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


War’s Therapeutic History


Florence Nightingale tending the sick and wounded during the Crimean War. Lithograph E. Walker; Day & Son. Located in the Library of Congress. Copyright expired.

By A. G. Moore

It is ironic that throughout history, war has been an effective laboratory for creating advances in medicine. Human beings are the raw material of war. Injured humans, sick humans, cannot carry out the mission of their masters. They cannot win victories if they perish from wounds, or struggle with illness. It is in the interest of nations and the leaders of nations to protect soldiers. And thus, history shows, war has been the environment in which medical innovation and discovery has often occurred.

Of course, there have been idealists who labored, in war and peace, to improve medical care. No slight is here intended to these heroes. I am in awe of often unacknowledged and anonymous benefactors who give their lives to save the lives of others. But even in these instances, it has often been the case  that the work of the idealist is sponsored and supported by a less altruistic actor.

For example, Florence Nightingale traveled to the Crimea in the midst of a terrible war because she wanted to save lives. No one has ever been able to impugn the motives of this great nurse and medical innovator. Her actions saved not only British soldiers but countless soldiers of all nationalities who fought in successive wars.

As is typical of medical innovation prompted by warfare, Florence Nightingale’s insight and reforms also extended to civilian populations. She began a revolution in sanitation and nursing that has benefited every generation, civilian and military, across the world.

Not only did Florence Nightingale improve nursing and hospital practices, she also inspired a transformation in battlefield ethics. Because of her example and advice, the concept of neutrality for professional medical personnel evolved as a modern concept in warfare. The Geneva Conventions, which cemented this concept in international law, were a legacy of Florence Nightingale’s influence.

However, without the Crimean War, and without the English Crown’s need for healthy soldiers to carry on in battle, Florence Nightingale might never have gone to the Crimea. The English Crown was in crisis because of the appalling number of deaths suffered by its soldiers in the Crimea. This crisis threatened to deny the English a victory in the Crimean War.

Florence Nightingale became an angel to suffering soldiers in the Crimea and a savior to the English war effort. She became a popular figure to families in Britain whose loved ones were saved and she became a national hero because of her contribution to the war effort. Queen Victoria personally awarded Florence a unique medal, The Nightingale Jewel, in commemoration of her extraordinary service.

Medical innovation in wartime did not not begin or end with Florence Nightingale. In the ancient world, Greek, Egyptian and Indian doctors traveled to battlefields to treat the wounded. Improved surgical techniques were the result.

In more modern times, Jonas Salk worked on an influenza vaccine at the behest of the US government during WWII. It was the successful development of a flu vaccine that helped Salk to understand the direction to take in his research on a polio vaccine.

The carnage of war throughout history has been a prompt for development of therapeutic medicine. This is an opportunistic result: the attention and energies of great powers focus on medical care at these critical junctures because of battlefield imperatives. A true advance would be for state leaders to see the urgency of focusing on medical care in peacetime, when the needs of civilian populations are front and center. This would represent not only a revolution in medical science but also a essential evolution in the human condition.

Fostering Curiosity in the Student

eclipse for site

Jonas Salk once said, in explaining his success, “I was curious...” (http://www.achievement.org/autodoc/page/sal0int-1).

In the history of human endeavor it is certainly true that more has been learned from questions raised than from answers given. The tension between theories of education seems always to come down to “traditionalists”, who believe children can learn best in formal environments, and “reformers”, who believe learning flourishes best in an environment where curiosity and imagination are encouraged.

Jonas Salk may have benefited from formal education, but he also came upon his interest in science informally. It was curiosity and a desire to help people that led him to medicine. It was curiosity that led him to investigate the link between the influenza and polio viruses.

Maria Montessori, Rabindranath Tagore, Marie Curie–even Albert Einstein  did not find a comfortable fit between inquiry and rigid learning routines. Each of these individuals was well educated, in the sense that they had access to a body of information. Each, however, forged new paths, offered new ideas, because they diverged from an established body of knowledge and explored.

The spirit of intellectual exploration cannot flourish in an environment which insists there is only one path to knowledge. This insistence imposes on the student the limitations of the teacher. A future based on the limitations of the past is no future at all.