My review and commentary continue:
(Part one here.)
Doctor Smith: Hokianga’s King of the North, by G. Kemble Welch.
Published by Blackwood and Janet Paul, Auckland and Hamilton, 1965. Printed in Great Britain by Latimer Trend and Co Ltd, Plymouth.
p. 26-27
Although the hospital was small, it was full of trouble…His chief worry was a boy of four with an appendix abscess on which he had operated. The wound had broken down; he had repaired it; now the second lot of stitching was giving way and the wound was full of pus.
It is difficult these days for a younger generation of doctors, let alone of lay people, to realise the constant anxiety that infection, and pus–its sign–were to a surgeon before the era of antibiotics. He was constantly aware that any kind of wound, from an insect bite to a surgical incision, might get a germ in it which would set up an infection he could not control, and he would have to stand by and watch his patient die of septicaemia. It was all part of the world in which he lived and worked and the risk was accepted as inevitable; but so was the worry inevitable and not less wearing for that.
We are in a new age of anxiety, this time over antibiotic resistance. Now the question is not necessarily one of infection but of superbug infection, of appropriate antibiotic usage, of the possibility that we may soon be right back in G.M. Smith’s era of worry, plus some.
A week ago, The Guardian ran this piece: Antibiotic-resistant diseases pose ‘apocalyptic’ threat, expert says. The World Health Organization has published figures for multidrug-resistant tuberculosis and staph infections such as MRSA that are worrying because they are so widespread. Extensively drug-resistant TB, for instance, has been found in 64 countries and counting.
What can we do about this? The strategy that seemed likely to work for limiting the spread of really bad bugs (screen new patients for MRSA or VRE and have health care providers use physical barriers like gloves and gowns) was discovered in 2011 to have “no effect.” The New England Journal of Medicine study (scroll down to “Intervention to Reduce Transmission of Resistant Bacteria…”) notes that “adherence to precautions was suboptimal.” However, the article just below (see “Veterans Affairs Initiative…”) gives us some hope that institutional change can be effective where everyone is responsible for infection control.
It’s a problem with many facets, of course, including high antibiotic prescribing rates, the shift to using newer broad-spectrum antibiotics, and patient non-compliance with finishing a round of prescribed antibiotics.
Rates of antibiotic-resistant infection peak in winter, when another unfriendly bug makes its rounds: the flu. This year’s a bad one, from everything I’m hearing from the northern hemisphere, with the CDC confirming an early beginning and a probable long tail. Just think: at least it’s not 1918.
p. 41-42 [The 1918 influenza epidemic]
Dr Smith and the district nurses were trying to be everywhere at once, but of course did not succeed.
At nearby Pakanae nearly every family was sick; but only two people died. This was probably due to the efforts of the Fells and the Websters, who alone remained unaffected. When they realised that in the Maori settlement all the people had sickened at the same time, were too ill to look after themselves and were starving, they organised a relief service.
To start with, the Fells killed a pig and gave one half to the Websters. From both halves broth was made and taken around in dixies in the family buggies. As they came to a house they would call out, and whoever was least ill would come outside with some sort of container. They would ladle out the broth, and go on to the next place. A bullock followed the pig, and with the twice daily supply of food the people began to get better. As they improved, Mrs Fell and Mrs Webster made scones, rice puddings and cakes to add to their diet of stews, until the people were well enough to look after themselves again.
…
In the middle of all this a call came from Waiotemarama. They were hard hit over there, with many deaths, and urgently needed more supplies. Could someone help? Mr Fell couldn’t really spare the time from his own worries, but it sounded as though Waiotemarama was worse, so he agreed to drive in a dray loaded with their requirements: coffins and whisky.
In November 1918 Mr J. Nisbet had just returned from the war to live in Rawene with his bride and they ‘walked right into the ‘flu’, and into Dr Smith’s handling of the situation.
He had decided that, since the disease was infectious, people must stop making contact with one another; if each family lived in their own house and there was no visiting, no travelling, the possibility of handing on or catching the disease would be greatly reduced. But he found that people were weak; they liked visiting and travelling and were not prepared to stop merely because Dr Smith said it might save their lives. The next step was to post armed men at crossroads to turn back travellers. There is no record of them needing to shoot anyone. No Parliamentary or other authority was given for this. It was G.M.’s idea. He said do it, and it was done.
G.M.’s ideas about quarantine weren’t new, and they weren’t ill-founded. If you keep people apart, the germs can’t spread from host to host. Galileo, for instance, was kept from seeing his beloved daughter because of the Catholic church authorities’ rules during the bubonic plague outbreak of 1629. She sent tonics by messenger that were meant to keep him safe from the plague (while rats roamed freely, of course).
We know about rats and their fleas now; we know about antibiotics for bacterial infection and precautions for avoiding flu viruses and still we fall ill, all too often. I’m thinking of my brother P and his wife C and their three kids, who’ve played unwilling hosts to this year’s flu bug. Get better, dear ones.
More excerpts of G.M. Smith’s biography to come!