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velvetpageLast week in Lakefield, I picked up a book of Canadian history by Michael Bliss. He is he author of such venerable works of medical history as The Discovery of Insulin and a biography of Dr. Banting. This particular book is called Plague: A Story of Smallpox in Montreal.
The year is 1885. Louis Pasteur is about to postulate the existence of bacteria as disease-causing agents. The cholera bacteria has just been identified. Variolation - the practice of deliberately infecting oneself with a mild case of smallpox in order to produce immunity - has been in practice for well over a century, with between a one and five percent chance of catching the disease and dying of it. Vaccination - the practice of taking cowpox virus (from the latin word for cow, we get our word "vaccine") has been in practice for about fifty years. Its biggest risks are from bacterial infection of the site. It has about a one percent death rate, and it has been recently discovered that revaccination every few years is required for lifetime immunity.
My interest in the book was primarily in the use of vaccination, and the opposition to it and to other measures designed to contain the spread of the disease. Some, we have done away with now; bacterial infection of vaccination sites is far less likely than it was then, thanks to modern standards of cleanliness that include sewage and garbage disposal and hand-washing, not to mention antibiotics. Others, like ignorance of science and a belief that diseases are a punishment from God that cannot be avoided, are still a problem.
The arguments against vaccination in 1885 have modern parallels in the anti-vaccination debate. The argument that vaccination is actually spreading the disease, and causes outbreaks, still exists. Ditto that injecting oneself with poison in order to prevent a disease is a fundamentally stupid idea. These arguments stem from a lack of understanding of the vaccination process, an area of medicine where our knowledge has been steadily increasing for well over a hundred years. Anti-vaccinators in 1885 claimed, then as now, that the vaccine was more dangerous than the disease it prevented. Since they didn't understand about bacterial infection or have a good grasp of proper sanitation, this analysis was a lot closer to the truth then, though still exaggerated: 1% died from the vaccine, while 25-30% died from smallpox. If there was no outbreak, vaccination was probably more risky; the problem was that no-one knew how to prevent transmission, since people could carry the virus on their clothing, in their hair, in blankets, in bodily fluids that came from an infected person, and infection could happen within the two-week timespan it took for the vaccination to "take." This argument carries a lot less weight now, since the risk of death from vaccines is almost nil. The new version of this point is the damage argument: the ingredients in vaccines cause X horrible condition, usually developmental (autism and ADHD have both been blamed on vaccinations.) Even the one that sounds the silliest to modern ears has a modern counterpart. Some anti-vaccinators believed that injecting oneself with cowpox would make humans take on some of the traits of a cow. The modern version is the urban myth that aborted fetuses are used as ingredients in vaccines.
I'm now at the part of the book where it has been admitted that the disease is out of control. I'm seeing parallels between SARS in Toronto in 2003 and the Montreal epidemic. People went to work while infected because they couldn't afford the lost wages. They snuck in where they shouldn't have been to visit the sick. They went out before the were fully recovered. Businesses suffered the loss of tourist trade - or trade of any sort, since no one wanted to purchase contaminated dry goods from Montreal. Vacationers from Montreal had to claim to be from somewhere else, or risk being denied lodgings. Economically, the city was a disaster.
I will get back to you with more observations when I've finished the book. It's a fascinating read, and well-told. I recommend it.
The year is 1885. Louis Pasteur is about to postulate the existence of bacteria as disease-causing agents. The cholera bacteria has just been identified. Variolation - the practice of deliberately infecting oneself with a mild case of smallpox in order to produce immunity - has been in practice for well over a century, with between a one and five percent chance of catching the disease and dying of it. Vaccination - the practice of taking cowpox virus (from the latin word for cow, we get our word "vaccine") has been in practice for about fifty years. Its biggest risks are from bacterial infection of the site. It has about a one percent death rate, and it has been recently discovered that revaccination every few years is required for lifetime immunity.
My interest in the book was primarily in the use of vaccination, and the opposition to it and to other measures designed to contain the spread of the disease. Some, we have done away with now; bacterial infection of vaccination sites is far less likely than it was then, thanks to modern standards of cleanliness that include sewage and garbage disposal and hand-washing, not to mention antibiotics. Others, like ignorance of science and a belief that diseases are a punishment from God that cannot be avoided, are still a problem.
The arguments against vaccination in 1885 have modern parallels in the anti-vaccination debate. The argument that vaccination is actually spreading the disease, and causes outbreaks, still exists. Ditto that injecting oneself with poison in order to prevent a disease is a fundamentally stupid idea. These arguments stem from a lack of understanding of the vaccination process, an area of medicine where our knowledge has been steadily increasing for well over a hundred years. Anti-vaccinators in 1885 claimed, then as now, that the vaccine was more dangerous than the disease it prevented. Since they didn't understand about bacterial infection or have a good grasp of proper sanitation, this analysis was a lot closer to the truth then, though still exaggerated: 1% died from the vaccine, while 25-30% died from smallpox. If there was no outbreak, vaccination was probably more risky; the problem was that no-one knew how to prevent transmission, since people could carry the virus on their clothing, in their hair, in blankets, in bodily fluids that came from an infected person, and infection could happen within the two-week timespan it took for the vaccination to "take." This argument carries a lot less weight now, since the risk of death from vaccines is almost nil. The new version of this point is the damage argument: the ingredients in vaccines cause X horrible condition, usually developmental (autism and ADHD have both been blamed on vaccinations.) Even the one that sounds the silliest to modern ears has a modern counterpart. Some anti-vaccinators believed that injecting oneself with cowpox would make humans take on some of the traits of a cow. The modern version is the urban myth that aborted fetuses are used as ingredients in vaccines.
I'm now at the part of the book where it has been admitted that the disease is out of control. I'm seeing parallels between SARS in Toronto in 2003 and the Montreal epidemic. People went to work while infected because they couldn't afford the lost wages. They snuck in where they shouldn't have been to visit the sick. They went out before the were fully recovered. Businesses suffered the loss of tourist trade - or trade of any sort, since no one wanted to purchase contaminated dry goods from Montreal. Vacationers from Montreal had to claim to be from somewhere else, or risk being denied lodgings. Economically, the city was a disaster.
I will get back to you with more observations when I've finished the book. It's a fascinating read, and well-told. I recommend it.