Simple Medicine For The Future
The year eighteen fifty is commonly taken as the date when mechanised production overtook craft work in the manufacture of goods in the western world. The middle of the nineteenth century marked, not the beginning of the industrial revolution, but the point that industrial production began to dominate manufacturing. At this point in history artisan production has almost, though not quite, been annihilated in most of the world.
For some time I have thought that it would be an interesting exercise to return in mind to the year eighteen fifty, or perhaps a little earlier, and think of how the world might have developed had it not become industrialised, if it had continued to be a world largely made by hand. Certainly the world would not have stood still. Culture would have continued to change, and improvements would have been made to craft technology.
Even without industrialisation technology, science, medicine, would not have ceased to develop and improve in the way they served humankind. Opportunities to improve human welfare without the use of fossil fueled machinery were manifold in the early nineteenth century, especially in a place like Canada which had hardly begun to implement the most efficient agricultural and forestry practices common in the old world. But what about health care?
Oral Rehydration
In medicine some powerful interventions capable of reducing mortality from common diseases use simple technology which could well be used by non-industrial societies .
The pre-industrial world was plagued, literally, by diseases, some of which can be combated by simple, low-tech means. For example cholera swept the world in the early nineteenth century, killing thousands of people in early Canada. In addition untold numbers of enfants died of dehydration from dysentery caused by other organisms. In the twentieth century a simple but immensely effective treatment for life threatening diarrhea has been developed: oral rehydration therapy.
The principle is atonishingly simple, so simple that it seems strange that no one had stumbled on it before. People with severe diarrhea die of dehydration and loss of sodium and potassium salts. However simply giving them water and salts is not effective because in severe cases the loss of fluids through the intestines is too rapid for drinking to replenish the fluids.
If you add a sugar, glucose for example, to the fluids, however, the transport of water and salts across the intestinal wall and into the body is accelerated enough that the bodily salts and fluids can be restored rapidly enough to keep ahead of the diarrhea. Plenty of sterilised water with some sodium and potassium salts, and a source of sugar provides a simple life saving remedy.
Oral rehydration therapy does not shorten the episode of illness but it reduces the probabiliy of death by over ninety percent.
Oral rehydration therapy, as simple as it was, found only after considerable scientific work, and yet, now that it is known, it can be used effectively at the village level to treat people, especially enfants, who in the past would almost certainly have died.
Masks
Only just this year the entire world has come to accept what has long been believed in parts of East Asia, that simple cloth masks can slow the spread of air born diseases. As recently as early 2020 some doctors and even health authorities in the west held that ordinary cloth masks were useless as a measure against the Covid19 (sars-cov-2) virus that had become pandemic. They believed that only the best surgical masks could stop the virus particles.
Now experimental evidence shows that simple cloth masks greatly reduce the chance of an infected person spreading the virus, and the mask will also reduce the chance of a non-infected person becoming infected. Even more importantly perhaps, while you can become infected with Covid19 even while wearing a mask, the viral load you acquire is likely to be tiny. Many infections acquired through a mask run their course without symptoms; you never know you had the infection unless you are tested for antibodies or memory t-cells.
The most telling evidence of this uunexpected benefit from wearing masks comes from several situations in which hundreds of people have been confined in closed space like a ship or meat processing plant, and have had to wear masks because a few people in their midst had tested positive for Covid19. Many of the people who wore masks nevertheless became infected but 80 to 90 percent or more of these people experienced no symptoms. They were in effect innoculated with a small amount of live virus, leading to mild illness and immunity.
This innoculation with tiny amounts of live virus, a risky procedure, is called variolation, and was first done with smallpox. People were innoculated with a tiny amount of live virus, in hopes of stimulating a mild disease and immunity. Some people did develop mild illness and immunity from variolation but a few became seriously ill, and some died.
Variolation predated the safer procedure of vaccination with attenuated or killed virus, or a milder virus that resembled the more virulent one enough to produce immunity. Edward Jenner in eighteenth century England observed that milkmaids were generally infected with a harmless illness called cowpox, and did not contract the serious, disfiguring and often lethal smallpox. He demonstrated that other people could be deliberately infected with cowpox too, providing them with immunity to smallpox.
In some ways the imperfect protection provided by ordinary cloth masks is better than perfect protection would be. With cloth masks many people will become immune to the disease without serious illness, while perfect masks would provide no immunity. With cloth masks "herd immunity" might be reached with far less suffering than would be the case if the disease simply spread unhindered.
If the manufacture and distribution of millions of doses of vaccine ultimately becomes impossible, the wide-spread wearing of cloth masks in cold and flu seasion, or during pandemics like Covid19, might prove a very useful second best.
Vitamin D : The Sunshine Vitamin
This year as well accumulating evidence has begun to convince many people that low levels of serum vitamin d, that is vitamin d in the blood, is linked to serious illness and death from Covid19, and probably some other respiratory diseases as well. Vitamin d seems to boost the non-inflammatory immune response, and suppress the dangerous inflammatory response that has been responsible for so many deaths during the current pandemic.
I take 3000 iu. or 75 micrograms of vitamin d3 supplement each day, but amounts up to 4000 iu. or 100 micrograms a day are considered safe. In fact the human skin, exposed to sunshine, will make large amounts of vitamin d, provided a substantial amount of skin is exposed. Light skinned people in a bathing suit on the beach for a half an hour or so will make thousands of international units of vitamin d.
In winter however light skinned people may not have enough exposure to the sun and dark skinned people living in the north may not have enough at any time of the year to make enough vitamin d to provide protection against illness. In the past cod liver was taken as a source of vitamin d3. Now most of our vitamin d supplements are manufactured, by chemical process and ultraviolet light, from the lanolin removed from sheep's wool. (There are vegan friendly vitamin d2 supplements, not as effective as d3 from lanolin, and a new plant based source of actual d3)
In the future vitamin d supplements may be less and less available, and it will be important for people to get enough sunshine to build up large bodily reserves of vitamin d, not just for good bone health, but for resistence to respiratory illnesses as well. Some kinds of oily fish may also be helpful, where available.