Thanksgiving

Sometimes I wonder what I’d be like if I was born in 1800.  I’d be crippled, since I have an arthritis requiring regular medication.  Once the arthritis affected my eyes and without medication, I might’ve become blind.  Then one time a mosquito bite on my calf got infected, my knee swelled up, and it took surgery and a month of antibiotics to clean up.  In 1800 the cure for this infection, to save the patient’s life, was a mid-thigh amputation.  Without anesthesia.

Modern medicine gives me lots to be thankful for, not being a one-legged, blind, crippled guy.  In the late 1800s anesthesia was invented, so patients didn’t have to be strapped down and shriek through their operations.  Also at that time aseptic technique was discovered, so that patients wouldn’t get infected during surgery.  Before that, surgery was a last ditch effort to save people, since many died from bacteria introduced in surgery.  Then in the 1930s, antibiotics were invented, another breakthrough that made today’s whole Scott possible.  Finally, the 20th century brought anti-inflammatory and non-narcotic pain medication.  In the 1800s the only pain medications available were opioids like laudanum, which was opium dissolved in alcohol.  That would’ve made me a one-legged, blind, crippled narcotic addict.

My pediatric patients have lots to be thankful for as well.  When I was a kid, if a child developed leukemia, the most common pediatric cancer, he was certain to die within months of diagnosis.  Today, leukemia has cure rates above 90%.  The majority of my cohorts who had cystic fibrosis, sickle cell disease, congenital heart defects, extreme prematurity, were dead by the time I had my fifteenth birthday.  Today most of these kids will live into old age.

Finally, in 1900, one in ten babies died before their first birthday due to infections like diphtheria, tetanus, and, pertussis.  One in three were dead before age 5. Thanks to improved living conditions and vaccinations, these deaths are rare.  During my own 26 year career, the invention of  meningococcus, pneumococcus, and H. Flu vaccines have emptied pediatric wards that were once filled with kids with meningitis and blood infections.  Modern medicine has kept me whole, and countless of my own patients.

What if there was an apocalypse, and technology reverted back to the way things were in, say, 1800?  The best-selling book, Station Eleven, explores what life might be like if a flu epidemic wiped out the majority of the world’s population, and civilization collapsed.  The book jacket come-on asks, “What would you miss most?”  Coffee?  Electric lights at night?  Recorded music?  Air-conditioning?

If this sounds like science fiction, don’t get too comfortable in that thought.  In 1919 the Spanish Flu epidemic was unimaginably huge.  One in four people on the planet got sick.  Millions and millions died.  In some towns, so many were sick that there weren’t enough able-bodied to bury the dead.  Today, when things go bad with water supplies after hurricanes in parts of the world, there are still cholera and typhoid epidemics.  One bad virus could turn the whole world into post-Katrina New Orleans, with few left to keep the lights on, bury the dead, and maintain order.

The movie Contagion, with an all-star cast including Gwyneth Paltrow, Laurence Fishburne, and Matt Damon, tells a more likely scenario.  In this film, the flu epidemic wipes out a lot of people and whole cities are quarantined, with resulting movie mayhem.  However, the CDC and government keep a lid on things while struggling to isolate the virus and develop a vaccine.

So this Thanksgiving, be thankful for the good things modern medicine has given us.  Like we discussed above, medical advances have kept so many more children alive than a hundred years ago- kids with infections, cancers, sickle cell disease, cystic fibrosis, and extreme prematurity.  Don’t let thanksgiving become complacency either. Though we rarely see kids with diseases we vaccinate against- meningitis, pertussis, polio- doesn’t mean they’re not out there, waiting.  Make sure your kids have their vaccines.

When I worked in the Philippines in 1998, where many don’t have the luxury of vaccination, I saw two kids die of tetanus.  One was an un-vaccinated teenager from a rural village.  He had stepped on a sewing needle, which inoculated him through his foot.  He died a slow death by asphyxiation, as his chest wall muscles spasmed and wouldn’t allow him to breath.

Be thankful for vaccination! 

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