In A case of more illness? (NH 6/6) Jeff Corbett basks in nostalgia for a healthy boyhood free of trivial illnesses for which his grandchildren seem to see their family doctor so frequently.
It is a charming image and, as for all simple notions when applied to complex realities, it is seriously flawed, but does illustrate how we perceive risk.
He does remember that skin boils were common in his childhood. These skin absences are caused by the Staphylococcus aureus bacterium ('Golden Staph', or just 'staph').
If his grandchild's skin were covered in painful boils he would be rightly horrified because it would be a sign of poor hygiene, if not neglect.
Now we see such skin infections almost only in the tropical north among children who live in unhygienic overcrowded houses.
As one of few doctors who has seen many babies and children die in agony from tetanus (in Africa), please take my word for it that we are blessed to have had tetanus immunisation.
What Jeff did not know was that staph skin infection was a common cause of death in newborn babies, but eliminated from the 1970s.
Even in 2018 more than 2600 adults suffered staph infections that entered the bloodstream (80 per cent community acquired) and 15 per cent (c. 400) died.
Back then, school sores, or impetigo, would have been common among his chums. Such open weeping sores are a compost-heap of "staph" and "strep" bacteria ("strep" refers to Group A Streptococcus).
The body's immune response to strep puts the child at risk of nephritis, in Jeff's day Bright's Disease, and also rheumatic fever.
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Nephritis is not yet a disease of the past, but remains very common (endemic) among children in remote Aboriginal Australia and is a major factor in their high risk of early death from kidney failure.
This was the situation in Newcastle in the 1940s and 1950s for everyone.
Rheumatic fever, with its terrible legacy of damage to the heart valves, remains a scourge in Aboriginal communities.
It was still common in the early 1970s in non-Aboriginal (white) children, but after that I did not see any cases apart from among children from communities in the tropical north.
In 1955 the general population the incidence was 6.4 (rates given as per 100 000 population per year) but fell to less than 0.25 in 1978. In contrast in the NT the rate remains over 1000.
Strep skin infection also used to worsen into an infection of the full thickness of the skin (erysipelas).
This was common until the late 1940s (rate 20), and before antibiotics became available it was a terrifying disease.
Once it spread into the bloodstream then death in delirium followed over the course of a couple of agonising days.
Likewise, scarlet fever, following a strep sore throat, brought a high risk of nephritis or rheumatic fever after a couple of weeks.
The rate between the 1920s and '50s was 100 to 200, reaching a peak in 1944 of 220, but by 1978 had fallen to around 1.0 and is rarely seen now.
The same strep bacteria caused puerperal, or childbirth, fever. A healthy young woman would have her baby, then after a day or so a fever set in, and she would be dead in three days.
From the 1920s and '50s the rate of this preventable cause of maternal death was 5 to 10, but is now a thing of the past in Western nations.
Does Jeff remember being warned about tetanus? It is unlikely, but as one of few doctors who has seen many babies and children die in agony from tetanus (in Africa), please take my word for it that we are blessed to have had tetanus immunisation as one of the first of a now lengthy array of immunisations that keep our children alive.
Although a benign result of this is that "grumpy old men" can reminisce about their healthy childhood, blissfully unaware of its risks, the really tragic effect is that otherwise sensible young people fail to understand this and argue against immunisation (anti-vaxxers).
They not only deny the benefit of immunisation for their children but put other parents' children's lives at risk, as we see from the deaths of babies from whooping cough (pertussis).
