Intermittent claudication and peripheral arterial disease

Even an educated man like George Minot had problems with his feet.  He often complained of numbness and pain in his feet.  He found relief from the pain from heat, so he often took off his shoes and propped his feet next to an electric sunbowl radiator while he read or rested [Inquis. Phys p 139].  The sunbowl radiator was a popular electric heater at the time.  It was a heatlamp surrounded by a parabolic reflector that provided radiant warmth when plugged into an electrical circuit.  George had several of these sunbowls.  He kept one at his office, another in his study at home and a third in his bedroom.

George Minot used a sunbowl radiator to warm his cold feet.
George Minot used a sunbowl radiator to warm his cold feet.

Minot’s foot problems first appeared in 1932.  Dr Joslin, the physician overseeing his diabetes treatment, sent him to see a specialist about problems with his left foot.  The surgeon noted that his left foot was substantially colder than his right, and diagnosed the condition as intermittent claudication, caused by a blockage of the arteries leading to the foot.

Intermittent claudication is typically the first symptom of peripheral arterial disease (PAD). Peripheral arterial disease is often associated with diabetes mellitus.  It’s caused by atherosclerosis.  When combined with neuropathy, another malady associated with diabetes, peripheral artery disease can lead to severe consequences.  Neuropathy, the degradation of the nerves, leads to a loss of feeling in the feet.  While peripheral artery disease leads to reduced bloodflow and problems with healing from minor injuries.  Together minor wounds can fester, become infected, and lead to amputation.

In early January of 1943, Minot was toasting his feet in front of a sunbowl, as he often did.  He got too close and developed a small 4 mm diameter blister on his left big toe. [inquisitive, p 257].  Most people might let this heal on their own, but Minot knew the importance and challenge of diabetic foot injuries.  He went to a specialist and had it treated.  It took about a month to heal.  In August of that year, he did the same thing, blistered his toe from too much heat.  This time it took about 3 months to fully heal.

Then, in January 1944 he did it again.  This time his surgeon tried to dress the wound as before, but had little success.  After two months of little progress on healing, the surgeon convinced Minot to check himself into the hospital or face the prospect of amputation.  Minot spent three weeks in the New England Deaconess Hospital off his feet.  This rest was enough to heal the toe.