A doctor's swine flu blog
Updated on 31 July 2009
In his latest swine flu blog from his Surrey surgery, Dr Peter Stott, looks at the ways society reacts to disease.
In mediaeval times it was common to come upon people wearing rags, ringing a bell and shouting "Unclean, unclean."
As they approached they would move to one side of the road.
They had leprosy which is still common in some parts of the world.
It is spread through physical contact and causes disfiguring lesions of the skin.
It was not until 1873 that a Norwegian named Hansen discovered that it was caused by a bacterium related to tuberculosis.
Now it seems, bells are being used again, this time in places where people with swine flu are prone to congregate, like accident and emergency departments.
I went down to the accident and emergency department at my local hospital this week. Outside the door was a new notice. "If you think you have swine flu, stop here and ring this bell. Don’t come in. Someone will come out to meet you."
The receptionist said they had been flooded with people who did not feel well.
She said: "Someone goes out to meet them with a mask on. Then they are taken through to the isolation ward where a member of staff will see them."
The nurse who sees these patients wears a mask, gloves and a gown.
Surfaces are wiped regularly and there is a lot of hand washing.
She told me that most patients are sent home after examination and reassurance.
A few very ill people have been admitted to special isolation wards within the hospital.
The department of health has issued a list of clinical indicators for patients who need admission to hospital:
- severe breathing problems (unable to complete a sentence in one breath)
- rapid breathing (adults more than 30 breaths per minute; children more than 40)
- so tired that people are unable to breath fast enough or that they stop breathing at times
- dehydration or ‘shock’ (including loose pale skin)
- altered consciousness or confusion; or ‘floppiness’ in children
- an illness which is rapidly becoming worse
In mediaeval times, no-one knew what caused leprosy. It was seen as an affliction from God. Priests would often perform an incantation at the door of the afflicted person. It may be useful to consider this today for it provides a very good list of what to do to avoid catching contagious diseases:
"I forbid you to ever enter a church, a monastery, a fair, a mill, a market or an assembly of people.
"I forbid you to leave your house unless dressed in your recognisable garb and also shod.
"I forbid you to wash your hands or to launder anything or to drink at any stream or fountain, unless using your own barrel or dipper.
"I forbid you to touch anything you buy or barter for, until it becomes your own.
"I forbid you to enter any tavern; and if you wish for wine, whether you buy it or it is given to you, have it funnelled into your keg.
"I forbid you to share house with any woman but your wife. I command you, if accosted by anyone while travelling on a road, to set yourself down-wind of them before you answer.
"I forbid you to enter any narrow passage, lest a passerby bump into you.
"I forbid you, wherever you go, to touch the rim or the rope of a well without donning your gloves.
"I forbid you to touch any child or give them anything. I forbid you to drink or eat from any vessel but your own."
Martene's De Antiquis Ecclesiae Ritibus, "Ordo I". In Martinus Cawley, "The Life of Alice the Leper and the Silver Age of Villers," Cistercian Scholars Quarterly.
I asked the A&E receptionist whether they drew straws to work in the isolation room.
She said: "We just take the normal level of car."
Despite the highly contagious nature of this virus, it seemed that no one in the department had yet become a sufferer.
If you go down to A&E and have to ring the bell, take a paper wipe, and make sure you don’t actually touch the bell push. You could catch something nasty.
