A Look Back at Vaccines

Mary Wortley Montague public domain

As various strains of the flu claim lives this week, I take a look back at a time before vaccines, when people tried to protect themselves from deadly epidemics with desperate measures.  The passage below is an excerpt from my book, Jonas Salk: The Battle Against Polio.  The passage refers not to polio, but to smallpox.  The idea of induced immunity took hold among some.  Variolation–deliberately infecting the healthy with smallpox–was one early practice.  A diplomat’s wife, Lady Mary Wortley, introduced the practice to Europe.

Lady Wortley’s practice was not that far removed from the development of the polio vaccine.  In the twentieth century, two varieties became available.  One, the Salk vaccine, introduced a killed virus into a healthy person.  The other, the Sabin vaccine, introduced a weakened, live virus.  Each of these vaccines carried risks, though the risks were not as great as they had been with variolation.

  What follows is a brief description of Lady Mary Wortley’s experience with variolation.

In 1716 Lady Mary Wortley Montagu accompanied her husband, Edward, to Istanbul, where he became Ambassador to the Ottoman Empire. In Istanbul Lady learned about variolation. Lady Mary’s brother had died from smallpox and she had survived the disease. Although little was understood about smallpox, one thing was certain: once people survived the disease, they would never catch it again. This was the wisdom behind variolation.

The Ottomans dealt with smallpox by taking a small bit of dried material from the scab of someone who was infected with a mild case of the disease. The dried material would be blown into the nostrils of a healthy person. The idea was to make the healthy person come down with a mild case of smallpox and gain immunity from the disease for life. This was the Ottoman version of variolation.

When Lady Mary brought the practice to Europe, it was a little different. In Europe, material would be scraped from a smallpox scab on someone who was actively suffering from the disease. This material would then be scraped into the skin of a healthy person. That person, it was hoped, would come down with a mild form of smallpox, survive, and then have immunity for life.

Variolation was widely used, especially among the powerful. Though many did not trust the procedure, it was the only way to induce immunity from smallpox until Edward Jenner discovered a vaccine. Variolation was largely abandoned after Jenner’s vaccine because it was possible to come down with severe cases of smallpox as a result of the procedure. There were deaths from variolation.

A. G. Moore

February 5, 2018


Bellevue Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital: Book Review

By David Oshinsky

In 2016, a Johns Hopkins safety review panel reported that every year, 250,000 deaths in the United States are attributable to medical error. That’s a whopping 9.5% of all deaths in the country. As eye-opening as this statistic may be, it pales in comparison to deaths attributable to medical misadventure in previous centuries. According to David Oshinsky, author of Bellevue, eighteenth and nineteenth century medical treatment was as likely to be the cause of death as it was to save life. The evolution of medical care from that dark age occurred in fits and starts. Dr. Oshinsky offers a gripping description of the journey from darkness to the relative enlightenment of today.

This author skillfully blends medical and social history. He demonstrates the knack of a skilled teacher as he weaves anecdotes into a narrative of hard facts. Dr. Oshinsky has so much information at hand, that he doesn’t need to resort to conjecture to enliven his story. Truth, he proves, is indeed stronger than fiction.

Examples of Dr. Oshinsky’s dynamic writing are on display throughout the book, most memorably in his descriptions of surgery without anesthesia and treatment without antiseptics. In the first case, a boy’s leg is amputated. The father is present and aids in restraining his son. The sound of a saw fills the surgical theater as the child, without benefit of anesthesia, loses his leg. Shrieks fill the room. The father faints. We, the readers, are left with an indelible impression.

In another instance, President James Garfield suffers the consequences of medical obstinacy. The President is shot. An assassin’s bullet must be removed. The esteemed Dr. Frank Hamilton of Bellevue is called in. He, confident in his skills, declines to follow new guidelines in medicine that prescribe sterilization before contact with a patient. Garfield dies, month later, of massive infection. It is the medical consensus that this death was due not to an assassin’s bullet but to medical misadventure.

Dr. Oshinsky comes to the task of writing his book with excellent credentials. He is a professor of history at New York University and the director of Medical Humanities at NYU Langone Medical Center. In addition, he has won a Pulitzer Prize for an earlier book, Polio: An American Story.

The current book, Bellevue, is about the history of a public institution, and it is more. It traces the history of health care in New York City. It introduces readers to some giants of modern medicine, including Robert Koch, Joseph Lister and Florence Nightingale. The author’s broad perspective offers insight into the immigrant experience and its intersection with New York City politics. Dr. Oshinsky’s wide lens creates a richly textured tableau in which Bellevue Hospital is the focal point.

Bellevue is an easy read. I recommend it to anyone interested in history, and to those readers who would like to gain insight into the culture of the medical profession.

By A. G. Moore 2/10/17

The picture of Bellevue Hospital (above) is used under a Creative Commons
 4.0 International License

Growing the Brain

In a previous blog I described a study that suggested creative activity encourages brain growth. Yesterday Nature Magazine published the results of another study that looked at brain development. This one linked income level to infant brain size.

Carried out by two researchers, Kimberly Noble from Columbia University and Elizabeth Sowell from LA’s Children’s Hospital, the study showed that infants from lower income families suffer a reduction in brain size. The implications of this study are that income disparity may have life-long, potentially irreversible consequences for children. These consequences go beyond the obvious disadvantage of diminished opportunity.  Even if at some point opportunity is equalized, children from low income homes may never be able to optimally exploit it.

Most of us are familiar with the nature/nurture debate.  Essentially, this discussion weighs the influence of environmental factors such as parenting, neighborhood and schooling against inherited traits. The Nobel/Sowell study, if it holds up, invalidates the debate. According to the study, nature is not a fixed element that can be juxtaposed against environment; it is a function of environment.

The observed effect of income level on brain size is so marked that even within lower income groups, variations of a few thousand dollars result in brain size disparity. If confirmed, the results of the Nobel/Sowell study ought to have a profound effect on the political dialogue that centers on economic equity.

Of thirty-three OECD countries,Chile, Mexico, Turkey, the United States and Israel were the five with the greatest income inequality.  That inequality may translate into millions of lifetimes of relative disadvantage.  Expand the focus of the results globally and a vast population, much of the world in fact, suffers that relative disadvantage.

It is true that we all want our children to maximize the potential with which nature has endowed them. But what if that potential is not fixed by nature? What if potential is at least partly a man-made artifact, a consequence of political and economic policies that perpetuate income inequality?

The authors of the Children’s Hospital/Columbia study are careful to explain that they don’t know exactly which factors influence brain size in infants.  The researchers guess the factors might be the usual suspects: nutrition, exposure to toxins, poor social stimulation. They suggest that tinkering with manageable factors during gestation and afterwards might have a beneficial influence.

However, it seems to me that the researchers pull back from the obvious remedy: close the income gap. This prescription, though obvious, is one that many people will find ideologically unpalatable.  Whenever wealth distribution is discussed there’s inevitably talk about freedom and choice. Which begs the question, what choice is given to an infant who lies in a crib with a destiny diminished by low income? What freedom does that infant have to forge a successful future?

Of course, there’s a larger issue than the individual tragedy of lost potential.  There’s the societal cost.  Children with less potential become adults who are less able. That is not in anyone’s interest, no matter their income level.

brain development
Credit for this image goes to Van Essen Lab(Washington University in St. Louis), in collaboration with Terrie Inder, Jeff Neil, Jason Hill, and others. http://brainvis.wustl.edu/wiki/index.php/Main_Page The image illustrates human cortical development through gestation and into adulthood.