Smallpox, Syphilis and Salvation Read online

  Two contrary laws seem to be wrestling with each other nowadays: the one, a law of blood and of death, ever imagining new means of destruction and forcing nations to be constantly ready for the battlefield—the other, a law of peace, work and health, ever evolving new means for delivering man from the scourges which beset him. Louis Pasteur,

  speech opening the Pasteur Institute,

  Paris, 14 November 1888

  INTRODUCTION

  It is a wonder that humans as a species have managed to survive and thrive. For thousands of years we have been bent on destroying our own kind and we continue to develop ever more sophisticated means of doing so. Apart from the wars we wage against each other we have also succeeded, particularly during the last century, in damaging our environment irreparably and destroying innumerable species that once shared Earth with us. But we are not our own worst enemy. It is the foe we cannot see that has from prehistoric times posed the greatest threat. Species of micro-organisms flourished before we did and they were the most determined killers of humankind long before we knew they existed. For millennia humans did not have the means with which to detect and identify these unseen disease-causing adversaries.

  When I began the research for this book on world-changing cures and medical breakthroughs it soon became evident that I had to discard a number of preconceived notions. Firstly I had to examine my understanding of what constituted a ‘cure’. My working definition was simple: you contract a disease, you are provided with some kind of medication, your symptoms disappear and they do not return. You are cured. What I came to realise is that until penicillin was discovered and used widely for the first time in the early 1940s, very few diseases actually had a cure.

  Since ancient times the search for ways to prevent and cure the devastating scourges that have afflicted humankind has been ongoing but it is only within the last 200 years that significant advances have been possible. The age of monumental medical breakthroughs began as recently as 1796 with Edward Jenner’s discovery of vaccination and his development of a vaccine for smallpox. Described as the ‘Founding Father of Immunology’, Jenner took the first of many protracted steps on the road to discovering the human immune system, how it works and how it can be manipulated to fight disease. In Jenner’s day there were no cures as I understood them for the plethora of diseases that plagued all societies, often with catastrophic consequences. If you were sick physicians could do little more than provide treatments that were often little more than comfort, an easing of symptoms perhaps, as you succumbed to your fate.

  Although there was an accretion of medical knowledge over the centuries as human anatomy became more understood, it was necessary that advances in technology also take place, especially in the development of instruments vital for discoveries to be made. The invention of the microscope, for example, was critical. In the seventeenth century, Antonie van Leeuwenhoek, a Dutch merchant, developed a single lens microscope that was powerful enough to reveal a microscopic world where micro-organisms and human cells battled for dominance, a world that was still unknown to Jenner when he gave the world its first great ‘cure’. As microscopes became more sophisticated, the microscopic realm of disease-causing organisms was slowly revealed.

  Almost a century passed after Jenner’s discovery until another effective vaccine was developed. It was Louis Pasteur who risked his reputation and roused the ire of the scientific elite of his day when he proposed Germ Theory and proved conclusively that microbes were the cause of human diseases. This knowledge facilitated the development of new vaccines. Pasteur discovered how to prepare and use attenuated disease-causing microbes as vaccines against anthrax and chicken cholera. In 1885 Pasteur developed the second human vaccine, a cure for the disease rabies even though at the time microscopes were still not powerful enough to enable him to see the rabies virus. The world applauded this momentous development and vaccination was established as an accepted and effective method of preventing disease.

  Pasteur built on the work of Edward Jenner and established the science of microbiology. Other scientific superstars of the nineteenth century took up the challenge to identify and defeat the invisible viruses and bacteria that cause disease—diseases such as tuberculosis, bubonic plague, cholera, typhoid, tetanus and diphtheria. Many of the early significant medical advances were made in laboratories headed by Louis Pasteur in France and by his rival, Robert Koch in Berlin. Robert Koch furthered the understanding of the role of micro-organisms in causing disease. He was the first to demonstrate that a specific pathogen caused a specific disease.

  Louis Pasteur and Robert Koch inspired a whole generation of ‘microbe hunters’, disciples who travelled the world in the search for the causes of disease and hopefully the cures. Producing a vaccine, however, often took years of painstaking work which could be fraught with both personal and professional difficulties for these early medical pioneers.

  By 1900 the medical profession had an increasing understanding of health and disease. Pasteur’s seminal work had revolutionised concepts of infection and the practice of surgery and obstetrics but still only a few ‘cures’ were to be found in the physician’s little black bag: morphine and aspirin to ease pain; quinine to fight off malaria; digitalis from the foxglove plant for heart failure; and vaccines for smallpox, rabies, typhoid, cholera and bubonic plague. However, Germ Theory had shown scientists who the enemy was and 21 micro-organisms that were the cause of human disease had been identified. The war against them had begun in earnest and was gaining momentum. Once identified, the microbes that cause disease could be targeted with vaccines that were toxic only to those microbes and harmless to humans.

  Although in the first decades of the twentieth century the number of vaccines being developed was increasing, there were at that time very few effective chemical treatments for disease. At the beginning of the century venereal syphilis was the most serious and dreaded of the sexually transmitted diseases. The micro-organism responsible for syphilis was isolated in 1905. The development of a chemical cure for the disease, a new ‘magic bullet’, took many years after that but the achievement was groundbreaking because it resulted in the establishment of the disciplines of chemotherapy and haematology.

  A contemporaneous breakthrough was Blood Serum Therapy, which resulted from the discovery that antitoxins in blood could be used to make vaccines against diphtheria and tetanus. In 1921 a vaccine to prevent tuberculosis was developed in France and at the same time in Canada the discovery was made that diabetes could be treated with insulin therapy. Although not a cure for diabetes, insulin has saved the lives of countless diabetics.

  During the 1930s and 1940s with the discovery and the introduction of penicillin and the subsequent development of other antibiotics a whole raft of cures became possible. Developed during World War II, the impact of penicillin on the war effort and the health of countless millions of people from that time on has been monumental. Since the introduction of antibiotics over 60 years ago the world has enjoyed an increasing mastery over microbial disease.

  In the 1950s, summertime was a time of great anxiety for many parents as children by the thousands became infected with the crippling disease poliomyelitis, a disease that engendered fear worldwide. The development of a vaccine for polio was hailed as a miracle, but the long and tortuous race to find a cure led to bitter and acrimonious debate amongst the scientific elite in the United States.

  New and astonishing cures resulted from the development of anti-viral drugs in the mid twentieth century. Using a process called rational drug design, scientists produced ‘medical marvels’ that worked against bacteria, protozoan parasites, malignant diseases and immune disorders. For the very first time acute chi
ldhood leukaemia could be cured.

  About three-quarters of all human diseases involve the immune system in one way or another. The 1960s saw an exponential increase in immunological knowledge which has facilitated progress in the diagnosis and treatment of auto-immune and malignant diseases, immunodeficiency and allergies. Researchers established that the immune system is also responsible for the rejection of organ transplants, another burgeoning field of medical endeavour. The understanding and manipulation of immunological tolerance and rejection is what has made successful organ transplantation possible. If a diseased or failing organ could not be cured, then it could be replaced. Following hard on the heels of this success was the introduction of bone marrow transplants.

  What I came to realise as I investigated these milestones in medical progress was that the personal stories behind the great cures of the nineteenth and early twentieth centuries followed similar plot lines which were often characterised by rivalry, subterfuge, professional infighting and jealousy, public humiliation, deprivation and dedication, and great personal struggle and sacrifice. It was intriguing to examine too the personal motivation of those who had done so much for the good of humankind, to understand if they had been driven by altruism, by ambition and ego or by the thrill of scientific discovery for its own sake.

  It was not only the pioneers of medical science who suffered or sacrificed as they dedicated themselves to the cause of combating disease. Many of the practices employed in medical experimentation in the past would be considered unethical today. As little as 50 years ago the ethics of a scientist trialling vaccines on prisoners, orphans or the scientist’s own family may not have been questioned and some were certainly not averse to trying experimental vaccines on themselves. There are many examples of medical trailblazers who, driven by their desire to succeed, exercised poor judgment and took risks which at times resulted in tragic outcomes. They then had to deal with their own consciences.

  Human trials were often preceded by many years of experimentation on animals and even today some vaccines have animal components. It would be impossible to estimate how many animals have been used in medical experiments since Edward Jenner’s time. The practice of vivisection, experimentation with living animals, has always had its opponents and the debate continues today. There are those who espouse the view that human need is greater than the rights of animals while others believe that in this day and age vivisection is unnecessary and repugnant. As medical science progressed issues such as these have had to be faced, and as a result another discipline within the study of medicine has emerged: the field of medical ethics.

  As my research brought me to the latter part of the twentieth century I found it more difficult to recognise a medical breakthrough, to pinpoint the exact moment when a cure was discovered and to identify an individual whose genius made it possible. There are singular moments however, such as the discovery of the DNA double helix in 1953 or the first cloning of a mammal, the creation of Dolly the sheep in 1997. Most scientific advances are now the result of accumulated knowledge resulting from research that has been undertaken by numerous people over the course of many years, dependent on progress and discoveries that have come before. The science behind medical breakthroughs has become more and more complex and specialised.

  Edward Jenner gave the world vaccination and the means for those who followed to provide an armoury of ‘cures’ to fight humankind’s major killers. How the doctor’s black bag has expanded. There are now medicines and treatments for almost every illness. Today the medical profession draws upon a vast arsenal of drugs, vaccines, and diagnostic tools that could hardly have been dreamt of in 1900 let alone 1796. Scientists from every corner of the globe have contributed to the medical revolution that began ever so slowly centuries ago. We hear almost daily now of some new and astonishing medical breakthrough. Medicine has progressed through various stages: anatomy, physiology, microbiology, surgery, pharmacology and immunology and, in the 21st century, molecular biology and molecular medicine. During each stage scientists have made astonishing advances in treatment and cure.

  Today, molecular biology, molecular medicine and genetic engineering are changing vaccine development by offering new and powerful ways of producing the antigens and attenuated materials necessary for vaccination. The manipulation of tolerance and the ‘creation’ of animals with cell-surface tissue antigens compatible with human self-recognition is also being pursued and extraordinary progress is being made in stem-cell research. All of this is nothing short of awe-inspiring. Even so, while cures for many diseases and conditions have been found, the causes of some diseases still elude the greatest scientific and medical minds.

  Although many milestones have been reached in winning the war against bacterial and viral diseases, it is still two steps forward and one step back. Scientists are now sounding an ominous note of caution. The tide could be turning against us as some diseases are making a comeback. The overuse of antibiotics has resulted in the proliferation and resurgence of resistant strains of bacterial and viral diseases including outbreaks of multi-resistant tuberculosis and polio.

  Today, when medicine has come so far and we are focused on new enemies such as terrorism and global warming, surely it is ironic that our oldest enemies are the most resilient and still present the greatest threat. They are tenacious foes, natural survivors, unseen and insidious, capable of engineering their own methods of making the weapons we use against them useless. With the emergence of bio-terrorism, humankind may yet face the threat of a disease like smallpox being brought back from the brink of extinction. The advances in medical science that have saved millions of lives are the very ones that could be used to bring about our destruction. The words of Louis Pasteur remain prescient: as a species we are capable of great good and inconceivable evil.

  CHAPTER 1

  ERADICATING THE ‘SPECKLED MONSTER’

  EDWARD JENNER AND THE DISCOVERY OF VACCINATION

  The joy I felt at the prospect before me of being the instrument destined to take away from the world one of its greatest calamities ... was so excessive that ... I have sometimes found myself in a kind of reverie.[1] EDWARD JENNER

  In the late eighteenth century an English country doctor named Edward Jenner set himself the herculean task of combating the most dreaded of diseases, smallpox. Without knowing its cause, however, the battle would prove to be a very long one. Edward Jenner changed the course of medical science and opened up a new and brighter future for humanity. A declaration on 8 May 1980 by the World Health Organization (WHO) that smallpox had finally been eradicated was an acknowledgment that Edward Jenner had been instrumental in removing from the world what had indeed been one of its greatest calamities.

  Smallpox, an ancient disease, was more vicious than any war ever waged. Century after century this disease shaped human history in every corner of the globe. It did not discriminate between kings and commoners or the rich and the poor, and countless millions were its victims. Contracting smallpox was an almost certain death sentence. Six out of every ten people who contracted the disease succumbed. In today’s terms smallpox was deadlier and more feared than cancer. Around one quarter of the entire European population was killed, blinded or left permanently scarred by smallpox before the lid was closed on its own coffin. For those who managed to escape death the disfiguring scars that were left after the characteristic ‘pox’ had healed were a frightening reminder to all of the power of the disease. Smallpox was ever-present and omnipresent.

  The ultimate victory against smallpox was achieved through inspired scientific discovery, technical innovation and international cooperation but this unparalleled triumph would not have been possible without the pioneering work, perseverance and great personal sacrifice of the ‘simple’ country doctor.[2] The breadth of Edward Jenner’s work, his contribution to public health and the legacy he provided for humankind are extraordinary, even more so because in his own era he had to struggle against vociferous and jealous critics who were be
nt on destroying his idealism and his reputation. The hardships that Jenner faced and the personal sacrifices that he made are not uncommon amongst the stories of those who have given us salvation through monumental medical discoveries.

  Edward Jenner’s determination to develop a cure for smallpox brought about the discovery of vaccination, a procedure that has since saved an unimaginable number of lives and without which the world would not have advanced in the way it has. Taken for granted in the Western world today, vaccination remains the only method medicine has in its arsenal to prevent the onset and spread of rapacious and deadly infectious diseases. With Jenner’s smallpox vaccination came the inception of one of the most important branches of modern medicine: immunology, the science of our body’s defence against invading microbes and chemicals. In the long term, developments in immunology have led to an understanding of allergy, auto-immune diseases and transplantation. And it all started with Edward Jenner.

  ***

  To appreciate how extraordinary Edward Jenner’s achievement was it is necessary to understand the context in which he set out to defeat smallpox—we must visit his times and know his enemies. Born in the middle of the eighteenth century, Edward Jenner was a humanitarian who possessed a prodigious intellect and eclectic knowledge, and as a doctor he saw firsthand how smallpox afflicted those around him like no other disease. In Edward Jenner’s eighteenth-century Europe, each year smallpox killed one-tenth of the population in rural areas, and in towns and cities where infection was rampant the losses were double that. It was a time when many children had little chance of living to adulthood and smallpox was responsible for 1 in 3 of their deaths. An even greater tragedy was the mortality rate among children younger than five years of age. In London where Jenner did his medical training, 80 per cent of children who were infected with smallpox died. Elsewhere in Europe the death toll was even worse. In Berlin, for example, a staggering 98 per cent of children under five did not survive the disease.[3]