Fighting the Implacable Foe

Article excerpt

Even as new infectious diseases appear unexpectedly and old ones proliferate with a vengeance, the battle against them requires global strategies that involve the general public as well as the scientific and medical professions.

It was May 14, 1796. James Phipps was just an 8-year-old lad in Gloucestershire, England, and could scarcely have dreamed of the far-reaching ramifications of what was about to happen to him. That was the day he allowed himself to become the "guinea pig" for a local physician's unconventional experiment--an experiment that placed the boy's health and probably even his life on the line.

That day, the physician went first to a milkmaid who had cowpox--a mild disease that people caught from cattle. He took some of the fluid from blisters on her hand and injected it into the healthy boy. Naturally, James contracted cowpox. But the real test was yet to come. After waiting for two months, the doctor inoculated the boy with fluid from the blisters of a person with another disease: smallpox. In those days, smallpox was both widespread and widely dreaded in Europe. During severe outbreaks, as many as one out of three victims died. Those who survived never got the disease again, but they often were pockmarked for the rest of their lives.

Fortunately, James not only survived but did not contract smallpox. Two years later, the physician successfully repeated the experiment and published his findings. That physician was Edward Jenner. He called his procedure vaccination--from vaccinia, the Latin word for cowpox. While Jenner's ethics in placing the boy at risk of disease raise legitimate concern, his success led to the rapid acceptance and application of the procedure across Europe and other parts of the world.

Jenner's work became a stepping-stone for the development of vaccines against other infectious diseases as well. Roughly a century later, Louis Pasteur demonstrated that attenuated (weakened) germs can be used to prevent sheep from getting anthrax and people from getting rabies. Today, the widespread use of vaccinations can be credited with lowering the incidence of a variety of diseases, including poliomyelitis, measles, mumps, rubella, pertussis (whooping cough), and diphtheria. As for smallpox, the last known case occurred in 1977.

Even as vaccines were becoming important agents in preventing the spread of infectious diseases, the medical community was being awakened to the value of simple sanitary principles. In the mid-nineteenth century, Hungarian physician Ignaz Semmelweiss demonstrated that women in hospital maternity wards would not get childbed fever as long as doctors who worked in dissecting rooms washed their hands with strong chemicals before touching the mothers to be. The rationale behind this approach came some years later, when the "germ theory" of disease gained credibility through Pasteur's studies. According to this theory, diseases are caused by minute organisms (germs), and infections are communicable through the transmission of these germs from one individual (or object) to another. Thus doctors who washed their hands would be destroying any disease-causing germs that might be on them. (Of course, the germ theory does not apply to congenital diseases or other noninfectious conditions.)

Pasteur's observations in support of the germ theory served as the basis for Joseph Lister's use of a chemical agent (carbolic acid or phenol) to destroy germs on surgical wounds. And Pasteur himself, during the war between France and Prussia, used his influence to get doctors at military hospitals to sterilize their instruments and bandages by boiling or steaming, thereby reducing the spread of infection. Because of the success of these efforts, the use of antiseptics and sterile techniques became additional important factors in preventing the spread of infections.

The fight against infectious diseases, however, requires appropriate treatments as well as preventive measures. …