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Last Updated: Tuesday, 23 November, 2004, 16:26 GMT
Waterloo lessons could aid medics
A dramatisation of the battle of Waterloo
British soldiers in a dramatisation of the Battle of Waterloo
The battle of Waterloo could help doctors fight death from multiple organ failure - the number one killer of intensive care patients.

Scientists at University College London are launching a study into why multiple organ failure kills some critically ill patients but not others.

Professor Mervyn Singer said impressive survival statistics from the battle may provide a clue.

He said they showed the body's ability to heal itself under harsh conditions.

We may need to be more strategic in our treatments and therapies, tailoring them to how the body responds naturally.
Professor Mervyn Singer
Of the 52 privates in the 13th Light Dragoons wounded by sabre, gunfire and cannon injuries at Waterloo, only two subsequently died.

Professor Singer said: "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."

Professor Singer said modern treatments trigger changes in the patient's inflammatory and immune responses, or influence other factors such as hormone release and circulation in ways we do not fully 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."

Radical theory

Survival statistics from the battle of Waterloo throw up an even more radical theory - that multiple organ failure, triggered by severe trauma or subsequent infection, may actually represent 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.

The UCL team will carry out 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 death 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.

The hormone leptin, which regulates hunger, body weight and metabolism, seems to play a key role.

Dr Paul Glynne, who is also working on the study, said: "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."



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