1. Epidemic Diseases of the 19 th Century Part 2

2. Smallpox  Known from at least 10 th century CE that smallpox conferred permanent immunity  Razes theorized it was a maturational process (like puberty)  Could not explain how it happened

3. 1. Inoculation  Ancient techniques to protect against smallpox –Inhaling dust of powdered scabs –Inoculation

4.  Reported in Europe by late 17 th century  Learned medicine slow to pick up on this knowledge  Partly due to intellectual arrogance –Practice associated with women

5. “Posterity will scarcely be brought to believe that a method practiced only by a few Ignorant Women, amongst an illiterate and unthinking People should on a sudden and on a slender Experience, so far obtain in one of the most Learned and Polite Nations in the World as to be received into the Royal Palace.” William Wagstaffe, MD

6.  Lady Mary Wortley Montague (1689- 1762)  Learned about inoculation while living in Constantinople  Had her 5 year old son inoculated there in 1719  Had her 5 year old daughter inoculated in England in 1721

7.  Very controversial  Procedure tested on 6 condemned prisoners; worked  Prince of Wales had two of his children inoculated

8.  Popularized the procedure  Physicians jumped on the bandwagon  Created complex procedures to try to create monopoly

9.  Inoculation created risks –Individual inoculated could spread disease to others –Could also develop full blown disease (rare)  Religious objections to the practice –Knox (Scotland)

10.  Slow to be accepted in France –Suspicion of anything British –Persistent doubt that infection conferred permanent immunity

11. 2. Vaccination  Edward Jenner (1749-1823)  Observed link between smallpox immunity & exposure to cow pox

12.  1796: vaccinated 8 year old boy with cow pox  Then inoculated him with smallpox  Child did not respond to smallpox  Submitted his findings to Royal Society in 1797  They returned his paper

13.  Vaccinated 5 children during 1798 outbreak  Published these findings  Became a celebrity  Not everyone agreed with vaccination

14.  Resisted state interventions to reduce smallpox mortality –Banned inoculation in 1840 –Compulsory vaccination of infants 1853 –Compulsory vaccination of all children under 14 years of age, 1867 –Compulsory appointment of vaccination officers, 1871

15.  These developments occurred during height of English liberalism  Anti-vaccination movement  Other problems with procedure –Using animal matter on humans

16.  Doubts about actual strain of pox virus was actually in Jenner’s vaccine  Arm-to-arm technique could spread other diseases –Syphilis  Vaccine did not confer permanent immunity

18.  Royal Commission on Vaccination struck in 1889  Met for 7 years  Allowed people to conscientiously object  Compulsory vaccination ended in 1948  Should immunization be compulsory?

19. Typhoid Fever  Class discussion after the video

20. Tuberculosis  A brief discussion of the complexity of TB prior to Dr. Hackett’s lecture on Jan. 31