‘What sort of infected material?’ asked Lark.
‘The standard test is for macerated brain obtained at autopsy
to be injected into mice to see if they develop degenerative brain
disease.’
‘Has such a disease ever been seen in man?’ asked Lark.
‘Yes,’ replied Munro. ‘In man it’s called Creutzfeld Jakob
Disease. It’s a brain disease of the old. It’s a relatively
rare condition and thankfully it has a very long incubation
period.’
‘What was the incubation period in this case?’ asked Munro.
All eyes turned towards Flowers. ‘Stoddart says that his man
reports that the patients developed the disease almost overnight
and were dead within three weeks. The brain pathology was
identical to
Scrapie
or Creutzfeld Jakob Disease. They’re practi
cally indistinguishable in terms of histopathology.’
‘Damnation,’ said Lark. ‘Three is not a big number. I still feel
we may be jumping to conclusions.’
‘I’d like to agree,’ said Flowers, ‘but three men working on a
farm with infected sheep die of a brain disease indistinguishable
from
Scrapie?
We have to take this seriously.’
This comment was digested for a moment in silence then Lark
said, ‘It’s still very hard to believe that a sheep disease that’s
been around for years without causing the slightest trouble in
man has suddenly managed to jump the species barrier and
start killing people.
‘Surely there would have to have been some additional factor
involved; a change to the infecting agent; a mutation of some
sort; an alteration, either spontaneous or induced.’
‘Let’s hope, if that’s the case, that the mutation was induced
by some local factor and that this is an isolated incident,’ said
Flowers.
Then it’s of the utmost importance to establish just what
caused the mutation,’ said Munro.
‘Agreed.’
‘Are there any clues?’ asked Lark.
There is one prime suspect,’ said Flowers.
‘What’s that?’ asked Munro.
The area around the farm in question includes the Inver
maddoch nuclear power station.’
‘Radiation,’ said Lark.
‘What better inducer of mutation?’
‘1 need hardly tell you what a delicate position this business
puts us in,’ said Munro. ‘If we suddenly announce that a
highland region is reporting that people living in the vicinity
of a nuclear power station are developing an infectious brain
disease which resembles sheep
Scrapie
in every way, we can
expect a storm of panic and protest. Apart from public outcry,
we will face the combined pressure of the agricultural lobby
insisting that there is no link between infected animals and
human brain disease, and the nuclear lobby maintaining that
atomic energy is safe and clean.’
‘So what
do
we do?’ asked Munro. ‘And what do we tell Her
Majesty’s Government?’
‘I think we have to treat the Scottish thing as a separate,
isolated problem for the moment,’ said Lark. ‘In broad, general
terms there is still no evidence that animal brain disease can be transmitted to man. I think we should admit that there has been
an increase in reported cases of brain disease in the population
but it is too early to assign a cause or say whether it is significant
or not. Let the government’s statisticians present the figures in
whatever way they want.’
‘But the government must be made aware of the potential problem in Scotland just in case it leaks out in the press,’ said
Munro.
The area doesn’t get much attention from the press so we
should be able to investigate quietly on our own for a while,’
said Flowers.
‘No disrespect to Stoddart and his people but I think we
should see the pathology evidence taken from the three men who died,’ said Lark.
‘I’ve asked for it,’ said Flowers.
‘Did
Stoddart say who the investigator on the ground was?’
asked Munro.
‘Yes he did,’ replied Flowers, referring to his notes. ‘A
pathologist named Dr Lawrence Gill.’
ONE
Dr Ian Bannerman sorted his notes before him
on the lectern and waited for the hubbub to die
down. He thought his audience of medical students looked depressingly familiar but quickly reminded
himself that this was a cynical thought. Sometimes
the borders between cynicism and realism were a
bit fuzzy.
Despite a solid middle-class background with its
attendant adherence to Christian ethics and values
he had always failed to be convinced that human
beings were ‘individuals in their own right’. People,
as he saw it, fell into certain discreet ‘types’. There
was a type of person who became a vicar, a soldier, a policeman and so on. From lecturing to medical students for the last five years at St Luke’s Hospital
he had come to recognise that there was a definite
type of person who became a medical student.
Medicine was seen by society as a profession for winners and because of this medical schools could
demand the very highest academic entry standards. This meant that the cleverest pupils on paper were
encouraged to ‘try for medicine’ as if entering a
competition to prove their worth. Egged on by
parents and teachers alike, such people would often
find themselves railroaded into something they had
not given much thought to.
Equipped with a brand new stethoscope from
proud parents and a dissecting set from Aunt
Mabel they would turn up at St Luke’s, ready to
start passing more exams because that was what
they were good at. ‘Doesn’t anyone ask the buggers
if they care about sick people?’ Bannerman had asked
at the last faculty meeting. The remark had been met
with good humoured tolerance. This did not please Bannerman; it only confirmed his thesis on people
‘types’. He reluctantly acknowledged that he was seen as the rough-diamond type; the kind of man who spoke his mind but was accepted because he
was good at his job, and when it came to pathology
there was none better.
Bannerman looked at the sea of faces, trying to
spot a few who might become ‘real’ doctors. It
was practically impossible but he always tried. It was easier to spot the ones who wouldn’t, the
loud-mouths who would bluster their way through the course, the quiet note-takers who would copy
everything down and rely on hours of study and a
retentive memory to see them through exam time.
There would be some who would fail, of course,
and not necessarily because they were bad students.
Although the course was tough and academically
demanding the entry standards ensured that not
many idiots reached the starting line. The ‘failures’
were often students who discovered that they were
square pegs in round holes; they were simply doing
the wrong subject.
Bannerman always took time to reassure such
students that it was better to have found out at an
early stage than to have been faced with the truth
when someone’s life was resting in their hands. He
always had much bigger problems with the students
who passed the exams yet clearly were not cut out to
be physicians. The frustrating thing was that there
was little he could do about it. He would do his
best to instil a genuine concern and regard for the
sick in them but he suspected that many would
go through their entire careers without ever seeing
patients as anything more than ‘cases’, temporary
intellectual puzzles to be solved along the path of
their careers.
Despite not being able to spot the ‘real’ doctors in his audience Bannerman knew that they would
be there and saw it as his duty to deliver the best
possible lectures he could for their sake.
‘
Today we shall continue with our study of dis
eases of the central nervous system,’ he announced.
‘A subject I know will be close to your hearts because
your essays on the subject of my last lecture suggest that many of you are suffering from one or other of
them …’
There was general laughter because although
Bannerman had an acid tongue he was popular with
the student body. He was a good lecturer, always
on top of his subject and had never been known
to prevaricate when asked a question to which he
did not know the answer. Instead, he would say
so immediately and tell the student to look it up
and let him know. This saved a lot of time and the
students appreciated it. Too much course time could
be wasted by lecturers waffling to cover up deficien
cies in their knowledge. The words, ‘I don’t know’
were too seldom uttered in the realms of academia.
‘Creutzfeld Jakob Disease and Kuru are the two conditions we will consider today. Both result in
nervous degeneration, loss of coordination of the
limbs and mental deterioration. Both are invariably
fatal.’ Bannerman switched on the slide projector
and clicked in the first slide with a hand held control
ler. ‘On the left is a brain section from a patient who
died of CJ disease. The section on the right is from a
normal brain. Note the spongioform appearance of
the diseased brain and the typical SAP fibrils.’
Bannerman changed the slide and altered the
focus slightly with his thumb. ‘This is a photograph
of a patient who contracted CJ disease after corneal
graft treatment. Note the vacant expression in the eyes and the lack of facial muscle tone.’
A voice from the darkness said, ‘Are you suggest
ing that the patient got the disease from the graft?’
‘Almost certainly,’ said Bannerman.
‘
Then this is an infectious condition?’
‘Yes, but not conventionally so.’
There was a murmur of amusement as the stu
dent body began to believe that they had caught
Bannerman about to prevaricate at last.
‘Yes or no?’ demanded the cocky student voice.
‘Officially the diseases are said to be caused by
unconventional
slow
viruses.’
‘How unconventional?’
The truth is that no virus has ever been isolated from an infected brain but in all other respects the material behaves as if an infectious agent is present.
‘Then the disease can be transmitted?’
Yes.’
‘Are there any other diseases like these?’
‘Several, in animals.’
‘Such as?’ asked the student, determined to catch
Bannerman out if he could.
‘Scrapie
in sheep; Bovine spongioform encepha
lopathy in cattle.’
‘Mad cow disease?’
asked the student.
‘Yes, also transmissible encephalopathy in mink.’
‘But surely a bit of research would determine the
cause of these conditions?’ said the student.
For a moment Bannerman was taken aback at
the arrogance of the proposition then he said,
‘Mister … ?’
‘Marsh,’ replied the student.
‘Mr Marsh, there is a small but significant grave
yard containing the careers of several top flight
researchers who insisted they had discovered the
cause of these diseases. Perhaps you would care
to do “a bit of research” and give me your written
submission on where you think they went wrong?
Shall we say by next Wednesday?’