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Dr Mark Porter on how today's medical knowledge can help to explain historical conditions that were tragically misdiagnosed.

Mark Porter Hindsight is one of the most powerful tools in medicine, as demonstrated by Channel 4's Secrets of the Dead, which comes up with a theory to explain the outbreak of witchcraft and possession that led to trials in Salem, Massachusetts, more than 300 years ago. And it's not just possession by evil spirits that can be explained with the benefit of current knowledge... but let's start with Salem.

Secrets of the Dead suggests that the people of Salem were suffering from a form of poisoning caused by mouldy cereals, particularly rye. The mould in question is Claviceps purpurae, which produces a number of toxic ergot-based alkaloids that survive cooking and lead to a form of poisoning known as ergotism (Saint Anthony's fire).

The most common form of ergotism is seen when people ingest small amounts of contaminated flour over a longish period, leading to pins and needles and burning in the extremities. Consuming large quantities in a short time can lead to a more acute form, characterised by dizziness, convulsions and hallucinations -just what happened to the poor people of Salem, for whom rye was a staple food.

Medical ignorance caused people to have superstitious beliefs

And it wasn't just poor villagers who suffered as a result of medical ignorance - it affected the high and mighty, too. Take King George III, whose reign was punctuated by periods of erratic behaviour and who is now thought to have suffered from porphyria, a rare inherited glitch in metabolism that leads to the build-up of toxins in the blood. Attacks tend to be intermittent and are characterised by stomachaches, paralysis, odd behaviour, delusions and hallucinations, seizures and difficulty in seeing. One telltale sign is that the urine may turn deep red on standing - something that must have been evident in the king's chamber pot, but which meant little or nothing to the horde of physicians trying to cure him. Poor chap.

Sometimes scientists and doctors themselves are affected. Antoine Henri Becquerel, the man credited with the discovery of radioactivity at the end of the 19th century, is a classic example. Such was his ignorance of the dangers of radiation that he once placed a vial of radium in his pocket. The resulting burn on his leg took weeks to heal. Becquerel and his co-workers still didn't catch on, though, and it was nearly three decades before safe radiation exposure limits were introduced in 1934. This ignorance cost more than 300 early radiation workers their lives and most, including Marie Curie, developed leukaemia. Curie's notebooks are dangerously radioactive even now.

The benefit of current medical knowledge has even been applied to the world's leading artists. I remember a lecture at medical school in which one of the country's leading ophthalmologists explained the painting styles of many of the world's masters through a series of visual defects, ranging from plain short-sightedness to astigmatisms and age-related macular degeneration. He even used corrective lenses to demonstrate his point and show how the paintings would have appeared to the artists in question.

And there is no reason to believe that hindsight in the year 2100 will prove any less revealing than it does today. Scientists and doctors then will hopefully be able to laugh at how their predecessors struggled to understand 20th-century epidemics such as cancer, heart disease, arthritis, asthma and eczema.
Hindsight maybe a powerful tool, but it's not a particularly helpful one, unlike a time machine... now we're talking.

Dr Mark Porter co-presents Watchdog Healthcheck Mondays BBC1 and is on Jimmy Young, alternate Mondays Radio 2.





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