JOHN MACLEOD: The prosaic little pill that might have saved my great-gran Annie from an insidious killer

In 1915, in a township near the Butt of Lewis, Mrs Annie Thomson, thirty-two, was delivered of her third baby and her first son.

There was natural rejoicing. But, within a day or two, she was unwell. Shortly, she was gravely ill – high fever, delirium, wracked and shaking.

Medicine at that time could avail little, and shortly she was dead. The death certificate attributes it to ‘puerperal fever.’ Today, doctors would call it post partum sepsis.

Today, statistically, fewer than one woman in Scotland a year dies in or as a consequence of childbirth. A century ago, it was still so dangerous a business that a blushing bride’s trousseau routinely included a shroud.

Annie Thomson was my great-grandmother. The trauma of her death resounds in the family still, especially as my great-grandfather’s second wife would also die prematurely – in 1926, of breast cancer – and he was left with still another brace of motherless infants.

And my grandmother, orphaned at two and orphaned anew at fourteen, had the no less shattering blow of losing her first child, a beautiful little girl, to meningitis (and in a matter of hours) in 1940.

Annie Thomson died of what would now be known as post partum sepsis, rod shaped bacteria in the blood

My great-grandfather endured till 1971 and, according to his wishes, was buried beside his Annie. His was the very last interment l in the old Ness cemetery, by the wife he had outlived for fifty-five years.

I have one clear memory of the gracious old man, but an aunt recalls she never once saw him smile.

I was reminded of the tragedy last week when, hastening for bedtime, distracted, I roused my dozing little dogs for their last excursion outside, lest there be forlorn puddles in the morning.

Normally I would tap them gently with the dangling lead, to rouse them without panic, but on this occasion I instead groped clumsily for Rommel’s collar. He started awake, instantly assumed someone had just arrived to kill us all, and snapped. And, unfortunately, what he snapped into was the ball of my left thumb.

I howled, but it could not be helped, and recrimination would have been unjust and pointless. When I rose in the morning, glancing at the perfect imprint of four canines, the hand was still more painful.

By the afternoon, so swollen I struggled to remove my wristwatch. I reported to my GP surgery. No nurse was available. They told me to dial 111. I saw little point hanging on the telephone for hours, just to be told in the end to attend A & E, and so simply took myself to the Stornoway hospital and presented myself at A&E.

I had been in similar straits before. In 2012, amidst a balmy evening’s fishing, my left hand had been bitten by cleggs and similar symptoms ensued. That was a Tuesday; by the Thursday morning, said paw was the size of a melon.

The GP saw me immediately, prescribed a vast dose of antibiotics, drew a line in ballpoint pen at the margins of the large rash, and told me to come back in two days for the practice-nurse to satisfy herself all was well.

He also grunted that, had I neglected it for another day, I would probably have fetched up in hospital.

An injury is one thing; an infected injury unpleasant and full-blown sepsis – or what we used to call blood-poisoning, when a localised infection decides to run rampant - extremely dangerous. The body goes into shock; organs start to fail; your coherence is lost.

Sepsis is swift, insidious, and especially dangerous if you live alone, with no one about to notice you have turned mottled, clammy and purple and are talking funny.

Primary medical care in the Western Isles must be the best in the country. I was seen within twenty minutes by three serene and competent nurses. Off-stage-somewhere, a doctor was consulted.

My temperature was taken, my injury was gently but thoroughly cleansed – with such skill that the pain was minimal – and then dressed, before I was given a tetanus jab.

Despite past precedents, on this occasion it was in my upper arm and the same shot also protects me for years to come against diphtheria and polio - a better deal than you’d get in any supermarket.

I was again ordered to report back in a couple of days, and sent home with a packet of hefty antibiotics – co-amoxiclav. A week later, the pain has gone, the injuries are healing nicely, and Rommel has been conspicuously good.

Sepsis is so dangerous because the initial injury is almost always trivial. The first patient ever treated in Britain with penicillin, in 1941, was a 43 year-old policeman who had scratched himself on a rose.

Gardening, putting the bins out, tidying up a ratty shed – the merest abrasion can lead to big trouble, for the best defence of all against sepsis is our unbroken skin.

Gloves should accordingly be worn for any grubby work and any cut washed at once. And, too, the smarts to seek medical help once infection is evident. (There will be redness, swelling, burning pain and, often, ‘exudate.’)

Most middle-aged men are loath to bother doctors and, of course, our recent emergency – when we were exhorted wholesale to protect the NHS by not using it – has hardly helped.

But sepsis is one of our biggest killers – typically, carrying off 48,000 people in Britain every year.

That’s more than the combined annual death-toll from lung cancer, breast cancer and bowel cancer combined. 80% or more of them would survive were sepsis diagnosed in time – and 50% of the fatalities are children.

Professor Peter Ghazal, formerly the head of Cardiff University’s Project Sepsis research collaboration, says the signs of sepsis can be subtle

‘The problem is that the signs of sepsis can be really quite subtle,” said Professor Peter Ghazal, who some years ago oversaw Cardiff University’s Project Sepsis research collaboration.

‘They can be nothing more than maybe your heart rate being slightly raised, you may have a temperature, and then people can very suddenly become very sick, feel absolutely awful and they’re about to die.’

To compound the mystery, the clinical issue is often much less the specific bug than how a given immune-system chooses to react to it.

‘The bottom line is that what kills you is really how you respond to the infection,’ says Prof Ghazal. “It’s not the bug per se.

‘So this is where diagnostics can come in, because you want to pick up those signals which show that someone’s going to go on this trajectory, that their response to that bug is going to be really detrimental and then get them into intensive care units.’

But doctors are still adjusting and updating diagnostic guidelines, and all on the front line of sepsis have one nightmare at the back of their minds – the growing threat of antibiotic resistance, which in the worst-case scenario could leave doctors as impotent against blood-poisoning as if they were throwing apple-cores at advancing tanks.

For this reason, we should not demand antibiotics when there is no point – they avail nothing against the common cold – and, when prescribed them, we should conscientiously finish the course.

I downed my last co-amoxiclavs last Sabbath, but will keep the empty packet for a bit.

Had they then been available, those prosaic pills would almost certainly have saved Annie Thomson’s life.