Your Tonsils or Your Job ! How The Post-Antibiotic Era could get you fired.

In 1934, The Los Angeles Milk Commission gave its employees devastating ultimatum- lose their tonsils or lose their jobs. When our antibiotics stop working, your employer may force you to make a similar choice. They'd be right to.
Infectious bacteria are developing resistances to our medicines at alarming rates, and we are entering a Post-Antibiotic Era. If you want to know how people will cope in this new era, look at how they coped in the era before antibiotics.
In the early 1930's, scarlet fever and strep throat were much more common than they are today, and without antibiotics to treat them, much more hazardous. In the worst case scenario, a sore throat could develop into full blown sepsis.
So when a report was published in 1931 describing 71 outbreaks of this disease that could be traced to one common factor, people paid attention. That common factor was milk contaminated with bacteria named Streptococcus epidemicus*. These bacteria tended to infect the udders of cows, causing mastitis. Since the udders also happen to be where the milk was produced, bacteria inevitably spread to the milk.
Needless to say, these outbreaks needed to be brought under control. That responsibility fell to the Los Angeles Milk Commission, which implemented a number of rules to prevent any more outbreaks occurring.
The first step was to find any dairy cows infected with the disease. Fortunately, there were already rules in place for this. Cows needed to be certified to be free of S. epidemicus, and any infected cows needed to be isolated from the rest of the herd.
Here is the problem. Both humans and cows could carry S.epidemicus. To control any outbreaks, the same restrictions that applied to cows had to apply to the humans who worked with them. Humans could carry S. epidemicus without any symptoms, and appearing perfectly healthy.
Out of a thousand employees tested, fifty were carriers. This was devastating. Once you carried this bacterium, that was basically it. This was before penicillin came on the market, and only one treatment.
It was known at the time that S. epidemicus survived in human tonsils. If the tonsils were removed, then the bacteria would have nowhere to go, and die off.
The workers were told that they needed to have their tonsils removed. The Director of the Milk commission describes the ultimatum they gave to the workers:
"care is taken in each case to impress upon them that the [tonsillectomy] procedure is not compulsory except that otherwise they must retire from employment at certified dairies"
Unsurprisingly, all but sixteen of the infected employees went through procedure. The remainder either refused to go through with it, or were denied on the basis of underlying health issues. They were forced out, and any dairy in the area was given their details to prevent them applying for another job. When some of them they did try to find work at other dairies, they were swabbed to test whether they still carried the bacterium. In all of the cases, they were still found to be infected. As long as they carried S. epidemicus, they were blacklisted from the industry. It was a cruel situation for the workers, but it's hard to see how else it could have turned out.
Would you send your kid to a school where teacher constantly infects their students with life threatening illness ? Or buy groceries from a man with chronic diarrhoea? have a meal made by Typhoid Mary?
I'm telling you this story because usually when people talk about a world without antibiotics, I often see potential casualty reports trotted out, all of the surgeries we will no longer be able to perform, diseases that will go untreated. What you don't often hear about is how the rise of antibiotic resistance will change way our society works. How we'll consume food, how we'll find jobs and even how we decide to relate to each-other will be afflicted. None of those sixteen workers didn't even show any symptoms. You don't have to be ill for bacteria to ruin your life.
Bonynge C.W. (1934). Solution of the Streptococcus Carrier Problem *†, American Journal of Public Health and the Nations Health, 24 (10) 1031-1034. DOI: 10.2105/AJPH.24.10.1031

*Streptococcus epidemicus is a defunct classification that tends to refer to what would be called S. zooepidemicus these days.

Reference

- I originally blogged this article at my personal blog, where I write about microbiology. Follow me on twitter @defectivebrayne.