The human immune system
In the wake of the coronovirus, there is a lot of discussion about the human body’s immune system. The immune system or immunity is the human body’s strong in-built defence mechanism.This immune systemis a collection of cells and various organsthat work together to form the body’s defence system. The organs that play a key role in the immune system include the spleen, bone marrow, lymphatic system,etc. Together all of them manufacture cells such as white blood cells (WBCs), which are otherwise known as leucocytes, phagocytes, T lymphocytes, and B lymphocytes.
The B lymphocytes and T lymphocytesare manufactured in the bone marrow. Once they have been created, the lymphocyte cells may remain in the bone barrow and become B lymphocytes. Others go to the thymus gland, situated in the neck on the thyroid gland, where they undergo ‘commando’ trainingand become T lymphocytes. These T lymphocytes are known as killer cells. The B lymphocytes serve as the intelligence gathering arm of the immune system. They locate the invader, including ones that are new to the body, judge the kind of damage it can cause to the body, orders the soldier cells (T lymphocytes) to go to the site and kill the invader. The order is followed immediately and the antigen (something new to the body) is destroyed. The specially-formed force of antibodies remainson alert in case they are needed again. Thus whenever an antigen enters the body, the immune system uses a diversity of forces to counter the invasion.
In my opinion, most Ladakhis have a strong immune system. The reason I make this assumption is that till about two or three decades back, the lifestyle in Ladakh was rather tough and to an extent, unhygienic. We lived along with our livestock and often drank from the same water sources. The current drinking water supply system is relatively new. Children would play with sheep and goat, which we assumed would help them stay warm. Children would play in the streets through the day, while the adults worked in the fields or herded the livestock for grazing. Irrespective of everything else, very few people, be it an adult or a child, were in the habit of washing their hands. And when people did wash hands, it was generally with plain water as soap was a luxury.
In comparison, people in developed countries have been living in relatively sterile conditions. For instance, they would not be sharing drinking water with their livestock like we did till fairly recently. Even their cattle live in relatively sterilised conditions!
In January 2020, I visited Vietnam with my son. We crisscrossed the country from Hanoi in the north to Ho Chi Minh in the south and also visited other places like the Mekong river delta. We ate a lot of Vietnamesefoodacross the country including street food. Even the street food was so sterilised that I started to suspect that the immune system of the average Vietnamese must be relatively weak. We stayed in a good hotel where hygiene and cleanliness were a priority. Unfortunately, such living standards decrease the body’s immunity even if we would have inherited some generic immunity. However, that is a discussion for a different time and place.
There were no cases of coronavirus in Vietnam while we were there. However, as we reached India, coronavirus was starting to appear on the news. As a precaution, my son and I visited Sir Ganga Ram Hospital in New Delhi where many of my batch mates are practicing. There both of us were tested and checked and received a clean chit.
In Ladakh, till the recent past, most of us were economically impoverished and lacked various facilities, clothes, food, warm living facilities, access to medical facilities etc. Most of us relied on traditional medicinal practitioners like the Amchi to cure various ailments. Despite this material poverty, people were eco-friendly and innovative.
At that time, small pox was the most horrifying communicable disease that a person could contract and many people died of it. Once someone contracted small pox, he or she would not be allowed to remain at home. They would be takento a designated place such as nearby cave or facility. They would remain here and be given food and water once or twice a day. Here they were left on the mercy of the gods like a wrecked ship in a storm. Amazingly, some patients did recover from this dreaded disease and would return to the village to rejoin normal life.
Infants and new-borns would generally be kept in hand-made half-open woollen bags called Tsemboo. Dried and powdered goat dung would be placed in the Tsemboo. A stone would be put in fire and when it was warm, it would be placed in the goat dung. Once the dung was warm, the stone would be removed and the baby would be placed in the Tsemboo. When a child would get a delicate bruise, we would apply fine goat powder where people today apply talcum powder. Infants were actually fed, if not intentionally, very small quantities of tetanus and gas gangrene. Both of these are deadly diseases that are caused by various Clostridium sp bacteria. However, when a very miniscule amount of sub-clinical dose of the organism entered the body of a baby, it would trigger the immune system to manufacture counter measures against this antigen. This would provide a degree of immunity that would remain in the body for a lifetime.
At the time, pregnant women would work in the agricultural field, take livestock grazing in the mountains and perform all sorts of heavy tasks. There are stories of ladies giving birth in a field, in the mountains or wherever they were working when the labour pain started. The delivery would sometimes be done by the mother alone or with the help of other ladies if they were present at the time. The child would then be brought home in a Tsepo (a multipurpose traditional basket) with grass covering the baby. Once home, the mother would be allowed to rest and be fed nutritious food for the next few weeks. There were no medical facilities at the time and there are reports of some ladies losing their lives during childbirth.
In the past, the used powdered goat dung would be thrown in the field as form of manure. In contrast, we nowadays use disposal diapers. Unfortunately such diapers are expensive and harm the environment when they are disposed. It is rare to see someone wash and reuse cloths napkins nowadays. Furthermore, the use of powdered goat dung also helped prevent, or atleast reduced the incidence, of some deadly diseases.
As an ENT specialist, I have seen only one case of tetany and that was in a non-local labourer who had a minor injury on his finger on which he had applied soil. In another case about 20 years ago, there was a patient from Garkone who had a superficial head injury on which he had applied fresh cow dung. He died in Sonam Norboo Memorial Hospital in Leh.
I have seen horrible wounds on different body parts. Many of them were not cleaned while others had tried to apply a burning cloth piece on it or dung powder or soil. Many of these wounds would heal and only leave a scar. Once in the 1990s, a labourer came to me with a horrible wound on his foot. He had managed to hit his foot with a pick axe, which had cut through the shoe and made a deep cut through his foot. He insisted that I just do a dressing to stop the bleeding. He refused to allow me to give him an injection of T. Toxoid and also did not agree to take antibiotics and pain killers. He was confident that he had the mental and physical strength to recover. In fact, he did not return to change the wound dressing for several days. I was rather surprised but his wound healed but left an ugly scar that does not seem to bother him.
These are things we can continue discussing and studying. During this time of crisis, we must remain hopeful. Please don’t panic or get stressed as this will only suppress your immune system. All of us must adopt all the precautionary and preventive measures advised by medical science and directed by Government of India. Hopefully everything will be fine soon but we must remember this episode as a warning sign to correct our errant ways.
By Dr (Kacho) Akbar Khan.
Dr (Kacho) Akbar Khan is a retired Ear, Nose and Throat (ENT) specialist and is based in Kargil.