Tuesday, 2 November 2010

Haiti, cholera and Carnaby Street

The Broad Street Pump memorial
How sad to hear the recent news from Haiti. What suffering the people have endure. And now cholera.

Sadly it took a very long time for the Victorian medical establishment to accept that cholera was a water born infection.  So many theories were advanced for both its causation and cure in mid Victorian Britain from the truly ridiculous to the sublime. One doctor who wrote in to The Lancet calling himself, a tobacco smoker’ suggested that smoking gave excellent protection against cholera, first, by relieving the mind from that most depressing agent, fear, and secondly by 'neutralising the miasm and disgusting noxious effluvia’ in other words purifying the air.

Of causation the ideas  were legion. One medic suggesting that it was the new railways changing the magnetism in the vicinity. The Board of Health set up by the government advised that , ‘vegetables, salads and pickles’ were to be avoided at all costs, leading the Lancet to proclaim, ‘grown up men and women tremble at the Brussel sprout or a gherkin!’.

Thankfully John Snow’s painstaking work was eventually recognised and the contaminated water theory was accepted as fact. I’m somewhat proud of my association with John Snow for he was a product of Westminster Medical School, which alas is no more having been gobbled up first with Charing Cross and then finally by Imperial. I thoroughly enjoyed reading his story and the develoment of his theory in The Medical Detective by Sarah Hempel

His Broad Street pump research and the famous map which is known to epidemiologists the world over is his great legacy. Broad Street no longer exists but the original site of it is only a handful of yards from Carnaby Street. There’s a memorial there now and it’s worth seeing.

Thank God for individuals who are willing to stand against the accepted view. With an explosion of guidelines somewhat suffocating today's doctors, we could do with a few more John Snows. Although of course his work wasn't just a reflection of a maverick temperament, but the result of dedicated and laborious research. 

Painstaking dogged research is so important, as is a willingness not to toe the party line (everyone including Florence Nightingale) and espouse the miasm theory prior to Snow. At a recent GP update course (which I thoroughly enjoyed and heartely recommend) we were reminded that it’s ok to deviate from national guidelines as long as you are aware of the guidelines and give good reasons for doing what you do.

Thank God for modern methods of re-hydration and antibiotics. Lets hope and pray that te suffering of the people of Haita will be short lived.

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A message from the other side

No, not that side! But thank God got through surgery ok yesterday. And thanks to all for love support and prayer.