Category: healthcare

Hemorrhoid surgery, circa 1200 AD.

Hemorrhoid surgery, circa 1200 AD.

The World Health Organization declared Dec. 1,…

The World Health Organization declared Dec. 1, 1988, the first World AIDS Day. On the 20th Anniversary, photographers and reporters reflect on their coverage of the epidemic.

A woman drank 3 gallons of water in 2 hours, t…

A woman drank 3 gallons of water in 2 hours, this is what happened to her brain.

from chubbyemu

A man drank 3 liters of rum everyday since age…

A man drank 3 liters of rum everyday since age 13. This is what happened to his liver.

from Chubbyemu

A teen ate 3 Tide pods. This is what happened …

A teen ate 3 Tide pods. This is what happened to his lungs and esophagus

from chubbyemu

When corpses and skulls were medicine

When corpses and skulls were medicine

from Ask a Mortician

A boy ate 25 laxatives brownies in 1 hour, thi…

A boy ate 25 laxatives brownies in 1 hour, this is what happaned to his kidneys

from chubbyemu

The Great Flu Pandemic of 1918,

The Great Flu Pandemic of 1918,

Holy Cow! This years flu season is quite a doosy! It seems like everybody has the flu and most times I leave work I’m totally exhausted. So I find it fitting to do a post on the worst flu pandemic in history, the Great Flu Pandemic of 1918.

The Great Flu Pandemic began in 1918, the final year of World War I. It’s a cruel irony that the world deadliest pandemic began at the end of what was then the worlds bloodiest conflict. Between 1918 and 1920 the flu swept across the world infecting around 500 million people and killing between 50-100 million. In 4 years of fighting World War I resulted in the deaths of around 20 million people, both military personnel and civilians. In that same era, the Great Flu Pandemic resulted in 50-100 million deaths in two years. 

World War I is of course inexorably linked with the pandemic as the movement of millions of people from their homelands to various battlefields and war zones across the world helped spread the disease. Poor hygiene, combat stress, and undernourishment may have also played a role in the spread of the disease (although the pandemic killed the healthiest as I shall detail later). At the time the Pandemic was referred to as the “Spanish flu”, not because the epidemic began in Spain or because the flu was particularly bad in Spain, but because war time censorship covered up or downplayed reports of flu outbreaks and deaths. Spain was neutral during the war, thus news reports flowed freely without interference from the Spanish government.

Perhaps the most unusual aspect of the particular strain of flu that caused the Pandemic was that it struck the most healthiest segments of the population. Typically, those most vulnerable to influenza are the very young and the very old; infants, children, and the elderly. However the Spanish flu seemed  deadliest to adults in the prime of their lives. 99% of deaths were people under the age of 60, 50% of deaths were people between the ages of 20 and 40. One reason for this may have been because the particular strain of flu (recovered from frozen corpses in the Arctic) that resulted in the Pandemic was a mutated strain that caused a massive overreaction of the immune system (cytokine release), which ravaged the body eventually causing the immune system to shut down. Most deaths from the Pandemic were not from the flu itself, but from secondary infections such as pneumonia. Thus, people of healthy age were at most risk because they have stronger immune systems. Another class of people particularly at risk were pregnant women, as pregnancy causes the body to boost the immune system to protect the baby. One study conducted by historian John. M. Barry found that pregnant women hospitalized with the flu had a 23%-78% fatality rate depending on region. Finally, native tribal peoples were most vulnerable, having little or no prior conduct with outside diseases. In the Pacific, Arctic, and in tribal parts of Africa entire villages were wiped out.

The result of the Pandemic was one of the worst public health catastrophes in history. Public health services were overwhelmed by the sick and mortuary services were overwhelmed by the dead. Large public buildings such as schools, convention centers, theaters, stadiums, factories, and military installations were converted into large makeshift hospitals were hundreds or thousands of sick were treated at a time. Many localities were so overwhelmed by the large numbers of corpses resulting from the pandemic that they dug mass graves.

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In many localities public services closed down entirely. People quarantined themselves at home while businesses sold goods by special order, setting the merchandise out on the street for customers to pick up.

The Pandemic continued throughout 1918 and slowed by the summer of 1919. By 1920 the Pandemic came to end.  Around ¼th to 1/3rd of the world population had been infected, resulting in a 3 – 6% decrease in the world population. I guess this years flu season isn’t that bad after all.

Fun Fact: During World War I the American Expeditionary Force suffered around 117,000 dead while overseas. Half were from combat. The rest were from the flu.

Repent, for the Antibiotic Apocalypse is Near!…

Repent, for the Antibiotic Apocalypse is Near!!!

“History shows again and again how nature points out the folly of man.”

In 892 AD the Viking warrior Sigurd the Mighty defeated the Scottish nobleman Mael Brigte in battle. In celebration of his victory Sigurd strapped Mael’s severed head onto his saddle, and rode around his army in triumph. Unfortunately Mael’s large buck teeth scratched the side of Sigurd’s leg, which became infected, leading to his death a few weeks later. Legend has it that famous whiskey  distiller Jack Daniel died after kicking his floor safe, resulting in a cut on his toe which became infected, leading to his death in 1911. In 1912 inventor and aviator Wilbur Wright developed food poisoning after eating bad shellfish during a business trip. He died at the age of 45. Lord Carnarvon, chief financial backer of the Howard Carter expedition which discovered King Tut’s tomb died in 1923 when a mosquito bite became infected resulting in sepsis. Modern myth has it that he was a victim of King Tut’s curse. More likely he was a victim of living before the advent of modern medicine.

Such was the life of mankind before the invention of modern antibiotics. Every cut or wound could pose a serious risk. Diseases like pneumonia or strep throat could very well lead to death rather than just a few days of bed rest. In fact, much of modern medicine is built upon a foundation of antibiotics. This began in 1928 when the scientist Sir Alexander Fleming (pictured above) identified the first antibiotic, penicillin, after extracting the drug from a mold which had accidentally grown in the culture plates of an unrelated experiment. Since then a wide variety of antibiotics have been developed, allowing mankind to fight a winning war against the bacteria.  However, in recent times, the bacteria have been making a comeback.

While antibiotics are effective, it is only a matter of time before bacteria evolve and adapt to them, developing resistance. When an antibiotic is prescribed but discontinued too early, bacteria that have survived the antibiotic can become immune to it’s effects. Those bacteria of course divide and reproduce, leading to a new strain of bacteria that is resistant to that antibiotic, making the antibiotic useless. A bacterium can even swap DNA with other bacteria, spreading the resistance further. Misuse of an antibiotics can also lead to resistance. For instance when an antibiotic is prescribed for the common cold, which is a virus and cannot be killed by an antibiotic. While eventually the immune system fights off the virus, the antibiotic effects the normal bacteria that makes up our bodily ecosystem, such as our gut bacteria or skin flora. An example of this the bacteria Staphylococcus aureus. For the most part S. aureus lives in the our noses and skin without causing any problems. It’s pretty normal, around 1/3 of all Americans harbor S. aureus in their nostrils. Sometimes, S. aureus can cause minor skin or throat infections, and on rare occasions major infections such as pneumonia and meningitis. Due to the widespread availability of antibiotics, in the past few decades new strains of S. aureus have recently developed, called methicillin resistant Staphylococcus aureus, or as it’s better known, MRSA.

Antibiotic resistance is not a new phenomenon, only a few years after the discovery of penicillin, antiobiotic resistant strains began to be identified. Alexander Fleming himself remarked,

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.”

Therein lies the problem, rather than being treated like a precious and limited resources, antibiotics have been overused and misused as a miracle cure-all. As someone in healthcare I’ve seen many times where physicians will be deluded into thinking that because a drug or treatment works exceptionally well for one thing, it must likewise work well for other things. This results in the physician prescribing the drug like its some kind magical elixir, when in fact it’s  completely unnecessary and am ineffective misapplication of the drug. 

Antibiotics are no different.

Antibiotics are prescribed for viral infections such influenza, most forms of bronchitis, or the common cold even though they only kill bacteria and parasites, not viruses.  Sometimes, a really sick patient in the hospital will be prescribed an antibiotic in case the illness is a bacterial infection, but when the lab results come back revealing it’s not, the patient will continue to be prescribed the antibiotic “just in case”. 

When I was a teenager I was even prescribed amoxicillin for acne. Yes, for acne!

Much of it is the fault of the patient. Decades of antibiotic proliferation have created a culture where people believe that antibiotics are a cure for anything. Back in the day, when you were sick, you went to a doctor for an antibiotic. Now patient’s demand antibiotics for any and all illnesses believing they are a miracle cure for everything. Finally there is the 800 lb gorilla in the room; the heavy use of antibiotics for livestock, which accounts for as much use as with humans. More and more, antibiotics have become less and less effective in agriculture creating both antibiotic resistance animal and human strains of bacteria.

In the past three decades, the problem has become a critical issue, with antibiotic strains of diseases plaguing our healthcare system. Research in new antibiotics has failed to keep up, as our current pharmacopoeia becomes less and less effective. If nothing changes, the only prospect for our near future is the “Antibitioic Apocalypse”, the time when most or all of our antibiotics will be useless.  In essence, modern medicine will be knocked back to the days of Sigurd the Mighty. Millions will die from common diseases such as pneumonia. Immunocompromised patients such as cancer patients and AIDS patients will be at risk of infection. Tuberculosis, once considered a 19th century disease, will become common again. Routine surgery could become seriously dangerous with the added risk of untreatable infections. Even simple acts like shaving or parading the decapitated heads of your slain enemies could result in death. 

Fortunately there are things that you, the average person, can do to stave off the Antibiotic Apocalypse. Don’t ask or demand antibiotics for the sniffles or the coughies. You won’t believe the hordes of people that come into the ER with stuff like the common cold when in reality professional treatment was never really needed. Drink plenty of fluids, get some rest, eat your fruits and veggies and you’ll probably be OK.  Stop your doctor from needlessly prescribing antibiotics.  If your doc is prescribing you antibiotics for something other than a bacterial infection or parasite, most likely it is a misapplication of the drug. If you do have an antibiotic, take it until the prescription is done to ensure the infection is completely eradicated. Either that, or ask your doctor if discontinuation is possible.

Do this, or the bacteria will win…

(Top: “Ignorance = Fear / Silence = Death” by …

(Top: “Ignorance = Fear / Silence = Death” by Keith Haring, 1989. Bottom: “He Kills Me” by Donald Moffett, 1987.)

Today is World AIDS Day/Day With(out) Art, inaugurated in 1988 during the height of the AIDS epidemic in the United States. These two works above, both by gay artists, were created to bring attention to the American government’s inaction and complicity in the deaths of many in the LGBTQ community. 

Via the Whitney’s show An Incomplete History of Protest.