Poverty, ignorance, overcrowding, bad sanitary surroundings, population migration, wars, famines and pestilence cause so much of human misery. More than 70% of deaths in sub-Saharan Africa are due to microbial diseases. Robert Koch was the one responsible for most of our ills in this area for a long time after he propounded his theory, wherein he said that a disease is due purely to a cause, such as a microbe. Medicine did not progress any further for nearly 100 years, until in the year 1915, an American physician, Theobald Smith, proclaimed that it is the body’s host resistance that is at the root of all our trouble and the microbes are there in the atmosphere always. It is only when the body resistance goes down do microbes produce illness. We are a part of this cosmos where all life is interdependent. Man’s proclivity for comfort has now made life difficult for many species of animals and even symbiotic microbes. Many of the newer varieties of innocuous germs have started raising their ugly heads, to produce human illness. In the recent past the British schools had an epidemic of viral appendicitis, an unknown entity in the past.

Newer microbial diseases are seen in places where they were not present in the past and some of the older diseases which showed a sign of remission have come back with a vengeance now, a good example is malaria. Man has changed many things in his own surroundings, the chief amongst which is the global temperature. This will bring in many new diseases in its wake. In the early part of the sixteenth century when most of Europe was wiped out by plague, Nature tried to come to man’s rescue. Suddenly that continent became a degree centigrade cooler and the rattus rattus, the black domestic rat, died a natural death. With that died the pasturella pestis, the organism that causes plague. The white rat, rattus novigenous, could not harbour the plague germ; so Europe was devoid of plague since then. Then came the white plague, tuberculosis, which was a nightmare for them for well over a century, before it almost disappeared from the European continent. With the advent of AIDS, the scourge of white plague is threatening the white man once again.

We were told that we have conquered most of the microbial diseases, but like the phoenix from the ashes the microbes have risen again. Recent outbreak of diphtheria in Eastern Europe after the downfall of the USSR, plague in India, and many staphylococcal infections in the West are reminders that things are not as good as they seem in the microbial front. One would shudder to think of the future consequences of hospital infections, as most of the simple organisms are exposed to all kinds of antibiotics in the hospital set up. They become immune to them and develop resistance. A recent study in the UK showed that school children admitted to hospitals for minor illnesses and even those children exposed to the hospital atmosphere acquired drug resistant germs in their throats posing a serious threat to their future health.

Wars have left millions homeless and forced them to flee their homes. Studies of Rwandan refugees has shown the prevalence of simple, but resistant, infections coming on easily in their camps. Construction workers in India migrating from one place to another in search of greener pastures, are the root cause of spread of many communicable diseases. Epidemics of cholera have spread along the routes of commerce. Malaria has even spread to Europe through the of travelers’ luggage, surviving the cold of pressurized luggage cabins of our large aircrafts. They spread around air ports and this new epidemic is called airport malaria. The world has shrunk a lot and doctors even in the West should be prepared to see exotic microbial diseases, which they have never seen all their lives.

There are now unprecedented opportunities to mix up humans and animals from far and wide because of the shrinking global markets. Newer tensions develop in the various parts of the world due to political and economic pressures. To give a small example, most wars have resulted in more number of deaths due to microbial diseases, than all the nuclear arsenal put together. The shining example is influenza. This killed nearly twenty million people in the year after the first world war and it is surprising that it is capable of killing even today. There have been periodic pandemics of this disease almost every decade, many deaths during the epidemics occur in able bodied youngsters.

The situation is gloomy and there is no solution in sight. It is unlikely that the global scenario of poverty, conflict, and political upheavals, will change for the better in the foreseeable future. It is also foolish to think that we can conquer these germs with the help of more powerful antibiotics. The only solution is to study the ecology of these and have a holistic perspective of infectious diseases, taking advantage of the lessons in the history of medicine that infections wax and vane in societies due to extraneous causes. If we can get some ideas from the world’s total perspective, we may be able to do something in this direction. An important step in this direction is the setting up of the global weather monitoring unit by the Unesco.

Microbes follow the changes in global warming and cooling. If we catch them before that and destroy them, epidemics could possibly be contained before inflicting heavy damage by way of loss of human life. We also must work with colleagues in the animal and plant world as many germs are ubiquitous. Could we expect this kind of wisdom, nay understanding, even in our own profession?!