Unit 8Section 2Eexercise 6Epidemics: A Different Face of Illness

This section explores the nature and impact of epidemics. An epidemic is one form of a broader array of disasters which have health implications. One important question that is infrequently discussed is how the health care professional, who is trained to interact with individual patients, should respond to larger threats to health. Traditionally, medical practice and public health emphasize different health care components. In the settings of epidemics, these components merge.

Read the following excerpt from Axel Munthe’s The Story of San Michele (pp 63-65).

Paris in the summertime is a very pleasant place for those who belong to the Paris qui s’amuse, but if you happen to belong to the Paris qui travaille, it becomes another matter. Especially so if you have to cope with an epidemic of typhoid at the Villette among the hundreds of Scandinavian workmen, and an epidemic of diphtheria in the Quartier Montparnasse among your Italian friends and their innumerable children….Of course there was no money to pay for a French doctor, so it fell upon me to look after them as well as I could….The Italians….who had brought nothing from their own country but their small means, their all-enduring patience and cheerfulness and their charming manners, were always satisfied and grateful and extraordinarily helpful to each other. When diphtheria broke out in the Salvatore family, Arcangelo Fusco, the street-sweeper, stopped work at once and became a most devoted nurse to them all. All three little girls caught diphtheria, the eldest daughter died and the following day the worn-out mother caught the terrible disease. Only the child of sorrow, Pertruccio, the helpless idiot, was spared by the inscrutable will of God Almighty. The whoe Impasse Rouselle became infected, there was diphtheria in every house and not a family without several small children. Both the hospitals for children were over-crowded. Even had there been a vacant bed the chances of getting admission for these foreign children would have been enxt to none. So they had to be attended by Arcangelo Fusco and myself, and those we had no time to see, and they were many, had to live or die as best they could. No doctor who has gone through the ordeal of fighting single-handed an epidemic of diphtheria amongst the very poor with no means of disinfection either for others or for himself, can think of such an experience without a shudder, however callous he may be. I had to sit there for hours, painting a scraping the throat of once child after another, there was not much to be done in those days. And then when it was no longer possible to detach the poisonous membranes obstructing the air passages, when the child became livid and on the point of suffocation and the urgent indication for tracheotomy presented itself, with lightening rapidity! Must I operate at once, with not even a table to put the child on, on this low bed or on its mother’s lap, by the light of this wretched oil lamp and no other assistant than a street sweeper? Can’t I wait till tomorrow and try to get hold of somebody who is more of a surgeon than I am? Can I wait, dare I wait? Alas! I have waited till tomorrow when it was too late and seen the child die before my eyes. I have also operated at once and no doubt saved the life of a child, but I have also operated at once and seen the child die under my knife. My case was even worse than that of many other doctors in a similar plight, for I was myself in deadly fear of diphtheria, a fear I have never been able to overcome. But Arcangelo Fusco was not afraid. He knew the danger as well as I did, for he had seen the terrible infection spreading from one to another, but he had never a single thought for his own safety, he only thought of the others.

Study Questions

1. What does the Munthe’s excerpt say about the socio-economic determinants of epidemics? Does this 19th-century scene have a modern-day mirror?

2. Who are the caregivers in this epidemic and what is their function?