Cathy, at 17, had come from far away to visit her aunt. When I was called from my bed to see her she was lying semiconscious on a trolley in casualty with a barely perceptible pulse and the telltale rash of fulminating meningococcal septicaemia.
Only a few week previously I had witnessed an 8 year old boy surrender in less than 24 hours to this killer, and I'd been left with a grim expertise on the condition unusual for a recently qualified house doctor. Whether this acquired skill proved helpful to Cathy I was never to find out. My triumph in keeping her alive was a high achievement in 1946, but when my own life events took me outside the hospital world into general practice I had no way of following up her progress, if that's the right word for what happened.
But the experience of the first case and some concentrated book learning didn't suffice to give me confidence. Despite the unearthly hour I telephoned the consultant I served, a courtly gentleman who had qualified in the reign of King Edward and had been brought out of retirement in 1940 to replace younger men called into the armed forces. His familiarity with meningococcal septicaemia was probably no greater than my own, but his long experience, his courtesy, and above all his self assurance helped us both.
“What do you propose to do?” he asked.
My response was well rehearsed: “I'll put her in isolation, take a blood culture, and then start her with high dose penicillin and give her DOCA. I'll also put her on a saline drip.”
“That sounds right,” said the consultant. “Carry on, and I'll see her in the morning.” He didn't add, as he might well have done, “if she's still alive.”
In 1946 penicillin came, if it came at all, as a phial of dry powder, which when diluted with sterile water looked like mulligatawny soup. It was available only to hospitals (and not all of them) and was intensely painful when injected. DOCA (desoxycorticosterone acetate) was what we used for adrenal failure while waiting another 10 years for the corticosteroids to appear. It worked sometimes.
And it worked for Cathy. In 48 hours she was conscious, if a little confused, and the next day she was smiling. We were all deceived by our own success—survival in such crises was rare, even rarer then than it is today.
She remained in hospital for several weeks, by which time the first ominous signs of impending tragedy had appeared. The huge purpuric patches that had disfigured her lower legs, instead of being absorbed, began to coalesce. Worse still, they became infected, and within a short time most of Cathy's calf muscles had become a stinking gangrenous putrefaction. Penicillin had lost its magic—no doubt the result of bacterial resistance, a concept not yet written up in the journals—and bilateral below-knee amputation was the only recourse.
After much heart searching and hand wringing by the surgeons called in to make a decision, that's what happened. I don't think it helped Cathy much, but by this time I had moved on—and even if I hadn't, coming face to face with what my brilliant diagnosis and treatment had achieved was humbling and uncomfortable.
Was there a lesson to be learnt? Even after 50 years, I still can't be sure. If there was, a lot of today's practitioners still have to learn it.
Footnotes
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