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Coughs and sneezes spread writs

Boz magazine, 52: 9, August 1998.

Brian J Ford

There was a time when we were celebrating the end of disease. Not any more. Fresh examples are springing up all around, and new names like Chlamydia and Listeria make today’s medical reports look like catalogues from a gardening centre. This is the first generation in human history where we are recording so many new diseases, for civilisation has spent centuries beating the old ones. There are exceptions you could claim - when measles was brought to America, or when syphilis travelled in the opposite direction to invade Europe - but they are minor perturbations in the path of progress. In some cases we largely conquered great diseases, like tuberculosis, whilst smallpox has been declared permanently vanquished.

In others we have seen the birth of new infections, such as the severe influenza-like illness disease which struck 200 delegates at a meeting in 1976 in Philadelphia. Because the victims were members of the American Legion, the infection was named Legionnaire’s disease, and the organism responsible was given the name Legionella. Some time ago in these pages I mentioned Acanthamoeba keratinoides which attacks the cornea in wearers of contact lenses, and which has sometimes caused irreparable damage to sight. These are not new germs, just new discoveries. Legionella had always lived as a parasite in amoebae, and could now live in some of our internal amoebae (the white cells in our blood) instead. Acanthamoeba must have lived somewhere else in nature, too, until someone invented contact lenses which provide them with a home. Microbes are supreme opportunists. They must be, or they would never have gathered together to form the great coordinated communities which we now know as ‘trees’ and ‘people’.

Create new systems, and there are microbes around ready to exploit them for their own ends. Salmonella has a difficult time surviving in the real world, but confine masses of captive chickens together and the organisms have a field day. HIV had a difficult time getting from the blood of one victim to another until the modern world found ways to help, and AIDS was quick to take hold. Our reliance on convenience foods has helped organisms like Listeria spread more than ever before. The move away from slow sand filters towards modern cheap methods of water treatment has allowed Cryptosporidium and Giardia to cause outbreaks of diarrhoea throughout the London area. With city-dwellers crammed into trains and buses, international travellers packed into aluminium tubes high above our heads, and office workers breathing captive air in sealed buildings, it is time we began to design with microbes in mind. There have been recent cases of TB contracted in a crowded plane. Already we have recorded ‘sick building syndrome’, which causes office personnel to have running eyes and a sore throat, among other things. Today's world offers microbes a chance to spread like never before. They evolved to get from host to host under trying circumstances, and tomorrow’s city seems purpose-built to help them on their way.

As if to warn us of the danger, TB - considered vanquished in the western world a generation ago - is on the resurgence. The new bacteria recently found in London are lethal. They resist all conventional treatments. So far we have survived the onslaught remarkably well. Our own immune systems, and the purifying effects of the natural world, are all on our side and serve us well. However, the need to change our ways is unmistakable. The insidious increase in diseases is a warning of how matters could be if we fail to act. Sceptics will say that things cannot be so bad, or we would all be ill already. They forget two facts. One is that we have already experienced countless new outbreaks, and this should be warning enough. The other is that the public have not yet awoken to the question of culpability. Some time soon, if we do experience a serious disease outbreak in a big office building, people will sue.

The water companies provide an interesting case in point. I remain astonished that nobody has yet claimed large damages from these companies for their losses through hepatitis caught whilst surfing at sea or playing on the beach, or diarrhoea contracted from tap-water. When someone realises how much we lose - through damage to business or personal suffering - the writs will start to fly. That is another reason why I am convinced we need to start designing with microbes in mind. Microbes may be great opportunists, but even they are no match for the greatest opportunists you ever find in cities - the lawyers. Perhaps the first disease of the modern world was repetitive strain injury, RSI, which afflicts thousands of computer personnel. It may not be infectious, but it is certainly debilitating. So far the courts have come down on the side of the defendant, and have airily decided that the whole syndrome is non-existent. Round One to them, then. How will they respond to a disease outbreak due to modern design or commercial self-interest? That will be far harder to dismiss with a wave of the hand.

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