By traveling to the Arctic and using video-microscope and thermal imaging technology, the scientists showed that the glow is from tiny blood vessels that are more abundant in the noses of reindeer than in humans’. Yes, seriously. The findings are being reported next week in BMJ, formerly known as The British Medical Journal, a publication with a quirky holiday tradition.
For the past 30 years, BMJ has devoted its Christmas-week issue to a lighter and sometimes brighter side of medicine, publishing unusual articles that vary from simply amusing to bizarre to creative or potentially important. All are based on methodologically sound science.
Alongside Rudolph on the cover of this year’s holiday issue is Cliff, a 2-year-old beagle who was trained by another Dutch team to accurately sniff out the sometimes fatal bacterial bowel infection Clostridium difficile and make the diagnosis in minutes — days faster than standard laboratory tests. The Christmas tradition began in 1982, originally intended as a one-time effort to give readers a break from stodgy scientific reports written in technical jargon. The editor then, Dr. Stephen P. Lock, recalled in an interview that he wanted to present “another side of medicine” by offering lighter reading: research oddities, bizarre stories and history. But this was no April fools’ issue: Dr. Lock insisted that the articles meet the same rigorous criteria as research published in regular issues.
Indeed, some articles in the holiday issue are also suitable for regular issues, said Dr. Tony Delamothe, the BMJ deputy editor who has overseen the last eight Christmas issues. “We are on an incessant search for novelty,” he said.
Over the years, BMJ Christmas reports have demolished myths, including a Danish one that people could get drunk by absorbing alcohol through the feet. After soaking their feet for three hours in a basin containing three bottles of vodka and measuring their blood alcohol levels, three Danish scientists found no such absorption.
The first Christmas issue included an account of a resuscitation from 1650 that still astounds today. An unwed 22-year-old mother in Oxford was condemned to death after being accused of murdering her premature, stillborn son and concealing his body. She was executed by hanging by the neck for half an hour while people present jerked her up and down.
At the time, the bodies of executed prisoners were given to doctors for anatomical dissection. Two doctors who opened the woman’s coffin were startled to hear raspy breaths. They revived her, and she went on to recover her memory and live another 15 years, marrying and giving birth to three children. The 17th-century doctors’ report met the criteria for a modern case report, wrote J. Trevor Hughes, the author of the 1982 article.
Dr. Lock, the editor, also encouraged historical back stories. In 1984, Dr. Charles Fletcher wrote about how he tested ways to safely administer the first precious batches of penicillin in 1941. The initial full test was on a 43-year-old British policeman who developed the widespread bacterial infection septicemia. He showed striking improvement from small doses of the antibiotic, but he died after the scarce supply — much of it recycled from his urine — ran out.
Many Christmas issue accounts would have upset earlier BMJ editors “like mad,” Dr. Lock said. “But so what?” he added. “It was fun.” Now there is so much competition for a spot in the issue that some authors submit papers early in the year and request publication at Christmastime.
Some articles poke fun at hoary traditions, such as diagnosing ailments in historical figures despite the lack of medical evidence. Mozart is a special favorite of armchair diagnosticians, Dr. Lucien R. Karhausen wrote in 2010 after tabulating articles reporting 140 possible causes of death and 27 mental disorders in the composer. Many, he said, were based on shoddy medical interpretations, undocumented “eyewitness accounts” or the ignoring of criteria that separate normal and abnormal behavior.
“Some causes are plausible,” Dr. Karhausen wrote, “only a few — maybe one, or maybe none of them — can be true, so most if not all are false.”
In 2006, BMJ reported on the results of a questionnaire sent to 110 members of the Sword Swallowers’ Association International. Forty-six members responded; they reported having swallowed more than 2,000 swords in the three preceding months. Sore throats (“sword throats”) were common during the learning phase, and after frequent repeated performances. Swallowers rarely sought medical advice. Of six who perforated their pharynx or esophagus, three needed surgery. No deaths were reported.
Still other articles play on the vanity of doctors, many of whose names are attached to instruments and syndromes. An article in 2010 extended the list to food products developed by doctors, including Kellogg’s Corn Flakes, various cookies, and Penfolds and Lindeman’s, the Australian wines.
As for the animals featured in this year’s holiday issue: The story of the infection-sniffing beagle began with a report from a nurse in the Netherlands, who mentioned that a patient’s stool had the distinctive odor of C. difficile — a bacterium that is causing serious and growing public-health problems in many countries, including the United States.
A team led by Dr. Marije K. Bomers at the VU University Medical Center in Amsterdam reasoned that it might be possible to train dogs to detect the infection, and Cliff the beagle did just that.
Cliff was trained to sit or lie down when he smelled C. difficile in the air walking by a patient’s bedside, and he also quickly and accurately identified all 50 stool samples with C. difficile and 25 of 30 infected patients — along with 50 stool samples free of the bacteria and 265 of 270 uninfected patients.
And the Dutch team that studied reindeer, working with researchers at the University of Tromso in the Norwegian Arctic, used a hand-held video microscope to observe the deer’s nasal capillaries as they ran on a treadmill.
The capillaries are arranged in circular clusters at different locations through the nose. Those in reindeer noses are 25 percent thicker than those observed in the human nose and are believed to perform critical roles like heating, delivering oxygen and humidifying inhaled air to keep the animal’s nose from freezing. (The leader of the team, Can Ince, a physiologist at Erasmus University Medical Center in Rotterdam, says he has a financial interest in the company that manufactures the technology, which is used to monitor reactions to various drugs and therapies among critically ill human patients.)
By showing that a large number of red blood cells flowed through the small nasal vessels, the scientists said they had unlocked the mystery of Rudolph’s red nose. May it long glow.
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