A Matter of Life and Death. Sue Armstrong

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      I’ll tell you about what got me into infectious diseases, and incidentally led me to where I am today. It was the drought summer of 1976 and I was at University College Hospital [UCH]. I was looking at a bowel biopsy late on a Friday afternoon when the rest of the department had gone home, and the case history said: 30 weeks pregnant, severe diarrhoea, query proctitis [inflammation of the rectum], query cause. It was a white woman, aged about 30. The usual diagnosis would be: nothing, or ulcerative colitis, or one of the standard diseases, but I looked at this biopsy and it wasn’t any of these. It was inflamed, but it actually had amoebae in it. I’d never seen amoebae before, but I knew what they should look like because I was vaguely interested in infectious diseases even then. So I looked at a book and there was a picture of amoebae; I looked down the microscope and there they were, and I said to myself, ‘This has to be amoebic colitis.’ So I rang the houseman and said, ‘This is amoebiasis.’ What she answered was unprintable! Because, she said, the woman was in theatre at that moment having her colon taken out because it was perforated. ‘She’s got peritonitis, and she’s probably not going to live.’ And she didn’t.

      This was a Friday afternoon and the biopsy had probably been taken on Wednesday, because processing these things takes time. I was thinking, ‘If we’d had the answer yesterday, might her life have been saved?’ Well, you can conjecture till Kingdom come, I don’t know. But the point is they thought she had ulcerative colitis and put her on steroids. That’s what you do if it’s ulcerative colitis or Crohn’s disease, but if you’ve got amoebiasis it’s the worst thing you can do: the disease just lets rip, perforates the bowel and you die. This is perfectly well known, but you have to think of amoebiasis first. And what on earth is a pregnant 30-year-old who’s never left North London doing having amoebiasis, a tropical disease?

      Not many people had ever seen a case of amoebiasis in this country. Certainly I never had. And certainly the main surgeon involved in this process never had. I remember presenting the case at the next gut meeting we had, and saying, ‘Actually, this is amoebiasis,’ and watching the physicians sink their heads in their hands and whisper, ‘Oh, God.’ Because this was a treatable disease …

      So I did a bit of further investigation … As I say, this is what got me into infectious diseases: this actually changed my life. I found out, probably from the widower, that what had happened was that his wife hadn’t felt like cooking and so the neighbours cooked something for her and passed it over the fence. Very nice of them. This is in north-west London, and they had just come in from Bombay. So basically the infection was on their hands. A goodwill gesture, sadly carrying rather unfortunate consequences. Because there is no endemic amoebiasis in that part of London.

      And it went further, the bizarreness of this story. In those days there was an amoebiasis research unit in the Hospital for Tropical Diseases, which was run by an extraordinary guy – he was an air vice-marshall, one of the older Air Force medics. I gave him a potted version of this story, and said, ‘There’s no question about the cause of death: it was amoebiasis. As far as I can see, the infection came from the neighbours who had recently arrived from India,’ where amoebiasis is endemic, and they were obviously symptomless carriers. I’ll never forget his retort: ‘This doesn’t happen in the United Kingdom!’ and he put the phone down. So the second message of this story – and I tell all the medical students – is: ‘Don’t always believe what old experts say!’

      And infectious diseases are intellectually very teasing and exciting, are they?

      Absolutely, yes. One of the things I do today, apart from looking at challenging autopsy cases, is a lot of infectious disease consultation work. People send me slides and say, ‘What is this? I think it might be this,’ or ‘I haven’t the faintest idea what it is.’ Every week will bring in one or two real gems.

      Two days ago someone sent me a liver biopsy, saying, ‘What on earth is this?’ I looked at it and thought, ‘I can’t believe this! I’ve never seen it before, but I know what it is.’ It turned out to be someone who had had some abdominal trauma which had obviously ruptured a hydatid cyst, which is a parasitic cyst, and bits of that had gone into the liver circulation, blocked it off and damaged the liver. I didn’t know that could happen, actually. I’d written about hydatid cysts in the standard textbook of liver pathology, but I’d never seen this version of it.

      That’s the thrill of this work: I’m looking at things which are either new versions of diseases I know, or genuinely really rare things, or even things that no one else has ever seen before. You’re kind of working on the edge all the time.

      Tell me about your involvement with HIV and AIDS.

      To my slight shame, I didn’t pick up on AIDS at the very beginning. It started nominally in 1981 when gay men in America started presenting with diseases no one had ever seen with any frequency before, if at all – that is, Kaposi’s sarcoma and Pneumocystis pneumonia [PCP]. In the AIDS calendar, 7 and 14 July 1981 are big days. That’s when Jim Curran of the US Centers for Disease Control [CDC] said, ‘I think we have a problem.’ He became the great man who drove the response to AIDS in the beginning. This is all in retrospect – I didn’t pick up on that at all at the time.

      In 1982, I was here at St Thomas’ as a research fellow working on tropical infections with a charismatic pathologist, Michael Hutt, and we had a frozen section from a patient who had a lung СКАЧАТЬ