HISTORY 135F

Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Lecture 18.  In-Flu-Enza.

The New Science of Bacteriology
1881-1885 prophylactic inoculation While studying the bacillus that causes chicken cholera, Louis Pasteur ran into a major research problem:  cultivating the microbe in the lab seemed to weaken its virulence.  Chickens injected with this weakened form of the microbe did not get sick!  Pasteur obtained a fresh supply of bacteria from a naturally occurring outbreak of the disease.	Louis Pasteur (1822-1895)
He injected these un-cultivated microbes into a new group of chickens as well as those that had not responded to the weakened microbes in earlier trials.  To his surprise, only the new chickens succumbed to the disease while the previously injected chickens remained healthy. It had long been noted that recovery from certain diseases confers protection from future re-infection.  But these chickens had never shown any signs of illness.  Nevertheless, they clearly had become cholera-resistant.  Pasteur concluded that injecting an individual with weakened microbes of a serious disease will artificially induce an effective immunity to that disease.  Based on this principle, he developed the method of prophylactic inoculation (from the Greek words pro-, meaning "before," and phylassein, meaning "to guard") for the following diseases: chicken cholera, anthrax, swine erysipelas, and rabies.
Ilya Metchnikov (1845-1916)	1883 phagocytosis Metchnikov observed that starfish larvae possess specialized cells that attack and envelop foreign matter that enters the organism.  A colleague suggested the name phagocyte for these cells--from the Greek words phagein, meaning "to eat" and kytos, meaning "a hollow" (cell).
Metchnikov noted the similarities between the behavior of these starfish cells and that of the white cells in human blood.  He suggested that white blood cells were phagocytic agents that serve to protect the body from invading microbes.
1888-1890 bacterial toxins Diphtheria is a deadly disease.  In addition to weakness and fever, symptoms can include the formation of a leathery membrane in the nose or throat, hence its name--from the Greek word diphthera, meaning "leather." Emile Roux and Alexandre Yersin worked with Pasteur at his Institute in Paris.  In their study of the diphtheria bacillus, they discovered that the microbe itself does not cause the disease's symptoms.  In fact, some individuals can harbor  and transmit diphtheria bacilli while showing no signs of the illness at all. Roux and Yersin found that diphtheria's symptoms are the body's response to a toxin given off by the bacteria. [We now know that production of this toxin is stimulated when the bacteria themselves become infected by a virus.  Once infected, diphtheria bacilli emit a powerful neurotoxin that is capable of paralyzing vital muscles like the heart and diaphgragm.]	Emile Roux (1853-1933)   Alexandre Yersin (1863-1943)
Roux and Yersin's discovery launched a two-pronged approach to controlling diphtheria's spread:  the search for both an antitoxin--a substance capable of counteracting and defusing the toxin's deadly effects--and a vaccine.

Epidemic Disease and the Public Health

Factors that generated concern for improving the public health: Industrialization exposed workers to new forms of environmental and physical hazard Urbanization enhanced already unhealthful conditions and strained the limited existing public services Advances in transportation made it possible the rapid transmission of disease over long distances Immigration brought new people and new germs into close contact in new and unfamiliar territory Unequal distribution of wealth and health left many healthful amenities inaccessible to the poor and disenfranchised We can no longer treat life as something that has trickled down to us. We have to deal with it deliberately, devise its social organization, alter its tools, formulate its method, educate and control it. In endless ways, we put intention where custom has reigned.  We break up routines, make decisions, choose our ends, select means. --journalist Walter Lippman (1914)

Problems tackled by public health advocates: Child welfare Infants pre- and postnatal care improved milk supply availability purity (pasteurization) School-age children school inspections school nurses annual physical exams free clinics subsidized school lunches dental health Community welfare Public health nurses Voluntary agencies Public health education
Epidemiology 1892--in response to Hamburg cholera epidemic, New York City Health Department establishes division of bacteriology and disinfection Hermann Biggs advocates use of diagnostic laboratory After cholera scare subsides, New York laboratory shifts its focus to diphtheria study Success of New York lab encourages others to establish similar facilities elsewhere: 1894--Massachusetts 1895--Philadelphia		Hermann Biggs, (1859-1923)

Influenza Pandemic -- 1918

There was a little bird Its name was Enza. I opened the window And in-flu-Enza. The first wave of the influenza epidemic began on Monday morning, March 11, 1918, at Camp Funston in Fort Riley, Kansas. Between March and September 1918, sporadic outbreaks of deadly influenza broke out around the country, often among healthy young men at military bases or in prisons.

March April May June July August Spread of influenza, March-August 1918

In late August 1918, the pandemic virus mutated.  The first victims of this new, more virulent form of influenza were stricken in three different and widely separated locations:  Brest, France (August 22); Freetown, Sierra Leone (August 24); and Boston, Massachusetts (August 27).

In September, a major outbreak of flu struck the men stationed at Camp Devens near Boston. "I saw hundreds of young stalwart men in uniform coming into the wards of the hospital.  Every bed was full, yet others crowded in.  The faces wore a bluish cast; a cough brought up the blood-stained sputum.  In the morning, the dead bodies are stacked about the morgue like cordwood." --Dr. Victor Vaughn, acting Surgeon General of the Army

The public were encouraged to wear masks to prevent the spread of disease.

	Public service announcements encouraged citizens to behave responsibly.
Many patent medicines were advertised as preventatives.

	Protective products were advertised.

Boston's Mayor, Andrew J. Peters is inoculated with a vaccine believed to protect against influenza.  However, at the time, researchers did not have microscopes powerful enough to identify the flu virus responsible.

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In an average year, influenza causes about 17,000 deaths nationally. In pandemic years, this number is greatly increased: 1957-58; so-called "Hong Kong" flu:  70,000 deaths 1968-69; so-called "Asian" flu:  more than 33,000 deaths In February 1976, a new flu strain was isolated: experts strongly suspected it was related to the strain implicated in the 1918 pandemic officials believed entire US population under age 50 would be susceptible March 1976:  medical experts and others recommend that the President instigate massive vaccination program: I have just concluded a meeting on a subject of vast importance to all Americans.  I have consulted with members of my Administration, with leading members of the health community, and with public health officials about the implications of this new appearance of swine flu. I have been advised that there is a very real possibility that unless we take effective counteractions, there could be an epidemic of this dangerous disease. At this time no one knows exactly how serious the threat could be.  Nevertheless, we cannot afford to take a chance with the health of the Nation.   --Gerald Ford, 24 March 1976 President Ford's announcement aroused considerable discussion in the press: