Category Archives: Vaguely medical

Anything that relates to medicine, medical education, doctors, medical students, health

Flu-express, Bermuda: a drive-by vaccination programme

I probably shouldn’t be surprised to read in Bermuda news that flu vaccination sessions are being held over the next few weeks, but on some level I suppose I had associated flu with inclement weather, rain, dark evenings, hot lemon and blankets. Seasonal flu, northern hemisphere November to March, and the annual flu campaign – why not in Bermuda, it is in the northern hemisphere, does have a winter season and is very much not isolated from the world. It just hadn’t occurred to me.

My next thought was “should I have one?” For several years now I have “qualified” for a vaccination in UK – first as a health care worker and then as a health “hazard” (aka “person with chronic illness” as the more politically correct term) so where do I stand on Bermuda?

How do I approach answering this?
Some background:
The virus:

Influenza Virus (image: wikispaces-microbiology 2009)

Influenza Virus (image: wikispaces-microbiology 2009)

Influenza is caused by a virus, an orthomyxovirus. There are types A,B and C. Seasonal flu is commonly from types A or B. All viruses will have special characteristic protein molecules sticking out of their coat and these are used to further classify flu viruses – type A flu viruses will have varieties of H proteins and N proteins (haemagglutinin or neuraminidase). The proteins themselves will differ and at least 16 different H proteins have been identified so far. So different strains of virus will have names, such as “H3N2“, which was the main one causing seasonal flu last year. Others in the news have been “H1N1” that caused the 2009 pandemic or “H5N1” which was an avian flu virus that jumped the species barrier to infect a human in 1997.

The viruses can change the proteins they display, akin to wearing a different hat, and this can happen if two strains meet each other in the same victim. A virus can only reproduce inside a living cell but if two or more are trying to duplicate in the one cell then it’s inevitable they will make mistakes and get stuck together with wrong or different proteins, so creating a new strain. While most strains prefer one species to infect, some can make a leap, such as when “swine flu” viruses because capable of infecting a human. This all makes keeping up with the new strains extremely difficult and is the main reason why we have to have a flu vaccination every year – the strains circulating can change quickly.

The vaccine:
The vaccine is reconfigured every year according to data from a worldwide surveillance programme that informs WHO which strains are in circulation. Commonly the vaccine consists of 3 strains ( 2 type A and one B) but from last year in some places four strains (2A and 2B) have been used. Northern hemisphere vaccines will often be different from Southern ones, it all depends on which viruses are predominant in the areas.

Vaccines are given just before the anticipated season, i.e. October or April. In tropical regions the picture is less distinct as the illness can occur year round without pattern so guidelines for vaccinations here are still being developed.  Bermuda is not tropical, it has seasonal flu in the winter just like UK, Europe and much of US.

Seasonal vaccination is 70-90% effective at preventing disease. It is slightly less effective in the elderly but where they do contract influenza after vaccination the severity of the illness tends to be much reduced.

The injected vaccine does not contain live viruses. It is not possible to contract flu from the vaccine. That may not fit with the tales you hear – but it is fact. Some people do feel unwell after vaccinations, which could be due to an inflammatory response, but it isn’t flu itself and will not have the bad sequelae that may follow flu infections.
The illness:
Worldwide each year there will be around 3-5 million cases of severe influenza and 500,000 deaths. Those figures need some context: there are just over 2 million new cases of HIV infection worldwide each year; worldwide there are around 100,000 new cases of melanoma. Just because flu is common doesn’t mean it is not serious.

Pandemics occurred in 1889, 1918, 1953 and 1968. Did they reach Bermuda?  Official reports from the island government claimed no cases of influenza on Bermuda in 1889-90 but at the time there was a Swedish ship quarantined off-shore with dengue fever that was later found to be influenza brought across from Cuba. It would be surprising if the island had escaped from the 1918 pandemic but I haven’t yet found a source for the data. WHO unfortunately does not list Bermuda as a separate country, rather it seems to be included as part of the Pan American Health Organisation (PAHO) which makes some sense given its proximity but none given it is a British Dependency. Neither US nor UK hold statistics for Bermuda, but maybe they don’t exist (triangles and all that)
In Bermuda:
Between 2000 and 2008 the average annual incidence was 744 cases per year.
Bermuda has used seasonal flu vaccination since the 1970s and coverage for the over 65s is around 60%. That figure isn’t all that good – Chile and Cuba claim a 100% uptake in the elderly and WHO were aiming for 75% coverage by 2010. In UK financial incentives for practices boosted uptake to above 80% but there doesn’t seem to be an equivalent drive in Bermuda.

One report on the drive-in flu campaign next week stated that it cost $10 for the vaccine, but in smaller print suggested those in health groups at risk should first get a prescription from their GP. I haven’t had to pay for any prescriptions yet on the island, they seem to be covered by insurance, but to see a GP the co-pay is $40 and I don’t know of you can get a prescription without a consultation – it might seem easier to pay the $10 at the drive-in.

The report also implies you don’t actually have to get out of your vehicle to have the injection – so much for the “sit in the waiting room for 10 minutes afterwards” advice we always gave patients in case they fainted or felt unwell. I think I would still suggest you don’t drive off immediately!

Conclusion:
All this makes me feel a little nervous – it’s different from what I normally do, I don’t know the rules, it’s not a familiar process. The publicity assumes a degree of knowledge, and although I know I do need one I am less clear on how I actually go about getting one. Are ex-pats entitled to the $10-government-subsidised vaccines? Should I book an appointment with my GP? Can I attend a drive-thru even if there isn’t one in the parish where I live?

Unusually for one of my blogs I have generated more questions that the ones I set out to answer. I am tempted to hide behind the low incidence of flu on the island – 744 is less than 1.25% of the population so in daily life I am unlikely to encounter the virus. But I am catching a plane back to UK at Christmas and that changes everything. If I don’t meet a virus on the plane then one of my relatives will probably introduce one with the presents or the turkey. So somehow I have to conquer my anxieties and join the queue for a Bermudian flu vaccination!

Please may I have your kidney?

Polycystic Kidney Disease

Today, September 4th is the American National Polycystic Kidney Disease Awareness Day (PKD)

It’s important to me because I have polycystic kidney disease.

Poly = many
Cystic = fluid filled spaces

In essence, instead of containing healthy functioning nephrons, the kidneys become non-functioning organs composed of many cysts.

There are different types but the more common is Autosomal Dominant PKD. 1-2 people in every 1000.

It’s genetic, inherited – I was born with it. My mother had it, her father, his mother … That’s as far back as we know.
“Autosomal dominant” means the abnormal gene is not on the X or Y chromosomes but on one of the others, and that having just one copy alone means you are affected. It also means there is a 1 in 2 chance (50%) that you will pass the gene onto your child.
If you are quick thinking you will have realised that for each of my children there was a 1 in 2 chance that I passed it on to them.
They know that. It’s a story we all live with even if it’s one I haven’t often told.

What happens is that over the years the kidneys, which are designed to filter and maintain a chemical balance in the blood, struggle and eventually fail.

Academically I find the physiology behind all this quite fascinating, but maybe that’s a defence mechanism by which I avoid the more emotional aspects of certain kidney failure.

The overwhelmed kidney gets confused and sends out messages that raise the blood pressure and that just makes the whole situation worse. The PKD patient will encounter antihypertensives early on and, although you know they are a “good thing”, you sometimes wonder if they don’t make you tired and slow. It’s a complex picture, other parts of the body step up in an effort to correct the disequilibrium but, not designed to do the work of a kidney, they muddy the field even more.

In medical school we were taught that a body can lose up to 90% of kidney function and still “go on”. It may mathematically be so, but I suspect that most patients with chronic kidney disease will experience some indication of impairment quite a bit before they reach the 10%-left-point. Nowadays the measure of renal effectiveness is the estimated glomerular filtration rate (EGFR). The downward curve below 60 is arguably more predictable than the stars, at least the astrological ones if not the astronomical. When it falls below 15 then you probably need some outside help: dialysis or transplant. Dialysis is just a holding measure.

Today in Britain there are 5616 people on the kidney waiting list. Actually phrasing it that way, on a waiting list, somehow distances it from the reality – there are 5616 people waiting for a kidney. So far this year there have been only 478 deceased donors. Just 703 kidney transplants have been performed this year. The numbers don’t compute perfectly because some donated kidneys aren’t usable and then some patients are fortunate to have living donations. But over 5000 people go to bed at the end of each day disappointed, more than disappointed, desolate.

On Bermuda the figures are smaller but tell a similar story. In fact it may be a sadder version because only 4 or 5 Bermudians each year will be lucky enough to have a kidney transplant. This week the dialysis unit on Bermuda will keep 160 people alive. Most of them will not get that longed for telephone call to tell them an organ match is waiting. Last year one of them did get the call but she couldn’t get to Boston in time for the operation and the kidney went to someone else.  It is too painful to imagine how she must have felt. 

Joseph Murray (1919-2012) was the surgeon who performed the first successful human kidney transplant, December 23rd 1954. He worked at Brigham Hospital in Boston. For this and subsequent work in the field he received the Nobel Prize for Medicine in 1990. In 2012, coincidentally and sadly the year Joseph Murray died, my daughter, then a medical student at SGUL, was involved in the development of a teaching case for their new approach of using PBL (problem based learning) and virtual patients for the delivery of the ethics curriculum. The virtual patient was named Joseph Murray. The scenario involved organ donation, permissions, dealing with relatives – if you want to try working through the case it is freely available, even has a video (look out for the patient’s mother – closest I will get to an OSCAR)

I was at home yesterday and in the unforgiving midday heat I sought respite inside and without any guilt at all sat watching TV. My selection, via AppleTV/UnblockUS/BBCiPlayer was a programme on tissue and organ procurement, The Human Tissue Squad.

It left me wondering just how organ and tissue donation works on Bermuda. Clearly it isn’t a big enough country to run it’s own procurement programme and there are no facilities for transplant surgery on island. So what happens?

Since proximity to US dictates a link to American healthcare, even though actually a British Overseas territory, Bermuda is part of the New England Organ Bank. So Bermudians can be organ and tissue donors – forms from doctors, TCD and post offices. But there must be huge logistical problems with a 3 hour flight each way to Boston, the closest transplant centre. In US and UK the donor-recipient distance has an effect on allocations and on outcome.  

I was surprised to read about the differences in allocation processes between US and UK. In the States the system is to be enhanced to include a donor index which acknowledges that some kidneys are better than others for factors not relating to the specifics of tissue matching. Bluntly, the non-smoking-kidney will probably be better suited to the new job description.

A person where I once worked had a strange way of paying a compliment with “That’s a nice jumper. Can I have it when you die?” We all laughed, politely, if a little nervously.

Yes, you can have all my jumpers when I die – I won’t have much use for them myself.
But, you know that kidney? Can I have it when you die?

2:30 (or finding a dentist in Bermuda)

I have been very brave and I am going to tell you about it for two reasons – one is that I want sympathy and two is that when I needed it the information was sorely lacking.

Wednesday night I was up with toothache. Ibuprofen and paracetamol did work after a while but I awoke with an unpleasant feeling of dread mixed with guilt. I knew the pain would return, not because I am clever, but because I have had it niggling on and off for several weeks and done nothing about it, hence the guilt.

Actually I had almost done something about it – I did find the telephone number of a dentist in Hamilton, but …..

I swallowed some more ibuprofen, cleaned my teeth for twice the recommended 2-minutes, ate breakfast on the other side of my mouth and tried my best to ignore it. Eventually there was no hiding my discomfort – my husband was oh so nice, but I still snapped back at him when he told me “You need an emergency dentist”. Excuses flew through my mind in one last attempt to avoid this – cost too much / hate making phone calls / insurance – but even as I heard myself pathetically claiming “It isn’t as bad as it was” I knew I had reached that point.

I am going to make it easy for those of you who have floundered on my blog because you have toothache in Bermuda:

RING King Edward Memorial Hospital on 239 2009

Ask for the phone number of the duty dentist on call

Ring that number!

It really is as easy as that. I made the call at 2:10 (2:30 would have been funnier, but I couldn’t wait, it was starting to throb again) and saw the dentist at 3pm and was home again by 4pm.
I would joke that the only bit that hurt was the bill but even that was really not too bad.

I am a little embarrassed to say I had two teeth extracted, it sounds like I have never bought toothpaste. I guess, like many, I did not take as much care with my teeth as I now wished I had, and I dread visits to the dentist in part because I anticipate being told off and lectured. But the dentist I saw yesterday did not lecture me, grimace at me or otherwise make me feel uncomfortable – he was gentle and kind, and, even better, he stopped my toothache. 🙂

So what if you just need a regular dental check and aren’t yet at the stage of mixing painkillers with red wine and denial? That may not be quite so easy. For a routine appointment with a new dentist you are looking at a 5 month wait as a new patient. Not many of the dental practices have websites. The best starting place is probably the Bermuda Dental Association

On the page helpfully titled “Find a Dentist” they have a list of 20 dentists who are taking new patients but, looking closely, the list was last updated in 2009 – come on, it is now 2014!

My daughter was aghast that the wait could be that long – she felt the whole population of Bermuda could be seen in that time, the maths does compute. I don’t know why it takes so long, I have contacted several practices and they give a similar story. (I suggest phone is best as few responded to email enquiries and only the newer practices have a web presence.)

All dentists on Bermuda are Bermudian – the Dental Board will sanction work permits only for specialists, such as a periodontologist, certified dental assistants or sometimes for a dental hygienist. There are a few government dentists who cover school children and prisoners with sentences longer than two years. In a surprisingly technological approach the Bermuda government produced The Tooth Team,  a short YouTube video  – sadly it has only had 154 views in 4 years. School dental health seems much the same as in UK, a dental nurse does screening of specific year groups and a letter home advises on what needs to be done. Children can be treated free but I understand most are seen privately using parental work health insurance.

Dental health insurance might be a recent phenomenon in UK but here it is an expected benefit from your employers health policy. I was extremely grateful for that yesterday – a total bill of $299 was reduced to my own liability for $130 which was the co-pay and emergency fee. I suspect it would have amounted to not much less back home. The dentists will also deal directly with the insurance company on your behalf so the hassle factor is virtually eliminated. For larger bills and restorative work it is advised to get an estimate approved in advance.

I found another blogger who talked about Bermuda dentists in 2010, she gives some helpful information. Her experience was perhaps not quite so good as mine was in the end, but I am grateful to her for blogging about it since it gave me a place to start when trying to solve my problem.

So today I am sipping soup, trying to distract my tongue and using salt mouthwashes as advised. I am grateful he didn’t suggest clove oil, black pepper, red bananas (really?) or stems of the castor oil plant.

 

On my doorstep this morning

Ornamental

Bufo marinarus

I thought it was an ornament, that the landlord had been round in the night adding to the inventory.

This is Bermuda’s only toad (as in only species):  Rhinella marinara, after Linnaeus in 1758 – commonly called a cane toad, but also known as :

  • Bufo agua Clark 1916
  • Bufo marinus Mertens 1969
  • Bufo marinus Schneider 1799
  • Bufo marinus marinus Mertens 1972
  • Bufo strumosus Court 1858
  • Chaunus marinus Frost et al. 2006
  • Bufo marinis Barbour 1916
  • or: bufo toad, giant American toad, giant toad, marine Toad, Suriname toad, crapaud, kwapp, maco pempen, Maco toro, Aga-Kröte

They were brought onto the island by Captain Nathaniel Vesey.

Captain Nathaniel Vesey

Captain Nathaniel Vesey

The Conservation Bermuda website confidently states that he imported 24 toads from Guyana in 1885, but it may not have been so precise as all that – this is an extract from a book written in 1917 by the Bermuda Biological Station for Research:

Interview with Captain Vesey reported in Science, 1900

Interview with Captain Vesey reported in Science, 1900

It is a direct quote from Science N8  Vol XIII No 322 p 342 which notes that a survey undertaken in 1884 on Bermuda found no amphibians at all on the island. Frederic Clayton Waite wrote the article in Science and he was a Harvard trained Professor of Zoology at Ohio State University.  I found some of his other work of particular interest – way back in 1908 he argued for less didactic teaching in the medical student curriculum and more hands-on experience, though he favoured anatomy and histology experience and I might favour patient experience.  He advocated the dissection of cats, dogs or rabbits as a precursor to human anatomy  (not to be encouraged at home).

Frederick Clayton Waite, Professor of Zoology (with ideas on medical education)

Back to the toad. Where was I?

Over time several species of flora and fauna have been introduced into Bermuda, usually well-intentioned, but sometimes with less than ideal outcomes (Ladybirds to eat aphids that necessitated Jamaican anoles to eat the ladybirds, then Kiskadees to eat the lizards etc. I think I mentioned this back in July last year when talking about ants and cockroaches)  Well the introduction of toads seems to have been successful – with voracious and opportunistic appetites they eat all sorts of insects and roaches, crickets, millipedes and snails. It could have gone terribly wrong because there are no natural predators above the toads on the island.  In fact worldwide they are considered tasty morsels by very few species – maybe one or two snakes eat them if they have to.  Probably because the toads secrete a poison from their parotid glands when squeezed and this not only tastes foul (I am told) but can actually cause death if ingested by dogs or cats.  The Invasive Species Compendium database informs that:   The toxin causes extreme pain if rubbed into the eyes  – who would even test that hypothesis? 

Captain Vesey was probably before his time since now there are many instances of these toads being introduced to control crop pests.  He was a member of the colonial parliament representing Devonshire Parish.  The ships that the master mariner sailed includes: Eliza Barss 1857, a barque W P Chandler c1860, the Sir George F Seymour,  Atlantic, a clipper called Ceylon of Boston, a brigantine Lady of the Lake and an appropriately named brigantine Devonshire.
It does seem however that what Google remembers him for is bringing toads to Bermuda!

Now this toad has one more interesting fact  – it was once used for pregnancy testing!

Sources disagree on the process – the Invasive Species compendium describes injecting a woman’s urine subcutaneously into the toad then if she is pregnant the toad will produce sperm in its own urine.   While the Welcome Institute states that African clawed frogs (Xenopus) were used,  and the procedure was to inject the woman’s urine into the leg muscle of a female who then was induced to lay eggs if the woman was pregnant. The former was called a Bufo test but the latter called a Hogben test.  Britannica supports the Xenopus frog while Wikipedia the Bufo toads.  After googling for ages I have found a 1948 article in Nature  where using the male Bufinus toad is described – with the benefit that you can reuse the toad in as little as five days.  The research is interesting – after establishing the theory worked using the isolated hormone hCG, then they used 60 pregnant women and all 60 had positive tests using this method,  which would seem to make it more accurate than todays pharmacy tests – but the paper omits details such as how pregnant the women were and whether controls were used.

It is tea time now, not that I have been writing this all day, but it did keep me entertained on an unusually rainy Sunday afternoon.  We will not be eating Toad in the Hole, nor playing it, nor watching it.  🙂

 

Bermuda Onions

The story goes that Governor Daniel Tucker had onions brought to Bermuda in the ship Edwin in 1616 because he was an enthusiastic farmer.  This fact appears in  lots of places:  Bermuda-attractions, Tuckers Point and news articles. But is it true?

  • Daniel Tucker was Governor of Bermuda in 1616-1619….. √
  • Daniel Tucker was a planter in Virginia when called to be Governor… √
  • He came to Bermuda aboard the ship George…..√
  • There was a ship “Edwin”  in 1616….√
  • Edwin sailed from England to Bermuda, then to West Indies and back to Bermuda….√

The next sentence is complicated:

  • Virginia Bernhard, in her book Slaves and Slaveholders in Bermuda, 1616-1782,
  • wrote that 
  • Governor John Henry Lefroy, in his book Historye of the Bermudas or Somers Islands
  • wrote that
  • Nathaniel Butler in a manuscript now in the British Museum (Sloane MSS750)
  • wrote that
  • the ship Edwin brought to Bermuda “One Indian and one Negroe”

……….  but nothing about onions!
True, he mentions   “plantans, suger canes, figges, pines, and the like,”  so maybe some onions were in the mix.

Bermuda Onions, Botanical Gardens

Bermuda Onions, Botanical Gardens

 

It probably isn’t possible to find out exactly so we will have to believe the current version of history: onions arrived on Bermuda very early on.  It is true that by the mid 19th century onions were a significant crop for the island: in 1844 some 332,735 lbs were exported.  By 1875 the figure was around 4000 tons.  The merchant seamen were nicknamed “Onions” and Bermuda itself “The Onion Patch”.  

You might be wondering why they are so popular and its to do with the mild but sweet taste, probably the combination of soil, sun and water, but I have found three journalist articles saying there is “some magic in the soil”.  A gardening website said to grow onions one should use lots of potash and water and if you harvest at 50 days you get Spring onion-style onions with green tips, but leaving for 120 days gives you larger bulb keeping onions.  It also suggested sowing onions in between rows of other vegetables because they protect from aphids and carrot flies  (after googling for an image of a carrot fly I am not sure I will eat carrots for a while)

Naturally the medical aspects of onions interests me – I didn’t know that freshly cut onion has 10 minutes of antibacterial action so has in the past been used for grazes, wounds, beestings, boils and bruises – note for any junior doctors reading this: probably not approved by the GMC!   In India and China onion has been used to treat cholera and dysentery – 30g onion with 7-10 black peppers ground together and given every few hours.  Onion contains potassium, vitamins A and C and sugar without fat so it might just work on any gastroenteritis.  There are also some interesting studies ongoing in Texas on whether onion can inhibit colon cancer.  The best study I found (in terms of I like the conclusion not that I have analysed the technical aspects of the study) is from Queen Elizabeth College, London, that has found adding fried onions to steak and chips reduces platelet clumping and so could be good for cardiovascular problems!

IMG_2635

This book was written years ago and you will have to come to Bermuda to get a copy – $12 at the Trustworthy Shop – has every onion recipe under the sun, or so it seems.  How about strawberries, onions, toasted almonds with lettuce and yoghurt poppy seed dressing?  Or an onion egg sandwich: 1 chopped Bermuda onion, hard boiled egg and 1 cup mayonnaise with chopped parsley, salt and pepper on decrusted bread.  For the National Trust researchers meetings Margie brings the most delicious egg sandwiches and I am wondering if this is the secret!

So I have covered history, medical and cookery – which leaves onion art?  This will make one of my daughters smile – onions are one of the few things I can draw.

 

Bermuda Samples

Almost hidden away on the top shelf of the Bermuda reference section of the library is a small book that one might easily overlook – just 5 inches tall in mid-blue cloth-covered hardboard with various stamps inside indicating it once occupied a shelf in Somerset Library and was for 14 day loan only. Sadly it is now never borrowed and possibly rarely read, “Bermuda Samples” by William Zuill sits between a volume of island-inspired poetry on one side and a large “Bermuda Development Plan for 2000” on the other.

William Zuill put this book together in 1937, selecting extracts from the Gazette (was Bermuda, now Royal) between 1815 and 1845.  His choice suggests an eclectic mind and definitely a sense of humour:

  • From November,1816 a warning to women wearing low-cut dresses that an “elderly gentleman of venerable appearance and correct manners” was imprinting their bare shoulders or backs with a “stain similar to that from lunar caustic” the words NAKED BUT NOT ASHAMED; washing would not remove it so the ladies were forced to cover it up with more respectable clothes.  [Lunar caustic is silver nitrate, used in the past to treat warts and in photographic developing, it darkens on exposure to light. My thoughts on reading that were that the elderly gent was not so correct in his manners.]
  • From June 1818, a letter to the editor bemoans latecomers to church services, for lying in bed on Sundays was “un-Christian-like“. The writer continues to comment on lowering of standards that permitted “ladies at the breakfast table in night or dressing gown” and “men with chins like a pigs back”.  [which I took to mean unshaven but was less clear as to whether this was lamentable at breakfast time or in church]

The selections that caught my eye were cures or remedies for various illnesses.

  • March 31, 1829, Cure for Consumption:  In the month of May gather flowers from the thorn bush and boil two bunches of blossoms in half a pint of milk. Let it stand until it is about as warm as milk from a cow. Drink it first thing in the morning and take a walk immediately afterwards, if the weather is favourable, and a cure will soon be effected. [Maythorn or hawthorn has its main effects on the heart and is unlikely to do much to help TB, but it might be beneficial to cholesterol levels] 
  • July 19, 1823, To remove pins and bones: Any person who may swallow a pin or the bone of a fish will find almost instant relief by taking four grains of tartar emetic dissolved in warm water and immediately afterwards the white of six eggs. So effectual is this remedy, that it has been known to remove no less than twenty-four pins at once. [who would swallow 24 pins?] [tartar emetic is antimony potassium tartrate, nasty stuff once used for treating alcohol intoxication, known as an emetic since the middle ages. The egg white protein would protect the patient to a degree from poisoning by binding with the antimony. ]
  • July 3, 1832, Recipe for Cholera: 1oz of cinnamon water, 35 drops of tincture of opium, 1 drachm spirits of lavender, 2 drachms tincture of rhubarb.  [1 drachm or dram = ⅛ fluid ounce or approximately one teaspoonful.  If it is a solid measure then 1 drachm = 3 scruples or 60 grains, almost 4grams. I rather suspect the opium might slow the diarrhoea but the rest is just to make it taste pleasant. ]
  • April 1, 1834, Simple Cure for Consumption: this distressing complaint which carries of so many of our valuable young men annually has been cured by a very simple remedy, viz:- the inhaling of the gaseous perfume of chloride of lime. [ Consumption = TB. Chloride of lime is calcium hypochlorite and was used then to bleach laundry, now for swimming pools; the gas given off would be chlorine but is not going to cure TB] 
  • April 21, 1835, Cure for the whooping cough: Take one fourth of a pint of sweet or olive oil, the same quantity of common leeks, cut them fine and simmer them moderately two or three hours; add honey to make it palatable; half a teaspoon full a portion for an adult if taken four or fibre times, it will in a few days remove this distressing disorder. [Cabbage water was also a well-known remedy for coughs] 

The final sample that caught my attention was a report from December 1840 documenting the occurrence of ice “a full quarter inch thick” on the low lying ground in the central parishes of Bermuda. Unbelievable?

Dr Luke Blackburn

lukepryorblackburn1

Munificent or Malefactor?

It was 1864 and Bermuda faced an epidemic of yellow fever.  Not for the first time, more than five outbreaks had devastated the islanders, in 1817 it had taken 213 people from St George’s town alone.  They had tried refusing landing to ships that carried disease and buried the victims in separate cemeteries, but they were no closer to a solution.

The illness began with fever, aching and weakness. Then briefly you might feel slightly better, but the short-lived reprieve was followed by jaundice and bleeding with progressive liver failure.   Vomited blood is customarily black as coffee-grounds and the stools become loose, tar like and offensive.  Few recovered from this point, kidney failure following rapidly and death usually within 10 days. Altogether pretty unpleasant.

Man with yellow fever Image from Wellcome Library

Man with yellow fever
Image from Wellcome Library

Pages from Nineteenth Century Textbook

Pages from Nineteenth Century Textbook

 

 

 

 

 

 

 

 

This was all going on during the American Civil War and although Bermuda was officially neutral it did play an important role in blockade running to enable trade with Southern states (for more on this you should visit The Globe National Trust Museum).  Amidst all the politics and fast ships, along came Dr Luke Pryor Blackburn.

You need some background in order to judge him fairly, he features on many websites, some clearly written to support the guilty verdict. I mean to be balanced but as I began to write that I realised I wanted to show him to be innocent.  Misguided physicians allegiance or hindsight that  what he did would not have worked?

Luke Blackburn was born in 1816, in Woodford County, Kentucky.  He was one of 13 children, born into a Presbyterian family strongly involved in politics. Apprenticed at 15 to his physician uncle, Churchill Jones Blackburn, he gained his degree in medicine at the age of 19 in 1835, which seems young by todays standards but was probably not that unusual at the time. Maybe he was primed to develop an interest in what would today be the field of Infectious Diseases – he witnessed cholera and yellow fever as it swept across the southern states.  His finals dissertation was on cholera:

Dr Luke Blackburn's Dissertation

Dr Luke Blackburn’s Dissertation

He married shortly after becoming a doctor, and had a child within a year (a son who later went into medicine) and for a while he cultivated his political interests.  His CV would have either been impressive with its variety of roles in working life or showed lack of sticking power to any one thing.  It was enough to impress the mayor of New York in 1854 who called upon Dr Blackburn to treat yellow fever patients – this seemed to be in exchange for a New York medical apprenticeship for his son so maybe not completely altruistic.

Kentucky was one of the border states during the civil war, while trading heavily in slaves for the southern states and being officially represented by the central star on the Confederate flag, they diplomatically tried to remain neutral. But Luke Blackburn was open for his support of the Confederates.

How he turned up in Bermuda is not exactly clear – some sources have the Canadian authorities sending him as a Confederal Agent, others claim he volunteered and had already devised his wicked scheme.  They report that he refused payment for his medical services, but far from intending to boost his credentials in generosity it is written as if to underline his evil intent.

Perhaps my favourite source is “The Biography of a Colonial Town” by Sister Jean de Chantal Kennedy, 1961. Not for its unbiased writing, but for the element of storytelling she manages to incorporate.  Luke is described as having “subdued an outbreak of yellow fever” and ‘stemming the onslaught” of cholera.

So, on arrival he took quarters in The Hamilton Hotel where the local medical men asked him to address their meeting.  One took offence at the suggestion that he used the “application of onion with tobacco to the stomach” as a remedy for yellow fever.  Luke Blackburn impressed upon them the need for strict quarantine procedures, a reasonable idea even if it would not have reduced the mosquito carriers of the disease. He began treating the fevered patients and again is noted for not charging a fee.

V0010538 A girl suffering from yellow fever. Watercolour.

A girl suffering from yellow fever. Watercolour. From Wellcome Institute.

 

 

 

V0011984 A parodic cosmological diagram showing opposing aspects of t

Fever!

 

 

 

 

 

 

What happened next may or may not be true.

Dr Blackburn reportedly (the nurse and the barman were witnesses) took the bedding and clothes from those who had just died of yellow fever and packed them into his trunks. In one instance he is supposed to have sent the relatives out to arrange burial while he himself laid out the deceased in an unknown nightgown, the patients own clothes “mysteriously” disappeared.  According to other sources he was in league with an Edward Swan whose role in this was to ship the trunks of (possibly) infected clothing to the northern states, to New York and Unionist ports.     It is even suggested that Blackburn himself selected particular fine shirts from amongst the dead persons’ clothing which he addressed to the President.

Note I have moved from referring to him as Luke, through Dr Blackburn and now Blackburn – and so they did on Bermuda as he fell from grace.  A man who might have been a federal agent or a double agent or a Unionist spy, Mr Fred Buckstaff, tracked the trunks and on finding them awaiting shipment challenged Edward Swan, who soon squealed.  Then another came forward , Godfrey Hyams, claiming he had been involved and had received shipments of infected clothing in Boston, Philadelphia and other ports, that the intent was a “cunning plan” to spread the contaminated clothes amongst the Unionists and so bring the Northern war effort to its knees.

The doctor’s supporters dwindled as the evidence seemed to mount against him.  It didn’t help that this was shortly followed by President Lincoln’s assassination so talk of conspiracy plots dominated the headlines.

No one seems to know quite how, but Dr Luke Blackburn left Bermuda and found himself in Canada. Here he was actually charged, but not with germ warfare or the equivalent of the time, but with damaging Canada’s neutrality.  His defence was reputed to be:  “it is too preposterous for intelligent gentleman to conceive”  The charges were dropped.

One might expect a guilty man to lay low, so perhaps it speaks well of him that he soon after travelled to the southern states when yellow fever took a hold in New Orleans.

I found one source that explains some of the research that was undertaken with respect to epidemics of fever – it appears that throwing cats from a height was involved …IMG_1044

So for the next ten years or so Dr Luke Blackburn seemed to have been an itinerant medic treating fevers of all descriptions with no little success – Memphis outbreak in 1873 and Florida in 1877.  Until he found himself back in Kentucky in 1879 and running in the election for Governor.   Some of his opponents tried to blacken his name with tales of “Dr Blackvomit” and reporting controversial statements of apparent evidence on a daily basis in the papers, but it seems his good deeds overshadowed any hint of malicious activity and he was selected as the Democrat candidate with a resounding majority of 935 votes to 22 and later on that year he was elected Governor of Kentucky with 56% of the votes.

He remained a controversial figure in this new role, granting pardons to criminals to avoid overcrowding in the prison, capping payments to state officials, reducing the number of jurors. After a tempestuous four years in post he withdrew from public life, set up a sanitarium where he worked until his death from an unknown illness in 1887.

The state of Kentucky erected a granite monument over his grave in Frankfurt (Kentucky town not German) which depicts the Parable of the Good Samaritan.

So what do you think? There is both information and misinformation on websites and it is probably impossible to get to the truth of the matter.  What I conclude is that no trunks were actually shipped from Bermuda with infected clothing; that it would have been a reasonable assumption that yellow fever was infectious and spread by contaminated bedding and clothes so it is logical to remove those items to prevent spread of disease;  that from all accounts it was a busy, scary period of time and fanciful stories tend to spread rapidly when tinged with the element of fear.

The link between mosquitoes and yellow fever was not far away – first proposed in 1881 but not confirmed until 1900.  The virus was isolated in 1927 and a vaccine developed by 1937, for which the South African Max Theiler won the Nobel Prize (1951). The same vaccine is used today and in 2013 WHO announced that one injection will confer lifelong immunity.  You don’t need one to come to Bermuda though 🙂

Postcard from DPLA  (US archives)

Postcard from DPLA
(US archives)