We're the clear losers in the latest round of germ warfare
Hospital-infection deaths expose how vulnerable -- and complacent --we are, writes John Crown
Future generations will laugh at the sheer arrogance and hubris that the medical profession exhibited with respect to infection in the 20th century.
As recently as the early 1900s, women feared childbirth because of the chance of dying of "puerperal sepsis". My generation were raised on stories of healthy young farmers who had pricked their finger on thorns, got "blood poisoning" and died.
Older professors related that every new medical school class before 1950 would lose at least one student to "consumption". Poor tenement children died of diphtheria, measles and scarlet fever, British doctors and nurses of hepatitis B in the 1970s. The "immoral" succumbed to syphilis, whole institutions to meningitis. Pneumonia "setting in" after a cold was a death sentence.
Then it all seemed to change. Advances in public health, anti-sepsis, vaccination and antibiotics led to an apparent "conquest" of infection, and to the disappearance of some of the most dread diseases known. Soon medical students survived university, and maternal death in childbirth became mercifully rare. People could now elect to have sex or surgery without the fear of deadly consequences. Or could they?
Our apparent victory over the bugs was illusory, short-lived and ultimately pyrrhic.
If anyone had told this newly-minted medical student in 1974 that before my training was over, a whole new, previously unrecognised sexually transmitted viral infection would emerge that would kill young people by the million, that patients would again fear that even minor surgery might result in their death, and that tuberculosis would again become a concern, I would have thought it was apocalyptic science fiction.
Such arrogance we all had!
If you thought the only tiny invisible thing you had to worry about was the Progressive Democrat party think again. Germs are everywhere, and an informed microbiological bookie would give huge odds that if only one of "us or them" survives, it won't be us.
There are many different kinds of germs, grouped together as bacteria, fungi, viruses or protozoans. The latter are responsible for much ill-health around the world, mostly in poor countries. However, the recent Galway water problem was due to one of their number.
Bacteria have been attracting most of the headlines lately. They have probably caused more deaths than any other type of infection. Different bacteria are responsible for TB, syphilis, diphtheria, pneumonia, and scarlet fever.
Luckily the cellular structure of the bacteria differs just enough from that of human cells that we can make drugs (typically antibiotics), which poison them and not us.
Because many of the greatest scourges of mankind were caused by bacteria, the development of antibiotics and the "conquest" of bacterial infections saved many millions of lives, and fed our complacency.
Our profligate use of antibiotics allowed the development of resistant bacteria. Such is methicillin-resistant staphylococcus aureus, or MRSA. MRSA sufferers and their families get justifiably upset when doctors say that this germ is not that dangerous. It usually isn't.
Many of you have it. The problem is that if you get sick with something else, then the infection caused by MRSA is hard to eradicate.
Clostridium difficile is another case in point. This germ is found in the intestines of many healthy people, where it is often kept in check by a balance of other bacteria.
If you are run down, however, or if you have had certain antibiotics, it can make you ill, or kill you. The germ is hardy and can live on floors, walls, bathroom porcelain etc. Special antibiotics can cure it, but it takes time, time that a sick patient may not have.
Viral diseases range from trivial colds to potential causes of human extinction. Unlike bacteria, it is harder to develop drugs which target viruses. There have been advances, spectacular in the case of HIV/Aids, a disease once uniformly fatal within a few years which is now compatible with long life.
The inappropriate treatment of common benign viral illnesses (e.g. colds) with antibiotics is a major cause of the emergence of MRSA and other resistant bacteria. Doctors who allow themselves to be browbeaten into the inappropriate prescribing of antibiotics are hastening the day when they will have to tell their infected patients "there is nothing I can do for you".
Our hospital infections are contributed to by bureaucratic and administrative neglect. Old, dirty, overcrowded and understaffed wards are a leading cause.
Incredibly, in one recent fatal hospital outbreak, the absence of the hospitals only infection control nurse on leave was judged to have been a principal cause. While doctors need to wash their hands to prevent infection, I am sick of seeing politicians washing theirs of any responsibility for it.
Professor John Crown is a consultant oncologist
