hmmm, diseases

[kaigou]

Watching Jin and there's talk of a cholera epidemic four years before the show (a time-travelling history work) takes place -- that would be the massive cholera outbreak of 1858, apparently. In the show, there's word that cholera has returned and naturally the population of Edo (and the few doctors, especially those trained in Western/Dutch medicine) are panicked about it.

Naturally this prompted another foray into wiki and beyond, into pdfs and google-books history analyses and texts, because hell if I know jack about cholera. It's just not an illness I've run into, or that has ever been a threat, in the part of the world where I live (though it does continue to be a threat in many other parts of the world). I had thought it was a virus, but it's not; it's a bacterium.

Doesn't that mean that if you were exposed to cholera and managed to be one of the one-in-two to one-in-twenty who survived (honestly, a 50% death rate is just unfathomable)... that your body would have developed the antibodies? Wouldn't that mean that epidemics would be separated by generations, because it'd take time before a large enough percentage of the population existed that had not been exposed? So you might have an outbreak four years later, but wouldn't it be substantially smaller due to a large part of the (surviving) population having developed antibodies -- in other words, city-newcomers and young children would be struck, but anyone who'd been around four years earlier might not be affected?

Or do bacteria mutate, such that a return of cholera could actually be a different strain? I know viruses mutate (and that's why they're so difficult to treat and/or inoculate, something to do with having to inoculate against the specific virus and if you're exposed to a different strain, the inoculation does little to nothing)... but I thought the life-cycle of bacteria changes was much slower, comparatively. At least, that's my uneducated reasoning, given how long it's taken bacteria to develop antibiotic-resistance. (I thought viruses develop a resistance much faster, because they change/mutate faster.)

Just curious; hoping someone might know because I'm failing at the google to find any article that answers that specific question.

Incidentally, wiki also notes that in terms of treatment: "Rice-based solutions are preferred to glucose-based ones due to greater efficiency." I wonder who first realized that, and was able to compare the two. I presume someone in Asia, since I doubt a rice-based anything would've been first on the list in Europe, rice not being a major staple of diet for most of European history. At least, that's my guess. Hell if I know, really.

Man, watching historical dramas (from any country) always ends up with me running to wiki to look stuff up, even moreso when it's not my own country's history. Get into time-travel stories and it's even worse, because characters will know or reference something and I'm lost. Although this time, at least, I got that one reference -- when the from-the-now doctor asks a young woman of Edo, "what year is it?" She replies, "the second year of Buncho" (something like that). He draws a complete blank -- he's a doctor, after all, not a historian. He waffles about, trying to figure it out, then lands on a definitive historical landmark: "have the black ships arrived?" Ah, she answers, that was ten years ago. Ahaha, do the math, it's 1862.

The show's full of nice little touches like that, like when the young lady offers to run back and get the medicines she'd missed. The doctor -- with patient at hand, needing attention -- asks how long that'll take. She replies, "a moment." How long, he asks, is a moment? She says, indignant, "a moment is a moment." Frustrated, he finally asks, "how much of the day will pass?" We take "hours" and "minutes" for granted now. It's almost incomprehensible to think of a time in which there's no knowledge of the passage of time, even when we don't have a clock right there on our wrist.

Well, incomprehensible... but not nearly as much as trying to fathom a disease that took out one person in every twenty.

(Incidentally, some of the epidemiology articles I've found suggest that Japan's deathrate was lower due to the Japanese habit of boiling water prior to drinking.)

Comments

[haya5h1.livejournal.com]

It's because cholera is a bacteria that the body cannot build up defenses against it. (Antibodies work against viruses, not bacteria.) There might be a factor of mutation involved but as I understand it, the white blood cells simply can't keep up as the bacteria multiply very fast once they take hold in the body. Victims generally die of dehydration due to diarrhea and vomiting. (Lately there've been reports of antibiotic-resistant cholera strains due to rampant misuse of antibiotics here, but that's a whole other story.)

Cholera is common in rural areas (where people get their water from rivers and wells) here, and there are occasional outbreaks in city and town areas especially when there's flooding. Better access to medical services and the increased availability of piped treated water has cut the death rate, but cholera-related deaths do happen in the more inaccessible areas or when people leave it too long without treatment.

[nagasvoice]

Our white blood cells do attack and destroy bacteria, but my impression has been that cholera bacterial divide so quickly (and the initial dosage of them in water may be so high in the first place) that they overwhelm the unresistant body. They also generate a toxin that damages the system independently.

[kaigou]

They also generate a toxin that damages the system independently.

*eyeswide*

Woah. That's fierce.

[nagasvoice]

It is. Very much like food poisoning, where the botulinum bacteria is not so much the problem as the chemical toxin it excretes

[kaigou]

Having had food poisoning (from curdled milk), all I can say is... *shudder*

[kaigou]

Antibodies work against viruses, not bacteria.

Ahh, so I had it backwards.

Lately there've been reports of antibiotic-resistant cholera strains due to rampant misuse of antibiotics here, but that's a whole other story.

I was just reading something on how using antibiotics for farm/food animals (cows, pigs, chickens, etc) may have been a major contributor to resistant strains of various diseases. In Denmark, I think it was, the pork industry changed their rules and forbade antibiotics, and the pig-farmers soon realized that if they just let the piglets nurse for a little longer, the mother's immune system's goodness was transferred to the piglets. The result: healthier pigs, sans antibiotics, and larger litters. Curiously, productivity (I guess in this instance, that means "number of piggies") has gone up, after halting the antibiotics.

[nagasvoice]

Yes, there's an editorial in SciAm this month pointing out that stopping the antibiotics there did not reduce productivity. The better management they had to use improved productivity--which says to me we could do a lot better on the management end over here, too.

some cholera info

[nagasvoice]

Bacteria can mutate very rapidly.
I've never heard of anybody developing a resistance to cholera, either--but it has to be if they have a vaccine for it, as noted below.

http://www.scientificamerican.com/article.cfm?id=the-enemy-within

Just read an article in SciAm discussing how bacteria conjugate and exchange genetic material so they can mutate faster. Something resistant can pass it along to things that aren't even in the same family of germs. This is particular fast and dangerous in the gram negatives, which have a lot of the nasties (due to a second bacterial cell wall granting increased resistance to drugs or one.)
You can d a search on their site for "cholera" and pick up a lot of info.
Here's one.
http://www.scientificamerican.com/article.cfm?id=cholera-outbreak-haiti
It has three problems: It does have mutating strains, it creates a very bad chemical toxin in the body, and it hides out in reserves in the environment. It has zero fatalities if you know how to treat it right away, however.

...What are the best ways to keep the disease from spreading to more people? Is it mostly an issue of clean water?
There are different ways of making your water clean. One thing I haven't seen out there so far is consideration of the vaccine, which is available now. It has only been since March this year that the World Health Organization has recommended the use of the cholera vaccine on a wide scale. I think this is a situation where it might be considered.

From the numbers that have come out so far, it seems that there's been a mortality rate of roughly eight percent. Is that a pretty standard number of expected deaths?
Standard mortality should be zero. I've worked in Bangladesh for many years, and in our hospital, we treated thousands of patients, and nobody died of cholera. So no deaths are inevitable if you provide the right treatment.

Nobody's had much experience with it in Haiti, so case mortality rates become very high at first, but as facilities become more experienced and people learn where to get treatment, the case mortality rates should come down very quickly.

Cholera seems like a disease of the past—will it ever be eradicated?
No, because of its environmental reservoir. I don't see any way we could eradicate it like eradicating polio or smallpox. As long as you have an environment, you will have cholera. ..

Re: some cholera info

[kaigou]

Wah, thank you!

...an article in SciAm discussing how bacteria conjugate and exchange genetic material so they can mutate faster.

Things like this half-amaze me, to think how far we've come in understanding the natural world... and half scare the living bejeezus out of me, for how much out there -- just part of the natural world -- could kill us.

There was something in one of hte histories I was reading, that mentioned someone developed a vaccine for cholera in the late 1890s, but it didn't go into major use until after the last massive outbreak in the 1920s, something like that. The coolest/oddest was an outbreak in, uhm, I want to say London, where an early epidemiologist argued that the outbreak's source was actually the water pump handle of a certain public water-well in the city. Once the city agreed and replaced the handle, the outbreak dropped off. I guess it wouldn't matter how much you boiled the water if you didn't wash your hands...

Re: some cholera info

[nagasvoice]

Yes, that was one of the first and most famous case histories justifying public health epidemiology. Unfortunately I'm blanking on the name of the gentleman who had the bright thought about mapping the outbreaks to pinpoint the source.

Re: some cholera info

[soukup]

John Snow.

Re: some cholera info

[nagasvoice]

Woot!! Awesome, thank you!

[kaigou]

Ahah, thanks! *off to wiki again*

Re: some cholera info

[mishalak]

The story is fairly cool and was made into a fantastic book called The Ghost Map by Steven Johnson.

Re: some cholera info

[tesserae]

Which is a really excellent book, if you enjoy that sort of thing - really fascinating.

[kaigou]

Putting it on my library list. The notion of diseases squicks me on some deep level (probably a natural reaction, come to think of it) but epidemiology fascinates me. Thanks!

Re: some cholera info

[pensnest]

It wasn't that the pump handle was the source—the cholera was in the water at that well, but when the handle was removed, people could not draw water out of that well and had to go elsewhere. (I went to a museum last summer which had a display on the London sewage system—quite fascinating—and this was of course the big story there.) Here's a link. As I remember, there were two or three weird outlying cases, one of which turned out to be the mother of someone who worked in the Broad Street area. She thought the water from that pump was better than from elsewhere, so her son used to take her a bottle of it regularly.

[kaigou]

It seemed more reasonable that it had to be the water, but the description made it sound like it was solely the handle. (Probably just not a very well-written section.) The intrusion of outlying cases in epidemic outbreaks are fascinating, because of the detective work for doctors in determining how the disease got from here to there. I think we tend to underestimate just how much detective-style work there is for doctors; I mean, a lot of the press/social assumptions around doctors is that the bulk of their work is patient relations... and really, it seems like the real bulk of their work is more like detectives going after teeny microscopic criminals.

(Which creates a bizarre visual in my head of a staff of doctors trying to pat down a disease...)

[tesserae]

Bacteria mutate rapidly because their lifecycles are so short. This book, Microsm, by Carl Zimmer, is perhaps the best explanation of bacterial genetics in reference to disease I've run across lately (it was widely recced on a variety of well-regarded science blogs, too).

[kaigou]

Bacteria mutate rapidly because their lifecycles are so short.

Ahhhh. I had no idea. Then again, the next episode (after the cholera one) deals with syphilis -- and there's an equally horrible way to die, if a much slower one overall. (Not to mention it's something that the average modern doctor would never in his/her entire lifetime, now, see as a last-stage illness. Okay, maybe one case in a bazillion people but enough to have studied it first-hand as a student? Probably not.) Off I went, back to wiki and on, looking up penicillin.

Best part? Apparently the method of mass-production of stable and effective penicillin... was invented by a woman, Margaret Hutchinson Rousseau. First woman to get a PhD in Chemical Engineering, too, IIRC.

I am learning ALL SORTS of new things!

[cyphomandra]

There are at least 150 strains of Vibrio cholerae, and protection against one strain may not carry over to another. In addition, protection can be lost over time. There's a bit of confusion in your comments above - antibodies can be formed to both bacteria and viruses, but may or may not be useful depending on the particular disease. Antibodies against measles stop people getting reinfected. Antibodies against HIV (like measles, a virus) do no good at all against the disease, but can be useful as a marker to tell if someone's infected. Antibodies against bacteria are useful for stopping certain types of pneumonia.

With cholera, people have tried to induce artificial immunity by vaccination for at least 100 years, which is usually a good indication that it's a bad disease. Oral live vaccines probably work best (closest to natural infection), but in early trials about 50% of people got diarrhoea on these. Currently they use killed oral vaccines as the next best, and protection from cholera due to that is about 85% at 6 months in large studies, dropping to 50% at 3 years (this was in Bangladesh). If you take those efficacy figures as a reasonable approximation of what might happen with natural infection, and add in people who escaped infection the first time round, epidemics are going to be a fairly close and present danger.

[kaigou]

me ← not medical student!

I'm rarely (if ever!) quizzed on this, so it's a little fuzzy to try and remember what I can recall from when I worked hospital-admin and would chat with various doctors and nurses. Most of my questions were random just-thought-of-this trivia, so I haven't really had a concerted attempt to get consistent and contiguous specifics... but this one post is a major eye-opener.

So basically antibodies can be created by dealing with either virus or bacteria, but in some cases the illness is just so virulent (or adapts/mutates so fast) that existing antibodies do nothing against the next round? Or just in some cases the body's immune system only keeps the record (so to speak) for a certain length of time before expiration? In a very non-scientific way of putting it, granted.

Sheesh. Y'know, sometimes people joke about how they wouldn't go back in time without advil and a year's worth of antibiotics, but... I'm not sure I'd even go back with that much. Ditch the simple nutrition and clean sanitation and safe drinking water and suddenly you're looking at a whole host of bad things. Very very scary bad things, actually. I already appreciated modern medicine, but when you look at the death rates from curable or preventable diseases... it's really freaking scary... and sad.

(Also drives home just how excited the medical field must've been in Japan, upon opening the doors to Western medicine's advancements, and the potential for dealing with diseases that had previously been absolute killers.)

[cyphomandra]

So basically antibodies can be created by dealing with either virus or bacteria, but in some cases the illness is just so virulent (or adapts/mutates so fast) that existing antibodies do nothing against the next round? Or just in some cases the body's immune system only keeps the record (so to speak) for a certain length of time before expiration? In a very non-scientific way of putting it, granted.

Very basically - the immune system has two main parts to it, innate and adaptive. Innate gets you the same response every time, whereas adaptive learns from what it encounters. Antibodies are part of the adaptive immune system, along with T cells and a bunch of other stuff, all designed to help get rid of that specific infection this time and remember it for next time, so if you do get exposed again the adaptive system kicks in that much faster and more effectively.

Antibodies are the easiest thing to measure after infection/immunisation, but there are a lot of other things going on and, depending on the infection, antibodies may be very important, moderately important, or completely useless. Because it's not the only part, though, you can still be immune. Flu vaccine protection doesn't correlate all that well with antibody levels, for example, and where I live no one checks flu antibody levels after vaccination. Location is important, too - for cholera you really want antibodies that get into the gut wall, not just those in the blood.

There's a Japanese doctor with Western medical training in Kaze Hikaru, actually, and it's fascinating seeing his take on things (and the complete ignorance of the locals about medicine also comes in handy for plot developments...)

[kaigou]

Kaze Hikaru -- a jdrama or a manga?

Thanks to watching Jin and googling, I've also learned that it was Japanese doctors who discovered "the serum therapy for tetanus, the discovery of the plague and dysentery bacilli, the invention of Salvarsan for the treatment of syphilis, and the demonstration of the neurosyphilis spirochete". Seeing how the episode I'm watching now is dealing with syphilis, it's also a fascinating window into learning about stuff (and people, and histories) I'd never learned before.

Jumping over to the flu vaccination thing... I've lived in multiple cities where the annual winter outbreak is pretty severe, and I've never taken the vaccination (nor have I even ever caught the flu, despite being exposed to plenty of friends/coworkers who've come down with virulent versions of it). I'm not even a diehard hand-washer, so all I can figure is that for whatever crazy reason, I got blessed with a strong immune system. I think? Or maybe it's that drinking so much c'cola puts so many toxins in my system that it kills everything else!

The problem with that is that in some ways, it's made me somewhat oblivious to the details. As a child, I got strep throat every year like clockwork until I was nine or so, and after that... hmm. I had bronchitis in college, and that was a shock to actually be so ill... but otherwise, I think such a personal history creates a wierd sort of blindness, y'know? Not quite a sense of invulnerability, so much as a "I don't need to worry about that, I've got plenty else on my mind". Either that, or it's karmic balance considering how much is wrong with my brain. Maybe the universe figures making me susceptible to the flu would be overkill... which is probably a bad choice of words.

(I also haven't travelled extensively in second- and third-world areas -- well, outside of Appalachia and Mississippi, that is -- or spent significant amount of time in non-Western medicine areas, so even "before you travel" prevention hasn't been an in-my-face issue for me.)

Regardless, my knowledge/awareness of antibodies consisted mostly of, "they stay after you have a disease, so you don't get it again" and that if a disease's critters mutate enough, they could bypass the antibodies and you'd get hit again (hence the repeated flu years that some friends suffer). Obviously there's more to it than that, and thank you for explaining the "more to it" for me! Much, much easier to understand than the supposedly-introductory level articles I was reading last night. Thank you!

[cyphomandra]

Kaze Hikaru - manga (as far as I know!). Tokugawa era Japan, with the tension between the Shogun and the Emperor over opening up Japan. Sei disguises herself as a boy to join the Shinsengumi and seek revenge for her family's deaths. Great characters, interesting and mostly not predictable plot (she does have a crush on the only guy in the troop who knows her real identity; on the other hand, her alibi for having her period is having her own prostitute who she visits monthly), fascinating historical detail, and I am doing all this from memory, so apologies if details inaccurate, but the mangaka does these brilliant research notes about her work, which has obviously become one of those overwhelming passions, and what exactly some small object was in the side of a particular panel. Very good.

[(Anonymous)]

Cholera is an interesting beastie: lives and reproduces in the human gut, secretes a toxin. As I recall, the toxin buggers up the sodium/potassium exchange protein pump in the cells lining the gut wall (I've forgotten the exact mechanism) causing osmotic pressure to drag lots of water into the gut, which gives rise to the characteristic diarrhoea. Death results from dehydration; meanwhile the cholera bacteria have been flushed into the water supply outside the body and may infect other people.

If a cholera patient is systematically rehydrated with isotonic fluid (basically boiled water with the correct proportion of salt and sugar dissolved in it) the infection is self-limiting -- the guts flush themselves clean within 48 hours, and the hydrated patient can recover.

Antibodies, though, imply the bacteria got into the body and the immune system got a chance to recognize it. Which doesn't happen. So you don't develop immunity to cholera.

[kaigou]

That is SO MUCH EASIER to understand than the articles I was reading last night!

So basically, if you survive cholera via staying hydrated enough, then the bacteria get wiped out before they've gone systemic, or does the cholera bacterium never actually go systemic to get that far? I guess that means systemic is required to develop antibodies?

The show did have patients being treated with a salt-sugar-water solution orally. (Then later by a jury-rigged intravenous saline drip.) In some ways, the show's writing is particularly deft, for mixing basic medicinal issues/procedures with a few modern nods, like when the back-in-time doctor (the Jin of the title) figures out the right proportion of salt, sugar, and water... and mutters to himself, "I've just made a sports drink."

I wonder how many people watching suddenly went, "wait, that's a sports drink? Salt, sugar, and boiled water?"

All in all, cholera does sound like an interesting beastie, but it's one I'd prefer spent its beastie time somewhere other than in me. Nothing personal, of course! Just... entirely professional. We're just not meant to be together, cholera. It's not you, really, it's me... who wants to be totally somewhere ELSE when you show up.

(thank you again for the clear & simple explanation!)

[taithe]

One aspect that hasn't been mentioned is that the cholera toxin causes the actual diarrhea. The toxicity of cholera bacteria evolved out of horizontal gene transfer -- meaning cholera bacteria evolved to have toxicity genes due to viruses infecting cholera bacteria and leaving behind specific genetic material. (This process of viruses infecting bacteria and accidentally leaving behind genes that become incorporated into bacteria DNA is a common way for bacteria to mutate.)

Whoever said antibodies work against only viruses and not bacteria is dead wrong. Antibodies recognize anything that's foreign to them -- antibodies are adept at recognizing bacteria and killing them through multiple methods. Look up opsonization and complement cascade system if you're interested in the details.

There are cholera vaccines out there -- the one mentioned in my microbio lecture had inactivated (killed) cholera bacteria that would trigger the immune system so that it would remember that bacteria if it encountered it again. This can prevent someone from getting the disease by allowing the immune system to react quickly and effectively against cholera. Antibiotics also help, but the issue of resistance is always in the air.

Doesn't that mean that if you were exposed to cholera and managed to be one of the one-in-two to one-in-twenty who survived (honestly, a 50% death rate is just unfathomable)... that your body would have developed the antibodies?

I'd say yes.

Wouldn't that mean that epidemics would be separated by generations, because it'd take time before a large enough percentage of the population existed that had not been exposed?

No, because I don't think cholera antibodies would be heritable. There are certain antibodies you inherit from your mother (innate immunity), but others you have to develop on your own (adaptive immunity). This would explain why you wouldn't have generational gaps. Even if you're not exposed, your children are still susceptible to cholera. Also someone else mentioned there are numerous cholera strains -- just because your body has antibodies for one doesn't mean you won't get cholera from a different strain.

If I'm repeating anything, I apologize. It's been a long night and I skimmed through the comments before replying.

[kaigou]

I think I was the one who got the virus/bacteria vs antibiotics confused, and afterwards I realized it might've been confusion over vaguely remembering that there are two types of bacteria -- one that antibiotics work on, and one that they don't (or maybe it's that the second one requires something other than penicillin).

By generation, I meant more like this:

If you have population of, say, 1,000 people, and the death rate is -- to pick easy numbers -- 10%, then after an epidemic, 1K people are dead. The other 9K were exposed in some way, or to some degree and either had natural immunity or antibodies or managed to survive somehow or... however it is that a percentage survives an epidemic. Figuring that means 9K people are now immune to some degree, it'd take X number of years of birth and in-migration to add 1K new, unexposed/non-immune people, but if cholera returned, only 1K would be susceptible, and 10% of that is only 100 people, so... smaller epidemic. But once the population's turned over to a greater degree, then you have larger number susceptible and suddenly epidemic on larger scale due to that. Which is why it confused me that the show would report the major epidemic (in Japan) in 1858 but then the modern doctor would be fearing an equally major outbreak only four years later -- I thought the bulk of the population wouldn't have turned over enough yet that there'd be a significant portion of people susceptible.

It wasn't really an issue of inheritability -- are any antibodies (other than basic immune system stuff we get from in the womb & breast-feeding) actually inheritable? I have no idea.

But I guess you've answered that question regardless, since if it's a different strain then all bets are off... regardless, when I went and looked up Japan's history with cholera, there's minimal outbreaks in the 60s and 70s, I think it was, then another massive outbreak in the 80s that coincided with a major outbreak in other places in Asia. I can't recall the precise dates, but it was a big gap. Big enough that same strain or different, seems like the population turnover would've been enough that the % who'd survived the first would be pretty small.

Frankly, cholera is definitely something on my "do NOT ever get this!" list. Right up there with tuberculosis and syphilis. Okay, not that I'm at risk for the last, but still. Just to make sure, I've already informed the universe. Because those three are vicious.

[taithe]

*smacks forehead* Ah sorry, my bad. You're right, it would be a smaller epidemic if it was the same strain of cholera focused in one region. Frequency of outbreaks in a region would depend on sanitation/water quality among other factors. Here's something interesting I came across just now:

After sifting through historical records of cholera deaths in Bengal, a team of scientists in the United States and Europe proposes a new explanation for these repeated outbreaks, suggesting that immunity to cholera wanes more rapidly than thought and that many more people than believed become infected without exhibiting symptoms.

Source

This means people who survive can still be infected and co-infect others. Even so this hypothesis would only explain why severe outbreaks would become epidemic/pandemic. Like you said, having another severe outbreak in a place that has just recently been already devastated with cholera doesn't really add up. Without intervention, cholera disappears once it doesn't have enough hosts.

(Another article suggests parasitic infections, which are common in poorer nations, would lower your immunity to cholera somehow. If I can use my university's database to find out more information, I'll let you know.)

[kaigou]

Hey, no worries on further research -- this is only for my own edification, so I won't impose further. I just find such things fascinating, if only to just, I don't know, maybe understand how the natural world works, a little better? Or maybe because I enjoy (oddly, I'm sure) the flush of humility at being reminded just how massive and strange and awesome (in the traditional, awe-inspiring, sense) the world is, all the way down to teeny little organisms otherwise invisible to the naked eye.

We (general 'we', our shared generation) likes to talk, it seems, about how amazing! and fast! and phenomenal! the internet is, that we've made all these incredible leaps in technology in only one lifetime. And we have, and it's amazing, true, but... I think there's something about the leaps in the past hundred years in medicine that are even more mind-boggling. I think we underestimate the power of the always-already, the sense that now that we grok the depth of things like bacteria and viruses and the vectors of disease and the ways to prevent and recover, that reading about the days when doctors stumbled blindly through knowing that this works but that doesn't and without the faintest idea of why... it's far more breath-taking than technology's development, or maybe that's just the added weight given due to the fact that technology saves lives, sure, but nothing quite on the direct scale as, say, the means to create a massive and stable and consistent supply of penicillin, and the sheer number of lives that can be saved with that single thing.

As a non-medical person (if traumatized by having nurses in the family, bwah), I look at, say, telephones and think, thirty years ago, you'd call someone and if they weren't home, you waited. Twenty years ago, you left a message on the answering machine, and a few years after that you could page them. Now you can reach them anywhere... but outside a few emergencies, we did business just as well when we had to wait an extra hour as we do, now, when it's more instantaneous. I mean, hospitals and libraries and hotels and restaurants have effectively had unchanged business-styles for thousands of years, and doing it faster now doesn't mean better, necessarily. Or shorter version: technology makes things faster, but that's not always the same as "more efficient" or even "more improved". It's just faster, and sometimes it's not even simpler or cheaper.

But the advances in medicine are indisputably making things life-and-death better. That aspect of always-already makes it hard, then, to watch historical dramas where people are suffering what's now a curable (or even easily preventable) disease. Or maybe I should say, it makes it really hard to romanticize the suffering, but it also makes it really hard (for me) to take the advances for granted. A very thin line, called antibiotics, is all that separates from the disease-free now and the too-easy-to-die then, if that makes sense.

The irony, of course, is that my mother is deathly allergic to penicillin. Fortunately I'm not, but still. When her immune system was suppressed by six years of steroid medication, and she caught a bacteria (that took the doctors almost two weeks to finally identify as a bacteria that lives in soil and the epidemiologist only put the clues together when my step-father mentioned Mom's gardening!) -- the best medicine would also kill her. It became a race to see whether, in giving her cousin-of-cousin-of-antibiotic at very weak levels could kill the bacteria before the antibiotic itself killed her. Holy freaking cripes. It was like a reverse of the from-the-future doctor in the past: how easy to save these people, if only I had simple antibiotics! except with my mom, it was: how hard to save this person when antibiotics are not an option! Yet at the same time, made me value/respect even more the delicacy made possible (of balancing bacteria-killing and medicine-allergy) via advances in understanding our bodies, and biochemistry, and medications, and all the rest of it.

Err, sorry to ramble on... AGAIN. I really need to stop doing that.