Tuesday, May 14, 2013

The Diagnosis: EAST BIRMINGHAM HOSPITAL, THURSDAY, 24TH AUGUST 1978

The art is long, life is short, opportunity fleeting, experiment dangerous, judgment difficult.
Hippocrates of Cos

Janet’s parents had grown tired of watching over their ailing daughter, as her condition went from bad to worse. They called their own GP, Dr Annis Price, to Myrtle Avenue to see Janet. Dr Price decided things were serious enough for a hospital opinion. He referred Janet Parker to the local infectious disease hospital with a diagnosis of “Rash and Fever”.

Janet made the nine-mile journey to East Birmingham Hospital in an ordinary ambulance. At three o’clock that afternoon she was admitted to a single isolation cubicle in Ward 32. Shortly afterwards, she was seen by the Duty Consultant Physician for the Department of Communicable and Tropical Disease, who that day happened to be Professor Hugh Vivian Morgan.

A quietly spoken Welshman, with deep Christian convictions, Hugh Morgan had been Professor of Medicine at the University of Khartoum in the Sudan from 1952 to 1968. In this role, he had criss-crossed the country in a truck-cum-trailer that acted as a mobile clinic and laboratory, ministering to the medical needs of the local population. His services to medicine and medical education in Africa culminated in the award of a CBE in 1966.

By the time he encountered Janet Parker, Morgan had been in Birmingham for over ten years, his clinical experience overseas and his good grasp of Arabic proving valuable in dealing with immigrants from the Tropics and Middle East. Now sixty-two years old, bald on top, with a wide-domed forehead, a warm friendly smile and an unthreatening avuncular demeanour, Morgan was close to the end of long and distinguished career. His memory was starting to falter—the nurses had already nicknamed him “the absent-minded professor”. Sadly, a few years later, in retirement, his forgetfulness was to be transformed into full-blown Alzheimer’s disease. But on that fateful day in 1978, although he might have started to loose his grip on the superficial trivia of the here-and-now, Morgan was still in full possession of a fine-tuned diagnostic acumen and of a rich treasure trove of clinical experience. Most importantly, from textbook knowledge and from face-to-face encounters in Africa, smallpox was seared deep into his intellect.

“Judgment difficult”, Hippocrates had said. What to do when faced with a difficult diagnosis? There is a saying among medics that “common things occur commonly”. This is applied as a corrective to those who have spent more time with textbooks than with patients, to prevent them jumping straight to the rare small print stuff when making a diagnosis. The three GPs who had seen Janet Parker—all good solid chaps, trained at the Medical School in Birmingham— had obviously been working to this rule. And not unreasonably: a year after it had been eradicated, not just from England’s green and pleasant land, but from the whole planet, smallpox had to rank as the smallest of small print in any differential diagnosis. In fact, it was quite frankly impossible!

Another medical aphorism along similar lines is “when you hear the sound of hooves, think horses, not zebras”. Smallpox, in suburban Birmingham in the summer of 1978, was not even a zebra; it was a unicorn!

But faced with Janet’s signs and symptoms, Morgan was worried. He trusted what his senses and his intellect were telling him—for someone with his tangible experience of the disease, smallpox, however improbable, could not be dismissed as impossible. Yet the quietly spoken veteran of Khartoum was no sensationalist. He was not going to announce triumphantly to the world, or even to his colleagues, that he had single-handedly diagnosed a case of smallpox. Instead, he did what any sensible person would do when confronted with a unicorn in the garden—he performed a sanity check: he sought a second opinion. He turned for advice to Birmingham’s designated smallpox consultant, a scotsman named Alasdair Geddes.

Geddes had held this position since he had returned from a stint working on the eradication campaign in Bangladesh in 1973. In this role, he had been called out half a dozen times in the previous five years to examine suspected cases of smallpox. All so far had turned out to be false alarms: either bad cases of chickenpox or a nasty rash from a condition known as Stevens-Johnson syndrome. Yet each time, he had been paid the princely sum of twenty pounds.

At 7.30pm, the Welshman phoned the Scotsman and asked him to come in and see what he called “a lady with an unusual rash who worked in the east wing of the Medical School”. Morgan might have fleetingly raised the possibility of smallpox, but for him it still didn’t make much sense. You didn’t get unicorns on the lawn in England.

No comments:

Post a Comment