The Empire Fights Back

In Western Europe, prior to the mid-nineteenth century, infectious diseases were considered to arise by spontaneous generation. At that time, it was widely believed that different “humors” within the body could produce debilitating, and often fatal, illnesses. Partly this came about because of a perception that harm was inflicted by larger organisms on smaller ones. The notion that a tiny creature could invade a huge one and wreak havoc was as alien as Belgium conquering France.

This belief had persisted throughout the middle ages in Europe, and even the scientific and artistic enlightenment of the renaissance brought little progress to medicine.  European medical science changed little in well over one thousand years. The concept of evil from within led to practices such as the use of leeches to bleed patients in the hope of sucking out disease. All this seems odd to us now, especially when we think about airborne or waterborne infections. The spread of the common cold, measles, or poisoning by contaminated shellfish, all seem to indicate the presence of external vectors, rather than spontaneous action.

Although the Englishman Jenner is often named as the father of vaccination, by immunizing against smallpox through infection with cowpox, the East had as usual much to offer in this area, and much earlier. Variolation, the practice of mildly infecting a part of the human body with the smallpox virus in order to stimulate the immune system to resist the disease, is documented as far back as the eighth century.

Just as the science of The India Road, developed by Indians at Pataliputra from the sages of Alexander the Great, was later carried west by Arabs and Jews, so also the medical wisdom of Indian and Chinese vaccination techniques migrated across Asia to the eastern borders of Europe. After Pasteur established that “germs” were external agents that invaded the human body, the medical understanding of infections began its rapid ascent. By the mid-twentieth century the use of penicillin was well established, and the West thought the war on bacteria had been won.

Because bacteria are conceptually very simple, with one circular chromosome and no cell nucleus, they are a good choice for study, and much of our knowledge on genetics has been based on bacterial models.  The organisms reproduce at a high rate, and they exchange genetic material with each other by means of “sex tubes”.  Many years ago, in a university lecture, a serious looking lady was explaining the finer points of genetics to a class of bored undergraduates. My ears perked up when she explained that there were strains of gonorrhea that had become resistant to antibiotics, and furthermore that the source of the resistance has been identified. The “spliced” genes that defied the drugs came from another bacterium, a resident of the human throat. By then I was already smiling. When she crowned it off by explaining that this had first been identified at Subic Bay, in the Philippines, I let out a guffaw. I remember getting a number of odd looks, but I think the prof. was glad someone got the point.

The famous "col de cygne" flask with which Pasteur demonstrated the "germ" theory

These days, bacteria have regrouped to fight another day. In large part, this is the fault of humans, who have abused antibiotic drugs both on themselves and on all farmed animals. Four years ago I was in Kunming, the spring city of western China, capital of Yunnan province. I had developed some kind of throat infection that refused to quit, so my communication was limited to croaking. Since I was called upon to croak with some vigor, the Chinese around me took pity and produced a range of therapies. Traditional Chinese medicine was procured, which I happily indulged in.

Nothing happened.

As a fallback, a number of those present delved into pockets and purses and handed me the most dizzying array of antibiotics. I came away with a multicolored collection of pills, without a clue as to what the active ingredient was in each. Multiply that by one billion and you have a big problem.

The other part of the problem is the versatility of the bacteria themselves. One of these critters is currently punching considerably above its weight in Germany. And spreading elsewhere, as travelers disembark from trains and planes, their intestine festooned with the wicked Escherichia coli. Maybe the German export boom isn’t such a good thing after all.

The thing is, E. coli, as it’s known in intimacy, is really a very close friend of ours. The rod-shaped bacterium colonizes the bowel of infants before they’re even two days old. And mostly, it’s not wicked at all. In fact, it is incredibly versatile, and can survive outside the body for a few hours.

These harmless strains are therefore used to analyse the water we drink, the food we eat, and the quality of bathing beaches. Coliforms, as they’re known, indicate the potential presence of nasty things which can make us seriously ill. Like typhoid, or salmonella. Or cholera. A good indicator has to obey certain rules, which include not causing diseases, being present before the disease vectors are there, and persisting after they’ve vanished. And E. coli does that. It lives best in our rich bowel broth at body temperature, but certain strains can survive in temperatures that are thirty per cent higher. Unlike us, they are quite happy to live without oxygen. But they can live with it as well. They, and a number of their friends, are what we call intestinal flora, and a requirement in the delightful euphemism of “staying regular”. There are entire aisles in western supermarkets devoted to this religion. And on the slightly lighter side (sorry), have a quick read of this. My favorite is:

…my company insists we share rooms – who wants to poo in front of their boss?

Once in a while, the faithful friend goes over to the dark side (sorry again), and strikes. By May 30th, this particular strain had caused 14 deaths and put 300 people in hospital. Today we’re up to 19 dead. It has also become both a misogynist and a gerontophobe, preferentially targeting older women, and, with inescapable irony,  Spanish cucumbers.

The Germans (well, the Hamburgers, to be fair) were quick to blame Spanish produce, causing a mere two hundred million euros of revenue loss in a country where unemployment runs to 20%. Much of that loss is in Andalucia, which has a far higher proportion of unemployed. Perhaps it’s the sort of levity, which in a humorless nation may be mistaken for seriousness, that proposed the sale of a Greek island to offset sovereign debt.

DNA sequencing allows us to pinpoint the enemy far quicker, and it’s a sign of the times that one of the labs doing much of the work is in Beijing. One of the state of the art approaches is called 454, which can’t be a very popular piece of equipment in China, for numeric reasons alone. So far Darth Vader has been shown to be resistant to eight antibiotics. The empire fights back.

The India Road QR links for smartphones: point your camera and click.

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