DR. GRAMMA

WE'RE ALL WORRIED about our health, and about our friends' health. We tell them to push fluids, sleep soundly, minimize stress, steam veggies. From a personal perspective we control only a few threads of our health. Ask a thoughtful, chess-playing, small town general practitioner who sees sickness played out on a small canvas over a few generations. He’ll agree that there’s not a lot we can do about sickness beyond a few things you heard from your gramma.

Like all grammas she droned on at length: wash your hands, get to bed, eat your vegetables, get out in the sun, stay out of the sun, shake a leg and get to work, wear clean underwear. It turns out that she was spot-on. The frustrating thing about old wives’ tales is that those wives got old by doing a few things right.

Wash your hands: plain soap and water turns out to be a powerful talisman against flus, coughs, and all communicable diseases. Lady MacBeth may have gone a little overboard but you should never pass up a chance to wash your hands.

Eat your vegetables: granted, your gramma probably underlined this as a matter of puritanical discipline but beneath the ugly-and-not-your-first-choice-so-it-must-be-good-for-you factor you’ve got the wealth of vitamins, way-high fiber and anti-oxidants in Brussels sprouts, cabbage, broccoli and oatmeal. Let’s not get carried away about about gramma’s laboratory virtues, however: she didn’t know beans (sic) about cooking veggies and probably stewed them into submission. Today we steam them lightly or, best (refer to The New York Times), microwave them briefly and with minimum vitamin loss.

Get out in the sun: important vitamin D, the “sunshine vitamin” is near-impossible to synthesize and is internally produced by our bodies’ interaction with the sun’s ultraviolet light.

Stay out of the sun: antique ladies wore sunbonnets for their complexions, but also because a bushel of their sunned-on friends succumbed to skin cancer. Given our immigration patterns, the prairie sun was especially deadly to fair-skinned Nordic, Irish and British families. Highest incidence of sun cancer in the world: Australia, where white-skinned Celts meet merciless sun.

Shake a leg and get to work: gramma didn’t have a Pilates studio down the block but knew that exercise made a difference. Or she just worked her bustle off, anyway. And if she didn’t know that exercise is healthy, perennial puritanical sensibility suggested that it was hard and, therefore, virtuous.

Wear clean underwear: we might make a case for fungus suppression but this is not gramma's finest medical homily and a social observance more than a clinical desideratum.

We could feel a bit more progressive and smugly scientific if gramma were a total loon and recommended nutso nostrums like echinacea. Embarrassing as it is, these are our New Age superstitions, driven by the narcissistic belief that “those know-it-all doctors aren’t any smarter than me!” Clinically, demonstrably, they are. Whole Foods may sell cool little vials of “safe and gentle” homeopathic cures but in double-blind studies homeopathic quackery registers no more than a placebo effect. Echinacea has no greater basis in logical pharmacopoeia than turning around three times and spitting between your feet.

Modern medicine is largely crisis oriented. Though antibiotics are wonderful and comforting, the statistical successes of real lifesaving medicine can be attributed to a few broader, earlier advances, and not many of those. There may be only five statistically significant advances in medicine.

The first is sepsis, recognition of the ubiquitous existence of germs. Even before germs were specifically identified, physicians learned empirically to wash their hands. One of the most mortal medical crises in the first three-quarters of the 19th century was postpartum infection caused by doctors delivering babies with dirty hands, killing children and mothers at a shocking rate. Civil War surgeons stropped their scalpels on their boot soles and made battlefield wounds doubly or triply lethal. The dangers of sepsis were recognized by the healing pioneer Louis Pasteur, an early gramma with a sly little French beard who insisted that midwives and doctors wash their hands and instruments before birthing. He also saved vast numbers of kids and grownups when he found a way to purify milk (a seriously lethal cocktail in days gone by) with high heat just under the boiling point (Pasteurization, look on your milk carton).

Dr. Pasteur also advanced the practice of vaccination. With it, we’ve conquered desperately lethal diseases like smallpox and polio. The defunct Soviet Union awarded a great distinction to a very few: Hero of the People. Pasteur deserved this award from all of us.

Clean municipal water supply is one of the basic wonders of health. This is a very old advance. The Romans determined, empirically, that tainted water killed, and brought fresh water from enormous distances through buried and elevated aqueducts, the engineering high points of an age. Providing reliably pure “city water” has been a municipal responsibility for many generations. One of the earliest documented tales of empirical epidemiology was the use of medical geography in tracing the source of an epidemic cholera in London of 1854. When Dr. John Snow persuaded officials to refuse use of the public well on Broad Street (where a “cluster” of 127 cholera victims had died), the situation improved. It was later found that the Broad Street well had been dug only three feet from a leaking cess pit. Quid erat demonstrandum.

Another municipal improvement is the fourth statistical advance in medicine: trash pickup. We’re so accustomed to this process that we don’t credit it for saving lives. It does. During one of the Great Plagues of London in the 17th century, a few careful observers commented that the healthiest place to live was London Bridge. This wasn’t the contemporary structure, or the bridge transported stone-by-stone to span an artificial stream in Arizona. Old London bridge was a teeming human marvel carrying shops, apartment buildings and residences, as well as London Bridge Gate (where the heads of traitors were displayed on pike-ends) and London Municipal Waterworks, which the flow of the stream past waterwheels as power. The structures were cantilevered out above the Thames’ flow, leaving a narrow, dim bridge surface for wagons and pedestrians. Cantilevered outboard of these sometimes flimsy constructions were “jakes” or “necessaries” – simple outhouses. The London weather is always damp, above the river damper still, wood is a porous material, nails were precious, so having an out-hung outhouse shear away from the main structure and fall into the river was a common source of annoyance (and even more annoying if someone were in it at the time). This, in this way, London Bridge was continually falling down, my fair lady. But why was it so healthy? Because the residents availed themselves of river’s conveniences: they threw their trash out the windows and their poop dropped directly into the river. Disgusting. But healthy. No trash, no cesspit, no rats. No rats, no fleas. No fleas, no bubonic plague. When American cities began to pick up domestic trash the health of the cities improved enormously.

The fifth great advance in medicine came late: anesthesia. Before properly administered surgical “sleep,” a patient could die from the shock of pain. Untold numbers died because the thought of enduring the knife without a pain-killer was too horrible, so operations that might have saved the patient’s life (or might not if infection from the dirty scalpel settled in the wound), were put off. Queen Victoria was the first “public” woman to received anesthesia for the pain of childbirth. “Laughing gas,” nitrous oxide, revolutionized dentistry.

During London Bridge’s fashionable height, around the year 1600, and right on into our mid-19th century, a physician’s pharmacopoeia was essentially useless. Indeed, the attentions of a “doctor” were flatly dangerous. In the thousands of clinical substances available, there were only three or four that had real effect. One, and the most effective, was the placebo. Another was laudanum, the alcoholic tincture of opium. Then there were a few topical remedies, some unreliable folk remedies, and an overwhelming world of superstition.

Antibiotics also arrived late, well into the 20th century. Though antibiotics are a comfort to all of us (King Tutankhamen might still be around if his jaw abscess had been treated with penicillin) they aren’t statistically significant. They haven’t made a major difference in public health and mortality. Before antibiotics, many robust folks survived infections like pneumonia, cholera, typhoid fever and even smallpox. A surprising number of soldiers and sailors survived amputations with filthy surgical instruments.

Most of the advancements of science aren’t a drop in the bucket compared to the gargantuan face of humanity. But what your gramma told you, that counts.

BRAXINOSO SPEAKS

Himself has been tossed out of some tolerably high-toned California dinners for taking up the cudgel against New Age superstitions allotted a holy place in Marin folklore – healing touch, homeopathy, chiropractic, acupuncture, Chinese herbals, &c. In some ways, being asked to leave because you're insulting ignorant guests is a badge of honor. In most ways – and Himself is learning this slowly – it's boorish. He's a well-intentioned fellow with a persistent inability to identify what's appropriate behavior and discourse.