Something I am missing

BOOKS

During this time of avoiding other people for very good health reasons, many of the pleasures of normal life have become temporarily unavailable. Theatres, museums, pubs, restaurants, and  travel (foreign or local), are things we will only be able to enjoy again in some distant future.

Even though I am surrounded by, nay drowning in, more than enough unread books for several long lifetimes, I miss browsing in the local second-hand bookshops. I do not actually need to buy another book, but I know I will be purchasing many more, most of which might never be read for many years to come. 

I have an urge to browse regularly in bookshops. It does not matter if I come out of a shop empty-handed, because running my eyes along the shelf gives me an enormous amount of satisfaction. Yes, I need my regular fix of bookshelf browsing. Let it not be long before I can resume this enjoyable activity.

Gandhi and the plague

GANDHI BLOG

IN THE CURRENT CORONAVIRUS OUTBREAK, infection is spread from person to person in close contact with one another. Isolation and quarantine are likely to be effective in eventually reducing the rate of infection.

At the end of the 19th century and beginning of the 20th, another deadly pandemic, the bubonic plague, spread around the world. It was then believed that separating people from each other was likely to help arrest the plague. It was not because bubonic plague is rarely contagious, but usually transmitted by a vector.

While researching the life of my great grandfather, Franz Ginsberg, sometime Mayor of King Williams Town and later a South African Senator, I needed to explore the history of bubonic plague in South Africa. While doing so, I discovered that the young Indian lawyer, Mahatma Gandhi, also entered the story. The following is extracted from my article that was published in a South African medical journal back in 2008:

INVISIBLE INVADERS

When the Boer forces, provoked by the British, started invading the Cape Colony in 1899, another invasion, covert in nature, was also beginning to threaten the area. The hidden enemy, a bacterium, lives in the blood of fleas and the rats (and other rodents) whose blood they ingest. These fleas are also partial to feeding off the blood of humans. When an infected flea feeds off the blood of a susceptible human, that person runs the risk of developing an often fatal illness known as ‘bubonic plague’. When my great-grandfather Councillor Franz Ginsberg (1862-1933) was serving on the Borough Council of King William’s Town in 1899, little was known about the transmission of the plague, even in the scientific world, except that its causativeagent was the bacterium Yersinia pestis (Y.pestis). This ‘bug’ is named after one of its discoverers Alexandre Yersin (1863-1943).

PESTILENT FLEAS

Today, much is known about the mechanism of transmission of Y. pestis. Bubonic plague is an example of a zoonosis: a disease that normally exists in other animals, but also infects humans. The danger to humans is that the bacterium is carried in the blood of certain kinds of rat, and that these rats often live in close proximity to humans. The rats serve as a mobile reservoir for this pest, but they are susceptible to its ill-effects. When a flea bites an infected rat, it ingests the blood of the rat and some of the bacteria living in it and the bacteria multiply within the flea’s digestive tract, causing considerable harm to the flea itself. If this same flea should bite a human, the human victim will receive some of the bacteria from the flea because the flea, while feeding, regurgitates some of its Yersinia-infected stomach contents into its human victim, who may then begin to exhibit the symptoms of bubonic plague. The plague can produce numbers of victims in epidemic or pandemic proportions. The Black Death, also known as ‘The Second Pandemic’, killed between one third and one half of the population of Europe and Asia between 1347 and 1351. It is thought by some to have been a pandemic of (bacterial) bubonic plague but others feel that it was a viral infection. The ‘Third Pandemic’ began in China’s Yunnan Province in 1855, and is known to have been caused by Y.pestis. Its dissemination around the world in the decades that followed was facilitated by global shipping. Rats and their fleas were frequent stowaways on ships, and as infected rats moved from port to port so did the bubonic plague.

AN UNWELCOME IMPORT

In September 1896, the bubonic plague reached India (most probably from Hong Kong) and had claimed its first of many victims in the port of Bombay. News of the plague spread faster that the plague itself. In 1896, the Natal Medical Council discussed the bubonic plague – by then well-established in India – and its relevance to Natal. The Council decided that the whole of India should be regarded as an infected area, and that all ships entering the ports on the coast of Natal should be quarantined.

In January 1897, an anti-Indian demonstration was held in Durban to protest against the landing of ‘asiatics’ on board two Indian-owned ships which arrived there in mid-December 1896. The ships had been held in quarantine for 25 days. A group of Indians in Durban, including Mohanlal K Gandhi (later to be known as ‘Mahatma Gandhi’) who had just arrived in Durban on one of these two ships, the ‘Courland’, sent a long ‘memorial’ protesting against this to the Secretary of State for the Colonies in London. Its authors shrewdly noted:

‘…that the quarantine was more a political move against the Indians than a safeguard against the introduction of the bubonic plague into the Colony’,

and they provided evidence that the measures taken to effect quarantine were done ineffectively and too late to have been of any practical use. Despite measures such as these, bubonic plague reached South Africa sometime between 1899 and 1901.

The Natal medical community had some grounds for its fears that the plague might arrive from India. At a meeting of the Borough Council of King William’s Town in February 1899,13 it was announced that the bubonic plague had arrived in Port Louis on the island of Mauritius (a place that ships sailing from India to South Africa may have visited occasionally), and the Council had received a letter from the Town Office of Port Elizabeth, asking for the support of King William’s Town in their request for the government to enforce quarantine regulations (the Transvaal and Orange Free State prohibited entry to Indians in early 1899).

My great-grandfather, Franz Ginsberg, moved that the Council of his town should cooperate with that of Port Elizabeth. Although fear of importing the dreaded plague was the cause of an anti-Indian demonstration in this port as early as about 1897, the disease only began to occur in the town in April 1901 –soon after its arrival in grand style in Cape Town in March 1900 (having possibly arrived on board a ship from plague infested Rosario in Argentina). As early as November 1900, a doctor in King William’s Town reported eight cases of bubonic plague amongst Africans, three of these leading to death. By early 1901, the inhabitants of King William’s Town had good reason to worry about the plague.

 

Mustard

My father’s grandfather lived in Cape Town (South Africa) during the Spanish influenza pandemic at the end of the first world war.

He was terrified that he would be afflicted with the deadly illness. He had heard that applying a mustard plaster would help him avoid the disease. So, he smeared his stomach with mustard and covered it with an adhesive plaster. Then, he retired to bed.

After about three days, my great grandfather developed a high temperature. Fearing the worst, he summoned a doctor. The medic tore of the plaster to reveal the damage that the mustard was causing. It had ‘eaten’ through the skin, which was then becoming infected. The infection caused by the mustard was causing the fever, not the dreaded ‘flu.

My great grandfather survived the Spanish ‘flu. What killed him several years later was something that was supposed to protect him from illness. He died following an adverse reaction to an anti-tetanus injection.

Going viral

Two bees or not two bees_240

I hope that I am not tempting fate by writing this!

I am puzzled by the excessive anxiety over the coronavirus outbreak, which is encouraged by politicians and the press.

On the one hand, the public is informed that the virus outbreak will lead to dire consequences on a global and local scale.

On the other hand, we learn that apart from a couple of susceptible groups at the two extremes of the age range, being infected by the virus is highly unlikely to cause the infected person to suffer much if anything at all.

What are we to believe? Should we be panicking as our politicians seem to be suggesting, or should we not let the coronavirus affect our mental harmony?

Whatever the answer, it is best to be careful!

 

Finally, here is a thought provoking article to read:

https://www.psychologytoday.com/gb/blog/culture-mind-and-brain/202002/the-coronavirus-is-much-worse-you-think 

 

Tooth powder

tooth powder

 

When I was a child, I brushed my teeth with toothpaste. My parents did not use paste. Instead they used Calox Tooth Powder. A small amount of this was sprinkled into the palm of one hand and then mixed into a paste using the wettened bristles of a toothbrush. The resulting gritty paste was then used to brush the teeth. I have no idea why my parents used the powder, but made us use toothpaste.

Many decades later, this year, I visited the Indian city of Pondicherry, which was a colony of France until 1954. We stopped at a tea stall that in addition to providing tea also sold small packets of paan and chewing tobacco (not very good for oral health) and packets of ‘Gopal Toothpowder’. Seeing the latter reminded my of my parents and their use of Calox. I asked the vendor how the tooth powder is used. He opened his mouth and rubbed his finger along his teeth. In his opinion, no brush is required. I bought a couple of packets, but have not yet been adventurous enough to try to use their contents.

Healing hand

hand

 

In the UK, dentists cannot refuse to treat patients who admit to having serious illnesses such as AIDS (HIV). Dentists are supposed to have taken precautions to protect their patients, their nursing staff, and themselves against the risks of spreading disease by cross-infection. However, human nature being as it is, some dentists fear catching diseaes from their patients despite adhering to the appropriate requisites to prevent cross-infection. Irrationally, they try to ‘palm off ‘ patients whose medical conditions they fear by referring them to dental hospitals and specialist clinics. This is unfair to the patients who are forced to wait for long periods to be seen at these referral places for ‘specialist’ treatment that they do not actually need. I was not one of these over cautious fear-filled dentists. I treated everyone whatever their medical status.

I have treated many patients who have been infected with AIDS and other worrying illnesses such as Hepatitis B and C. I followed cross-infection guidelines and treated them no differently than I did for other patients. 

Many, but by no means all, of my patients were grateful for whatever I had done to deal with thier dental problems. Some of them, but not all of them, used to shake my hand and the end of an appointment or of a course of treatment. I appreciated that. What I noticed over the years was that the patients most likely to shake my hand were those who had been diagnosed with AIDS. I had the feeling that they were really grateful that I was prepared to touch their mouths without making a fuss about, or showing any fear of about their undoubtedly serious medical condition. The AIDS patients seemed to appreciate that I did not treat them as pariahs.

Head to toes

It's raining again_240

 

This patient of mine was a local school teacher. An educated person, you would imagine.

One rainy afternoon he sat on my dental chair. Then, I reclined it so that he was lying almost horizontal: his head and mouth at one end of the chair and his feet at least five and a half feet from his mouth. I administered the local anaesthetic, waited for anaesthesia to become established, and then repaired the teacher’s decayed molar tooth with a silver amalgam ‘filling’. When the procedure was over, the teacher left my surgery apparently quite content.

An hour or so later, the teacher returned to our practice and asked the receptionist to allow him to speak to me. He entered my surgery and pointed to a mark on one of his brown suede shoes.

“I believe that you must have dropped some of your chemicals on my shoe while you were treating me,” he said.

I looked at the mark and quickly realised that this fellow was hoping to be compensated, possibly for a sufficient to buy a new pair of shoes.

“Unlikely,” I replied, “while I was treating you, you were lying horizontally. Your mouth was a long way from your feet. If I had dropped something, it would not have fallen anywhere near your feet.”

“Mmmmh,” he replied.

“Furthermore,” I added, “it’s been raining heavily all afternoon. Maybe, you picked up that mark while walking along the wet streets.”

The teacher left, and I heard no more about the problem with his footwear. I was left thinking what an unintelligent man he was, and that somebody had qualified as being capable of teaching young people.

This won’t hurt a bit!

human fist

 

One of my dental colleagues, a very confident fellow and a competent operator, told me this true story many years ago.

One day, he had a nervous male patient, a well-built strong looking man. However, the patient was extremely anxious, as many dental patients often are. The patient needed to have root canal treatment and was convinced that he would experience much pain during the procedure. 

As my colleague prepared his local anaesthetic syringe, he said, trying to be reassuring:

“Don’t worry, sir, after I have given you this injection, the procedure won’t hurt a bit!”

The patient turned to my colleague brandishing his tightly clenched fist, and said:

“You’d better be right because this will certainly hurt you!”

 

Photo by Pixabay on Pexels.com

Stung on the tongue: a careless diagnosis

Big bee_640

I cannot remember the name of the person who taught us dental pathology back in 1981 at University College Hospital Dental School, but one thing he told us made a deep impression on me.  He said that it was unlikely that we would see oral cancers frequently in general dental practice, but when we did see one we would feel a certain ‘jizz’ (our teacher’s word), a feeling that we were looking at something unusual and worrying.

One day when I was in practice, a delightful late middle-aged woman visited my surgery as a new patient. She said there was something on her tongue that had been bothering her for several weeks and was making eating and speech difficult. She had been to her doctor (medical), who told her that she had had a bee sting on her tongue. She told me that she had been taking antibiotics prescribed for it for  quite a time and the condition was only getting worse.

I had never encountered anyone with a bee sting on their tongue. The lady’s story and her doctor’s diagnosis sounded strange. She showed me her tongue. As soon as I saw the huge ulcer on the side of it and its peculiar border, I felt that ‘jizz’, which our pathology teacher had mentioned. I knew that the poor lady had, almost without a doubt, a carcinoma on her tongue. I told her my suspicions, and she looked relieved, and was grateful. Clearly, she had not believed her doctor’s story. I phoned the local oral surgery department, and they admitted her promptly.

About a year later, the lady reappeared. During the surgical treatment of her cancer, she had lost several teeth and wanted a denture to replace them. Sadly, her mouth was by now so distorted that making a prosthesis was beyond my competence. I referred her to a prosthetic specialist. Unfortunately, she did not live long enough for his work to be completed.

Whether earlier intervention would have saved her life, or at least prolonged it, is a question than cannot be answered. 

In my 35 years in dental practice, I only ever saw two patients with obvious oral cancers. However, I did refer many patients to have unusual looking lesions seen by oral surgical specialists. None of these gave me that ‘jizz’ nor turned out to be cancerous.