Miasmatics


Out of the night that covers me, Black as the pit from pole to pole, I thank whatever gods may be, For my unconquerable soul.  This may be how we choose to think about ourselves as we screw our courage to the sticking place. And yet, much as we hate to admit it, there is something a little frightening about things that surround us which we cannot see. Clouds that, had we not been made aware of them, would have drifted as unseen and unregarded as smoke on a moonless night.

Bacteria, at least in popular culture, have usually been associated with filth, contamination, and especially, illness. The Germ Theory, which postulates that some diseases are caused by agents (microorganisms), was first proposed in the mid-1500s and later substantiated with the advent of microscopes and public sanitation advances. The recognition of microorganisms as causes of disease supplanted the previously held disease theory of Miasma –bad air- as propounded by Galen, a Greek physician and philosopher in the mid second century CE Roman empire.

As counter intuitive as it might sound nowadays, new discoveries have lately suggested that he may well have been on to something: http://www.bbc.com/news/health-34314065. I suppose this shouldn’t come as a complete surprise, though. As the news article observes: ‘Studies have already shown that our microbiome – the collection of bacteria, viruses and fungi that live on our skin and in our bodies – outnumbers our own cells 10 to one. These can be spread through direct contact, airborne emissions and shed skin cells in dust.’ Or, perhaps more disturbing, ‘Walk through someone else’s cloud, and it will “rain” bacteria on your skin and be breathed into your lungs.’ The study, from scientists at the University of Oregon, was published in the Sept. 2015 edition of Peer J: https://peerj.com/articles/1258/ -a fascinating read, to be sure.

I suppose I found this article a timely reminder that we all approach the idea of ‘cleanliness’ in different ways, and to different degrees. Not everybody who pays attention to it has OCD.

Lisa was a good example, I think. A beautifully coiffed, tall woman in an almost obsessively ironed white, frilly blouse and perfectly pleated black skirt, she sat primly, but in isolation in the fully packed waiting room. Trying not to seem rude, she had managed to negotiate the chaos of hyperactive children and their large-tummied mothers, by contracting herself into the smallest possible dimensions in a corner. She wasn’t obvious about it, nor did she seem at all uncomfortable –just careful to avoid undue and unnecessary contact. As if everyone around her had the flu –or something else of which they might not even be aware. Yet.

As I led her down the corridor to my office I noticed she stopped at the front desk for a quick dab of alcohol hand rub from the dispenser the secretaries had placed there, probably for their own protection. Good, I thought, she’s getting her hands ready so she won’t contaminate me when we shake. Then it occurred to me in kind of uncomfortable shiver, that we had already shaken hands. So, to make her feel that it was indeed an appropriate thing to do after touching, I helped myself to a dollop from the same container. I don’t think she noticed; she was too engaged in straightening the sleeves of her blouse and then making sure no hair was out of place to ruin the effect. I put it down to nervousness.

Once she had settled into the chair across from my desk and examined my office with what seemed like polite curiosity, I asked her why she had been sent to see me in consultation. Her expression immediately changed. Her initially benign and neutral face suddenly wrinkled suspiciously, and her eyes wandered over my face for a moment searching for a safe place to stand. Or were they looking for reasons –any excuse- to terminate the visit and seek help elsewhere?

I thought I’d make it easier for her. “Well, your family doctor seems to feel you have… issues in the vaginal area that he can’t resolve. Would you like to tell me about them..?”

Her face gradually hardened. “I told him I wanted to see a female gynaecologist! But he never listens. He’s too busy to listen, I think.” She stared at a painting on the wall beside her, for a moment. “And your waiting room looks even fuller than his, I have to say.” Her eyes migrated slowly around the room stopping to feed on the eclectic tidbits I had scattered almost randomly throughout: the wooden statue of an Ethiopian woman holding a child and seeming to hide behind a plant on my desk; the terracotta woman sitting on a flimsy oak table holding a begging bowel filled with shiny coins that require constant vigilance from every mother who visits with her children; the jade apple on my desk; the multicoloured painting of a peasant woman leading a horse…

Interestingly, it was to the painting that her eyes continually returned. “But he never had pictures on his wall. Nothing at all interesting about his office except a window with a tree right outside it…” She lowered her eyes for a moment and then they flew back to my face and settled there. “So, what did you want me to tell you?”

“Dr. Grossac seemed concerned about your vaginal issues, as he put it.” I couldn’t suppress a smile at his turn of phrase and she noticed it.

“He just got fed up with not finding anything. He seemed to be a one-trick-pony: if his swabs and cultures didn’t show anything abnormal, then of course nothing was abnormal. A standoff.

“There is an odour, however –but like describing the taste of wine, words sometimes fail to capture it -or validate it… I don’t expect most family doctors will have a gas chromatograph in their offices, but I do think most noses are able to detect differences, don’t you? I mean, isn’t that what they’re for?”

She had a point.

She hesitated a moment, and then continued with a guilty expression. “I don’t mean to imply that Dr. Grossac doesn’t know his medicine -he told me he could smell something, but he didn’t know what. I guess he thought you would…”

“What have you tried so far?”

“I’ve tried scented oils in the bathwater; I’ve tried different laundry soaps, different personal products, but they only seem to help for an hour or two…”

“How long has this been going on, Lisa?”

She shrugged. “I don’t know –maybe a couple of weeks now.”

“And has this ever happened to you before?”

She shook her head, thought better of it, and then looked at me with caged eyes. “I suppose maybe something similar when I was a teenager…” She stopped, no doubt hoping I wouldn’t demand a fuller description. Sometimes you’re just not supposed to ask.

I smiled expectantly. “Oh, and what did your doctor find then?”

She blushed and looked at the horse painting once again. “Actually, I found it…”

I pretended to look at something on my desk. “And what did you find?” Sometimes I’m merciless.

She looked down at her lap, embarrassed beyond words. “I… I left something inside.” Her head snapped back upright and she unleashed her eyes on my face, daring me to pursue it. “I mean I was really young –just starting my periods, really…” Her voice trailed off in distress. This was a woman’s issue after all; she didn’t really expect me to understand.

“And this time?”

“Nope,” she mumbled to her knees. “Couldn’t find anything…”

“And your doctor?

“He never really looked in there…”

I tried not to show surprise. “Do you mind if I look?”

She shook her head –with relief, I think.

After I’d examined her and dealt with the issue, she came back into the office with an awkward smile on her face. “So,” she said, “Where there’s smoke there’s fire, eh?”

I had to smile again. “Ever heard of the Miasma Theory?”

She returned my smile. “Galen?”

I nodded. “He wasn’t entirely wrong was he?”

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