Published December 12, 2007
In 1922, when an epidemic of diphtheria was sweeping central Canada, my paternal grandmother sat by the beds of three of her young children, begging God to save their lives. Prayer was all she had. Back then, as it had been for centuries, infectious and parasitic diseases were the biggest threats to human life, especially young life. The challenge of staying alive made the question of a "good death" a moot one. Death was a constant visitor and half of all deaths occurred in childhood. My grandmother knew that reality too well. By the time of the diphtheria epidemic she had already lost two children to infectious disease. Willy, her second child, had died of whooping cough in 1910 at only six months of age. In 1918, Gerald, then five, had cut his foot on the blade of an ice skate. Within a few days his foot had become swollen and red and the infection soon spread through his body. Without antibiotics to stem the spread of the bacteria, Gerald slipped into a coma and died of blood poisoning, septicemia, within two weeks of the innocent cut. Helen, Reg and Rita became sick with diphtheria, a disease that was the scourge of childhood and every mother's fear. The two older children had been lucky and received a new diphtheria anti-toxin inoculation at school, and they recovered. But Rita was only four and too young for school; she hadn't been inoculated. Six weeks later Rita died of heart failure. As if the toll of three dead children wasn't enough, my grandmother was to lose two more before the dawn of the Second World War. In 1929, eight-year old Dorothy died of meningitis in Toronto's Sick Children's Hospital. Jack, her eldest son, was lucky and lived past childhood, but he died at age thirty-five of a lung abscess that today would be treated by antibiotics. William, her husband, died suddenly, too, at forty-five of what was probably chronic asthma. His death came two weeks after she gave birth to their tenth child, my father. My grandmother then developed tuberculosis in 1930 and spent two years in a sanatorium while her children were dispersed to relatives' care. It never surprised me, with such a family history, that my father chose to become not only a doctor but a surgeon, an area of medicine in which physicians have the greatest sense of power and control over the outcome of a treatment or a disease.
While such a litany of grief and tragedy in one family - all caused by what are now treatable or preventable illnesses seems almost inconceivable to modern ears, sixty years ago such a story was commonplace. Families almost expected to lose a child or two, especially if they were poor. In 1921, for every 1,000 children born in Canada, eighty-eight died before they reached their first birthday. By 1985, just 7.9 of 1,000 children would fail to reach that milestone. Dr. Lewis Thomas, a U.S. physician and essayist, described in his medical memoirs, "The Youngest Science," how much medicine had changed during his own lifetime as a doctor. "When I was an intern on the wards of the Boston City Hospital the major threats to human life were tuberculosis, tetanus, syphilis, rheumatic fever, pneumonia, meningitis, polio and septicemia of all sorts. These things worried us then the way cancer; heart disease and stroke worry us today. The big problems of the 1930s and 1940s have literally vanished." They vanished in less than thirty years through a combination of improved nutrition and sanitation, immunization of children, and the discovery of truly effective drugs, particularly penicillin, widely available by the end of World War II. By the I950s, public optimism about what medicine could do had soared. Hospitals, which in previous centuries had been avoided and or held in suspicion, were now almost temples of worship and the doctors the deities who performed miracles. Those miracles seemed all the greater with the birth of "rescue medicine." One after another in the 1950S, machines were perfected that could stave off death by temporarily doing the work of the lungs, the kidneys and the heart. These technologies pulled patients back from the brink of death until the organs could resume their function.