Medical Mysteries: The Testament of a Clinical ScientistBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7534.184 (Published 19 January 2006) Cite this as: BMJ 2006;332:184
Have you ever wondered while treating a patient with rheumatoid arthritis or hypertension what causes their condition? This authoritative book, based on research and patients with whom the author has worked, tries to unearth such causes.
Book Guild, £15.95, pp 505 ISBN 1 85776 976 7 www.bookguild.co.uk
An updated version of 21 Medical Mysteries by the same author, this time John Dickinson, emeritus professor of medicine at St Bartholomew's and the London School of Medicine, covers 42 subjects, each relating to a condition not fully understood, thereby making it a medical mystery. He includes all of the conditions you might expect and more—asthma, irritable bowel syndrome, myalgic encephalitis, multiple sclerosis, and schizophrenia, to name a few. It is clear from the preface alone that he has a deep passion for his subject and that years of careful work have been distilled into this book.
Professor Dickinson has turned much of what I thought was common knowledge on its head. For example, in relation to stroke, lowering blood pressure in most cases apparently increases cerebral blood flow and normal cerebral arteries do not in fact burst under high pressure. In the chapter on hypertension there is a study that shows that the vertebral arteries may play a role in its control—news to me. There are too many examples to mention so I will recount the one that excited me the most—endometriosis.
“Endometriosis (EMT) is a common but bizarre condition,” it begins. Professor Dickinson states that the condition is rare in central Africa and that he could not find any published work on abdominal endometriosis in Indian women. He then discusses its widely touted theories, placing much weight on Sampson's implantation model but not on that of retrograde menstruation: “If bits of endometrium can easily be induced to stick onto and grow on abdominal organs in normal non-human primates whose female pelvic anatomy closely resembles human female anatomy, why don't all women get endometriosis if retrograde menstruation is as common as most people say it is?” Good point. He concludes with his own fascinating postulation based on pressure. He suggests with the aid of diagrams that the garments a woman wears during menstruation could be the key—that by wearing tight fitting clothing there is a rise in intra-abdominal pressure and when those tight garments are removed, retrograde menstruation occurs because of the pressure change. “Could the almost universal wearing of loose-hanging saris by Indian women and chadors by Arab women give them protection against endometriosis?” It seems he may be on to something.
The whole book is not quite as electrifying as the endometriosis-preventing sari in terms of new theories, but it is written sensitively, carefully balancing anecdotes with evidence. There are few omissions from this book but the inquisitive reader who shares the professor's sense of detective work will naturally start to think of questions. For instance, while reading the chapters on inflammatory bowel disease I suddenly wondered whether there might be any cultural difference in the incidence of colorectal conditions based on whether people squat or sit on the lavatory.
Medical Mysteries makes you think about what the future of medical science might hold for conditions that have perplexed us for many years, and that can only be a good thing.