Monday, 25 August 2014

Infection: the Car Crash Killer of the Past

One of the aspects of writing historical fiction is showing how things have changed and how some things never do.  This month I planned to write purely about infection in a world without antibiotics and a full understanding of how infection spreads; i.e. the past.  As I composed this blog it expanded as I thought more about what was the biggest killer in the past and how it affected people.

I try to get things right when writing historical fiction, though I always focus on story first.  Clothes, tools and the environment are a starting point.  I'll admit, I tend to abandon the language because if the reader was experiencing the time and place like a native, it wouldn't feel strange or out of place, though I do try to avoid modern idioms.  Attitudes I keep, and that had me thinking:  what was the common killer and how does it affect people's thinking?

Antibiotics have been around for approximately a century.  That's almost three generations where infections, on the whole, have gone from stalking death to something a handful of pills can deal with - most of the time.

Today in the UK about 37,000 people a year die of sepsis.  That's in a population of roughly 60 million.  In the USA it's 700,000 infected with up to half dying in a population of approximately 300 million.  Until antibiotics came along the proportion of deaths was much larger.  Infection, coupled with diseases like cholera, was the biggest killer unlike today, where in the 'West' it is cancer and heart disease.

Until World War Two and the arrival of antibiotics, in almost all conflicts, more soldiers died of infection than from direct action.  There is a lot of concern about the reduction in antibiotic effectiveness and what would happen in our modern world without them; however, it mustn't be forgotten today there is a much better understanding of what infections are.  It gives us possible methods to beat them if this powerful tool is lost.  And of course, there is a massive pharmaceutical industry busying itself on solving the problem, for profit, but solving the problem all the same.

Our ancestors chance of surviving what we arrogantly call simple infections was much reduced.  Their understanding was limited, their weapons against the danger even more so.

I wanted to flag up death through infection as an effect on people and their attitudes.  Common causes of death over time change. Today the motor car kills more than war and terrorists combined, yet international murder gets the headlines.  Throw in all gun-crime and the car is still ahead in the life-ending.  Before the car, it was infection, grinding away at our numbers.

Think about infection and then think about your attitude toward cancer, heart attacks and road accidents.

Infection and Disease

Antibiotics are fantastic, they have saved millions of lives, but before them a simple scratch, a throat infection or an insect bite could kill  and people knew it.  Here's two famous people who died that way:

In 1799 George Washington had a sore throat aggravated by cold weather and getting soaked while out working.  That's another historical thing to note:  poor wet weather gear.  The infection, with no effective treatment, grew worse until taking the life of the great man.

In 1923 The Fifth Earl of Carnarvon, sponsor of the expedition that discovered Tutankhamen's Tomb, died from an infected insect bite.  Forget about the curse cobblers, with nothing to halt an infected wound,  he hadn't a hope.

What killed them we would hardly worry about in the modern world.

There used to be sepsis wards where the infected were kept isolated, tended to as best the medical staff could, but it was up to the poor sufferer's body to win or lose the battle for life.


When you think of King Henry VIII of England, which wife do you think of?  Is it Jane Seymour?  She was dead at twenty-eight years old, not by her husband's hand, but weeks after her first child was born.

It fits with the misconception that childbirth was the biggest killer of women until modern medicine started to turn the tide.  It's not that simple.  It's obvious many of the crises and traumas of childbirth were beyond the medicos of history; however, statistically it wasn't the biggest killer, infection was, but it played on the mind of every woman, probably many fathers-to-be too.

In The Tudor Housewife by Alison Sim there is an extract of a letter from a Lady Cornwallis to a friend.  She is expecting a baby and is terrified.  It's her fourth child; so it's no new mother-to-be's fear.  She's like a soldier going back to the front line.  She knows the risks and there is nothing she can do, but face them.  If you're writing a story of a happy couple expecting their first child it should be twinged with more anxiety than today.

Infection and diseases were big killers and even poor Jane Seymour probably died from an infection than the giving birth itself.  Childbirth made the mother more vulnerable to the risks about at the time.  Compared with everything else that could kill, childbirth was relatively rare even in the past - or there wouldn't be so many of us about now - though it was at the forefront of women's minds.  Ms Sim has a good theory, that since all the women of a household would attend a woman in labour it meant one terrible death would be witnessed by many.  This plays out for infection in general, there were few hospitals, at least that the ordinary soul could afford, and so death would be in the home, witnessed by all.

I like to think about attitudes, a good example is the midwife.  Sometimes a professional, sometimes a woman with a reputation for success.  In most past cultures where women received little respect or power, a midwife would be different.  Imagine a pompous male physician, with little time for folk remedies or amateur meddlers, especially women.  When it's his wife that is expecting, no matter what her social status, the best midwife in the area will be with her when the time comes.  Imagine the irony of a supposedly educated man deferring to Old Mother whoever, who can barely make her mark.

One of my great grandmothers was such a woman.  Without a medical certificate to her name,  her reputation was all she needed.  She turned down an offer of employment from the local doctor because of a fear she would have to charge for her services and thus price the poor out of the help they needed.

In middle ages Europe midwives were allowed to baptise children if they thought they wouldn't survive, so as not to suffer a death outside the Church.  Now there's power to the notionally powerless especially if you think about how many organised religions of the time liked to keep its power in male hands.

Flesh Wounds

There is no such thing as a 'flesh wound'.  Think about this the next time you get a paper cut and how much it hurts.  Then imagine the savage slash of a blade opening muscle or a bullet doing the same.

I love action movies, especially the 1980's and 1990's ones.  The heroes getting progressively cut, battered and bruised as he - and it is nearly always a he - battles apparently insurmountable odds.  Trouble is, I've seen historical versions and there's the catch.  One scratch could kill you, a bit of fabric trapped in a wound would go septic.  Your square-jawed hero could save the day, only to die a week later in a fever with puss pouring from what had been a simple cut.

If you are writing a historical tale, it's worth studying a bit of medicine and the medical theory of the time.  for poor George Washington, the physicians thought bleeding would remove the poison, where of course it weakened him further.


Our ancestors didn't die with every paper cut, wood splinter or sword blow.  Alexander the Great received eight notable injuries.  Lapham's Quarterly has a good diagram here of the locations of the wounds.  These didn't kill him.  I once read (sorry, can't remember the book) about a soldier from the War of the Roses who took a sword blow to the face.  He survived and someone rebuilt his features as best they could.  That is re-constructive surgery from five hundred years ago.  

Folk remedies too,  based on generations of experience saved lives; for example:  the importance of a clean wound and the efficacy of salt, were well known.

In Ian Mortimer's book The Time Traveller's Guide to Medieval England: A Handbook for Visitors to the Fourteenth Century, he reminds us that as time travellers we'd meet many people with limps, deformed arms or other disfigurements.  People did get injured, but they got better too.  Elizabeth the First of England was scared with smallpox.  That was a big killer of the time, but she survived, as many did.

When writing about the past remember the car crash killer is infection grinding away, poorly understood, but battled all the same.  It would be thought about like cancer and heart attacks are today and finally the power to heal can give rights to those who often have none.

Useful Books
The Tudor Housewife by Alison Sim.

The Time Traveller's Guide to Medieval England: A Handbook for Visitors to the Fourteenth Century by Ian Mortimer

Useful Links

Eye Witness to the Death of George Washington - An eye witness account of the First US Presidents final days.

The 5th Earl of Carnarvon's Death - A letter in the Lancet giving the details of the Earl's infection and death.

Sepsis: Antibiotics 'not working'  - A recent article about the current state of sepsis in health care.

A Historical Perspective on Sepsis - this paper says over 700,000 people in the USA get sepsis annually, up to half die.

Monday, 11 August 2014

‘You Write On’ Online Review Exchange Site

Getting unbiased reviews of your writing is vital to improve as a writer.  Local writers' groups are a good option.  If you are holding down a day-job like mine, evenings are for recovering for the next round of bread-winning not for nipping out to the local school or library.  I looked for something where I could use the time (and energy) I had, when I had it.

I like to think of myself as a SF writer and there are dedicated review sites like available.  I’m also a member of the +British Science Fiction Association  and they have the brilliant Orbiter group; however, I am utterly off-genre at the moment and I didn’t want to trouble the SF community.

I found and decided to investigate.

Reviewing the Review Site is a community criticism website, where members review each other's work.  It is non-genre specific, and whereas the main aim is the same for all these groups; that is: to improve members' writing, it runs this process as a rolling competition with Top Ten Charts and the carrot of high achievers having their work presented to professional editors.

Its home page mentions top performing authors and pushes the possibility of six figure book deals.  This created a sense of unease for me.  Another concern is that the site owners offer publishing services.  This smelt a bit like vanity publishing.

Despite the concerns, I decided to give it a go.  I joined in late 2012 to judge the site before submitting my own work in January 2013.

The site works on Reading Credits earned by reviewing other members' submissions through Reading Assignments.  Asking for an assignment leads to a randomly allocated piece of work (short story or novel extract) to review.  An assignment must be completed within four days to earn a credit.  Up to six assignments a day can be requested.

Once earned, Reading Credits are then attached to the writing to be reviewed. A member can have several pieces of work under review if they wish.  If a Reading Assignment is completed within two days it increases the rate at which your writing is reviewed, thus rewarding more active members.

Users can only see their reviews after four have been completed and after eight the work enters the charts.  If you end up in the top ten for that month you get the professional critique.

If you are in the top ten, then you have to keep earning a credit every week to stay there.  There are limits to prevent the same work hogging all the professional reviews, which are explained in detail on the site.
If a submission gets into the top ten and stays there for more than 25 days it is then listed in the best-seller chart where it gets more attention.

Apart from the overall Top Ten, there are ones broken down by genre whether this increases professional access or simply helps genre-fans pick out their own niche more easily is unclear.

Initially, I reviewed other people’s samples without submitting my own.  This is probably as close as any non-professional gets to dealing with the slush pile.  The standard of work is variable.  Out of the twenty or so pieces reviewed two thirds were readable, the remaining third felt like first drafts with only two being truly unreadable.  There have been chick ‘lit’ entries, a few psychological thrillers, some YA work, a couple of supernatural fantasies and one hard science fiction tale.  Assignments can be turned down without penalty.  You can turn down an assignment.  The only one I have was a Fifty Shades of Grey clone.

Reviewing has been the most difficult part.  It is hard to be constructive rather than critical and avoiding the pat advice, although ‘show don’t tell’ and ‘read it aloud’ is sometimes all that can be said.

What others have said on the same submission is hidden from view while you are reviewing it.  You can look at them afterwards.  Usually reviewers spot the same weaknesses and strengths.  Only once have I given a poor review to discover everyone else loved it.

Reviews must be 100 words or more.  To prevent users maximising reading credits by accepting everything and not reviewing the work, there is a reading test before a review can be submitted.
Once I was comfortable with the process I uploaded the first 5,000 words of my novel.  The limits are 5,000 to 7,000 words for novels and 2,000 to 5,000 words for short stories.

Reviews appeared roughly every two to three days.  All were honest and helpful leading me to rewrite my submission and achieve more positive reviews.  I have also worked through my novel and dumped 10,000 unnecessary words.

I did watch my chart position – fairly steady in the low twenties – and I did get twinges as it rose and fell, but the reviews mattered to me more.  I am still concerned about the competitive element because human nature tends to make people play the competition instead of the objective.  Every five reviews a one can be deleted.  The system automatically highlights the lowest rating review and the temptation is to zap it and rise a little higher in the charts.

Chart position appears to be very sensitive.  After a two week break caused by life in general, my position plummeted to 60th position from 25.  It returned to the teens once a new review had been earned.  I could imagine people watching their chart position and getting emotional about slipping down the order, loathing anyone who dared score them low.  I wonder what the top-ten-achiever thought of my negative comments of their popular prose.

Am I aiming to achieve a top ten spot?  No. I feel whatever the pros will tell me, I have already heard from dozens of ordinary readers, though I never turned down advice (listening to it is another matter).

Would I recommend it?  

Yes, with the proviso that you ignore the competition element.  Accept the reviews, don’t take them personally and do not look at your chart position.

The reviews were helpful and I was free to review and submit when I had time and didn’t feel like I letting anyone down if I couldn't.

Use it as a review site, be open, be honest and it will help you improve your writing.

Useful Links – the review site I’ve been talking about. – the science fiction/fantasy and Horror Workshop/critique group.  If you're thoroughly genre, it’s worth taking a look. – British Science Fiction Association.  If you're a SF fan join this and you won't regret it.  If you do regret it, I'm sorry, I must have been talking to someone else.

Update December 2014

You Write is changing their approach slightly.  I received an email explaining this, which I have reproduced the relevant parts below.

 YouWriteOn changes 2015: Apart from January 1st 2015, in which the top ten revealed that day will receive professional critiques as normal, the site will change as outlined below to have Development Periods and Competition Periods. Development Periods, as outlined below, are where members are not competing for professional critiques, with an aim of members exchanging peer reviews to develop their writing in a non-competitive environment. Competition Periods, as outlined below, are where the highest rated stories receive feedback from leading publishers such as Random House and Orion. The aim is to alternate development periods where members concentrate solely on developing their writing with competition periods.

How YouWriteOn works 2015 - Development Periods and Competition Periods

Development Months: During January to March each year and July to September all members provide feedback to each other so that collective feedback helps story development. The results for each month are displayed on the 1st of the month that follows, e.g. January’s results are displayed on 1st February. The development months above are solely feedback by members to members without feedback from Random House or Orion or other publishers on the 1st of the month that follows them.

Editorial Critique Competition Months April to June inclusive, and October to December inclusive, are competition months with the Top Ten from May 1st, June 1st, July 1st read by Random House, Orion or other editors who will provide Editor critiques to the ten authors from the thirty they consider have the most promise. Similarly, the Top Ten from November 1st, December 1st, January 1st are read by Random House or Orion who will provide Editor critiques to the ten authors from the thirty they consider have the most promise. For each ten that receive critiques, the top three from each ten will receive a longer critique, and the remaining seven mini-reviews, from editors from publishers such as Random House and Orion.

The aim is to alternate development periods where members concentrate solely on developing their writing with competition periods as outlined above.