Ebola and the wisdom of Haygarth

Unusually, this issue of JRSM begins and ends with poetry. Salil Patel’s editorial on the role of instinct in medicine opens with a quote from Socrates which proposes poets write poetry on instinct rather than through wisdom.¹ Instinct may not be backed by evidence. A judgement based on instinct may be unpopular. Medical journals tend to avoid poetry for these very reasons. One reader’s inspirational poem may be another’s nightmare verse. Nevertheless, two poems by poet Robert Vas Dias close this issue and describe his experience of transient ischaemic attacks.² What are your instincts? Does poetry have a place in medical journals?

In 1793, reasoning, probably with a dash of instinct, led John Haygarth to propose his rules of prevention.³ Society was faced with a threat from an infectious disease that had no cure but a high death rate. Spread of the disease was fuelled by poverty and cramped living conditions. The USA approached smallpox with near panic. In Rhode Island, people with smallpox were sent to a ‘pest island’, transported in a large box with holes to admit air. The response in England may have been alarmist too but it was more measured, thanks largely to the work of Haygarth.

Smallpox was transmitted to a ‘susceptible individual by close contact or by contact with the clothes, scabs, or serum’. It was the Ebola of its day and Haygarth’s rules, now over 200 years old, may be equally applicable to the latest infectious disease to invoke mass fear. As a biographical piece by the late Christopher Booth explains, Haygarth’s rules ‘stressed that patients should be isolated, that no one who had not had the disease should enter the house of any victim, that no patient should be allowed out after the pocks had appeared, that the most utmost attention to cleanliness was absolutely essential, and that everything to do with the patient’s illness must be meticulously washed’.⁴

Haygarth’s rules worked for smallpox. He was ahead of his time though in proposing a grand plan for eradicating smallpox that was essentially a blueprint for our public health service. By contrast, the world’s response to Ebola is a throwback to the days when fear of disease dominated reason and even instinct. It is hard to find wisdom in our response to Ebola. There is plenty of politics and scaremongering. Would we allow the wisdom of a 21st Century Haygarth to be heard now? It seems unlikely. Perhaps as improbable as Socrates seeing wisdom in poets?