The Long Road To Liverpool

I have to admit it; some things just fucking annoy me! Maybe it's my age, perhaps, but sometimes you see some things that just make your blood boil.

Where do I start? Well today's is simple. How about this for little headline in the Telegraph, no doubt pulling them in a little money too for what actually amounts to an advertisement because the general public is no wiser of anything of significance after reading it except of the existence of yet another stupid product.

"Giant Microbes: Soft toy versions of bacteria and viruses such as HIV, Herpes, Swine Flu and Ebola"

Sings out the inane headline. The guff beneath informs us:

"A bizarre range of soft toys which look like bacteria and viruses have become popular with students, health care workers and children. The fluffy Giant Microbes are shaped like the real bugs, but are about a million times bigger."

Giant Microbes is mentioned twice, that's the plug, that's the trade mark.

"What do you want for Christmas Johnny?"

"I've got Herpes and I had double pneumonia, so I swapped one for Syphilis but I haven't got Pig Flu yet or maybe Measles would be nice."

As usual with anything microbial they get it wrong. A "million times bigger" well the scale is all wrong particularly for their cuddly little viruses, but who cares? I do, I spent most of my career as a microbiologist often trying to get over concepts to laymen and often being misquoted. So I'm sensitive to it. Getting things right is important in microbiology.

Bugs always make news, usually horrific news. In the same issue there was an Emeritus Professor of Microbiology in Aberdeen speaking dire warnings about hospital taps and the bugs to be found on them. I met that poor old deadbeat not so long ago when we were both involved in dealing with among other things, the scare about Listeria. He fell in love with publicity and has gone the way of all those who do; wheeled out into his garden on a cold December day to provide a scary sound bite and then completely forgotten until the press need the misguided old sod again to make the public tremble in their boots. It probably does him good. Probably reassures him that he's not really over the hill and of some use still. Me, I think he should retire peacefully and shut up if he can't say anything sensible. Anyway, back to soft toys.

The range of soft toys is quite eclectic and there are three degrees of luxury; three "mini microbes" (presented in what looks like a receptacle for sputum); and the 5-7 and 15-20 inch ranges of plush dolls for the more well-heeled microbiological connoisseur and collector. The range is wide, there is everything from stick-on tattoos, mugs and hats; Anthrax to Black Death, common cold to clap, Diphtheria to Ebola. I couldn't bear to wade through the depressing web catalogue for long.

Now God knows I have written enough in my time about how microbes sometimes get unwarranted bad publicity that leads to hyperbolic reactions to threats, which in reality are relatively small in probability, affect generally few people, yet have an impressive mortality rate that seems to grab the attention. But at no time have I ever recommended complacency. Which is what these soft toys risk doing.

The agents of infectious disease cuddly? Tell that to someone suffering from Leishmaniasis; unrecognisable to his little daughter because the parasite is finding its way out of his body via his nasal mucosa, leaving his face a suppurating mess. Tell that to the relatives of someone with Ebola virus who if they are very unlucky, would have seen their loved one from behind a category four glass screen in a high containment ward in agony from internal haemorrhage and with blood streaming from his eyes, dying in a final thro of bloody vomit. Tell that to me if you dare - you idiotic bastards.

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In 1994 Edith had a fall at home while her son was at work. She was of that generation of country-bred women who had learned to live with stoic determination through hard times, little money and a World War. Her mother, who would have liked to have become a nurse, had called her Edith after Nurse Edith Cavell, shot in Belgium by the Germans in 1914 for harbouring allied soldiers.

An illegitimate child, Edith had known the stigma and the taunts of other children in the hamlet where she was born. At the age of thirteen she was running home across the common when her foot disappeared into a depression at the base of a dead clump of heather. Before she knew it she was surrounded by a cloud of buzzing angry hornets. She was badly stung, particularly her leg. Someone passing heard her screams and rushed her to her grandparents' home where she lived; a small tied cottage in a line of houses locally known as "Poll Parrot Row".

The doctor was sent for. Luckily, he was one of the few in the local village in 1928 with a car so he arrived quickly. She was delirious for 3 days but eventually recovered her senses. The Doctor was worried about her leg however, it was infected. Edith's mother had been summoned, she was away in service. The Doctor told her that he feared Edith might have Osteomyelitis, an infection penetrating the bone into the bone marrow, she would have to go to hospital.

Edith was sent to London to Great Portland Street Hospital. She didn't know it at the time but if she could have walked, just a mile or so down Tottenham Court Road she would have arrived at St. Martin's Place where she could have seen the statue of Edith Cavell that had been erected only eight years before.

Her leg was operated upon and the surgeon was able to scoop out the infected bone and debris. Edith remembered well the anaesthesia. At that time, there were few full time anaesthetists, most were only in large teaching hospitals. However, with the aid of laudanum, she remembered feeling no fear as the Doctor loomed over her and with soothing words began to drip the ether on to the gauze of the steel-framed mask over her nose. She remembered too that it seemed such a long time that she spent there afterwards. In that spruce scrubbed ward, she was gradually getting better with the aid of the strict but kind words and attention of the doctors and nurses who saved her leg and the infrequent, eagerly awaited visits of her mother, when she could get a day off from her employers.

She was there until September when the Doctor finally said she could go home, provided she rested, and as the nurse wheeled her out of the door on that September day she was happy, brandishing her crutches and laughing as they went to the waiting conveyance at the kerbside.

If Edith had looked to her left that day she would have seen the Marylebone road in front of her stretching for a mile and a half into the distance towards Paddington Station and St. Mary's Hospital in Praed Street down the side. She didn't know it, but that very morning at that very moment a Scottish Doctor was uttering a Gaelic curse under his breath because he had found an unwanted green-blue mould growing on what should have been a pure bacterial culture on the surface of the jelly in the Petri dish in front of him. Then he had a sudden realisation; an idea that changed the face of medicine forever.


When she got back to her hamlet home, Edith became "Peggy" a playful shortening of the inevitable "Peg leg" tease of her young friends. Peggy could walk, she still had her leg, and she had survived in a time when survival was not that easy. She had survived at a time when others were still dying of TB, Meningitis, Diphtheria, Polio, Measles and Scarlet Fever; strange and mysterious threats lurking in the air the water and the milk.

Her education though was finished, she still had a long road to recovery. She had been a good pupil and could have gone on to be a pupil-teacher or even gone to the nearest "Modern School" just over the county boundary. But recovered, Peggy went to work in a local hat factory with many other local girls making helmets for the police, the fire brigade, the armed forces and the Colonial Services. A local remnant of the millinery industry of the region founded originally on Hertfordshire and Bedfordshire straw platting, an occupation in which six generations of her family had worked at home by candle light on winter nights.

She was a good singer, joined a local concert party run by a local lad she knew and she met a boy from a nearby small town and fell in love. The war came and she worked by day and as a member of the auxiliary fire service watched for fires by night from the tower of the village church as German bombers droned their way to drop death on the nearby automobile factory and the aeroplane factory and airfield of the De Havilland Company. In quiet moments she would think of Ron, her beau, fighting somewhere in North Africa.

They married in 1941 in the same church where she watched for fires and when the war finally ended the two of them and her mum looked forward to a Britain fit for heroes. Malnutrition in the army had taken its toll but their first child was born three years later followed by two others, all three born in the same bed in the same council house attended by the same district nurse and the same doctor, who was called only if needed. All the family would benefit from a State Health Service that provided vitamin C in orange juice, vitamin D in Cod liver oil and regular checks for the children during their school years. Newly discovered vaccines would virtually eradicate the killer diseases of childhood and school playgrounds would throb with the sound of healthy, happy kids.

Life is never easy, particularly with three kids in the 1950's, a husband in the building industry, in those days a seasonal employment. In 1965 she lost her mum, her best friend and like a sister to her. Two years later she lost her beloved Ron to Cancer, developed due to the chemicals he worked with when he got a more steady occupation in a plastics factory. She was left bereft with three boys, 9, 14 and 18 yrs, with no money except for the equivalent of 12.5 new pence (25cts) offered by the Natonal Assistance which she was to proud to accept.

But stoic, she picked herself up and carried on got a job at the same helmet factory. Her boys became a civil servant, a scientist and a forklift driver in a warehouse. The two younger ones, the scientist and the forklift driver married and had families of their own. The eldest remained with Peggy and looked after her as she got older. He nursed her through Cancer, caused by the solvents in the glues in the hat factory where she worked. He nursed her through an operation that left her with a urostomy and did all that she required to change the bags and fittings when needed and did everything t make her life happy and comfortable. Peggy wasn't happy to think she might be a burden on anyone but she wasn't, she was as light as a feather.

So when Peggy fell that day, she didn't mention anything until the pain became too great for her and she told her son later that night. He took her to the local hospital where they diagnosed a broken rib. They discharged her with painkillers. Some days later Peggy had a fever and her son took her back to the hospital where they diagnosed pneumonia which had developed because she couldn't cough or breathe deeply enough due to the pain of her rib.

She was admitted to the geriatric ward, such a shame for someone who had never been old in her mind. They started her on antibiotics and after an initial rally she became ill with diarrhea and stomach cramps. Things were getting serious. The eldest son informed the scientist who was living abroad that perhaps he should come home, because things weren't looking good

The scientist arrived at the hospital straight from the airport. He was shocked to find Peggy in such a state. The first thing she said was "what are you doing here?" and the initial smile, faded to a realisation seeing straight through the lie about him being there for work. She did smile again though at the drawing he brought her from her grandson but that was the last he ever saw of her smile.


The thing that the scientist noticed most in the ward was the filth. Not overt filth but yes, dust and mould on the window sills and the tops of the curtains that most certainly became mobilised every time a nurse bustled by. The floors too were dull and dirty, not bright and shiney. In the time that the scientist had been away from Britain it had in this respect become a third world country.


The eldest son arrived and explained that she had contracted Clostridium dificile enteritis and invasive infection, an increasingly common side-effect of antibiotic treatments for the pneumonia. They had tried everything. They said she would get worse and at that stage they would like permission to turn off the drip, continue the pain relief and allow her to die gradually from dehydration. Apparently it was the "kindest" thing to do.

The scientist who knew a thing or two about infection asked them if they had really tried everything.

What about metronidazole? "Yes said the young doctor". He said the same for vancomycin. He didn't seem to have heard of fusidic acid, nitazoxanide, rifampin, rifaximin and bacitracin but he did know that teicoplanin was too expensive so they didn't use it, not on geriatric cases anyway.

So Peggy, who had survived 79 years was to be allowed to fade away down what today they call the "Liverpool Care Pathway". To thirst in the parched nomansland of impending death. Left in a side ward and may be looked in on a couple of times morning afternoon and night.The eldest son stayed with her every moment he could.

When she was awake, in her drugged confusion she would sometimes see little men on the curtains and she would sometimes return to her childhood, rambling once again on the common. I wonder if she ever saw herself back on that London kerbside in 1928? Young, and glad to be alive, she didn't know that just two miles down the road a Scottish Doctor was firing-up the railroad train of the antibiotic era that 66 years later would finally run her over.

On the 23 July the eldest son stepped out for a moment to buy some essentials and Peggy passed away. She never liked a fuss.


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Everyone has to die. However, Clostridium dificile has two simple causes. One is filth. Filth such as I saw in the Hospital where my mother Peggy died. Filth such as never would have been seen in the Hospital where they saved her leg all those years ago. Where nurses were ruled and disciplined in pristine carbolic scrubbed wards by an iron-willed Matron and where medically qualified people with patients foremost in their minds managed the establishment, rather than overpaid arriviste accountants better suited to managing the throughput of an abattoir.

The other cause is of course antibiotics. Antibiotics used to fight her pneumonia, disturbed the natural flora of the intestines allowing "Cdif" to get a foothold. "Cdif" which, present only in a percentage of people naturally, could also have had its origins in the filth and faecal dust found in abundance in that disgraceful ward where she eventually died.

The same antibiotics which have since 1928 saved millions of lives and allowed wars to be won or lost by human effort alone rather than by rats and lice, microorganisms and pestilence. The same antibiotics that because of their efficacy have led penny-pinching hospital managers to skimp on cleaning and the same antibiotics that led me once, while in hospital myself, to have to explain to an astonished nurse why I was refusing to allow her to take blood from me using a syringe with a needle that she had just dropped on the floor.

Medical men will blame the nasty bacteria for becoming resistant to our efforts to get rid of them. This is nothing to do with our use of antibiotics if we use them properly in conjunction with good hygiene. If one takes organisms from collections of bacteria made well before the era of antibiotics, one can find that many show resistance already to completely synthetic antibiotics with no known equivalent in nature as well as to the commoner penicillins.

Disinfectants on the other hand act on less specific properties of microorganisms. Chlorhexidine, known as Hibitane in the UK was banned because of some skin reaction or perhaps it caused mutations in a completely unreliable test for carcinogens called the Ames Test. I can't remember or be bothered to look it up. That disinfectant was very efficient, particularly against Staphylococcus one of the organisms causing much trouble in UK hospitals nowadays because of its resistance to antibiotics.

Our major enemy is not antibiotic or microorganism, it is our own complacency in believing we could ever not be vigilant in our fight against disease and neglect the simple rules of hygiene. In many ways, for non-scientists among you it is the same thing as happened when companies were given a 'holiday' from pension payments by Gordon Brown. A gulf opened in the pensions system, never to be filled again. Let up in hygiene for one hour and it will take ten hours to redress the damage done.Hygiene is logarithmic.

Bacteria live on surfaces and they are transferred from surface to surface by humans, flies or other vectors until they finally happen upon a fertile breeding ground where they grow. When they grow they cause trouble. The average total surface area of a hospital ward has increased significantly since 1928 due to the increased number of machines and apparatus in them, leading to more surfaces on which which organisms may gather and be transferred. The number of visitors allowed into hospitals has increased with visiting times being relaxed and almost unrestricted making cleaning a continuous necessity and an uphill process.Antibiotics have indeed led to an increased frequency of resistant organisms in the general population. Their indiscriminate use in animal husbandry too has increased the problem. So the patients entering hosptals are themselves major sources of infection.

Most of my career has been spent preventing the companies I worked for from poisoning their consumers. They never do that on purpose. Something has really gone wrong when a contaminated product gets past the factory door.

However, to do this it was necessary to spend immense amounts of money on research into the types of organisms characteristically found in food raw materials and food factories and their environments, their sources and the routes by which they obtained access to the final products. This involved much time, manpower and extremely sophisticated cutting-edge techniques for detection and identification of microorganisms involving DNA and RNA analysis. The situation was even more acute when the food industry decided that chilled foods lacking many of the traditional preservation barriers were the products with potential. Products then became more like ill human beings, even more sensitive to infection and production hygiene even more critical.

If we spent half the amount of money doing the same investigations in our hospitals as the Food Industry does for food safety in its factories, then we would at least approach the ideal of doing our best. Because that is what has not been done recently, our best - and it has led also to a general unfortunate complacency concerning the value of a human life such as that of an old frail lady who might, had things been otherwise, have had just enough time allowed to her to say "goodbye , I love you" to her three sons, before she embarked on her last journey on the Liverpool pathway.


So come near me if you dare with your fluffy cuddly germs particularly if you are a "health care professional", and I will show you how creative I can be with them!