Back in the old days….
Nearly forty years ago, the AIDS crisis kicked off rather quietly about the time I entered medical school. As young medical students, we found ourselves with a unique perspective on a massive epidemic that initially defied understanding. All sorts of explanations were attempted to comprehend the strange array of illnesses which suddenly appeared. Hospital admissions radically shifted. Entire wards became dedicated to this new illness. Internship and residency training took a bizarre twist. Conventional diseases became less important. We became experts in a list of bizarre new diseases.
There was another rapid shift that is easily forgotten: The rise of Universal Precautions.
In the old days, when we placed intravenous lines and drew blood, we did not wear gloves. Let me repeat this: We drew blood and placed IV’s with our bare hands. We got blood on our hands. Often, we got a LOT of blood on our hands. It also got on our white jackets and we wore it like a badge of honor. The danger never occurred to us.
Gloves? They were usually hidden in a locked cabinet away from the students and residents. We couldn’t use them if we wanted them. The keys were usually in the possession of a very scary head nurse.
As we realized AIDS was caused by an infectious agent, we pivoted in our precautions. We went from no gloves to far more extensive isolation gowning. Gradually, we figured out the proper balance.
Now, in the era of Coronavirus, our body coverage has become far more intense. Yet, healthcare workers are still getting infected by their patients.
About thirty-five years ago, I did this cartoon for the magazine “Resident and Staff Physician.” The difference was, instead of “Coronavirus,” I wrote “AIDS.”We have a rough couple of months ahead of us. I pray our lives return to normal, soon.
https://www.wsj.com/articles/emperor-josephs-solution-to-coronavirus-11586214561
Emperor Joseph’s Solution to Coronavirus
Before modern medicine, the Habsburg monarchy kept epidemics at bay for more than a century and a half.
Interesting article on Joseph I of the Hapsburg Monarchy. Or, as his friends called him,
Joseph I, by the grace of God elected Holy Roman Emperor, forever August, King in Germany, King of Hungary, Bohemia, Dalmatia, Croatia, Slavonia, Rama, Serbia, Galicia, Lodomeria, Cumania and Bulgaria, Archduke of Austria, Duke of Burgundy, Brabant, Styria, Carinthia, Carniola, Margrave of Moravia, Duke of Luxemburg, of the Higher and Lower Silesia, of Württemberg and Teck, Prince of Swabia, Count of Habsburg, Tyrol, Kyburg and Goritia, Marquess of the Holy Roman Empire, Burgovia, the Higher and Lower Lusace, Lord of the Marquisate of Slavonia, of Port Naon and Salines, etc.
Try signing that on a check.
He created a “Cordon Sanitaire”, though I think that exact term came into being in the 19th century. That’s what it would ave been called, had the term been coined.
The idea was to create a barrier between the Hapsburg Monarchy and the Ottoman Empire. At issue was the transmission of smallpox from the Ottoman Empire to the Hapsburgs. Borders between nations were often blurry, but the Ottoman siege of Vienna in 1529 and 1683 resulted in a peace treaty with well-defined borders, rivers, mountain peaks, and military outposts.
We have 21,000 Border Patrol agents. The Ottomans had up to 100,000 Serb and Croat infantry on the border, dozens of miles deep into Hapsburg territory, and agents were sent into the Ottman region to provide intel to Vienna. There were 19 border crossings, with quarters to quarantine all travelers from Ottoman to Hapsburg land. Between occupants, the quarters were cleaned with sulfur and vinegar.
Trade goods were inspected and quarantived
The Hapsburgs were trying to keep a disease at bay. The opposite country was a geostrategic rival, and on more than one occasion, an invading enemy. At the same time, they were an important trading partner when they weren’t at war. The Hapsburgs wanted to keep out the Ottoman foreigners, but a significant number were refugees……Christians, escaping Ottoman rule.
“Liberals” of the time opposed the cordon because it impeded trade.
“Nationalists” in Hungary and Croatia opposed the cordon, because control was ceded to Vienna.
The similarities are of interest to a nerd like me.
The Hapsburgs were fighting a disease that came to them from a military and geostrategic rival, that at the same time, was a trading partner. Political factions opposed the cordon.
And Joseph I died in 1711.
From smallpox.
I was a medical student in New York City in the early-mid 1980’s. I drew blood and started IV’s on AIDS patients in Greenwich Village. I drew blood and started IV’s on IV drug users in Harlem and the South Bronx. We did not know how the disease was transmitted. I never wore gloves. Fortunately, I was not infected.
Now there is a movement to forgive student loans to residents working with COVID 19 patients.
When I was a medical student, no one suggested that my tuition be discounted event though I was risking my life (and paying for the privilege!). When I was an internal medicine resident, no one suggested forgiving my substantial loans with interest rates of 14% and 16%.
I am ALL FOR forgiving or discounting student loans for those docs on the front lines.
I still can’t start an IV with gloves on.
And besides, as I have told “kids” a hundred times:
HIV+ blood on intact skin: Cannot transmit, not an official “exposure.”
What is it you really fear when treating an HIV+ pt.? A needlestick.
How much do gloves protect against needlesticks?
So… ?
WOW,someone else who remembers the OLD DAYs, Thank you and I hope your mentation and abilities continue to help you thrive in this glorious profession of Medicine.
I am a PA-C since August 1976, HIV/ Kaposi’s sarcoma, Aids came on scene. In 1981 or 82. Full swing by 84 or so.
several prominent person’s came down with it ,made it more acceptable. Now it is a chronic illness controlled by anti-viral meds/cocktail. Some may help with corona virus. That was the silver lining to HIV/Aids. Took us into area’s of research we were not yet going into and has opened many doors.
Folks in Medicine have to be reminded of Universal precautions. Often get sloppy with being familiar. all very Human but sometimes a costly error. Cannot help others if you do not take care of yourself.. Thanks for all you have done/will do. I am a GWU PA program alumnus. Still doing primary care,still having FUN everyday. In Montana.
Remember it well we were pretty relaxed about blood back then. We probably should have been worried about hepatitis B (which in these days was called serum hepatitis) but we weren’t. The AIDS epidemic started the year I finished residency. Didn’t see much of it at first being in a smaller town but of course eventually it was everywhere and in every community. Of course I remember everybody being pretty surprised when we started seeing legionnaire’s disease in the community as a resident. Point is there will always be novel diseases. We have to adjust our mindset and practice accordingly.