Devoted and obedient
Huge is harmful
Descensus Averno

Devoted and obedient

In these days of interprofessional relationships, when we think in terms of primary health teams and co-operation between specialists, it is helpful to meditate upon what our fellow professionals mean to us and to society at large.

Consider the nurse, for example, someone taken for granted more often than not, but an essential member of the health care team. To the Romans, a nurse was called nutrix, and had an obvious connection with the feeding of the young and the sick. In our own language the nurse used to be “a woman employed to suckle and otherwise attend to an infant’’, or “one who has general care and charge of a young child”. Originally a distinction was made between a wet-nurse and a dry-nurse. The definition was widened to “a person, generally a woman, who attends or waits upon the sick”. In this form it is still generally applicable, although male nurses have increased in numbers during recent decades.

Great discretion was always exercised in choosing a nurse for any specific purpose. Phaer in his ‘Boke of children’ (1553) knew the hazards: “Ye must be well advised in taking of a nourse,” he wrote. Indeed, we have seen neglectful nurses, even murderous nurses, let loose on society when they should have been weeded out long ago.

Florence Nightingale was, of course, taken as a shining example of nursing at its best. She set up the Nightingale school of nursing in St Thomas’s hospital in 1860, and it stands as her memorial. In her ‘Notes on nursing’ of the same date she wrote: “No man, not even a doctor, ever gives any other definition of what a nurse should be than this - ‘devoted and obedient’. This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.”

Nurses have achieved stature and asserted themselves since then. Today we have nurse prescribing for chronic diseases such as asthma, diabetes, minor ailments and palliative care. Long may nursing progress continue to undermine the excessively arrogant attitude of some of the medical profession.

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Huge is harmful

Considerable disquiet is being expressed today about the ever-growing power of huge transnational business corporations to determine the shape of politics. We have seen that in the United States big business exerts strong opposition against any co-operation with other countries in taking measures to reduce energy consumption and pollution of the atmosphere, which are adding to the notorious greenhouse effect and accelerating global warming and all that results from it. In the chemical and pharmaceutical industries there has been a trend towards financing universities, which should by any sane judgment be strictly objective and never biased. If an institution, however venerable and prestigious, comes to depend on handouts from interested parties, which dictate to some extent what researchers shall publish and what they should keep in wraps, its claim to be following truth at all costs will be smirched.

In Science for January 19, Stanley Falkow and Donald Kennedy point out that many years ago proposals were set out to terminate the addition of certain antibiotic compounds to animal feeds with the object of promoting growth. Such a practice was leading to the increase in microbiological resistance to antibiotics that were of great value in treating infections in humans. Businesses concerned with the manufacture of antibiotics and livestock production refused to accept this argument, but “there are unmistakable links between the subtherapeutic use of antibiotics and the prevalence of resistant bacteria”. The US National Academy of Sciences found “insufficient evidence for a direct influence on human health”, and so averted pending regulations. Meanwhile, Denmark, Finland and Sweden eliminated antibiotic use in animal growth promotion and the World Health Organisation advised against the practice of dosing animals with those antibiotics that are relied upon in human medicine. A proposal in the US to withdraw fluoroquinolones from chicken and turkey rearing because of Campylobacter resistance in humans has been queried by a large manufacturer there.

It is high time, Falkow and Kennedy write, to develop novel antimicrobials that are specific against animal pathogens but do not affect human ones. Meanwhile money continues to rule despite scientific fact.

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Descensus Averno

I do not think it can be denied that mankind is becoming increasingly arrogant with every technical advance made by society. There is an assumption, devoid of evidence, in political circles that whatever assails human beings in the shape of diseases, climate changes or social revolutions can be dealt with and properly counteracted, or even turned to advantage, by the clever boffins and the spin doctors at the Government’s disposal. Yet, every time someone in authority boasts of a solution to a looming problem, something else arises to destroy our confidence in it.

We have been told of marvellous and infallible ways of safeguarding our water supplies and quality, decongesting our cluttered roads, improving the education of out children, improving the level of our health and hastening the treatment of disease when it strikes, and speeding and widening our means of communication with each other. We learn of steps to diminish the gulf between the obscenely rich and the desperately poor, and to improve the standard of living and enjoyment of life of everyone. But, in fact, what do we discover? That our hospitals breed infections and botch operations, that our railways are run by people who seem to have no notion of safety and efficiency but are bent on profit for directors and shareholders, that much of our food is suspect, and that dishonesty and imcompetence pay dividends in all walks of life.

Those who study to be expert and who work hard earn a pittance compared with others who bluff their way through life as public entertainers. In short, our values are in a hopeless confusion.

It is easy, in the face of such circumstances, to grow pessimistic and to seek the quick buck, usually by some process of gambling. The only alternative, very often, is to accept a modest lifestyle, strengthened by an acute sense of ethics and morality. There are siren voices around us seeking to convince us that the path to success lies in asserting our own interests above those of our fellows. To rest content with a state of mind where we find happiness in simple things may appear to the ambitious and the arrogant to reflect a return to the medieval cloister and a retreat from modern ways of living. Possibly they are right in thinking so. Yet I retain a nasty suspicion that we ought to take a firm hold on our scale of values and not adopt the facile attitude that, since human technical ability is virtually unlimited and human pride unconquerable, we are able to overcome any reaction of Mother Nature to our interference with her simpler ways.

As Virgil once told us: Facilis descensus Averno (easy is the decent to Hell). The path leading upwards is, in comparison, tedious, but not to be dismissed as a better one.

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