If you learned in school as I did that Edward Jenner invented immunization, you learned wrong. If you use an extremely narrow definition he probably invented vaccination but I’ll get back to that later.
Immunization by exposure to diseased persons or disease “material” goes back at least a millennium and is probably much older. There are attestations that the Chinese practiced “variolation”, a process by which smallpox scabs were blown up the noses of persons to prevent them from contracting the disease from at least as early as 1000 AD. By the 16th century the practice was widespread in the Far East, in India, throughout the Ottoman Empire, and in adjacent parts of Africa. Only Europe and the New World’s European colonies lagged behind and there is evidence that African slaves practiced variolation before their American masters did.
In 1717 Lady Mary Wortley Montagu, the wife of Edward Wortley Montagu, the British Ambassador to the Ottoman Empire, learned of the practice in Constantinople. When there was an outbreak of smallpox in London in 1721 Lady Montagu and the Princess of Wales engaged in an experiment in which they inserted smallpox “material”, i.e. scabs or pus, under the skin of prisoners and abandoned children and then exposed them to individuals with the disease. None contracted smallpox so it was deemed safe. It sometimes seems that medicine progresses one atrocity at a time.
In reality the fatality rate from variolation was about 3% compared with a fatality rate from smallpox contracted naturally of from 14% to 30%.
Edward Jenner was himself variolated and suffered from health repercussions from the treatment for the rest of his life. Jenner, apprenticed to a surgeon at 13, had noticed that milkmaids rarely contracted smallpox but frequently presented themselves for treatment for a similar but milder disease called “cowpox”. Farmers told him that cowpox prevented smallpox. In 1796 he inserted pus taken from a milkmaid’s cowpox lesion under the skin of his gardener’s young son and then exposed him to smallpox. He did not contract the disease. The material was called “vaccine” and the process by which it was administered “vaccination”, ultimately from the Latin, vacca, “cow”.
Vaccination proved so successful that it quickly spread through Europe and its colonies. In 1840 the British government banned variolation which had itself been known to produce smallpox outbreaks and made vaccination mandatory and free of charge.
In the 1870s Louis Pasteur, in working on chicken cholera, discovered that weakened versions of the pathogens worked as well as the fresh, live ones in producing immunization. Nowadays “killed” vaccines are much common than live ones. Pasteur developed vaccines for chicken cholera, rabies, and anthrax, just to name a few. He earned the enmity of physicians by a) being a chemist a b) urging them to wash their hands, something that remains a problem today.
Jonas Salk famously developed a vaccine for polio in 1954.
Today there are vaccines for hundreds of different diseases. When I was a kid vaccinations for diphtheria, tetanus, pertussis, and smallpox were compulsory. When I was in school the polio vaccine, too, became compulsory. I knew kids who had polio, something not nearly so common today and there’s little doubt that the successful vaccine is the explanation.
In Illinois today not only are the vaccines I was required to take required but also vaccines that weren’t available when I was a kid—measles, rubella, mumps, haemophilus influenzae type b, hepatitis type b, and chicken pox—are compulsory.
Immunization has never been without risks and has always been the subject of controversy. Recently, opposition to vaccination, popularized by celebrities, has probably resulted in new outbreaks of pertussis. I attribute it to ignorance of history, science and, particularly, statistics.
Note: in doing the research for this post I learned that in the 15th century medical treatises occasionally took the form of epic poems. Those were the days!
Speaking of things health, I thought I’d share this. About a week and a half ago, I must have pushed too much weight in the gym because my back was acting up. That passed in a day or two, but I then did some moderately strenuous work in my back yard and that seems to have triggered a case of sciatica (something I’ve not had before and no doubt connected with the stressed back). Pretty damn painful in my right hip and leg. Well, sciatica is generally thought to be some kind of inflammation, so onto ibuprofen. However, while the ibuprofen might be doing something for the inflammation, it does zip for the pain. And the pain can be pretty bad. What I’ve discovered is that with a couple of cups of coffee, the pain greatly attenuates — it doesn’t completely disappear, but I can sleep and move around now. Looking around the web, I saw many articles about the dangers of caffeine and sciatica. These articles are, for the most part, written by health food zealots who remind me of the anti-smoking crusaders of yore in The Reader’s Digest. I did find one article that supports the coffee-as-anodyne position. I don’t know if it will work for everyone, but it works for me. If you should be unfortunate enough to be afflicted with sciatica, give the coffee therapy a try. I’m still taking ibuprofen for the inflammation.
Acupuncture is also helpful for relieving sciatica pain.
I think I’ve told my acupuncture story before but I may as well repeat it. Back when I was first trying to manage my pain issues and after I tried a succession of physicians who succeeded in moderating my pain by doping me into semi-consciousness, at one point I went to a group alternative medicine practice that consisted of a couple of MDs and a variety of other therapists. The MD suggested I see the acupuncturist and I did so, once a week, over the period of about a year.
I have no doubt that the acupuncturist was highly skilled but nearly every time I went he hit a nerve with one of his needles, generally remarking “That’s not supposed to happen.” All in all it was pretty successful in producing pain, not much for alleviating it.
I’m not claiming that’s everybody’s experience. Just mine. As the endodontist I saw recently put it “You really respond differently.”
I’ve had very different acupuncture experiences than you, Dave. For one thing, not every acupuncturist is skilled in their profession — much like western MD’s, in which it’s sometimes a hunt-and-peck mission to find a good one.
For example, my husband broke some ribs and suffered from chronic pain for 5 years until he found a wonderful acupuncturist practitioner, and was totally expunged of pain in 5 treatments. I’ve had similar positive experiences, especially with some back pain, in which it only took one treatment.
Dave:
Yeah, but see? It distracted you from the initial pain. So. . . call it a partial success?
I’ve found Scotch to be helpful. No, not for pain, just generally.
I take coffee as a preventative against sciatica and pretty much everything else. Seems to work most if the time.
I don’t know jack about coffee or acupuncture and nerve compressions, but as a veteran of nerve compressions a word of caution. The nerve can be compressed by mechanical means (like a bulging disc) or self compressed (nerve swelling) or simply inflamed by irritation of the nerve and/or surrounding tissue. (Including a rare issue called piriformis syndrome) Blocking the pain is fine unless the underlying irritation mechanism persists.
Extended periods of compression can result in outer sheath damage which is sensory, and deeper compression which can result in motor dysfunction and/or muscle wasting. IT CAN BE PERMANENT, or take maybe a year to (partially) recover. So be careful of pure pain management, whether acupuncture or coffee or steroids or, er, uh, scotch, whether it has any merit or not, and monitor chronic nerve insult carefully.
Respectfully, your permanently left hand tremoring from herniated C4-5, C5-6 and cubital tunnel friend.
You made a believer out of me. Just made an appointment with the medico for tomorrow. Thanks.
The anti-vax people should be shot. At the very least, they should be isolated.
Steve
One of the concepts I was unable to work into this post is that of “herd immunity”. In researching the issue I learned two things. First, that the development of the concept is obscure. Second, that it’s controversial. It’s astonishing to me that it’s controversial. Claims that the concept is only relevant to natural immunity, which seem to me to presuppose a lot, are commonplace.
The “anti-vax” people have a strong presence on the web.
Immunization depends on people voluntarily participating, and the information that I’ve seen that gets circulated emphasizes the potential harm to the individual. To mention herd immunity issues directs attention towards the issue of social obligation, potential lack of efficacy, and perhaps unnecessary risks if others get immunized (free-riders).
It probably depends on the disease, but I’ve always assumed most of the harm from not getting immunized fell on others, the children too young, the adults too old, or all those in between with compromised immune systems?
I was not familiar with this older history of variolation. If we were to look at the practice from the context of the time, this was monstrous — similar to looking back at trepanning. But we look at it from what we know now, and we shrug.