16. George Washington and sexually transmitted disease
During the American Revolutionary War, sexually transmitted diseases, primarily syphilis, ran rampant in the Continental Army. The only known treatment widely employed used mercury, itself toxic, and though it worked against presented symptoms it did not cure the disease. Washington ordered punishment for those diagnosed with sexually transmitted diseases, which led to men afflicted refusing to report their illness, further weakening the ranks of the army. Others sought treatment from nearby civilian communities, which often led to secondary infections and death. During the Revolutionary War, about 25% of men who suffered combat wounds died of secondary infections, and many more died of infections inflicted by medical care providers.
Washington imposed fines on those in his army found to be suffering from sexually transmitted diseases. Officers faced fines of $10 and were cashiered for repeat offenses. Enlisted men paid fines of $4, and if non-commissioned officers, were reduced in rank to private. Washington established the amounts of the fines in his General Orders, and directed the proceeds be used to purchase much-needed medical supplies, including bandages, bedding, and what medicines were available at the time. They did little good. Venereal disease outbreaks remained a problem in the Continental Army throughout its existence, a misfortune which continued in the American Army and Navy through the War of 1812.
Tetanus is not an infectious disease which can be transferred among people, or from the bites of mosquitoes, but it has been a serious killer since the beginning of time. The Greek physician Hippocrates described the disease in the 5th century BCE. As recently as 2015 there were over 200,000 cases reported worldwide, with well over 50,000 deaths as a result of contracting tetanus, despite the existence of vaccines against the disease. It develops from bacteria which enter the body through a break in the skin. If left untreated serious muscle spasms occur, along with fever, high blood pressure, and an accelerated heart rate.
John Augustus Roebling’s experiments with and manufacturing of wire ropes changed the face of American industry and travel. First used in mines, railroads, and canals, wire ropes allowed for the building of ever longer suspension bridges. While surveying a site for a bridge between the cities of New York and Brooklyn in June 1869, Roebling’s foot was crushed by an arriving boat. The injury required the amputation of the toes, but an infection soon set in, and Roebling’s overall condition deteriorated rapidly. Less than a month following the accident Roebling suffered the serious symptoms of tetanus, and died on July 22, 1869. Vaccines against tetanus arrived in the 1920s.
Louis Pasteur’s work saved uncounted millions of lives throughout the world, simply by encouraging health care workers to frequently wash their hands and to sanitize them and equipment prior to examining patients. Prior to Pasteur’s work with germs and microbes, few doctors bothered to wash their hands between patients. Pasteur developed vaccines for animals and human beings, including a vaccine against anthrax, and for rabies. Pasteur created the first rabies vaccine for humans in the 1880s, growing the live virus he used in rabbits. In July 1885, Pasteur successfully used the vaccine on a 9-year-old boy who had been bitten by a rabid dog days before.
Pasteur was not a licensed physician in France, where the vaccination took place. Over the course of eleven consecutive days, Pasteur administered 13 inoculations to the boy. The boy did not develop rabies despite the fact that he had been bitten by a rabid dog. Pasteur later tested the vaccine on other patients, and in 1886 administered 350 vaccines to people, only one of whom developed rabies. Had any of the patients pursued legal action Pasteur faced prosecution for practicing medicine without a license. None did, and Pasteur basked in the acclaim awarded him as a national hero in France. He left strict instructions to his descendants to never reveal his personal notebooks and diaries. Not until 1964 did his papers appear in the French National Library, with severely restricted access until 1971. Numerous controversies over Pasteur and his methods have emerged since access to the papers loosened in the 1980s.
History books, particularly American textbooks, give the credit for identifying mosquitoes as culprits in seasonal yellow fever epidemics to Walter Reed, a US Army surgeon. Reed himself gave the credit to Carlos Finlay, who first presented the theory of mosquito-borne spread of the disease in 1881. For the remainder of the decade, Finlay presented a wealth of proofs supporting the theory. Reed arrived in Cuba in 1900, charged with examining several of the tropical diseases which afflicted American troops in the region. Reed used human volunteers for several experiments, which disproved many established beliefs regarding the disease and how it spread.
It also established Finlay’s hypothesis regarding the spread between humans via mosquitoes as correct. Reed cited Finlay’s work in his own papers, and in private and professional correspondence, though he became famed as the man who made the discoveries ending the yellow fever outbreaks through mosquito abatement. Reed returned to the United States in 1901 and lectured widely on yellow fever and the discoveries made by the American team he had led in Cuba. In November 1902, he suffered a ruptured appendix, developed peritonitis, and died at the age of 51. The United States Army honored him with several facilities in his name, including the Walter Reed Army Medical Center. In America, Carlos Finlay is all but forgotten.
Malaria, like yellow fever, was for centuries viewed as a seasonal illness, the product of pestilential air during the warm and humid months. In addition to smallpox, George Washington suffered from malaria in his youth. Not until Carlos Finlay identified the mosquito as the vector which delivered yellow fever to humans did scientists and researchers eye the same mode of transmission for malaria. Ronald Ross worked at the Presidency General Hospital in Calcutta (Kolkata), applying Finlay’s findings to malaria in India, which occurred at exponential rates annually. Ross proved the life cycle of the malaria virus in mosquitoes, and the transfer of the virus to and from infected birds in 1897.
Ross’s discovery received further support when Walter Reed’s board confirmed the work of Carlos Finlay in 1900. The relationship between mosquitoes and the two greatest of the tropical killing diseases, yellow fever and malaria, offered new means of battling their annual outbreaks. Mosquito abatement through pesticides and the issuance of mosquito-proof clothing and nettings offered protection against the diseases. The first vaccine against yellow fever appeared in 1938. Vaccines against malaria continued to elude researchers into the 21st century. Malaria continued to be treated with quinine, and mosquito abatement efforts continue in areas where malaria is likely to appear in the 21st century.
Edward Jenner gave the world the words vaccine and vaccination, developed from the term he created for smallpox of the cow, Variolae vaccinae to describe cowpox. In 1798, Jenner produced a work he titled Inquiry into the Variolae vaccinae known as the Cow Pox, in which he described his finding that cowpox protected against the more lethal smallpox. Smallpox was lethal indeed in Jenner’s day, killing up to 10% of the British population annually, with localized outbreaks often reaching death rates as high as 20%. Other British physicians observed that cowpox appeared to protect against smallpox before Jenner, and inoculation was practiced by some before he did (using weakened smallpox), but Jenner made the procedure widespread. He noted the commonly accepted phenomenon that milkmaids often did not develop smallpox during outbreaks.
Jenner postulated the milkmaids were exposed to pus from the blisters caused by cowpox on the cows they milked, and were thus immunized from smallpox. Jenner scraped pus from the hands of a milkmaid with cowpox and inoculated the eight-year-old son of his gardener. He later injected the boy with weakened smallpox virus, the standard method of immunization at the time. The boy should have reacted with a weak case of smallpox, but no smallpox presented at all. Despite initial resistance from the medical community, eventually, inoculation using smallpox was banned and in 1840 the British government authorized the free distribution of inoculation using cowpox. In 1979 the World Health Organization listed smallpox as an eradicated disease. The world no longer needs to fear smallpox outbreaks.
Of his discovery of the world’s first antibiotic, benzylpenicillin (penicillin G), Alexander Fleming wrote, “One sometimes finds what one is not looking for”. Fleming discovered penicillin through fortuitous circumstances while researching staphylococci. The ability of some forms of mold to combat infections had been known by the ancient Egyptians and in pre-Columbian America, but Fleming was the first to discover why. His study and testing of penicillin led to its identification as effective against the causes of scarlet fever, diphtheria, meningitis, and other infections. Nonetheless, after publishing his work with the new antibiotic Fleming largely abandoned it, convinced that it would not retain its effectiveness in the body long enough to work against any but surface infections.
In the 1930s Fleming’s pioneering work led others at the Radcliffe Infirmary to study the ways of making penicillin an effective antibiotic, easily mass-produced. Using money provided by the British government, supplemented with funding from the United States, and led by Ernst Chain and Howard Florey, they developed the means of mass-producing the drug in the late 1930s. Mass production of penicillin began shortly after the attack on Pearl Harbor, primarily in the United States, with the product routed to the Allied troops. By the end of the war penicillin was widely available, hailed as a wonder drug. Fleming also pioneered research into microbes developing resistance to penicillin and other antibiotics, and cautioned against its overuse by physicians.
During the 1980s the AIDS outbreak swept a frightened gay community, though it affected others as well. American movie and television star Rock Hudson received his diagnosis of having Human Immunodeficiency Virus (HIV) in June, 1984. Despite his increasingly gaunt appearance and his deteriorating speech, he kept the diagnosis secret as he traveled to other countries to seek treatment and the elusive cure. He searched in vain. Hudson collapsed in a French hotel room in July, 1985, leading his publicist to announce the star suffered from liver cancer, and denied he had contracted AIDS. Four days later, a French publicist working for Hudson announced the star did have AIDS. Hudson was the first international celebrity confirmed with AIDS during these outbreaks.
In late August, 1985, after a month of hospitalization in Los Angeles, Hudson retired to his Beverly Hills home for private hospice care. He died at his home on October 2, 1985. Following his death, his sexual orientation and the disease which killed him became a subject of open discussion among the celebrities that knew him, sympathetic for the most part. Hudson’s admission of having AIDS brought it to the forefront of mainstream public attention, and private donations for AIDS related research more than doubled following his announcement and subsequent death. Hudson’s death did not completely erase the stigma associated with the disease, but it remains an important milestone in the battle against the worldwide pandemic.
24. Magic Johnson and Human Immunodeficiency Virus (HIV)
On November 7, 1991, Earvin “Magic” Johnson abruptly announced his retirement from professional basketball, due to a diagnosis of him having acquired HIV. The announcement came 45 days after his marriage to his wife, Cookie. At the time of Magic’s announcement, a relatively small percentage of heterosexual men in the United States tested positive for HIV, the virus which leads to AIDS. Johnson’s diagnosis, and his frank public disclosure, led to increased awareness that HIV could be contracted through heterosexual relations. His announcement and the subsequent public discussion removed the stigma of HIV and AIDS as the “gay cancer” it carried at the time.
Johnson admitted a premarital life of multiple sexual partners, though he denied rumors of bisexual and homosexual partners. His openness increased public awareness and the need to exercise caution with partners. Johnson returned to the NBA for the 1995-96 season, playing in 32 games for the Los Angeles Lakers. He considered returning for the following season before retiring permanently, though his appearance did much to display to the public that HIV diagnosis no longer meant a death sentence. He established the Magic Johnson Foundation to fund the fight against AIDS, later expanding it into other charitable activities. Johnson remains an activist against the spread of HIV and AIDS outbreaks in the 21st century, having fought the outbreak for nearly three decades.
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