IELTS Academic Reading Practice Test 348

On the battlefields of the eighteenth century, a wounded soldier's chances of survival depended less on the skill of the surgeons than on how quickly he could be taken away from the fighting. Armies employed civilian contractors to collect the injured once the guns had fallen silent, and these men, who worked for profit, were accused of robbing the very soldiers they were supposed to carry. Anyone who could not walk was often left where he fell for a day or more, and many died of loss of blood, shock or cold before a surgeon ever saw them.

Dominique-Jean Larrey was born in 1766 in Beaudéan, a village in the Pyrenees, the son of a shoemaker. He was apprenticed to an uncle who practised surgery in Toulouse, and later travelled to Paris to study under Pierre-Joseph Desault, one of the most celebrated surgeons of the day. After a period as a naval surgeon he joined the revolutionary army in 1792 and was posted to the Army of the Rhine as a junior surgeon at the age of twenty-six. The wounded men he saw there were scattered across the countryside in barns and churches, often many miles behind the lines.

That first campaign showed Larrey the system at its worst. Because the ambulance service was run by contractors, treatment began only after a battle had ended, and the wounded were carried from the field in heavy wagons that jolted over rough ground, adding to their injuries and their pain. Larrey proposed a corps of soldiers trained to carry stretchers, supported by light, sprung carriages that could keep pace with an advancing army. His superiors approved the plan, and the vehicles that resulted became known as ambulances volantes, or flying ambulances.

The lightest flying ambulance was a covered two-wheeled cart on springs, drawn by horses, in which two seriously injured men could travel lying down; a larger four-wheeled version carried four. It carried dressings, splints, bandages and surgical instruments, and a surgeon and an assistant rode with it. Because it was light and fast, it could wait close behind the troops instead of at the rear, so that a soldier might be on the operating table within an hour of being hit rather than several days later. The first of the new vehicles entered service with the Army of the Rhine before the end of 1793.

Larrey also changed the order in which the injured were treated. Faced with hundreds of casualties and very little time, he sorted them into three groups. The first contained those whose wounds were dangerous but could be repaired by prompt surgery, and these he treated first, regardless of rank or nationality. The second were the less urgent cases. The third were the mortally wounded, who were made as comfortable as possible while the surgeons worked on the others. This sorting of casualties, later given the name triage, is now a principle of every emergency service in the world.

He insisted, too, on operating early. The usual practice was to wait several days before removing a limb, in the belief that the patient would be stronger; Larrey argued from his own cases that delay allowed infection to take hold, and that an operation performed within the first twenty-four hours was far more likely to succeed. He treated the wounded of the enemy exactly as he treated his own, and during the Russian campaign he is said to have operated on Russian prisoners as readily as on French soldiers.

His abilities were noticed. Larrey followed Napoleon to Italy and then to Egypt, where he studied the eye disease that affected so many of the troops and published a description of it. In 1804 he was appointed surgeon-in-chief of the Imperial Guard, and in 1809, after the Austrian campaign, he was made a baron of the Empire. He was with the army that invaded Russia in 1812 and at Borodino, where the casualties numbered in the tens of thousands; contemporary accounts describe him working for days with almost no sleep, moving from one operating table to the next.

At Waterloo in 1815 Larrey was wounded and taken prisoner by Prussian troops, who recognised him, treated his injury and released him. With Napoleon's fall he lost his post and faced financial hardship for a time before being restored to the military medical service. He died in 1842 in Lyon, on his way home from an inspection of hospitals in Algeria. His name is one of the seventy-two engraved on the Eiffel Tower, and his insistence on bringing treatment forward to the battlefield is regarded as the foundation of modern military medicine.

Other armies were slow to copy the flying ambulances, but the principle behind them could not be ignored for ever. By the time of the Crimean War and the American Civil War, organised ambulance corps formed part of every large army; in the twentieth century the horse-drawn carriage gave way to the motorised field ambulance. Meanwhile the word itself had come to mean the vehicle rather than the mobile hospital it had once described.

The common cold is not one illness but a family of them. More than two hundred different viruses are known to cause the familiar combination of a blocked nose, a sore throat, sneezing and a cough, and the rhinoviruses, a large group within that number, are estimated to account for around half of all cases. Because so many agents are involved, a cold that lays one person low may leave another completely untouched, and the immunity gained from one infection offers little protection against the next.

Infection usually begins when virus-laden droplets from a cough or a sneeze land on the lining of the nose or the eye. The hand is an equally important route: a person who touches a contaminated door handle or keyboard and then rubs an eye can transfer the virus directly to the tissues it prefers. Once the virus has entered, there is a quiet period of a day or two before any symptom appears, during which it is already multiplying inside the cells of the airway. Children, whose immune systems have met fewer of these viruses, catch colds more often than adults.

The nose is protected by a thin layer of mucus, a sticky secretion that traps particles, including viruses, and is then carried backwards by microscopic hairs called cilia and swallowed. This clearance system is remarkably efficient, and most virus particles never reach a cell at all. The ones that do must first attach themselves to a specific receptor on the surface of an epithelial cell, a molecule that happens to fit the outer shell of a rhinovirus almost exactly.

Once inside, the virus takes over the cell's machinery and forces it to produce copies of itself. The cell does not submit quietly. Like most cells, epithelial cells carry sensors that recognise molecular patterns typical of invading viruses, and within hours of detecting them the cell begins to secrete interferon, a signalling protein that alerts neighbouring cells. Those cells respond by shutting down many of their own normal activities, which makes it much harder for the virus to reproduce.

Interferon does more than interfere with the virus. It produces many of the sensations we associate with being ill: aching limbs, tiredness and a general sense of heaviness. This is one reason why a cold feels worse than the damage to the nose alone would suggest. The immune response, in other words, is not simply a defence that switches on when required; it is an event with costs of its own, and some of the misery of a cold is the price the body pays for fighting it.

Within a day or two the response becomes visible. Chemical signals released by the infected tissue widen the blood vessels of the nasal lining, so that it swells and the airway narrows; this is what a blocked nose actually is. The same signals draw white blood cells to the area. The most numerous arrivals are neutrophils, which release enzymes and other substances that damage infected cells but also irritate the lining, and these are largely responsible for the soreness and for the sudden production of thin mucus that runs from the nose. Macrophages, which engulf virus particles and the remains of dead cells, follow them.

Behind this immediate defence comes a slower, more precise one. Cells known as cytotoxic T cells recognise infected cells and destroy them, while B cells produce antibodies. In the nose and throat the most important of these is a type called IgA, which is secreted into the mucus and can neutralise virus particles before they attach to a cell. This adaptive response clears the infection within about a week, but the protection it leaves behind is partial, short-lived and limited to the type of virus that caused it.

That is also why there is no vaccine against the common cold and no drug that cures it. A vaccine would need to cover well over a hundred distinct types of rhinovirus, and the most variable part of the virus, its outer protein shell or capsid, is precisely the part the immune system recognises. Antiviral drugs designed to block that shell have been tested and have largely failed. Antibiotics are useless against any virus, though they are sometimes prescribed when a bacterial infection develops on top of a cold, and the evidence that vitamin C prevents colds is weak.

Research continues on several fronts. Human challenge studies, in which volunteers are deliberately infected in controlled conditions, have allowed scientists to follow the immune response hour by hour. Some groups are trying to design drugs that attack features shared by all rhinovirus types rather than the variable outer shell. Others are asking why the same virus makes one person mildly uncomfortable and another genuinely unwell; the answer appears to involve age, previous exposure, sleep, stress and genetic variation. Much of this remains uncertain.

Two persistent beliefs are worth correcting. Cold weather does not itself cause colds, although people spend more time indoors in winter and dry indoor air may help the virus to spread. Antihistamines, so effective in hay fever, bring little relief in a cold, because histamine plays a much smaller part in the nasal swelling caused by a virus than it does in an allergic reaction.

Every week, in private clinics around the world, someone under the age of eighteen asks a surgeon to change a part of the body that they have come to dislike. The request may be for a smaller nose, flatter ears, a different chin or larger breasts. The surgeon must decide whether the patient is a customer with a right to be served, a patient with a medical need, or a child who should be protected from a decision that cannot easily be undone.

The numbers are not easy to compare between countries, because registers record different procedures, but the trend is clear: cosmetic surgery has become an ordinary part of medicine in many high-income societies, and the age at which people first seek it has fallen. Advertisements, and more recently social media, have made procedures visible to audiences that earlier generations would have regarded as far too young to be interested. Regulation has not kept pace. Some countries set a formal minimum age for aesthetic operations; others leave the matter to professional guidelines; still others rely on the judgement of individual surgeons. In Britain, the health service rarely provides operations carried out purely for cosmetic reasons, and although cosmetic injections were banned for under-eighteens in 2021, private cosmetic surgery has been far less strictly controlled.

The argument for allowing young people to decide is not frivolous. By sixteen, many are making serious decisions about their education, their health and their relationships, and the law generally treats them as capable of consenting to medical treatment. Consent is not the same as whim, and the law already accepts that many adolescents are competent judges of their own interests. A young person who has been mocked for years because of protruding ears may have thought about the operation for longer than the surgeon has. To deny such a patient any say, the argument runs, is paternalism, and it treats a physical feature that causes real distress as though it were a trivial matter of vanity.

Against this stands a growing body of evidence about the adolescent brain. The regions that generate strong emotion and sensitivity to social judgement mature early, while the systems that allow us to weigh a distant consequence against an immediate desire are still developing into the twenties. Adolescents are, on average, more responsive than adults to the opinions of their peers and more focused on the present. This does not make them incapable; it does mean that a decision taken at sixteen may reflect the intensities of one particular year rather than a settled view of the self.

There is a further difficulty, which is that the wish for surgery is sometimes a symptom rather than a solution. Surgeons are advised to look for signs of body dysmorphic disorder, a condition in which a person becomes preoccupied with a slight or imagined flaw in their appearance. Studies of people seeking cosmetic procedures have found such symptoms in a notable minority, and patients with the disorder are often dissatisfied with the result of an operation, returning for further procedures that do not resolve their distress. For a young person whose sense of self is still forming, that cycle can be especially damaging.

Yet prohibition has costs of its own. A young person who is refused an operation by a responsible clinic does not necessarily abandon the idea; they may travel to a country with looser rules, or turn to a provider who offers cut-price injections in a hotel room. A ban can therefore move the procedure from a regulated setting into an unregulated one, where the risks are greater and follow-up care is often absent. Nor does it address the immense pressure that social media places on young people, which is the force actually driving much of the demand. The lesson of other areas of public health is not encouraging: make a substance illegal and the market does not vanish, it simply changes hands.

This suggests that the question needs to be more precise. It is one thing to pin back ears that have attracted cruel comments since primary school, or to correct a nose that interferes with breathing; it is quite another to insert a permanent implant into a body that is still growing. Operations differ in how reversible they are, in the burden they place on a young person later in life, and in the likelihood that the underlying unhappiness will remain afterwards. A rule that treats all procedures alike will be either too strict for the first kind or too permissive for the second. Age is a crude measure of maturity, but the nature of the operation is a much better one.

My own view is that restriction, not prohibition, is the right answer. A legal minimum age of eighteen should apply to operations that are irreversible and purely aesthetic, such as breast enlargement; procedures that correct a genuine deformity or relieve physical symptoms should remain available to younger patients after assessment. For anyone under eighteen, a psychological assessment and a compulsory waiting period of several months should be conditions of surgery, so that a decision made in the misery of one winter can be reconsidered in the calmer light of summer. That is a compromise, but it is one that protects the young person without pretending that appearance does not matter.