Professor Keith Manchester
The post-antibiotic era. Plague, pestilence, and death. Lessons from Palaeopathology

An era in the near future of global disease resistant to all known antibiotics seems almost certain. The horrific sequelae are almost incomprehensible to modern peoples.
For the greater part of human history, there was an acceptance of inevitable morbidity and mortality in bacterial infectious disease; acute and chronic, endemic, epidemic, and pandemic.
Palaeopathology provides skeletal specimens of chronic osseous infective lesions which are secondary to acute soft tissue pyogenic infection, or which are due to specific non-pyogenic bacteria. By their transient nature, acute infectious diseases do not manifest in osseous lesion. Both acute and chronic represent the constancy of endemic infectious disease. The evidence of acute epidemic and pandemic bacterial infections in antiquity, is mainly artform. But, from ancient skeletal remains, the true prevalence of infectious disease in antiquity cannot be determined with accuracy, only inferred by the palaeopathological paradox. From the 19th century more accurate causes of death were recorded and the differential mortality of diseases can be assessed. It is assumed that this reflects the mortality rates in previous centuries.
The 19th century was a period of medical and public health enlightenment, and established measures for the prevention of infectious diseases in surgery and obstetrics. But it was the discovery of Penicillin in 1928 that introduced the concept of curative therapy for bacterial infection, which was finally achieved in 1940. Despite the caution on antibiotic usage expressed by Fleming in his Nobel Prize address, and the immense proliferation of new antibiotics in succeeding decades, awareness of developing antibiotic resistance was slow and did not generate a responsive policy until recent years. Recent warnings from Professor Paul Cosford that “antibiotic resistance is one of the most dangerous global crises facing the modern world today” indicates that the response may already be too late.
This lecture will be structured a) Pre-antibiotic era of acceptance, in which the infective disease spectrum in antiquity will be illustrated by palaeopathological skeletal specimens and artforms, b) Antibiotic era of complacency, in which the discovery of Penicillin and the proliferation of new antibiotics, the basic tenet of bacterial resistance, and an outline of the responsible factors (medical, veterinary, agricultural, societal culture) will be presented, c) Post-antibiotic era of global alarm, in which the escalating global effects of antibiotic resistant infections will be outlined.

Location

Richmond JSB