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Letters

in which haemoglobinopathies are burns to the chest as a result of water benefits natural and experimental common colds.
BMJ 1989; 298(6683): 12801283.
common have been associated with spilling from the bowl. The total body
2. Hendley JO, Abbott RD, Beasley PP, Gwaltney JM, Jr.
faiths that do not find termination surface area of the burn ranged from Effect of inhalation of hot humidified air on
acceptable. For this reason informed 13% superficial partial thickness and experimental rhinovirus infection. JAMA 1994;
271(14): 11121113.
consent from the mother for these tests none of them required hospital admission.
3. Singh M. Heated, humidified air for the common
must make it clear what these tests may The parents of all three children claimed cold. Cochrane Database Syst Rev 2004(2):
lead to. Her beliefs must be respected they were advised by their GP to use CD001728.
4. Forstall GJ, Macknin ML, Yen-Lieberman BR,
even if this is expensive for society. steam inhalation for symptomatic relief. Medendrop SV. Effect of inhaling heated vapour on
A final question to ponder is the There is insufficient evidence in the symptoms of the common cold. JAMA 1994; 271(14):
11091111.
message these screening programs give literature to support the use of steam
5. Eadie PA, Williams R, Dickson WA. Thirty-five years
to those many individuals in our society inhalation as a treatment. A Cochrane of paediatric scalds: are lessons being learned? Br J
who live with one of these review of the use of heated, humidified air Plast Surg 1995; 48(2): 103105.
haemoglobinopathies. The point has for the common cold found only three 6. Sheller JL, Thuesen B. Scalds in children caused by
water from electrical kettles: effect of prevention
been eloquently put by the sociologist trials demonstrated beneficial effects on through information. Burns 1998; 24(5): 420424.
Shakespeare that a policy of termination the symptoms of the common cold.3 Other 7. Murphy SM, Murray D, Smith S, Orr DJ. Burns
caused by steam inhalation for respiratory tract
of disabled fetuses gives the disabled in studies have shown steam inhalation has infections in children. BMJ 2004; 328(7442): 757.
the community a strong, if unintended, no effect on viral shedding as well as a
message that they are not valued.4 failure to improve symptoms.2,4
The number of scalds in children has
Gervase Vernon risen over the last three decades
Hepatitis E and
General Practitioner, Essex according to a Welsh study.5 Scalds also meat carcasses
E-mail: gervase@jth.demon.co.uk remain the most frequent type of
paediatric burn admissions in Denmark
REFERENCES where majority are due to hot beverage I would like to report an interesting case
1. Marteau T, Dormandy E. Haemoglobinopathy
screening: an end to institutional racism? Br J Gen spillage.6 Murphy et al have reported of hepatitis. The patient is a 54-year-old
Pract 2005; 55: 419420. seven cases of burns needing admission, butcher who presented in January with
2. Thomas P, Oni L, Alli M, et al. Antenatal screening caused by steam inhalation treatment for nausea and vomiting. On examination he
for haemoglobinopathies in primary care: a whole
system participatory action research project. Br J Gen the common cold. In their report, two of was mildly jaundiced and reported dark
Pract 2005; 55: 424428. the parents claimed they were advised by urine. Biochemical profile confirmed
3. Vernon G. Can there be a moral dialogue between
doctor and patient? Catholic Medical Quarterly 2001;
their GP to use steam inhalation jaundice with a bilirubin of 76 and an
51(3): 511. treatment.7 The patients in our series were ALT of 560. The patient had had no
4. Shakespeare T. Choices and rights: Eugenics, genetics fortunate not to have sustained more recent foreign travel, no blood
and disability equality. Disability and Society 1998;
13: 665681. extensive burns. However the morbidity of transfusion and no history of IV drug
the pain and distress, possibility of wound use. His only risk factor appeared to be
infection, parental anxiety and several trips his occupation. Discussion with a
Steam inhalation to the dressing clinic can not be ignored. consultant medical microbiologist
Scalds from steam inhalation treatment suggested testing for Hepatitis A, B, C
treatment for are entirely avoidable. It is perhaps time to and E plus other viral antigens. Hepatitis
children start discouraging patients from using this E IgG was present, while antibody tests
form of home remedy, as there appears to for Hepatitis A, B and C were negative.
Nasal inhalation of steam has been be no significant benefit from steam The patient recovered after 6 weeks and
proposed as treatment of viral colds on inhalation. GPs are in prime position to his liver function tests have returned to
the assumption that increased intranasal educate parents on how to care for their normal.
temperature will inhibit replication of coryzal child and avoid the risky business Hepatitis E is prevalent in large parts
rhinovirus.1 Some clinical trials looking at of steam inhalation therapy. of the world though it is uncommon in
the effect of inhalation of steam on the UK. It is usually associated with
rhinovirus infection have used machine- MA Akhavani contaminated water supplies but is
generated heated humidified air.2 Most SHO, Burns and Plastic Surgery, Mount known to occur in animals, particularly
Vernon Hospital, Northwood pigs. The patient spent much of his time
people at home use the old fashioned way
E-mail: mo@doctors.org.uk
of head over a bowl of steaming hot water. butchering pork carcasses imported
During January 2005, three children from the European Community and the
RHJ Baker
were assessed in our burns unit following Far East. It is likely he became infected
SHO, Burns and Plastic Surgery, Mount
scalds with steam inhalation. All were while eating his lunch without
Vernon Hospital, Northwood
under the age of 5 years. Two children appropriate handwashing. One other
had burns to the feet as a result of kicking REFERENCES patient who worked as the same
the hot bowl of water. The other child had 1. Tyrrell D, Barrow I, Arthur J. Local hyperthermia butchers was found to have hepatitis E

British Journal of General Practice, July 2005 557