Superbug got me musing…

       The Lancet magazine has finally  apologised for the nomenclature of the new  antibiotic resistence inducing bacterial enzyme after New Delhi. Superbug aka New Delhi beta-lactamase -1 (NDM-1 ) took the medical fraternity and the world by storm after its discovery last year. The bug’s nomenclature caused a lot of political upheaval .It was bit of double standard  on part of Britain. While on one  had David Cameron was trying to proclaim India as a potential strategic partner following steps of America, and on the other hand  blemishing India’s image by using such nomenclatures. Well though Shakespeare said ‘What’s in a name?’ , it was a much talked about issue as the first Swedish patient who carried the bacterium travelled from Delhi to Sweden with the infection. In a way the name could have given a great blow to the booming medical tourism industry in India.

                 Names apart I would focus on the larger issue , the superbugs possessing this enzyme were practically resistant to all broadspectrum antibiotics. Still striving to find cure for human immunodeficiency virus , we certainly are not ready for bacteria that laugh away merrily  and multiply  while we see about a century of antibiotic research and development transforming to dust. There were several articles indicating that we might be getting  back to the pre-antibiotic era!  There is a definite abuse of antibiotics specially in Indian set ups lacking proper sterilization and hygiene. The whole sequence of events aroused in me a thought that while we are struggling to make a place in the medical field as competent doctors and so many times we nag about workloads and textload , we have become so blind and take so many things for granted. Now going back to the pre-antibiotic era sure gave me a chill.

 

 It is said the Alexander Fleming’s serendipitous observation turned a common yeast into the source of life saving penicillin . None of us can imagine being doctors without antibiotics . But there was not only a pre-antibiotic era but also a pre-anesthetic and pre-sterilization era too. Bringing in hand washing into practice by surgeons and physicians faced great resistence. I know it’s hard to believe that doctors had to be convinced for the benefits of handwashing!! Lister faced huge opposition to his method of antisepsis. I guess we need to give sometime to muse and appreciate the pioneers who strived to cure and even risked their lives in this pursuit. All of us atleast know Edward Jenner who inoculated his son and family  to test the smallpox vaccine. What followed this observant and courageous doctors act is a whole science of vaccination and benefits.

There would be myriad examples to substantiate my plea that we all should appreciate more deeply the achievements of this life saving field of ours , but I choose one story at my own discretion to show that where we stand today is a result of some daring, observant, skillful doctors and even more courageous patients.  This is a story in the time when Surgery was developing, anaesthesia was unknown and gynecology hadn’t yet developed as a separate speciality. There was hardly an insight in female genital pathology.

          Ephriam McDowell was an excellent surgeon in the seventeenth century. In December ,1809, he was called to see Mrs . Crawford who for several months had thought herself to be pregnant. She was affected with pains similar to labour ,for which she could not find relief. So strong was her suspicion that the two physicians she called to deliver her finally asked McDowell to come to their aid in delivering her. The abdomen was considerably enlarged, and  had the appearance of pregnancy, though inclination of the tumour was to one side , admitting of an easy removal to the other side. On examination he found nothing in the uterus, which made him conclude that it was an ovarian tumour. Having never seen so large a mass to be extracted and seen an attempt to do so he informed the patient of her dangerous situation. However Mrs. Crawford was courageous enough to agree to undergo and experiment which he promised to perform if she went to Danville. With assistence of his nephew and collegue Ephrium McDowell perfomed the never before tried surgery when anesthesia was unheard of. The abdomen was opened with a 3 inch incision and the after ligating the fallopian tubes near the uterus the huge tumour was removed piecemeal. They took out 15 pounds of gelatinous material followed by extraction on the sac weighing seven and half pounds. The whole act took them twenty five minutes before they stitched back the abdomen.

   The operation was successful and infact the patient outlived her surgeon. This case was published much later in  1816 and it did not mention the tense drama of this Christmas Day operation. When the people of Danville had heard about this experiment they were furious .They had gathered in a tense group outside his house, with a rope slung over a tree, ready to lynch the surgeon if his experiment failed. This however did not deter the doctor or the patient from performing and undergoing the surgery.

                                                         

               So the superbug though named wrong and a terrible threat has actually reminded us- that we should wake up and not take these miraculous achievements of our field for granted. That we should be observant, responsible and compassionate as by practicing the art everyday sincerely we pay silent homage to these unsung heroes and pioneers.

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