Intended for healthcare professionals



BMJ 1999; 318 doi: (Published 09 January 1999) Cite this as: BMJ 1999;318:136

Doctors may feel under siege from government quality initiatives, but things could be worse. An ancient Babylonian quality initiative found on a column at Susa reads: “If a physician shall make a severe wound with an operating knife and kill (the patient), or shall open an abscess …and destroy the eye, the (physician's) hand shall be cut off” (Quality in Health Care1998;7:228). King Hammurabi, who issued the edict, ruled Babylon over 4000 years ago, but the tabloid influence was unmistakable even then.

Simple lanolin cream and breast shells are better than hydrogel dressings for sore nipples in breast feeding women (Archives of Paediatrics and Adolescent Medicine 1998;152:1077-82). A randomised controlled trial in 42women found that both treatments worked, if used alongside lessons in breast feeding technique, but lanolin and breast shells were better at healing cracked nipples and relieving pain. The group using hydrogel dressing also had more infections.

Quinolone antibiotics like ciprofloxacin are increasingly used against urinary tract infections and chest infections. A commentary in British Journal of Sports Medicine (1998;32:280) warns, however, that they should not be prescribed for athletes. The whole class of drugs can cause inflammation of tendons, which may rupture if subjected to repeated strain. Ruptures …

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