SIR ROBERT MUIR, SEPSIS AND SCOTTISH HEALTHCARE

Having been interested in the human blood system since his time in Edinburgh, it is no surprise that Muir writes about sepsis in his Textbook of Pathology. Sepsis is caused by an invasion of micro-organisms, bacterial or fungal, into the bloodstream, coupled with the host’s severe reaction against the causative agent. Sepsis is still a major healthcare challenge and the leading cause of death in intensive care units. An estimated 20-30 million patients are currently affected globally each year. It is important to note that sepsis is not one disease, but an umbrella term used to denote any life threatening bacterial invasion into the bloodstream and the ensuing enormous host response to this threat.

Sepsis is still a major healthcare problem, despite the 90 years since Muir wrote about it, but how has its epidemiology changed and how has our perspective on the disease altered with the rapid advances in science and medicine? 

In 1924, ninety patients in Scotland were diagnosed with, and died of sepsis. However, it is important to remember than in 1924, people were not living as long as they do now, and diagnosis would not have been as quick or accurate. In addition, 1924 being pre-World War II, there was no National Health Service, and therefore potentially limited standardisation of care and diagnosis across Scotland. Despite these caveats, by comparing the death statistics from 1924 and 2014, it is clear that the ages most affected by sepsis have altered considerably. In 1924, 26.7% of sepsis deaths were in infants less than a year old, the highest percentage in any one age-group; in 2014 no babies died of sepsis. It can be postulated that this is due to improved hygiene during birth, decreasing the risk of neonatal infection. 

In contrast, in 2014 the most deaths were in the over 85s, which is understandable, as these individuals have a reduced capacity to fight infection due to their age, and are also the population sector most likely to be cared for in intensive care. The overall percentage of death caused by sepsis has risen from 0.128% of all-cause mortality in Scotland in 1924 to 0.784% in 2014. Again, it can be speculated that this change is due to better diagnosis, the increased age of the population, and better healthcare allowing more people to live longer. Sepsis caused the death of more people in Scotland in 2014 than Human Immunodeficiency Virus (14 deaths), Tuberculosis (16 deaths) and Viral Hepatitis (21 deaths) combined. Sepsis caused the death of 425 people in Scotland in 2014. 

So sepsis is a major healthcare problem, which affects more people now than it did in Muir's time. But how have approaches to the illness changed and what are the major obstacles still precluding unilateral survival or prevention of sepsis?