Tag Archives: covid-19

A year of plague

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BY THE SUMMER, five hundred people were dying every week in London. The fatalities included both the rich and the poor. Parliament was moved from the capital to the city of Oxford. By July, the plague was destroying the city of London and every Londoner became regarded as a potential carrier of the disease. Towns such as Bristol would not admit Londoners unless they had proof that they were free of contamination. This proof was in the form of a document issued by the Mayor of London, in whose own household illness was rife. Towns near London shut their doors to Londoners and their citizens stayed at home.

In London, volunteer searchers inspected every house and whenever they came across one in which at least one resident had signs of the disease, they posted a notice above the door. This bore the words “God have mercy on us.” Then, two soldiers were posted by the entrance of each affected house to make sure that no one entered or left.  By August, the theatres, inns, and markets were closed in London. When business was conducted, coinage used to pay for goods was dropped into a tub of water by the customer and then retrieved by the vendor or supplier. Nobody touched the hands of another. Later that month, terrified Londoners began fleeing from the diseased city, but they were turned away from wherever they went. By September, 5000 Londoners were dying each week. Schools were closed. As a result, schoolteachers applied to the government for financial relief.

What I have been describing is nothing to do with the current covid19 pandemic, even if there are some remarkable similarities. Also, when considering the number of deaths, it is worth noting that London’s population in 1625 was about 300,000. It refers to a plague (possibly bubonic) that afflicted London in 1625. The information I have given has been extracted from a book that I am reading at the moment: a biography of Sir Harry Vane (1613-1662) by the historians JH Adamson and HF Folland, both professors at the University of Utah in the USA.

And, why, you might wonder, am I reading a book about a man whose existence was unknown to me less than a couple of months ago. The answer lies in Hampstead in north London. I was brought up in this part of the metropolis and recently have been revisiting old haunts and thus begun to become interested in Hampstead’s rich history. It was whilst rambling around Hampstead one cold February morning that I saw a gatepost (near the upper end of Rosslyn Hill) with a commemorative plaque. This memorial recorded the fact that the gate post was all that remained of the house in which Sir Harry Vane, politician and for some time a Governor of the Massachusetts Bay Colony, resided for some time before his arrest (ordered by King Charles II), trial, and execution.

What struck me when reading about the plague of 1625 and comparing it with what we are facing currently was how similar were some of the actions taken then with those taken now, almost 400 years later. By the way, in case you were wondering, the 1625 plague subsided almost completely by November that year and that was without any vaccines being available.

At the sharp end

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“THIS WON’T HURT A BIT” are words that I never used when I was practising as a dentist. However careful and gentle one is when giving an injection, the recipient is bound to feel at least a tiny bit of discomfort. So, I never uttered those words because to do so would be telling the patient something untruthful and that would have risked undermining his or her confidence in me. So, today, when I went to our beautifully well organised local clinic (at St Charles Hospital in London’s North Kensington) to receive the first of my vaccination ‘jabs’ to protect me from covid19, I was pleased that the clinician, who administered it did not say those words which I always avoided, but instead told me that I might experience some discomfort. Despite the needle being of a larger gauge than usual, my jab was not at all painful.

Years ago, a friend of mine, ‘X’, who was married to ‘Y’, a medical doctor involved in biological research, related her experiences of receiving vaccinations and other injections. Until she went into hospital to have her first child, she had always been given injections at home by her husband.

On arrival at the hospital, X was terrified when she was told she needed an injection. However, after it was done, her fears evaporated, but was left with a question in her mind. After she returned home with her baby, she asked her husband the question that had occurred to her in hospital. She said to Y:

“It’s really strange, dear, but the injections I had in hospital were completely painless unlike those you give me. I wonder why that should be.”

Y did not answer immediately, but after a short while, said:

“That’s easy to explain. I always inject you with the type of needles that I use for injecting, or taking samples from, experimental animals, the rats and so on.”

It is no wonder my friend found her husband’s injections painful. The syringe needles he used for laboratory animals were of a much wider bore than those normally used for administering jabs to humans. They were wide enough to be cleaned by pushing a wire along their length prior to sterilizing them.

This reminded me of the somewhat painful injections that our family doctor, Dr C, gave us when we were children in the early 1960s and before. Even though this was long ago, I can remember that his surgery had a gas fire, and its gas pipe had a small branch that fed a burner that heated a container in which he boiled his glass syringes and reusable needles between patients. These needles, like those used on animals and my friend, X, had to be wide so that they could be reamed out prior to being boiled. Furthermore, repeated boiling in water, blunted the needles and made them increasingly likely to cause pain when penetrating the skin. It was lucky that when we were vaccinated as kids, we did not come away with some infection as bad as whatever we were being protected against. There was no HIV in the 1960s, but there were other bugs, which were certainly not inactivated by boiling water.

Today, at the vaccination centre, a beautifully laid-out facility in a Victorian hospital building, I was shown the wrapped disposable syringe and needle, and felt confident that the vaccinator at St Charles had done a good job of jabbing.

French connection

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WE HAVE BEEN WARNED repeatedly that during the current covid-19 pandemic that travelling abroad, leaving the UK, is not without the risk that after returning home we might have to go into quarantine for fourteen days. The rules relating to quarantine are strict and include remaining at home twenty-four hours a day. This means, amongst other things, not emerging from home even for exercise, shopping, or going to work. For those who must leave home for work and cannot work from home this quarantine can lead to serious loss of earnings. Currently, the state will not compensate those who have to quarantine because they have returned from a country that the British Government considers having a higher rate of covid-19 virus infections or infection rates. I suppose the argument is that like heat, which flows from a higher to a lower temperature, the virus tends to flow from an area of higher infection to one with a lower one. The quarantining is meant to be part of minimising the risk of importing the virus into the UK from abroad.

Some countries may be visited by people living in the UK without the need for people returning from them to have to stay in quarantine. Until recently, the Government was happy for visitors to France to return to the UK without needing to go into quarantine for a fortnight. Because of this and despite warnings that covid-19 infections were on the increase in France, British holidaymakers were happy to take a risk by travelling to France. From the outset, the Government warned that at any moment there might need to be a change in the situation regarding quarantining after visiting abroad.

On the evening of Thursday 13th August 2020, the British Government announced that anyone who visited France and had not returned to the UK by 4 am on Saturday the 15th of August would need to go into quarantine for 14 days after reaching home in the UK. Between this late evening announcement and early Saturday morning, many British holidaymakers in France were panic stricken and tried to reach British soil before the 4 am deadline because they wanted to avoid being compelled to quarantine. Many of those people shelled out enormous amounts of money to obtain last minute bookings on ‘planes, trains, and ferries, in the hope of beating the deadline.

The panicked return was entirely understandable, and I do not blame anyone for trying to avoid a quarantine period that they could ill afford. What I cannot comprehend was what was magic about 4 am on Saturday the 15th of August. If the risk of importing covid-19 from France (or elsewhere) is so great that it is considered necessary to impose quarantine on returnees, why, for example is someone landing in the UK at, say 3.45 am on the 15th of August, any less likely to pose a danger to public health than someone arriving any time after 4 am on that day? In my opinion, if the chances of bringing in the virus from a certain country are deemed dangerously high and it is determined that quarantine will reduce the chances of imported virus from adding to the already significant local supply, the quarantine requirement should have been imposed immediately, without over a moment’s delay.

As for the effectiveness of the enforced quarantine on reducing imports of infection, that remains to be seen. Recently, the owner of a well-known budget airline poured scorn on the idea of quarantine. He pointed out that many travellers landing in British airports travel to their homes by public transport. During that journey to the places where they plan to quarantine for fourteen days, they have plenty of opportunity to spread the virus to others travelling on the same bus, train, or other public transport. By the time they get home, the damage might well have been done. This airline owner was saying this to help save his business from further destruction caused by ‘lockdown’ conditions, but what he said is true.

Examining the past

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ON 13th AUGUST 2020, MANY YOUNGSTERS in England received the results of the state’s university admission examinations. This year of plague and social distancing, 2020, the results have not been determined by the students themselves writing examination papers but by a clumsy, somewhat arbitrary, algorithm that takes various factors other than a student’s own ability into account. Things were quite different last year and back in 1970 when I sat the A-Level examinations required for admission to university.

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Back then, as now, universities offered places to potential students subject to achieving or exceeding certain grades at A-Level. The place that was my first choice amongst the six universities I chose was University College London (‘UCL’). In ‘my time’, UCL invited potential students for extensive interviewing. I was invited to spend a whole day at the Physiology Department. During that day, I was interviewed at least three times by different people and met both members of the academic staff as well as students already embarked on their courses of study.

Several days later, I received a letter from UCL offering me a place on the BSc course providing I achieved three E grades at A-Level. The top grade at A-Level was A, the lowest pass grade was E. At first, I was not sure whether to be pleased that all I needed was just to pass my three A-Level examinations. Was that the best that they thought I could manage? No, it was not. In those days, if UCL liked a candidate at interview, they took the strain off the candidate by not expecting high grades. Thee Es was normal for most subjects except medicine and dentistry when 3 Cs were required.  These days, candidates to places like UCL would be expected to get 3 A grades or something awfully close to this. Well, having been offered a place subject to my attaining at least 3 E grades and being neurotic by nature, I began to worry. What if I could not manage the three Es?

I became obsessed by examination papers to such an extent that I used to use my father’s typewriter to compose examination questions that I hoped would never appear in front of me in the examination hall. Whether or not composing these impossible questions was a kind of self-therapy or simply an opportunity to enjoy using the typewriter, I cannot tell, but it did me no harm. At the very least, It gave me short breaks in what for me was long hours trying to understand what I was studying.

My three A-Level subjects were Biology, Physical Science (a mixture of chemistry and physics), and mathematics. I found that all of them were most interesting and not too taxing. When I was at school, it was possible to opt to attempt supplementary papers in the subjects chosen for A-Level. These papers were known as ‘S-Levels’ and were designed to test a candidate’s deeper understanding of a subject. I chose to do S-Level papers in biology and mathematics. The biology S-Level paper was enjoyable. I was able to show off what I had learnt from reading around the subject. One of the questions was something to do with discussing the origins of life on earth. Well, in addition to various then current theories I decided to include what is described in the first chapter of the Old Testament. I passed that S-Level. The mathematics S-Level paper was a quite different ‘cup of tea’. Even though I had attended special classes to learn the mathematics that was required, I was stumped. For the first 30 minutes of the three-hour paper, I just stared at the questions. There was not one that I could even begin to tackle. So, after 20 minutes, I walked out of the examination room, leaving a blank script on my desk.

I can remember where I was when I received the A-Level results in August 1970. I was in Italy with my parents and sister on one of our annual visits to that country. We were in Venice, staying, as we always did, at the Pensione La Calcina, where many decades earlier the eminent John Ruskin(1819-1900) used to reside when visiting the island. The establishment’s façade is on the Fondamente Zattere across the water (of the Giudecca Canal) from the famous Santissimo Redentore church (completed 1592) designed by the architect Andrea Palladio.

We had just eaten lunch at the pensione and were taking the air on the waterfront prior to retiring indoors for a siesta when Signorina Steiner, the manageress, came rushing up to us with a telegram. My parents opened it to discover that my aunt in London had sent my A-Level results, which to my great relief were way in excess of the minimum required to gain admission to UCL.

If I had not managed to attain even 3 E grades, I would certainly not have expected to be admitted to any university. I would have had to accept the result and might well have decided to re-sit the examinations a few months later. As far as I am aware, in my day, there was no appealing to have papers re-marked as has become normal in the last twenty or thirty years. During recent times, it is not unusual for someone who is not satisfied with a grade to have his or her examination papers re-marked. Often, the revised grade is higher than the original, but things can go less favourably for the candidate.

This year, when young people have not been able to attend school since March and have not been awarded A-Level grades based on final papers written under strict examination  conditions, they have been awarded grades based largely on statistics (generated by what appears to be a poorly conceived algorithm) rather than individual ability. Many students have been awarded grades well below what they and their teachers expected. Thank heavens that there are appeal procedures in place.

I remember how much of a nail-biting experience it was waiting for my A-Level results back in 1970. This year, it was far worse for candidates. Not only did they not know on what basis their grades would be estimated, but also many of them will have to remain anxious for even longer whilst their appeals are being considered.

Seated above a cow

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I HAVE WALKED PAST IT OFTEN, noticed it, but had never examined it carefully until a few days ago. I am referring to the statue of Edward Jenner (1749-1823) that surveys the formally arranged pools and fountains in the Italian Gardens at the north end of the Serpentine Lake. This body of water was created in 1730 at the request of Queen Caroline (1683-1737), wife of King George II.  Originally it was fed by water from the now largely hidden River Westbourne and Tyburn Brook. Now its water is pumped from three bore-wells within the confines of Hyde Park.

 

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Jenner is depicted seated in what looks like an uncomfortable chair, resting his chin on his left hand, his left arm being supported on an armrest.  The bronze statue was created by the Scottish sculptor William Calder Marshall (1813-1894). He also created the sculptural group representing ‘Agriculture’ on the nearby Albert Memorial. The Jenner sculpture was originally located in Trafalgar Square, where it was inaugurated in 1858 by Prince Albert, the Queen’s Consort three years before his demise. In 1862, the sculpture was moved to its present location in the Italian Gardens. Incidentally, the design of the gardens was based on those at Osborne House on the Isle of Wight and were created in 1860 to the design of the architect and planner James Pennethorne (1801-1871).

Jenner, a qualified medical doctor, is best known for his pioneering work in developing protection against smallpox. This derived from his experimentation based on his (and other people’s) observation that the pus from blisters that milkmaids received from cowpox protected them against the far more serious disease smallpox. Justifiably, Jenner has been dubbed the ‘father of immunology’. So great was his achievement that Napoleon, who was at war with Britain at the time, awarded Jenner a medal in 1803, the year Napoleon was planning to invade Britain with his recently formed Armée d’Angleterre. The French leader said:

“The Sciences are never at war… Jenner! Ah, we can refuse nothing to this man.” (see: https://www.nature.com/articles/144278a0).

Maybe, these words of the great Napoleon can still teach us something about international cooperation generosity of spirit.

His fame in the field of vaccination overshadows Jenner’s other achievements in science and medicine. He was a first-rate zoologist. For example, his observations, dissections, and experiment established for the first time that the baby cuckoo is born with a depression in its back that allows it to displace the eggs of the  bird whose nest the cuckoo has colonised. The baby cuckoo ejects his or her host’s eggs without the help of the adult cuckoo, which has deposited her eggs in the nest of another species. Jenner published his findings in 1788. This was a few years before he established the effectiveness of vaccination in the late 1890s. He self-published his results in 1898 after his most important paper was turned down by The Royal Society.

Getting back to his statue in the Italian Gardens, there are two features that I had not noticed before examining it carefully recently. One of these is a depiction of the Rod of Asclepius on the backrest of Jenner’s seat.  The serpent entwined helically about a rod is traditionally associated with medicine and healing. Beneath the seat, there is a depiction of a cow’s head. This is appropriate symbolism given the importance of cows in the discovery of smallpox vaccination. The word vaccine is derived from the Latin word ‘vaccinus’, which in turn is derived from ‘vacca’, the Latin for ‘cow’. There is an object depicted below the cow’s head, which I fancy, using a little imagination, might be a stylised depiction milk maid’s cloth hat.

Jenner was not the only person experimenting with inoculation against smallpox, but he is the person best remembered for it because his results and reasoning convinced the world of the concept’s validity and applicability.

Although I do not find the monument to Jenner to be particularly attractive, it is one of London’s statues least likely to arouse anger as its subject had nothing to do with slavery. In contrast to many other well-known figures of his era, Jenner should be remembered for his important involvement in a development that has benefitted mankind for well over two centuries. I hope that his scientific descendants currently working around the world in laboratories will be able to create a vaccine to counter the Covid-19 virus as soon as possible.

What? No gloves!

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DENTISTS ARE FRONT-LINE workers, risking their lives for you. We put our fingers in people’s mouths and risk inhaling their expired breath and droplets of saliva and infected material. This has been the case ever since the start of human endeavours to resolve problems related to dental and oral pathology. I began hands-on dentistry in 1977 during the second year of my course in dental surgery undertaken at University College Hospital Dental School (‘UCHDS’). I qualified in early 1982 and worked in general practice until September 2017.

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At UCHDS we never wore gloves or masks while treating patients. The exception was for extractions that required minor oral surgery (cutting the gum etc.) when we were required to wear disposable latex gloves. For extraction that only needed forceps (‘dental pliers’) and elevators (wedge-like instruments), gloves were not required, but we did wash our hands between patients. When using the dental drill, we were required to wear safety googles over our eyes. What I have just described was what was considered correct practice at one of Britain’s leading dental schools. In those days, as in the future, any patient we treated was capable of harbouring nasty pathogens that could cause diseases such as tuberculosis, herpes, hepatitis B (and other forms of this virus), mycobacteria, fungi, and rarer diseases, all of which could have proved very detrimental to the clinician or his or her assistant.

The first practice I worked in was rightly considered to be one of the most ethical in the area. Once again, gloves and masks were not worn. Patients rinsed from a proper glass that was washed between appointments before being re-used. Instruments that had been used on a patient were placed in a bath of Savlon disinfectant for a while until they were needed again. All needles and local anaesthetic cartridges were single use only. At lunchtime and at the end of the day, all our metal instruments were sterilised in a hot air steriliser. It was not every practice that bothered to do this.  Horrified? Well, you might well be if you are old enough to have had dental treatment in the UK before the second half of the 1980s.

After I qualified, I subscribed to the New England Journal of Medicine with a vague idea of keeping up to date with medical science. Most of the articles were beyond my comprehension. However, in the mid-1980s, I began noticing many articles were being published about t-cells (a kind of white blood cell). What I only realised later was that these were being published because of the arrival and proliferation of a new threat to health: HIV (‘AIDS’). This epidemic prompted a dramatic change in how dentists operated. Almost overnight, we were required to wear gloves; advised to wear masks; commanded to sterilise instruments before re-using them; giving disposable single-use paper or plastic mugs for patients to use for rinsing.

What amazes me is that during the 35 years that I worked as a dentist, I never heard of or read about more than a handful of patients who were infected following dental procedures. There have been some newspaper reports of patients contracting HIV after seeing a dentist, but in some of these cases the mode of transmission was other than from clinical procedure. Over the years, I attended several lectures on the latest developments in cross-infection control. After each of these, I always asked the lecturer whether there was any scientific evidence that showed whether cross-infection controls in dentistry significantly affected patient mortality. Not one of these academic clinicians could provide an answer. One of them said to me:

“That would make a very good topic for a PhD.”

Whether they make a difference or not, modern cross-infection protocols make both the patient and the clinical team feel safer. I hope that everyone will feel sufficiently safe to be treated now that the atmosphere is infiltrated with particles of the Covid-19 virus. The nature of this highly contagious airborne pathogen justifies the many advances in cross-infection control that the profession has made since HIV appeared on the scene and will require further refinements especially in the field of air purification.

When I think back to my days of providing dental treatment with my bare hands and uncovered face, I am amazed that I and most of my colleagues never succumbed to anything much worse than fatigue and frustration caused by awkward patients.

 

 

Fading with time

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SINCE THE IMPOSITION OF ‘LOCKDOWN’ in the UK, use of public transport has been discouraged, as has wandering too far from home when taking exercise. While not exactly ‘confined to barracks’, the distance that we have been allowed to move away from home has been limited, more or less to the amount of distance that we can manage to walk (or, not in my case, cycle) comfortably, without exhausting ourselves. This meant that for many weeks we have been walking around our local area. A friend of ours in Dublin told us, half-jokingly, that during the Irish lockdown, he felt that he had got to know every blade of grass in his neighbourhood. I understood what he was saying.  For me, greater familiarity with our immediate locality has not bred contempt for it, but the opposite. We have been walking along small streets we never knew existed and discovering interesting details in those thoroughfares that we thought we knew so well.

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I have been walking along Sheffield Terrace, which leads off Kensington Church Street, two or three times a week for the last 25 years, yet it was only yesterday that I noticed a small square metal plate on the wall of a house in that thoroughfare. It recorded the fact that the author GK Chesterton was born in that house on the 29th of May 1874. A few doors away on the same street, there is a much larger and far more obvious plaque commemorating that the founder of the Church Army, Prebendary Wilson Carlile (1847-1942) had lived there. I had often noticed this memorial, but I had never noticed the far more discreet memorial to Chesterton, which looks like a simple grey wall tile from a distance.

Sheffield Terrace leads to the northern end of Hornton Street, which is marked on 19th century Ordnance Survey maps as ‘Campden House Road’.  Hornton Street leads south and downhill towards High Street Kensington. Once again, this is a street along which I have walked several times a week over a period of at least 25 years. Various roads lead off Hornton Street. The short Pitt Street is one of these. On the corner of Pitt and Hornton Streets, there is a faded rectangular sign that I have always assumed carried the words ‘Hornton Street’. However, I had not looked at it closely enough until yesterday.

I do not know what made me examine the faded sign closely, but I am glad that I did. Some of the letters on it have disappeared. The following are just about visible, and even more so on enhanced digital photographs: H, O, R, N, …, D, G, E. The last three letters are not ‘E, E, T’, which you would expect to see if the sign had read ‘Hornton Street’. I wondered if the sign had originally read ‘Hornton Lodge’. I went home and searched for ‘“Hornton Lodge” Kensington’ on Google.

One of the most useful things that came up amongst the Google search results was an offer on eBay for two pages of the issue of “Country Life” magazine, dated 21st of March 1968. These pages contain an article about Hornton Lodge on Pitt Street. The article bore the title “Serene Vision of a Modern Interior”. It describes the interior of a house built in 1948 on a bomb site and owned by Mr and Mrs James Melvin. The house, a long rectangular building, was called Hornton Lodge. The fading sign is all that remains of the house described in the magazine. Currently, builders are erecting a new building on the part of the plot nearest to the corner where the sign can be found. This new construction is, according to a planning application submitted in December 2019 by Nash Baker Architects, to replace an:

“… early post war semi-detached property … constructed circa 1948-49, on the site of a former villa known as ‘Hornton Lodge’. The architect/owner, James Melvin, was a partner in major architectural firm: Gollins Melvin Ward Partnership. However, at the time it was constructed, the firm was in its infancy, and this project was a modest family home for a young architect and his family; designed with modernist intentions during a time of austerity.”

I found references to a ‘Red House’, also referred to in at least one item, maybe erroneously, as ‘Hornton Lodge’.  The Red House was built by Stephen Bird in 1835. It was also known as ‘Hornton Villa’. This was not the property on Pitt Street demolished by a bomb in WW2 because it stood across Hornton Street opposite the western end of Holland Street, which is south of Pitt Street. A future president of the USA, Herbert Hoover, lived at that address between 1907 and 1918. Hornton Villa, The Red House, was demolished in in the 1970s, and on its site stands the architecturally undistinguished Customer Service Centre of the Royal Borough of Kensington and Chelsea.

There is more evidence of a Hornton Lodge, quite distinct from the Hornton Villa, mentioned above. Joseph Foster’s “Men-at-the-bar : a biographical hand-list of the members of the various Inns of Court, including Her Majesty’s judges, etc.” (published in 1885) published the address of a barrister Richard E Webster (1842-1915; called to the Bar in 1868), Lord Alverstone, as “Hornton Lodge, Pitt Street, Kensington W”. He became Attorney General between 1885 and 1886.  Even earlier than that, “Allens West London Street Directory” (published in 1868) lists a Theodore Aston as living at Hornton Lodge.

Close examination of a sign that I have passed and seen many thousands of times, assuming it bore a simple faded street name, has revealed that I had never looked at it carefully enough before. The constriction of my field of activities to a small part of London has, to my surprise, heightened my powers of observation rather than blunted them, which could have easily happened when visiting the same locality repetitively.

Soon, the faded sign on the corner of Pitt Street will either be removed or become even more illegible. I am glad I noticed its clue to the past before either of those things happen.