Biomedical Ephemera, or: A Frog for Your Boils

Cerebrospinal meningitis due to influenza bacillus

This 4-month-old was suspected to have developed meningitis due to the influenza bacillus crossing into the brain either by the frontal sinus (which is thin to begin with, but extremely delicate in young children), or through the nasopharyngeal lymph channels near the base of the brain. 

The brain was found to be partially covered in a muco-purulent exudate, with a large necrotic patch in the right frontal lobe. The infant had several seizures during the course of the illness, but it was suspected that they were febrile seizures (caused by high fever and not uncommon in babies), and unrelated to the necrosis of the frontal lobe. The bacterial infiltration of the cortex was suspected to have blocked one or more blood vessels, causing a stroke.

Influenza may not be killing off 5% of our population every year like it did in 1918 (which was after this case and, interestingly, spared the frail and killed the healthy), but it’s still a fatal disease to many infants and elderly patients. And really, even the healthiest person can come down with really awful complications from the yearly flu virus. It just happens to be much more prevalent in those whose bodies are not fully capable of fighting off infection.

So if you’ve had the flu recently, and felt awful and unable to breathe and your body hurt like you had been sleeping on a bed of lumpy rocks, you probably can see where bad complications can come from. But if you never get the flu or haven’t had it in ages, don’t think it’s just some little thing, or just like a bad cold or something. It’s something that’s actually worth going out of your way to protect yourself (and those around you) from!

Diseases of Infancy and Childhood. Louis Fischer, 1917.

This is your yearly reminder to get your dang flu shot if you’re able to, because there are those out there who can’t.

* “Influenza bacillus” is the term used in the reference material, in reference to Haemophilus influenzae - the bacteria that causes the most common secondary infection to influenza. It was supposed to be the causal agent for influenza until 1933, when the viral origin of influenza was discovered.

Haemophilus influenzae is an opportunistic infection which can cause meningitis, ear infections, epiglottitis (inflamed epiglottis which leads to serious problems breathing), sinusitis, and pneumonia, especially in children and the immunocompromised.

(Thanks to With Grace and Guts for the correction! The lay texts I read are sometimes mistaken, and any corrections are always welcome.)

Today in History - May 14

Berkeley, Gloucestershire, England, 1796

On May 14, 1796, Edward Jenner performed the first of his 23 case studies involving inoculating people with cowpox (Vaccinia virus) in order to protect them from the worst effects of smallpox (Variola virus).

Dr. Jenner took the pus from a blister on the hand of milkmaid Sarah Nelmes, who had contracted cowpox from a cow named Blossom. He then injected this virus into eight-year-old James Phipps, allowing him to develop cowpox (similar to, but far less deadly than smallpox), and once he was healed, exposed him to smallpox. When James developed no symptoms, Edward Jenner presented a paper proposing widespread vaccination against smallpox to the Royal Society of London.

Both clergy and traditional physicians expressed credulity and disgust at the idea, despite the fact that it had been shown decades earlier to be a plausible concept - in 1721 Lady Mary Wortley Montagu had herself and her children inoculated with cowpox sores after witnessing the procedure in Istanbul, and not 20 years earlier, Dr. Benjamin Jesty had success inoculating himself and his wife with cowpox during a particularly deadly smallpox outbreak.

More recent studies have shown that the practice of cowpox inoculation against smallpox may have occurred in China over 2500 years ago, but it was never widespread, and the west never truly caught on to the idea until Dr. Jenner proved with twenty-two subsequent subjects (including his own 11-month-old son) that cowpox inoculation was effective and far safer than smallpox itself. Following his second presentation on the subject at the Royal Society of London (including the case studies of his own family), the concept was still widely ridiculed by clergy and some of the public, but the efficacy was no longer seen as a matter of being an “Old Wives Tale”.

Despite his being far from the first to assert the value of vaccination, Edward Jenner is still seen as the one who saved “more lives than anyone else in human history”, because he’s the one who persisted and found a way to convince the community at large of the efficacy of the procedure. After all, in the words of Francis Galton,

More on Edward Jenner and Smallpox:

Edward Jenner at Columbia University

BBC History: Edward Jenner

History Learning Site: Edward Jenner

Proceedings of the Baylor University Medical Center: Edward Jenner and the history of smallpox and vaccination