Monday, 14 November 2016

"We Have Conquered Infectious Disease!" Not.

“We have conquered infectious disease!” This may sound like Donald Trump, but it wasn't. It was a Surgeon-General of the United States, Luther Terry, in 1964.

No one would make that claim today, except Trump and supporters in the case of coronavirus. Even if we discount the current pandemic of Covid-19, infectious disease is one of the greatest causes of death in the world, accounting for about 25% of deaths worldwide and over 60% of deaths among children. 

But in 1964 the Surgeon-General's claim did not seem far fetched. Mortality from infectious disease had dropped sharply during the previous decades, at least in wealthy countries, and life expectancy had risen steeply, from about 50 to 75.

Many things contributed to the drop in deaths from infectious disease: better nutrition, clothing, and housing, improved sanitation and water supplies, vaccines, and antibiotics. Unfortunately, the drop was not uniform throughout the world:  poorer nations did not see the huge gains in life-span that richer ones did.

But even in the richer nations, the claimed “conquest of infectious disease” began to look like wishful thinking by the late 1970s and 1980s. New or newly recognized infectious diseases appeared, like AIDS, Legionnaires’ Disease, and Ebola, and old ones began to re-emerge, like TB, whooping cough, yellow fever, measles, and diphtheria. 

New, more deadly strains of malaria, cholera, TB, and dengue fever emerged. Many of the new strains of bacterial disease were and are resistant to antibiotics, partly as a result of overuse and incorrect use of these lifesavers. Others were viral, for which antibiotics are useless.

Many of the deaths from infectious disease today, especially among infants and children, are the result of poor sanitation and water supplies. Ironically, we have known how to prevent these deaths for more than a century. It is lack of resources and will, not lack of knowledge, that is the problem.

But it is not always lack of money that produces poor results in terms of controlling infectious disease. The US, which spends far more than any other country on health care, lags well behind many other countries in terms of health care outcomes. The problem is that too many people cannot afford adequate medical care because they cannot pay the high premiums for private health insurance, or cannot get it at all.

Ironically, another US Surgeon-General, Rupert Blue of South Carolina, proposed a national health insurance system in 1911, a universal plan that would cover everyone. “Public health is a public utility,” he said. “We are our brother’s keeper.”

Perhaps Blue didn’t choose the best audience to deliver the message. He spoke to a convention of insurance executives. They made sure Blue's idea didn't become reality. A century later, the US remains the only developed country in the world without a system of national health insurance. Perhaps Blue was just a century or so ahead of his time -- in the case of the USA, that is.

Changing that by itself would not conquer infectious disease, but it would help combat it, especially if combined with an effective program of preventive medicine, which the USA also lacks. It would also go far to reduce anxiety about the costs of medical care in the minds of many millions of Americans. 

Tuesday, 18 October 2016

A VERY Short History of Medicine

Fathers of Medicine and Allied Arts

Hippocrates & Co. 

“Doctor, I have an earache.”

2000 BC – “Here, eat this root.”

1000 BC – “That root is heathen, say this 


1850 AD ­– “That prayer is superstition, drink 

this potion.”

1940 AD – “That potion is snake oil, swallow 

this pill.”

1985 AD – “That pill is ineffective, take this 


2000 AD – “That antibiotic is artificial. Here, 

eat this root.”

Medical Education

Robert Koch Establishes Germ Theory; Sells Chocolate

The Triumph of American Medicine

Wednesday, 28 September 2016

The New Moral World: Robert Owen's New Lanark

New Lanark, Scotland, is a UNESCO World Heritage Site about 25 miles from Glasgow on the Falls of Clyde. David Dale founded New Lanark as a textile mill village in 1785, taking advantage of the water power the falls provided. It became famous as a model factory town in the early 19th century after Dale's son in law, Welshman Robert Owen, took it over.

Contrary to the ideas of many factory owners of the early industrial era, Owen was convinced that he could treat his workers humanely and still make a profit. Besides offering better wages and shorter hours than most mills, he provided the workers and their families with decent housing and opportunities for education and self-improvement. He established the first infants' school in the UK in 1817, to take care of and educate young children while their parents worked. 

New Lanark flourished. Owen made a lot of money, and the town became well known, attracting the rich and famous from all over the European world. At its height, it was home to 2500 people. Owen's success convinced him that he could replicate it elsewhere, and go further in the direction of what he called "The New Moral World."

Owen believed, in common with many Enlightenment thinkers, that environment shaped human character, and that the right environment would produce morally superior people, a "New Moral World." By the 1820s, he had decided that the right environment was a "cooperative" one, in which people worked together for the common good.

In effect, Owen had embraced what Karl Marx later called "utopian socialism." In 1825, Owen sold New Lanark and sailed to America, where he founded a cooperative community, New Harmony, in Indiana. Below are two images of Owen's concept of the community, with housing, workshops, schools, and factories.

The New Harmony experiment was largely a failure. The inhabitants, not Owen's employees, proved to be un-cooperative. Perhaps, too, Owen was seen as a tyrant, trying to direct people's lives too much. 

After a few years, Owen gave up on New Harmony and sailed back to Britain, though several of his children remained and carved out successful careers in America. Back in Britain, he tried to establish a union of all British workers, The Grand National Consolidated Trades Union. Due in part to government persecution, it failed by 1834, and Owen began to promote a new movement to found producers and consumers co-operatives. The first successful co-op was founded in 1844, in Rochdale, Lancashire, by the Rochdale Pioneers. It soon became a model for countless others since.

New Lanark itself went into a gradual decline after Owen left. It continued producing textiles until 1968. After the mill closed, people moved away and the buildings began to deteriorate. In 1974 a trust was founded to save them, and they have been gradually restored. About 200 people live in the restored housing and thousands more visit the site every year, learning about Owen's "New Moral World."

The old mill is now a hotel and some of the housing is now used as a hostel.

The infants school has also been restored to what it looked like when Owen established it. (School and Mill Race)

Today, New Harmony, Indiana, is also a popular tourist destination and so, in some form, Owen's legacy lives on. 

Further Reading: JFC Harrison, Robert Owen and the Owenites in England and America: The Quest for a New Moral World (Charles Scribner's Sons, 1969)

Thursday, 8 September 2016

Tom Paine, Rejected Hero

Poor Tom Paine. Rejected by American Patriots he served so well for being too radical, nearly guillotined by French revolutionaries for being too conservative, he died poor and forgotten in an America he helped to create. Ironically, he became a hero to many people in the land he rebelled against: Great Britain.

Paine was born in Thetford, England January 29, 1737. He trained in the same trade as his Quaker father, as a maker of rope stays used on sailing ships (not corset stays as some detractors claimed). At various times he also worked as an excise officer and schoolteacher.

In 1768 he was appointed an excise officer in Lewes, in Sussex, a town with a strong republican tradition. He lived in the 15th century Bull House.

Paine soon became involved in the town government of Lewes and often held forth on politics at the White Hart Inn, now Hotel. I stayed here on my trip to Lewes a few years ago.

During his time in Lewes, Paine became increasingly anti-monarchical and anti-aristocratic, sentiments he took to America in the autumn of 1774. He emigrated at the suggestion by Benjamin Franklin, then representing colonial interests in Britain. Paine arrived in Philadelphia to find the thirteen colonies on the verge of revolt against British rule. He quickly became involved in politics, and surged to fame with the publication of his immensely popular pamphlet Common Sense in January 1776.

Paine argued that independence was just that: common sense. He avoided the formal, scholarly political discourse of the day, writing in an easy to read, punchy style that rendered politics intelligible to the average reader. The work converted many ordinary Americans to the idea of independence.

At the end of 1776, Paine published a pamphlet series The American Crisis, designed to inspire sacrifice in the struggle for independence. It opens with some of the most famous words ever written: “These are the times that try men’s souls.” Washington had it read aloud to his soldiers.

During the War for Independence, Paine served the revolutionary government in various capacities. It was a bumpy time for him, as he clashed with some of his fellow revolutionaries, accusing them of corruption.

Perhaps Paine’s most important contribution to the revolutionary cause was his mission to France in 1781, with John Laurens of South Carolina.

Paine and Laurens succeeded in gaining funds and a French commitment to send a fleet and army to America later that year. The arrival of the French during Washington’s Siege of Yorktown, Virginia played a crucial role in bringing about the surrender of British forces under Lord Cornwallis in October.

Peace talks began a few months after Yorktown, and a treaty recognizing American independence was finalized in 1783.

Paine returned to England in 1787 to pursue business projects. He soon became involved in the Revolution that began in France in 1789. In 1791, he wrote a long defense of the French Revolution, The Rights of ManIt sold over a million copies, to the horror of British conservatives. 

James Gillray's cartoon, below, attacks Paine as he tightens violently Britannia's corset, a reference to his supposed occupation as a corset staymaker.

A second volume of The Rights of Man, in 1792, argued for a comprehensive program of universal, free education and social security. The book helped inspire radical movements, as well as major government efforts to suppress them and the book's author.

Paine went to France to avoid arrest, and became involved in the radical phase of the revolution. He was elected to the National Convention. When Louis XVI was tried for treason in 1792, Paine, who opposed capital punishment, voted against execution. 

Paine's plea to spare the king, although unsuccessful, angered radical Jacobins who soon came to power and began the Reign of Terror. They arrested Paine. He spent ten months in prison and narrowly avoided being guillotined. After his release, he criticized President Washington and other American leaders for not helping him.

In the late 1790s, Paine supported Napoleon, but turned against him when his authoritarian aims became clear. At the invitation of President Jefferson, Paine returned to the United States by 1803. 

Paine's welcome was not warm, partly because of his scathing criticisms of Washington and other American leaders. His opposition to slavery also alienated many people. And another work he wrote in installments during these years, The Age of Reason, attacked Christianity. 

The Age of Reason sold well, but it outraged many people in America, where a great evangelical revival was underway. Paine died impoverished and nearly friendless in New York in 1809. Only six people came to his funeral, two of them black freedmen. A widely reprinted obituary stated that he “did some good, but much harm.”

In 1819 William Cobbett, a British radical, took Paine’s remains back to England for a proper burial. (image)

The burial never happened and the ultimate disposal of Paine’s remains is unknown. 

During the 19th century, Paine and his works helped inspire progressive movements in Britain and America. He is remembered fondly in the town of Lewes, Sussex. There is even a Rights of Man pub. Drop in for a pint when in town and toast the memory of Tom Paine, a friend to mankind.

Lewes, Sussex

Monday, 8 August 2016

John Laurens, Liberty, and Slavery

John Laurens is remembered today, if at all, for two things. One is his advocacy of freeing enslaved blacks to fight against the British during the War for Independence. The other is his tragic, senseless death in one of the last skirmishes of that war. To be sure, he is now remembered for something else. Some historians argue that he had a homosexual relationship with his undoubtedly close friend, Alexander Hamilton. But I'll leave that to others, and focus on the first two.

John Laurens (1754-1782) was the eldest son of planter Henry Laurens of Charleston (then Charlestown), South Carolina. (For more on Henry, see my previous post, The Tower of London's Only American Prisoner: Henry Laurens

Henry Laurens had made a huge fortune in the slave trade and as a rice planter. During the dispute with Britain that led to the American Revolution, he became a major Patriot leader, serving as president of the Continental Congress.

Following the example of many of South Carolina's elite, Henry had sent John to Europe for education. The War for Independence began while John was finishing legal studies at Lincoln's Inn in London. Against his father's wishes, he returned to America and joined the Continental Army. Also against his father's wishes, he left behind his heavily pregnant wife, Martha Manning, daughter of one of Henry's British business associates. John confessed that he had carelessly gotten Martha pregnant and married her not for love, but out of pity. He never saw Martha again, nor did he ever see the daughter she gave birth to a few months later.

Once in the Patriot army, John rose quickly to the rank of colonel -- too quickly in the view of some fellow officers. He fought bravely at Brandywine and other battles, and earned a reputation for courage bordering on recklessness. He became an aide de camp to George Washington and formed close friendships with two other aides, Hamilton and the Marquis de Lafayette.

In 1779 Laurens returned to South Carolina. The British army had captured Savannah, Georgia and were threatening Charleston. He fought bravely in several actions, but his return is best remembered for the proposal he brought before the South Carolina General Assembly. With the blessing of Congress and Washington, Laurens moved that South Carolina, which had a black majority, enlist blacks in the Patriot army in return for their freedom.

He enlisted the support of his father, who had publicly claimed in 1776 that he favored the abolition of slavery. Henry promised to give John forty of his enslaved blacks to form a nucleus of a unit of free black soldiers. When John formally proposed the creation of a black regiment in South Carolina, however, Henry got cold feet. He tried to convince John that the idea could never win a majority in the state assembly.

Henry proved correct. John moved the proposal before the assembly three times between 1779 and 1782. Much to his distress and disgust, the delegates repeatedly rejected it by large majorities. The most vocal of Laurens' opponents were John and Edward Rutledge and Christopher Gadsden, designer of the famous "Don't Tread on Me" flag. (Images: John Rutledge and Christopher Gadsden)

The second rejection took place as the British were advancing on Charleston with a large army under Sir Henry ClintonThey took the city after several weeks' siege, the worst Patriot defeat of the war to date. The entire defending army was made prisoner, including Laurens, who was convinced that the enlistment of black soldiers could have saved Charleston from capture. (Image: The Siege of Charleston, 1780, from the British lines)

Laurens was soon exchanged for a British prisoner, and resumed his crusade against slavery. On one occasion he wrote that if South Carolina could not be cultivated without slaves, "we should flee from it as a hateful country." This quotation may hold the key to his ultimate fate.

A few months after the last rejection of his proposal, in August 1782, Laurens was killed leading his men against a British foraging expedition against orders to wait for reinforcements. The Battle of the Combahee, a minor skirmish in fact, was one of the last actions of the war. The British evacuated Charleston in December. Laurens was 28. 

One must wonder if John Laurens was seeking death in battle, having despaired that his new country would eliminate the institution that mocked its call for liberty.  

John Laurens is buried at his father's favorite plantation, Mepkin, now a Catholic monastery, near Moncks Corner, South Carolina. The epitaph which Henry chose for his son's grave marker, is a famous line from the Roman poet Horace: "Dulce et decorum est, pro patria mori." (It is sweet and proper to die for one's country.") An odd choice, given that Henry had tried to keep John out of the army.

Was John Laurens sincere in his advocacy of abolition? It seems that he was, whether out of a sense of guilt or conviction. He adopted an abolitionist viewpoint in Britain while being educated. He became friends with British opponents of slavery, including Thomas Day and John Bicknell, who had written an abolitionist poem, "The Dying Negro."

Laurens was influenced as well by British claims that the American demand for liberty was hypocritical, given the large number of African slaves in the colonies. 

When opponents of his proposals claimed that the enslaved blacks were incapable of appreciating and handling liberty, Laurens countered that blacks and whites shared the same humanity, abilities, and desires. It was slavery itself that had debased a people who, under better circumstances, would prove to be excellent citizens of the republic:

"We have sunk the Africans and their descendants below the Standard of Humanity, and almost render'd them incapable of that Blessing [Liberty] which equal Heaven bestowed upon us all."

During the early nineteenth century, southern writers extolled John Laurens as a chivalric model for the region's youth, but ignored or suppressed his views on slavery. Many of those young men went on to die for a cause far less worthy than his.

Further Reading: 

Gregory Massey, John Laurens and the American Revolution. Columbia, South Carolina, University of South Carolina Press, 2000.

The Papers of Henry Laurens. Columbia, South Carolina, University of South Carolina Press. Volumes dealing with the revolutionary years in particular.

Wednesday, 27 July 2016

The Tower of London's Only American Prisoner: Henry Laurens

The Tower of London, originally a royal castle-palace, later a royal prison, has housed many famous prisoners in its thousand year history, including the Little Princes, Anne Boleyn and Sir Thomas More. But only one was an American: Henry Laurens, during the American War for Independence. [Image: Henry Laurens, Boston Magazine, 1784]

Laurens, who had made a fortune in the slave trade in his native Charleston, South Carolina, and owned several plantations, became a leading Patriot during the conflict between colonists and mother country. He served as President of the Continental Congress in 1777-78. Congress then named him minister to the Netherlands. He made a successful voyage there in the spring of 1780, gaining some financial assistance from the Dutch. On a second voyage that autumn, a Royal Navy frigate captured his ship at sea, along with a draft of a treaty with the Netherlands, a document that led the British government to declare war on that country. 

The British government lodged Laurens in the Tower on suspicion of treason. Laurens recorded that the guards of the Tower serenaded him with a rendition of "Yankee Doodle Dandy" when he arrived to take up residence, passing through Traitors Gate on the Thames. (below)

Laurens remained in the Tower for more than a year. During that time two artists painted his portrait, an indication that his treatment was not especially harsh. The portraits are by Lemuel Francis Abbott and John Singleton Copley.

The mildness of Laurens' treatment owed something to important British friends, notably the enormously rich Richard Oswald, a former slave trading partner. Laurens had been Charleston agent for the slave factory at Bunce (AKA, Bance) Island, Sierra Leone, in which Oswald was heavily invested. [Image: 18th century drawing of Bunce Island]

Oswald secured Laurens' release from the Tower on bail in December 1781. Not long after, the British government exchanged Laurens for Lord Cornwallis, the British general who surrendered to Washington at Yorktown in October 1781. Oswald later became chief British negotiator at the peace talks in Paris. 

After Laurens' release, the US government ordered him to join the American peace delegation of John Adams, John Jay, and Benjamin Franklin. [Image: Benjamin West, American Peace Delegation, Paris, 1782, unfinished. Laurens is in the red coat, Franklin, Adams, and Jay to his right.]

Laurens put off going to Paris for months, pleading ill health. He did not arrive until late November, the day before the preliminary treaty was to be signed. He insisted on an addition to the treaty: that the British government return all runaway slaves to their American masters. Thousands had run away to British lines. Despite the fact that the British government had promised the runaways freedom, Oswald agreed to Laurens' addition, and the clause went into the final document. 

The runaway clause proved largely unenforceable. Sir Guy Carleton, the new British Commander in America, refused to hand over thousands of them under his protection in New York. Before evacuating the city, Carleton shipped them to Nova Scotia. Some of them later went to Sierra Leone, where they established a freedmen's colony and the current capital, Freetown. [Image: Early Freetown]

After the preliminary treaty was signed, Laurens returned to Britain and served briefly as US minster to the former mother country. In 1784, he returned to South Carolina. He spent his remaining years restoring his fortune and estates. He avoided politics, dying at his favorite plantation, Mepkin in 1792, surrounded by his slaves. His body was cremated, allegedly one of the first cremations in the United States. Today, Mepkin is a Trappist monastery, Mepkin Abbey.

[Images of Mepkin, by Charles A. Fraser, early 19th century]

Friday, 1 July 2016

The Battle of the Somme: Dress Rehearsal for Brexit

The Battle of the Somme, the bloodiest battle of World War I, produced 300,000 dead and one million casualties, with virtually no change in the battle lines. The Somme came hard on the heels of the second worst battle of the war, the Verdun, and preceded the third worst, the Battle of Passchendaele. For people suffering through the current Brexit mess, it is a reminder that things could, after all, be worse. Much worse. The politicians and generals responsible for the Somme battle were perhaps even more incompetent, myopic, and dishonest than the leaders now in charge of the Battle of Brexit. Let that sink in.

The Somme battle began on July 1, 1916 and continued futilely until December of the same year, pitting British and French armies against the evil Huns (AKA, Germans). The attack on German lines that day was preceded by a three day artillery barrage, the biggest in history, involving the launching of 1.5 million shells. High command assured the British soldiers that the barrage would make their job as easy as beating Iceland in the Euros. "You will be able to walk to Berlin. The Germans will all be dead." Sounds like "the EU will give us our cake and let us eat it, too."

Not quite. The barrage alerted the Germans that an attack was coming. They rushed up reserves. Most of them stayed safe in deep underground dugouts, ready to cut down the advancing British. And mow them down they did, with machine guns, rifles, artillery, and gas. Even a new British weapon, the tank, did not help much. Most of them quickly broke down and no one knew how to use them anyway. 

On the first day of the battle, a massive British attack across No Mans Land resulted in 20,000 dead and 40,000 wounded: the worst day in the history of the British Army.

In northern France, at Thiepval, there rests a ponderous monument to the 72,000 Allied dead whose bodies were never recovered, mainly because they were blown to bits or buried under soil thrown up by exploding shells. I like to think at least a few ran away and lived in caves. (Image: Thiepval)

Lots of talk about "sacrifice" at commemorations. Did the sacrifice accomplish anything beyond piles of dead and mutilated men, and have we learned the lessons of the Somme? The answers are sadly obvious.