Bill Bryson - A short history of nearly everything

Precisely the same thing happens with meningitis. At least 10 percent of young adults, and perhaps 30 percent of teenagers, carry the deadly meningococcal bacterium, but it lives quite harmlessly in the throat. Just occasionally-in about one young person in a hundred thousand-it gets into the bloodstream and makes them very ill indeed. In the worst cases, death can come in twelve hours. That’s shockingly quick. “You can have a person who’s in perfect health at breakfast and dead by evening,” says Marsh.

We would have much more success with bacteria if we weren’t so profligate with our best weapon against them: antibiotics. Remarkably, by one estimate some 70 percent of the antibiotics used in the developed world are given to farm animals, often routinely in stock feed, simply to promote growth or as a precaution against infection. Such applications give bacteria every opportunity to evolve a resistance to them. It is an opportunity that they have enthusiastically seized.

In 1952, penicillin was fully effective against all strains of staphylococcus bacteria, to such an extent that by the early 1960s the U.S. surgeon general, William Stewart, felt confident enough to declare: “The time has come to close the book on infectious diseases. We have basically wiped out infection in the United States.” Even as he spoke, however, some 90 percent of those strains were in the process of developing immunity to penicillin. Soon one of these new strains, called Methicillin-Resistant Staphylococcus Aureus, began to show up in hospitals. Only one type of antibiotic, vancomycin, remained effective against it, but in 1997 a hospital in Tokyo reported the appearance of a strain that could resist even that. Within months it had spread to six other Japanese hospitals. All over, the microbes are beginning to win the war again: in U.S. hospitals alone, some fourteen thousand people a year die from infections they pick up there. As James Surowiecki has noted, given a choice between developing antibiotics that people will take every day for two weeks or antidepressants that people will take every day forever, drug companies not surprisingly opt for the latter. Although a few antibiotics have been toughened up a bit, the pharmaceutical industry hasn’t given us an entirely new antibiotic since the 1970s.

Our carelessness is all the more alarming since the discovery that many other ailments may be bacterial in origin. The process of discovery began in 1983 when Barry Marshall, a doctor in Perth, Western Australia, found that many stomach cancers and most stomach ulcers are caused by a bacterium called Helicobacter pylori . Even though his findings were easily tested, the notion was so radical that more than a decade would pass before they were generally accepted. America’s National Institutes of Health, for instance, didn’t officially endorse the idea until 1994. “Hundreds, even thousands of people must have died from ulcers who wouldn’t have,” Marshall told a reporter from Forbes in 1999.

Since then further research has shown that there is or may well be a bacterial component in all kinds of other disorders-heart disease, asthma, arthritis, multiple sclerosis, several types of mental disorders, many cancers, even, it has been suggested (in Science no less), obesity. The day may not be far off when we desperately require an effective antibiotic and haven’t got one to call on.

It may come as a slight comfort to know that bacteria can themselves get sick. They are sometimes infected by bacteriophages (or simply phages), a type of virus. A virus is a strange and unlovely entity-“a piece of nucleic acid surrounded by bad news” in the memorable phrase of the Nobel laureate Peter Medawar. Smaller and simpler than bacteria, viruses aren’t themselves alive. In isolation they are inert and harmless. But introduce them into a suitable host and they burst into busyness-into life. About five thousand types of virus are known, and between them they afflict us with many hundreds of diseases, ranging from the flu and common cold to those that are most invidious to human well-being: smallpox, rabies, yellow fever, ebola, polio, and the human immunodeficiency virus, the source of AIDS.

Viruses prosper by hijacking the genetic material of a living cell and using it to produce more virus. They reproduce in a fanatical manner, then burst out in search of more cells to invade. Not being living organisms themselves, they can afford to be very simple. Many, including HIV, have ten genes or fewer, whereas even the simplest bacteria require several thousand. They are also very tiny, much too small to be seen with a conventional microscope. It wasn’t until 1943 and the invention of the electron microscope that science got its first look at them. But they can do immense damage. Smallpox in the twentieth century alone killed an estimated 300 million people.

They also have an unnerving capacity to burst upon the world in some new and startling form and then to vanish again as quickly as they came. In 1916, in one such case, people in Europe and America began to come down with a strange sleeping sickness, which became known as encephalitis lethargica. Victims would go to sleep and not wake up. They could be roused without great difficulty to take food or go to the lavatory, and would answer questions sensibly-they knew who and where they were-though their manner was always apathetic.

However, the moment they were permitted to rest, they would sink at once back into deepest slumber and remain in that state for as long as they were left. Some went on in this manner for months before dying. A very few survived and regained consciousness but not their former liveliness. They existed in a state of profound apathy, “like extinct volcanoes,” in the words of one doctor. In ten years the disease killed some five million people and then quietly went away. It didn’t get much lasting attention because in the meantime an even worse epidemic-indeed, the worst in history-swept across the world.

It is sometimes called the Great Swine Flu epidemic and sometimes the Great Spanish Flu epidemic, but in either case it was ferocious. World War I killed twenty-one million people in four years; swine flu did the same in its first four months. Almost 80 percent of American casualties in the First World War came not from enemy fire, but from flu. In some units the mortality rate was as high as 80 percent.

Swine flu arose as a normal, nonlethal flu in the spring of 1918, but somehow over the following months-no one knows how or where-it mutated into something more severe. A fifth of victims suffered only mild symptoms, but the rest became gravely ill and often died. Some succumbed within hours; others held on for a few days.

In the United States, the first deaths were recorded among sailors in Boston in late August 1918, but the epidemic quickly spread to all parts of the country. Schools closed, public entertainments were shut down, people everywhere wore masks. It did little good. Between the autumn of 1918 and spring of the following year, 548,452 people died of the flu in America. The toll in Britain was 220,000, with similar numbers dead in France and Germany. No one knows the global toll, as records in the Third World were often poor, but it was not less than 20 million and probably more like 50 million. Some estimates have put the global total as high as 100 million.

In an attempt to devise a vaccine, medical authorities conducted tests on volunteers at a military prison on Deer Island in Boston Harbor. The prisoners were promised pardons if they survived a battery of tests. These tests were rigorous to say the least. First the subjects were injected with infected lung tissue taken from the dead and then sprayed in the eyes, nose, and mouth with infectious aerosols. If they still failed to succumb, they had their throats swabbed with discharges taken from the sick and dying. If all else failed, they were required to sit open-mouthed while a gravely ill victim was helped to cough into their faces.