Morning Call: pick of the papers

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

1. The NHS is not a creaking relic, whatever the Tories may say (Daily Telegraph)

The NHS is being asked to do too much with too few staff – but Andy Burnham might just have a cure, says Mary Riddell.

2. It's crunch time on Trident for Miliband and his party (Guardian)

Labour's leader can break with Blairite and Tory nuclear business as usual – and show some real statesmanship, writes Nick Harvey.

3. Lynton Crosby and the myth of neutrality (Financial Times)

Those who exert power in a democracy should be accountable, writes John McDermott.

4. Arab Spring? No, more of a temper tantrum (Times)

These uprisings are mostly incoherent protests by young people, writes Daniel Finkelstein. Only when they are older will democracy thrive.

5. The day Labour lost the moral high ground on the NHS (Daily Mail)

The Tories needn't be intimidated by Labour's 'record' on health care, says Simon Heffer.

6. The Egyptian coup is a warning to Turkey – but will Erdoğan listen? (Guardian)

Like the Muslim Brotherhood, Erdoğan's AK party has alienated opponents, writes James E Baldwin. Ennahda in Tunisia shows a way forward for democratic Islamists.

7. Can Crosby cross the line? (Daily Telegraph)

Campaign strategist Lynton Crosby has revived Conservative Party fortunes, but can he win them the general election, asks Iain Martin.

8. The Keogh report: Don’t judge the NHS by its failures (Independent)

With so much fur flying, the substantive issue risks being obscured, says an Independent editorial.

9. Globalisation in a time of transition (Financial Times)

Trade remains vulnerable to problems such as financial crises and inequality, says Martin Wolf.

10. Bernanke makes markets twitch but what counts is the economy (Independent)

Higher interest rates will be a signal the economy is healing, writes Hamish McRae.

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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