While we were taking blood samples from cardiac
surgical patients to study platelet function and blood loss(1-3) we observed a common
phenomenon. Several patients asked how much blood was going to be taken, and a proportion of
them responded uniformly to the reply that it was to be only enough for one large syringe.
They first appeared shocked, uttering: "What, that's almost a whole armful!" A hysterical
phase manifest by uncontrollable laughter would then follow, usually ending in an apology in
response to the concern of medical staff. As a means of explanation the afflicted patient
would often utter a bisyllabic word sounding like Hancock. This psychomotor disturbance
with its unique combination of bizarre facial expression and a common vocalisation phase
terminated by apparent hysteria seems to be uniquely associated with phlebotomy, and I
suggest the term "phlebomania Hancocksia" to describe it. I report the prevalence of this
disorder in cardiac surgical patients.
Patients, methods, and results
I
prospectively diagnosed and recorded the presence of phlebomania Hancocksia in 290 cardiac
surgical patients involved in the study.(1-3) Fifty two patients (18%) showed the
disturbance. There was no significant difference between those with or without the
disturbance in the mean number of grafts required,
preoperative
ventricular function, the number or type of drugs taken, presence of carotid bruits, or
history of cerebrovascular accidents. The only differences apparent between the two groups
were the age and sex distribution of the patients. The mean age of those with phlebomania
Hancocksia was only slightly higher than that of those without the disorder (65 (range
53-77) v 63 (37-85); P=0.32, Mann-Whitney U test). However, none of the 29 patients
under the age of 48 years in the study population (10%) had the disturbance (P=0.004,
Fisher's exact test). All 52 of those with the disturbance were men, compared with 177 of
the 238 (74%) without the disorder (P=0.00009).
Comment
Readers of the BMJ
who are old enough are probably aware of the cause of phlebomania Hancocksia. The first
known case of this condition is shown in figure 1.
Fig 1 - Tony Hancock, Patrick Cargill, and associates in "the Blood Donor", first broadcast in 1961.
The original outbreak in 1961 seems to
have made a lasting impression on a proportion of the population who were exposed to it.
Those who were under 18 at the time seem to have been comparatively protected from any long
term effect. They would have been under the age of 48 at the time of the study.
The
reason for the universal association of phlebomania Hancocksia with male sex is unclear. It
may be related to the apparently well recognised, completely unjustified belief among men
that their humour is original (K John, personal communication).
Perhaps the most
interesting facet of this condition is the manner in which some events enter national
consciousness. What people were doing when they heard of the assassination of John F Kennedy
is remembered by many. This is unsurprising, although it happened over 30 years ago, given
the importance of the man. What is surprising is that a single line from a comedy broadcast
a similar time ago is also remembered and reproduced appropriately by a significant number
of people who had heard it at that time. It is a tribute to the genius of the first known
sufferer of phlebomania Hancocksia that it is being described 35 years after its first
occurrence.
Funding: The original study on platelet function and blood loss in
cardiac surgical patients was supported by the Thrombosis Unit and the Joint Research Board
of St Bartholomew's Hospital.
Conflict of interest: None.
Department of
Cardiothoracic Surgery,
St Bartholomew's Hospital,
London EC1A 7BE
Lindsay C H
John,
senior registrar
References:
1 John L, Rees G,
Kovacs I. Inhibition of platelet function by heparin: an aetiological factor in post bypass
haemorrhage. J Thorac Cardiovasc Surg 1993;105:816-22.
2 John L, Rees G,
Kovacs I. Reduction of heparin binding to and inhibition of platelets by aprotinin. Ann
Thorac Surg 1993;55:1175-9.
3 John L, Rees G, Kovacs I. Different
anticoagulants and platelet reactivity in cardiac surgical patients. Ann Thorac Surg
1993;56:899-902.
