There is a striking difference in the structure and appearance of the arteries and the veins. The walls of the arteries are three layers thick, with muscles in the middle layer, the outer layer being tough and elastic. They hold their shape even when not distended with blood. The veins, in contrast, are thin and have little elasticity so that when empty they are hardly noticeable, and thus may be especially bothersome for surgeons. An artery stands boldly forth. One may see or feel its beat. If it is cut, the spurting blood tells where to seize it. But a big vein with soft weak walls cannot be told from other tissue when pressure has caused it to collapse. After the pressure is released, the blood oozes up from one knows not where.

Right here is probably the best place to talk about the control of bleeding by amateurs. The first-aid manuals have told people to use tourniquets. I believe that in the overwhelming majority of cases the tourniquet is unnecessary and is usually harmful. It is not a simple thing to apply a tourniquet efficiently. The arteries are deeply situated and stiff-walled, and hence difficult to compress to the point where bleeding is stopped. But the veins are superficial, flimsy, and easy to compress. It is difficult to tighten the tourniquet evenly to the point where it will stop arterial flow. Doing so causes great pain. I have no doubt that in a large majority of cases the blood keeps going through the arteries, but the pressure stops the return through the veins. Result — increased bleeding. Fortunately it is a rare case where bleeding is not stopped by clotting in the wound, especially as the low blood pressure resulting from shock or fainting hastens the clotting. Pressure over the point of bleeding is the best procedure for anybody but an experienced surgeon to use.

The arteries in early life are elastic and their diameter may enlarge or shrink from time to time according to the action of the muscles in their walls. The individual has no command over these muscles as their action is regulated by the involuntary, or sympathetic, nervous system. These nerves can be affected in various ways, as for instance by drugs, called vasodilators and vasoconstrictors. Nicotine is a vasoconstrictor. In such a condition as Buerger’s disease, in which the diameter of the vessels to the hands and feet is lessened, smoking is always forbidden. Emotions temporarily affect the size of the arteries. Thus blushing, resulting from shame or embarrassment, is due to the dilating of the small arteries in the skin.

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Medical professionals insisted that DES was safe for pregnant women until they discovered many years later, that women whose mothers took DES suffered from very high rates of cervical cancer. The authors of the Cancer Research study concluded, the use of soy-based infant formulas in the absence of medical necessity and the marketing of soy products designed to appeal to children should be closely examined.”

A policy statement of the Royal College of Australian Physicians includes their comments about soy formulas. They concur about the dangers of soy infant formula. The rationale for the use of soy formula has been the assumption that soy protein is less allergic than cows’ milk. But this is not the case. Soy protein can cause intolerance reactions with gastrointestinal symptoms as well as acute allergic reactions. In fact, up to 40 percent of infants intolerant of cow’s milk also develop soy protein intolerance. Soy can cause a loss of vitamins, minerals and trace elements from the gut. High aluminum content has also been documented in soy formula. It has over 1000 percent more aluminum than conventional milk-based formulas. Infants fed soy formula also had lower levels of antibodies in response to routine immunizations and more infections than those fed human milk or cow’s milk formula, leading to compromised immunity.

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Although better known for causing genital herpes, the herpes simplex virus (HSV) can infect skin anywhere on the body. HSV type 1 is a more common cause of these nongenital infections. The major difference is that type 2 is more prone to recurrence.

The virus is spread by direct contact and respiratory droplets. Primary infection occurs within 1 week of contact, frequently beginning with generalized symptoms such as fever, headache, and myalgias. Clusters of uniformly sized vesicles appear on an erythematous base. The vesicles erode and heal over a course of 2 to 6 weeks. During primary infection, virus ascends peripheral nerves to dorsal root ganglia, where it enters a latent stage. Secondary infection occurs through reactivation of these dormant clusters of virus. Secondary lesions are typically preceded by tingling, itching, or burning and are sometimes preceded by a prodrome of generalized symptoms.

There are a number of manifestations of HSV infection. Lesions that occur on the fingers are called herpetic whitlow. Herpes gladiatorum, classically described in wrestlers, occurs on abraded or traumatized skin. Vesicles can occur near the eye and should be taken very seriously, since ophthalmic infection can lead to permanent visual impairment. Prompt ophthalmology referral is crucial in such cases.

Nongenital herpes infections may be treated with acyclovir, valacyclovir, or famciclovir. Prophylaxis can be used for frequent recurrences (more than six per year). Prophylaxis should also be considered for patients in whom recurrence presents an occupational limitation (e.g., those in health care or athletics).

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