World Immunization Week began yesterday, on the 21st of April and I wanted to take a moment to reflect on how grateful I am that immunization exists. I’ve written about this before…With every shot my son gets, I breathe a little sigh of relief only to hold my breath again when I read about outbreaks of measles and pertussis.
It’s a good thing we couldn’t get tickets to the Euro 2012. Or the Superbowl. And here I thought that it was all the sitting around drinking beer and eating pigs’ ears processed into elongated tube shapes that was the chief hazard to your health.
When I mentioned that it was World Immunization Week to TAF, he asked me about the history of immunization. All I knew was the old story about Jenner inoculating a young lad with stuff from a woman infected with cowpox. Yes, that was the depth of my knowledge. “Stuff from a woman infected with cowpox.” Stuff. I’m not sure “stuff” is found in my medical dictionary.
Smallpox was a horrible disease. It killed somewhere between 20-60% of infected adults and 80-98% of children and blinded 1/3 of survivors. I can imagine the terror people felt when the disease came to their community. The chill that might grab you in the marketplace when you saw a pustule…is it? or is it just a blemish? I suppose if you could, you would leave town. The rich would probably do what they did when any plague came – decamp to the relative isolation and safety of their country houses. The poor would just die.
I didn’t know this before, but long before Jenner, people practiced “inoculation” or “variolation.” Essentially, you would pay someone to take fresh pustular innards and jab them into your arm or leg with a sharp object. This would give you, hopefully, a mild form of the illness and not fulminant smallpox. After the New World was discovered, you would hope to not be gifted with a bonus of Treponema pallidum spirochetes (syphilis) at the same time.
It was the continued advocacy of the English aristocrat Lady Mary Wortley Montague (Figure (Figure22) that was responsible for the introduction of variolation in England (10). In 1715, Lady Montague suffered from an episode of smallpox, which severely disfigured her beautiful face. Her 20-year-old brother died of the illness 18 months later. In 1717, Lady Montague’s husband, Edward Wortley Montague, was appointed ambassador to the Sublime Porte. A few weeks after their arrival in Istanbul, Lady Montague wrote to her friend about the method of variolation used at the Ottoman court. Lady Montague was so determined to prevent the ravages of smallpox that she ordered the embassy surgeon, Charles Maitland, to inoculate her 5-year-old son. The inoculation procedure was performed in March 1718. Upon their return to London in April 1721, Lady Montague had Charles Maitland inoculate her 4-year-old daughter in the presence of physicians of the royal court.
Don’t you just love how that paragraph implies she was motivated equally by her disfigurement and her brother’s death? I believe no such thing. I believe she was terrified. You would have to be. What, short of terror, would motivate you to have your son pierced by a lance covered with pus from someone who might that very moment be dying or becoming blind from smallpox?
Charles Maitland was then granted the royal license to perform a trial of variolation on six prisoners in Newgate on August 9, 1721. The prisoners were granted the king’s favor if they submitted to this experiment. Several court physicians, members of the Royal Society, and members of the College of Physicians observed the trial. All prisoners survived the experiment, and those exposed to smallpox later proved to be immune. In the months following this very first trial, Maitland repeated the experiment on orphaned children, again with success. Finally, on April 17, 1722, Maitland successfully treated the two daughters of the Princess of Wales. Not surprisingly, the procedure gained general acceptance after this last success.
There is a long and sordid history in medicine of experimenting on the powerless and disadvantaged. I remind myself of that fact every time I am even slightly frustrated with the research ethics boards at my hospital and university. Some things, however, haven’t changed. Back then, like today, ordinary people seemed to be extraordinarily influenced by celebrity behaviour. I really hope Snooki vaccinates her baby.
Then I learned that we might have variolation to thank for gifting Canada with mandatory french classes in school, poutine and Trudeau…amongst other things:
In 1766, American soldiers under George Washington were unable to take Quebec from the British troops, apparently because of a smallpox epidemic that significantly reduced the number of healthy troops (13). The British soldiers were all variolated.
I also learned that the anti-vaxx crowd has a long history of distorting fact to support their shaky argument. Before Jenner conducted his immunization experiments, he dabbled in a bit of field biology:
Jenner conducted a particular study of the cuckoo. The final version of Jenner’s paper was published in 1788 and included the original observation that it is the cuckoo hatchling that evicts the eggs and chicks of the foster parents from the nest. For this remarkable work, Jenner was elected a fellow of the Royal Society. However, many naturalists in England dismissed his work as pure nonsense. For more than a century, antivaccinationists used the supposed defects of the cuckoo study to cast doubt on Jenner’s other work.
Even though Jenner didn’t come up with the centuries old idea of inoculation or vaccination himself, he is widely credited with the discovery. It seems he was a bit of a renaissance man, and if he suffered from a lack of originality when he carried out his first inoculations, he more than made up for it with charisma:
…he enjoyed substantial success, for he was capable, skillful, and popular. In addition to the practice of medicine, he joined two local medical groups for the promotion of medical knowledge and continued to write occasional medical papers. He also played the violin in a musical club and wrote light verse and poetry.
When he wasn’t distracted by his other interests:
he continued to make many observations on birds and the hibernation of hedgehogs…
In May of 1796, Jenner inoculated a young boy, James Phipps, with material from a dairy maid, Sarah Nelms, who had fresh cowpox pustules. One wonders what he told James’ mother. James got sick…then he got better and when Jenner re-inoculated him with smallpox, nothing happened. The Royal Society promptly rejected the paper he submitted on his experiment…I bet it wasn’t because of the lack of informed consent. Maybe they were hoping for more material on the hibernation of hedgehogs.
However, eventually people were convinced. In fact, the practice spread so quickly and was so well received that by 1800, a mere 4 years after Jenner first inoculated young James, Thomas Jefferson, an entire ocean away, had created the National Vaccine Institute to set up a national vaccination program in the United States.
Some vaccine rejectionists like to cry that vaccination is simply a tool to make money off of ignorant dupes like you and me…but Jenner didn’t think so. He endured ridicule and personal attacks. He built a shed in his back yard where he vaccinated the poor for free. He never tried to monetize his discovery. The British Parliament voted to give Jenner £10 000 and then a further £20 000 five years later. Seems a pretty cheap price to pay for the tool that would eventually eradicate an entire disease from the planet.
No word on what Jenner did with the money.
Riedel, S. Edward Jenner and the history of smallpox and vaccination. Proc (Bayl Univ Med Cent). 2005 January; 18(1): 21–25