Thursday, 16 February 2017

Metal Nurse: Edward Jenner healthcare hero

Me in Hyde Park, with  Edward Jenner
Some time ago I went to London with my beloved to spend the weekend. Whilst there I visited Hyde Park for the first time where I came across this monument of a man who changed the landscape of healthcare indefinitely. For the better. I am of course talking about one of the great pillars of public health, Edward Jenner. The father of vaccinations. You will undoubtedly read many many ‘Alternative Facts’ by anti-vaxxers. But as usual they tend to be more confined within the fiction section of third hand bookshops. They lie about vaccines in general, but some of the lies they repeat over and over again about Edward Jenner are astounding. There is a made up story that his son died after receiving the smallpox vaccine. He died at 21 from tuberculosis, which incidentally we now have a pretty effective vaccine for. They also lie about smallpox, alternating between it being never eradicated, just renamed, or simply never that bad in the first place. Yeah, between 300-500 million people died from it in the 20th century alone (until it was eradicated of course), it had 20-30% mortality rate, couldn't have been too bad a disease.

Smallpox had been a scourge on mankind throughout written history. Ancient writings about it were found in a medical book from India, dating from as early as 1500 BC. King Ramses V had been infected by it, cases found in China dating at least 1100 BC. It made no distinction between classes, it knew no boundaries, afflicting the poor and rich alike. Those who were "lucky" enough to survive would be left with permanent scarring. It is a virus mostly transmitted via close contact and droplets coughed by the infected individual. The virus could even be spread via infected cloths, incidentally how the British conquered the Americas when General Jeffrey Amherst gave Native Americans blankets carrying the smallpox virus, quickly decimating the previously unexposed population. The afflicted remained contagious until the last scab healed. There was no treatment available. The only way it could be controlled was with vaccination. And thanks to extensive immunisation programmes the last known wild case of smallpox was in Somalia, in 1977. But it is known that there are vials of smallpox left in both the US and in Russia.

Chinese Variolation
In itself the idea of immunisations wasn't anything new, an immunising technique called variolation had been practised in China and Turkey and some parts of Africa since at least 1000 BC. That form of immunization was introduced to England by the 1700's. It wasn't a particularly safe practice, though safer than getting the disease itself. It involved drying the scabs of previously infected individuals and blowing them up people noses. (Which admittedly is awfully similar to the flu nasal mist spray we use today.) In Sudan and Turkey this practice consisted of collecting fluids from the smallpox postules and rubbing the pus into a cut on the person receiving it. Uptake of either practice in Europe was lacking because the medical establishment had dismissed the practices as witchcraft or folklore. It wasn't until the 1700's that an Italian doctor by the name of Emmanuel Timoni witnessed the practice in Constantinople and then wrote about it and got it published in Philosophical Transaction in 1714, that it received some attention from the higher classes of Europe. Mostly thanks to Lady Montagu who had been permanently scarred by smallpox herself and lost her brother to the same illness.

Edward Jenner was a doctor hailing from England. Jenner himself had been inoculated when he was 8 years old via the practice of variolation. During his medical apprenticeship he took a keen interest in cowpox and how it might possibly lead to protection against smallpox, something that had been taken note of before, specifically by another English physician John Fewster, a friend of Jenner's, and a farmer named Benjamin Jesty. They had observed and reported that milkmaids infected with cowpox were invariably immune to smallpox, this essentially started the mass immunization programs. In essence he didn't discover vaccinations, he popularised it.

Jenner first experimented on eight year old James Phipps, injecting a small amount of cowpox into his arm. After James had recovered from the inoculation Jenner attempted to infect him with smallpox. Neither James nor the children who shared his bed developed smallpox, thus discovering herd immunity. His theories were revolutionary for the time and a lot of people refused to believe them. With the advent of vaccinations came the Anti-Vaccine Movement. Because the idea was so mind blowing even the establishment initially refused to believe it, leading Edward Jenner to do further experiments with more children, including his own child.

By today's standards these were extremely unethical experiments. But thanks to these experiments Jenner managed to convince the establishment of the effectiveness of his method, replacing the more dangerous variolation. Jenner was reportedly an extremely generous man, when James Phipps had married later in life and had children of his own, Jenner gave him a free lease on a house. He refused to use the discovery to make himself rich. Instead he'd devote his time to vaccinating as many people as possible, even negotiating to vaccinate French soldiers in exchange for British Prisoners of War. By 1840 variolation was confined to the past and Jenner's form of immunisation had taken over.

In addition to his research on vaccinations he also made some great headway into research on Angina Pectoris.

Without Edward Jenner there is a very good chance that we would still be dealing with mass epidemics of deadly, dangerous and disfiguring illnesses like smallpox, measles and polio. I believe Jenner's research into vaccinations was as important as John Snow's sanitation investigation, Joseph Lister’s insistence on equipment sterilisation, Ignaz Semmelweis preoccupation with the importance of hospital staffs hand-washing and Alexander Fleming's discovery of penicillin.

Vaccines save lives.

Edward Jenner was a hero. Even Napoleon accepted that.

History Of Vaccines

BBC: History, Edward Jenner.

History of Immunology by Arthur Silverstein

Edward Jenner and the History of Smallpox and Vaccination, by Stefan Riedel.
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