Battle of Waterloo could help doctors fight death from multiple organ failure

Nov 23 2004

Waterloo’s battlefield is reigniting the debate about whether modern medicine is always good for you, according to University College London (UCL) scientists who are launching a study of why some critically ill patients recover and others die from multiple organ failure - the number one killer of patients in intensive care.

Speaking today at a public lecture held in London, Professor Mervyn Singer from UCL’s Institute of Intensive Care Medicine said the impressive survival statistics of injured soldiers at the battles of Waterloo and Trafalgar serve as a reminder of how we underestimate the human body’s ability to heal itself under the most extreme conditions. Of the 52 privates in the 13th Light Dragoons wounded by sabre, gunfire and cannon injuries at Waterloo, only two subsequently died.

Prof Singer says: “Despite the non-existence of antibiotics, blood transfusions, life-support machines and other paraphernalia of modern intensive care, most of these soldiers recovered, often from life-threatening injuries. Yet with all our technical advances in medicine, mortality rates from conditions such as sepsis (bacterial infection of the bloodstream) haven't improved dramatically over the past century.

“The question we need to ask ourselves is whether our present understanding of underlying pathology in medicine is leading us down the wrong path, and whether our current interventions may even be injurious to the healing process.

“Modern treatments trigger changes in the patient’s inflammatory and immune responses or influence circulatory, hormonal, bioenergetic and metabolic systems in ways we don't appreciate. Even lowering the temperature of a feverish patient may be counter-productive. We may need to be more strategic in our treatments and therapies, tailoring them to how the body responds naturally to sepsis and other critical illnesses.”

Survival statistics from the battle of Waterloo throw up an even more radical theory – could it be that multiple organ failure, triggered by severe trauma or subsequent infection, actually represents the body’s last-ditch attempt to survive in the face of a critical illness? By switching itself off and becoming dormant, as with hibernating animals during extreme cold, the body may thus be able to tide itself through the critical period. Support for this theory comes from the fact that the organs invariably recover, to the point of appearing remarkably normal, within days to weeks when the patient survives.

Professor Singer and colleague Dr Paul Glynne from UCL’s Institute of Hepatology are about to embark on a large study of multiple organ failure induced by sepsis, which kills around a third of patients in intensive care. Ultimately, they hope that by understanding why people either survive or die from this condition, new therapies can be developed to reduce the period of illness and mortality rate.

Preliminary work suggests that the body’s ability to store and use energy efficiently may play a part in determining whether a patient will recover. A recent study by Dr Glynne and Prof Singer has linked leptin, the protein hormone regulating hunger, body weight and metabolism, to sepsis-induced organ failure and recovery.

Dr Glynne says: “The body’s inability to regulate energy expenditure seems to play a key role in the development of sepsis-induced multiple organ failure. We think that some septic patients become deficient in leptin and this leads to energy failure and subsequent organ dysfunction. Exploring the relationship between leptin, body energy regulation and the severity of critical illness will reveal whether leptin, or one of its downstream targets, could potentially be developed as a new therapy for septic patients with organ failure."

Professor Mervyn Singer’s lecture, “Are we Ignoring the Lessons of Waterloo at our (Patients’) Peril?” held today at 1pm at UCL, is part of a series of lunchtime lectures which are open to the general public.