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

Photo: Getty
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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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