help if the fever isn’t “controlled”. A mythology has developed in which the fever is viewed as a dangerous phenomenon, one requiring treatment, and a cause for grave concern if it doesn’t respond.

Fevers, though, are part of our body’s natural fightback against infection. High temperatures, though unnerving if they cause a convulsion or delirium, are in reality helpful. Interestingly, recent research suggests that febrile convulsions are provoked not by the fever per se but by rapid changes in temperature. There is no evidence that antipyretics
are of any use in preventing seizures; indeed, they may make matters worse. It is possible that using them routinely to blunt this important part of the body’s immune response may ultimately prolong the course of infectious illnesses.

Children outgrow febrile convulsions. They’re most common in the first year, becoming progressively less frequent thereafter and virtually unheard of beyond the age of five. This coincides with the maturation of the “electrical insulation” – called myelin sheaths – that surrounds nerve cells in the brain. Once myelin has been fully laid down, the “short circuits” between nerve cells that kick-start seizures seem no longer to occur. It will take far longer to dismantle the mythology that surrounds fever, overturning beliefs that have become as ingrained in the health-care professions as they are in the wider culture.

This article first appeared in the 30 September 2014 issue of the New Statesman, ISIS vs The World

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The triumph of Misbah-ul-Haq, the quiet grafter

How Misbah redeemed Pakistani cricket.

It was an incongruous sight: the entire Pakistani cricket team doing press-ups on the revered pitch at Lord’s, led by its captain, Misbah-ul-Haq. This unusual celebration marked not merely a Test match victory over England on Sunday but something greater: the rehabilitation of Pakistani cricket.

Seven years earlier, the Sri Lankan team bus was en route to the cricket stadium in Lahore for the third day of a Test match against Pakistan when it was attacked by Islamist militants. Gunfire killed six police officers and a driver; several Sri Lankan cricketers were also injured. That was the last Test match played in Pakistan, which, despite protestations, opponents consider too dangerous to visit.

A year later, Pakistan toured England for a Test series. The News of the World alleged that in the final match at Lord’s three Pakistani cricketers had conspired to bowl no-balls in exchange for money. All three received bans of five years or more for corruption. The entire squad was lampooned; police had to shield its members from abuse as they arrived home.

Misbah was on the periphery of all of this. Aged 36 at the time, he was dropped from the squad before the English tour and seemed unlikely to play international cricket again. But the turbulence engulfing Pakistani cricket forced the selectors to reassess. Not only was Misbah recalled but he was made captain. “You have to ask yourself,” he later said: “‘Have I been the captain because they supported me, or because they had no alternatives?’”

Pakistani cricket prizes and mythologises teenage talent plucked from obscurity and brought into the international side. During his decade as captain, Imran Khan picked 11 teenagers to make their debuts, often simply on the basis of being wowed by their performance in the nets. Misbah shows that another way is possible. He grew up in Mianwali, a city that was so remote that: “The culture there wasn’t such that you thought about playing for Pakistan.”

At the behest of his parents, he devoted his early twenties not to his promising batting but to gaining an MBA. Only at 24 did he make his first-class debut, strikingly late in an age when professional sportsmen are expected to dedicate all their energy to the game from their teenage years.

Pakistani cricket has always been “a little blip of chaos to the straight lines of order”, Osman Samiuddin writes in The Unquiet Ones. Misbah has created order out of chaos. He is unflappable and methodical, both as a captain and as a batsman. His mood seems impervious to results. More than anything, he is resilient.

He has led Pakistan to 21 Test victories – seven more than any other captain. He has done this with a bowling attack ravaged by the 2010 corruption scandal and without playing a single match at home. Because of security concerns, Pakistan now play in the United Arab Emirates, sometimes in front of fewer than a hundred supporters.

Misbah has developed a team that marries professionalism with the self-expression and flair for which his country’s cricket is renowned. And he has scored runs – lots of them. Over his 43 Tests as captain, he has averaged at 56.68. Few have been so empowered by responsibility, or as selfless. He often fields at short leg, the most dangerous position in the game and one usually reserved for the team’s junior player.

Misbah has retained his capacity to surprise. As a batsman, he has a reputation for stoic defence. Yet, in November 2014 he reached a century against Australia in just 56 balls, equalling the previous record for the fastest ever Test innings, held by Viv Richards. The tuk-tuk had become a Ferrari.

Late in 2015, Misbah tried to retire. He was 41 and had helped to keep Pakistani cricket alive during some of its darkest days. But the selectors pressured him to stay on, arguing that the team would need him during its arduous tours to England and Australia.

They were right. His crowning glory was still to come. The team arrived in England following weeks of training with the national army in Abbottabad. “The army people are not getting much salaries, but for this flag and for the Pakistani nation, they want to sacrifice their lives,” Misbah said. “That’s a big motivation for all of us. Everyone is really putting effort in for that flag and the nation.”

Now 42, almost a decade older than any cricketer in England’s side, Misbah fulfilled a lifetime’s ambition by playing in a Test match at Lord’s. In Pakistan’s first innings, he scored a century and celebrated with push-ups on the outfield, in homage to the army’s fitness regime and those who had had the temerity to mock his age.

When Pakistan secured victory a little after 6pm on the fourth evening of the game, the entire team imitated the captain’s push-ups, then saluted the national flag. The applause for them reverberated far beyond St John’s Wood.

“It’s been a remarkable turnaround after the 2010 incident,” Misbah-ul-Haq said, ever undemonstrative.

He would never say as much, but he has done more than anyone else to lead Pakistan back to glory. 

Tim Wigmore is a contributing writer to the New Statesman and the author of Second XI: Cricket In Its Outposts.

This article first appeared in the 21 July 2016 issue of the New Statesman, The English Revolt