The BBC has just finished its excellent Genius Of The Modern World series, which traced the lives of giants of contemporary thought. I didn't make the shortlist - too young, obviously - but Karl Marx, Sigmund Freud and Friedrich Nietzsche were stars of the show. My clinical eye likes to rove in documentary land, and I was particularly interested in what they had to say about the skin of Karl Marx.

The world's most famous leftie had a serious problem with carbuncles - or boils, as patients call them. We're not talking the odd pimple here. Marx had chronic eruptions of large abscesses throughout his adult life, and revisionist thinking suggests it may have affected his mood and outlook on things.

Karl Marx suffered from abscesses all over his body, but particularly badly affected were his backside, his groin and under his armpits, which he himself described as 'a mess'. Painful lumps on his inner thigh would grind against his trousers, making even a short walk very difficult. Sitting was often impossible because of the carbuncles on his bottom. A large boil beneath the shoulder blade would make lying down quite an ordeal. In particularly black moods, Marx would hack at them with a cut-throat razor. Understandable, but not medically recommended. He lived in London for most of his adult life and all his doctor could do was recommend serious poisons that were once prescribed frequently for skin diseases. In the summer months, his physician would send him on bathing holidays to Margate for the 'sea cure' together with a prescription for arsenic three times a day. Marx felt that arsenic dulled his mind. It probably did a lot more besides. In dark days, and there were many, he would blame bourgeoisie 'swine' for his carbuncles. Modern thinking is that Marx suffered from a severe form of hidradenitis suppuritiva (sometimes abbreviated to HS). This is a relatively rare condition of the sweat glands that causes clusters of pus-filled abscesses, often in the nether regions where sweat glands proliferate. The Irish Skin Foundation has an excellent section about HS on its website.

The London Marathon claimed another life this year, with the sudden death of a 31-year-old army captain. The veteran of the Afghan war had a cardiac arrest just three miles from the finish line. The medical director of the race said it was a "total tragedy" and a "very rare occurrence". Not that rare, perhaps, because there have now been 14 deaths in the London marathon alone. It has been suggested that everyone should be screened for heart problems in advance, but we all know that heart screening isn't anything like the exact science we might like it to be. Crystal balls simply do not exist in medicine. Not counting skin chafing and minor injuries, dozens of participants need hospital assessment in every city marathon. There are chest pains, cases of dehydration, shortness of breath, collapse, hypothermia and gastrointestinal upsets. The health benefits of extreme sports are often extolled, but it does no harm to give at least some consideration to the risks. Dogs are great experts in the field of exercise. Very few of them run marathons.

Professor Des O'Neill in Tallaght Hospital is a great champion for older people in Ireland. Writing recently from a conference in Finland, he expressed his dismay at seeing plans for a number of new nursing homes in Ireland that fail to embrace the homely environment that has become the norm in Nordic countries. The Irish model he cites as quadrangles of long bedroom corridors, with large dayrooms to cater for all. In northern Europe, they are seeing the advantage of building separate units of no more than 10 bedrooms with small sitting rooms, private spaces, kitchens and dining areas. Des sees this model as facilitating dignity and independence, something that our giant care edifices lack. Some years ago, I wrote here about Dutch nursing homes, which see a great advantage in central locations so that residents can integrate in local shops and communities. It's a great pity that there are no real champions for older people in the current Dail or Seanad. For far too long now, we have allowed property developers and investors set State policy on the care of older people. The growth of institution-sized nursing homes that keep residents remote from their communities needs to end.

I have been collecting your family memories of the Great Spanish Flu of 1918, and was delighted to hear from Newry, where I would have had some relatives at the time. A reader from the town is active in a local history society, and a few years ago she researched and wrote a local history of the epidemic, which she has sent to me. It's a fascinating piece. In November 1918, Dr Flood recommended the discontinuation of 'wakes' in the town. The dispensary doctor told Newry District Council that he knew of one instance where the wake of a person who died of a virulent attack of influenza was attended by 80 people. He said there was a terrible risk in such gatherings, especially as the flu was not a notifiable disease, and nobody had any idea how many were dying in the area. Schools and picture palaces were closed. Churches remained open, and were merely disinfected. Local doctors and nurses succumbed to the disease, and the Board of Guardians had trouble getting replacements. One Dr O'Connell agreed to take on responsibilities, provided he was paid a guinea a day to cover night as well as day duty. A guinea was probably a week's wages for the average man in 1918, but desperate times sometimes call for desperate salaries!

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

drmauricegueret.com

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