Early stirrings of the germ theory

The germ theory of disease, which holds that certain diseases are caused by living organisms, occurred to people thousands of years ago, but  it was proved only in the 19th century.

In the western tradition, the Roman scholar Marcus Terentius Varro first laid out the germ theory in his book, On Agriculture, a practical guide published in about 36 B.C. In it, Varro advises the farmer against building near swamps because “certain minute animals, invisible to the eye, breed there and, borne by the air, reach inside the body by way of the mouth and nose and cause diseases that are difficult to get rid of.”

Varro was a prodigious scholar and well known public figure, and his works were highly influential. However, at least some of his contemporaries, apparently including the writer/philosopher/statesman Marcus Tullius Cicero, considered his germ theory a crackpot idea.

It is worth noting that the Atharva Veda, the first Indian book that addresses medical topics, includes a fairly detailed germ theory. The book identifies a number of living organisms that were deemed responsible for causing various diseases, and prescribes cures to kill the organisms. The Atharva Veda was written down about 200 B.C., but its ideas may date as far back as 1,000 B.C.

Making birth possible for millions

For the first time ever, the Nobel Prize committee has awarded one of its coveted medals — and $1-million-plus in prize money — to a scientist who worked in the area of reproduction.

The British biologist Robert G. Edwards won the Nobel Prize in "physiology or medicine" today for pioneering in vitro fertilization with a colleague, Patrick Steptoe, a gynecologist and medical researcher who died in 1988. The pair's efforts led to the birth of the first "test tube baby," Louise Brown, on July 25, 1978.

Since then, four million babies have been born with the assistance of IVF, in which sperm and egg are united outside the mother's body and then transferred to the womb.

The Nobel Committee waited more than 30 years to make the award. Edwards, who spent most of his career at Cambridge University, is 85 years old and "not in a position to understand the honor he has received today,” a colleague, Dr. Michael Macnamee, was quoted as saying in a New York Times article by Nicholas Wade.

Edwards and Steptoe unlocked many of the secrets of the human reproductive system on their way to success with IVF. They tried 40 embryo transfers before they achieved a pregnancy, which turned out to be ectopic. The second try led to the birth of a daughter to Leslie and Gilbert Brown of Oldham, in Greater Manchester, England.

Like virtually all medical visionaries, Edwards and Steptoe were subjected to vitriolic attacks. The British medical establishment withheld all manner of support from them, even after Louise Brown's birth.

But the joy of millions of families all over the world who were able to hold their own babies as a result of IVF technology eventually quelled the critics.

Louise Brown, herself the mother of a three-year-old boy, said of the award today: "It's fantastic news; me and Mum are so glad that one of the pioneers of IVF has been given the recognition he deserves. We hold Bob in great affection and are delighted to send our personal congratulations to him and his family at this time."

Blood draw

The science writer Douglas Starr has made something of a specialty of blood.

His book, Blood: The Epic History of Medicine and Commerce, and the PBS documentary series it inspired, Red Gold, cover the waterfront on this vital component of life, and our relationship to it.

The PBS website has a great discussion guide that sums up the topic impressively, and includes a timeline of important developments in our evolving relationship with blood.

Red Gold

Even before we understood its function, humans invested blood with value and meaning. As Starr writes in an essay in the guide:

Blood: It’s strange that this most familiar of substances has always been so laden with feeling, so heavily freighted with mystery and symbolism. Consider the vocabulary: blood of our fathers; blood of Christ; the nation’s blood; lifeblood; blood brothers, blood sacrament, blood libel.…The history of blood involves not only medicine, but also culture and religion. It is a story of change — how a mysterious liquid became a global commodity and reflected the soul of each society that used it.

On the cusp

This is my 75th post, something of a milestone for me, especially as it coincides with roughly six months of blogging — and a change of status.

I was part of a group laid off last week from the Chicago Sun-Times, where I had loved, loved, loved being a features reporter. The economics of print journalism caught up with me, as they have with so many others.

Where do I go from here? This is no idle question for me, and I'm just beginning to work out the answer.

Over the course of the past couple of years, I have enjoyed learning about new media, and now here I am, with both feet in the 21st century. I blog three times a week, I tweet, I even built my own website (with lots of help).

At the same time, I believe in the values of old media — checking facts, maintaining a certain distance from sources, and allowing both sides to have their say in a civil discourse.

Even while I find myself slipping into the conventions of the new, I hang onto my belief that the best journalism serves the reader's need to know about, and understand, the society she lives in.

I think I have picked a great topic to write about, because it seems to me that birth is on the cusp, just like me. Modern medicine knows how to make birth safe, and yet the maternal mortality rate appears to be going up.

Not only that, but I can't help but notice that while 99 percent of American women have their babies in hospitals, most of the voices making themselves heard in books and blogs belong to women who are dissatisfied with and critical of the hospital experience.

And with Caesarean-section rates rising out of all proportion to any statistical need for their use, those voices are gaining an intelligent and often passionate following.

Where do we go from here? I believe that one thing that will help us answer that question is an understanding of how far we have come.

 

A cascade of errors

At the ACOG meeting last May, Dr. Robert Wachter talked about a case in a teaching hospital in which two women with similar names -- Jane Morrison and Joan Morris are the pseudonyms assigned to them -- were confused with one another, resulting in one of them receiving an invasive procedure intended for the other one. This case did not involve a birth story, but every medical specialty can take lessons away from it.

This case, which Dr. Wachter and colleagues published as "The Wrong Patient," in June, 2002, in the Annals of Internal Medicine, demonstrates how easily a series of oversights can cascade into a shocking medical error. (It could have been worse. The procedure was a cardiac electrophysiology study, not, say, a leg amputation.)

In fact, the team that analyzed the mishap identified 17 junctures at which the process could have been stopped but instead moved forward. No single mistake would have been enough to keep this juggernaut moving. Human error fed into institutional weaknesses, including "frighteningly poor communication," a lack of standardized protocols and a culture that had become sufficiently dysfunctional that more than one person thought, incredibly, Gee, this doesn't seem right, but I'm going to do it anyway.

"Human performance can beimproved but not perfected," the team concluded. Protocols must be in place to head off the inevitable errors before they converge into tragedy.