So, let me move on now to smallpox.
As you'll see as I go through the rest of this talk,
I happen to have a profound interest
in infectious diseases because that's my area of clinically and immunology.
So, let's talk a little bit about smallpox, which has a pretty neat history.
Smallpox was first described by Al-Rhazi, who I had mentioned earlier,
probably about 900 AD.
In the 11th century, there actually were protective measures
being used throughout the world, taking scabs from smallpox pustules
and putting them in the nostrils of a healthy subject.
And that actually offered some protection if you didn't get smallpox.
People were wearing the clothing of someone who had the disease.
People ingested powdered fleas from infected cows,
which may have perceived the relationship of cowpox to smallpox.
In the 1720s,
the process of what's called variolation was practiced in Africa, China, and India,
where you would take a scab from a patient who had smallpox, remove it from the subject,
and take the contents of that scab and scratch it into a healthy person.
Most people got protected; some people got smallpox.
And Lady Mary Worley Montague, who was British and the wife of the British
ambassador, observed, in Turkey, in Constantinople, this variolation process.
And she brought it to London and she even inoculated her own two children.
And a hospital for smallpox inoculation was founded
in London in 1745 using this approach.
The first known use of cowpox to protection against
smallpox was done by Benjamin Jesty, who lived in 1736 to 1816.
And he was a farmer who lived in a village
of Yetminster in North Dorset, United Kingdom.
And he was convinced that milkmaids who contracted cowpox
were protected from smallpox.
And in 1774, he inoculated himself, his wife, and two sons
with cowpox lymph from the underside of a cow udder.
And in1805,
he publicly inoculated his son, Robert, with live smallpox after he had inoculated
or immunized him, and he demonstrated that his son was protected.
So, this was before Jenner.
But what Jenner did in 1776 was actually do a large study.
And here you see him vaccinating James Phillips,
the first person who was vaccinated.
And he did a large study, and he recorded the data, and talked about it.
And it was after Jenner's work with smallpox
that a vaccine that was efficacious was developed.
Now, before we conclude smallpox, I just want to mention one historical fact.
I don't want to dwell on Lord Jeffrey Amherst.
He actually did the first biological warfare of taking blankets from people
who were infected with smallpox and giving it to the Indians in the French Indian War.
That's pretty horrible.
But George Washington did something remarkably clever.
In 1775 and 1776, when the British were surrounding Boston
and the Continental Army in the United States was threatened,
the British Army had an epidemic of smallpox, which had not hit the Continental Army.
And Washington made the decision that he wanted
to do the variolation technique in the soldiers.
But he wouldn't do it without the consent of the Continental Congress.
And so, he got John Adams, who, on July 3, 1776, the day
before the Declaration of Independence was signed, he got Adams to get
the Continental Congress to give approval for mass immunization of the Continental Army.
And this was, to my knowledge, the first example of mass
immunization of -- in the military or probably anywhere else.
And it worked.
It probably saved the Army and enabled the United States to beat
-- or the Continental Army to beat the British, eventually.
And, now, of course,
smallpox has been eradicated through the work of D.A.
Henderson.
And the last case was in 1977, and the World Health
Organization declared smallpox completely eradicated in 1980.
So, genetics.
We all know about genetics.
We know about Mendel, who was the Father of Genetics, working with plants.
And you may not know about Barbara McClintock, who lived from 1902 to 1992,
and was a fabulous cytogeneticist, and did groundbreaking research
in developing the technique of visualizing maize of corn chromosomes,
and used microscope analysis to generate many fundamental ideas,
and discovered transposition and used it to demonstrate the genes
that are responsible for turning physical characteristics on and off.
And in 1983, she won the Nobel Prize for her discoveries of mobile genetic elements.
And you know about Darwin, who lived -- and in 1859, published his book, "On
the Origin of The Species." You may not know that he created
the first tissue bank and demonstrated the importance of meticulous records.
During his travels, he took tissues from all the different species
that he studied, and he actually created a tissue bank.
So, clinical medicine depends on epidemiology for much of the work.
And I want to just mention John Snow, who was an anesthesiologist
who lived from 1813 to 1858, who was British.
And he was a real medical hygiene pioneer and,
really, the father of modern epidemiology for work
tracing the course of a cholera epidemic in Soho, England, in 1854.
And he created this spot map in the city of London in Soho
to illustrate each case of cholera during this epidemic.
And he demonstrated that it all centered around a water pump.
And he illustrated the connection between the quality of water source
and the cholera cases.
And he said, "Remove the water pump and you'll get rid of the cholera." And they did.
And then, the community went ballistic because they had to walk
long distances to get the water, so they reopened it.
The cholera came back.
So, he really proved his point.
Then they closed the pump and the epidemic subsided.
So, this was a major event in public health history.
Maybe the greatest public health invention in the 1800s
was by Semmelweis, who I'll tell you about in a minute.
But remember what I told you, that Sushruta had advocated
sterilization of wounds and Hippocrates promoted clean hands for wound management.
But it was this man, Ignaz Semmelweis,
who really solidified the importance of sanitation in medicine.
And he lived from 1848 to 1863, a short life.
He studied puerperal sepsis in Vienna, over the protests of his chief.
He was an anesthesiologist.
He had noted that the sepsis rate was three times higher in Division
One in his hospital than in Division Two.
And these two divisions were identical
except medical students worked in Division One and midwives in Division Two.
And he had a dear friend who died following infection of an autopsy that his friend did.
He was a pathologist.
And it was autopsy in a patient who had a wound similar to puerperal sepsis.
And this led him to the primary hypothesis that the infection that was seen in the women
who were delivering babies came from the autopsy room
by the medical students to these women who were giving birth.
So, he said students had to wash their hands and he used chlorinated lime solution.
This basin still exists that he used.
And when he did that, the mortality rate dropped from 18 percent
to 1 percent per year and, in some months in 1848, it was zero.
And these are the data that he published.
And you can see by this yellow line, which is the number of women who had sepsis
who died, and the red arrow is when he started having them wash their hands,
and it immediately plummeted.
So, he told his chief about this,
and the chief didn't believe his data, and he was fired.
So, then he moved to Budapest, Hungary, where he repeated these experiments
and got the same results.
And wrote a paper,
The Etiology, Understanding, and Prevention of Puerperal Sepsis,
and it was rejected by the Vienna Medical Journal.
And, ultimately, he had to pay to get this work published, but it was published.
And I can tell you, he had a sad outcome.
He went crazy because nobody believed him.
And he was admitted to a mental hospital, and he cut his leg
on the edge of a bed, and he died of puerperal sepsis.
Now, his work was known by some folks in the United States
and I'll tell you about that in a second.
But in the interim, in 1882, Joseph Lister
also was working on the importance of sepsis in the operating room,
and he used carbolic sprays to clean wounds, open wounds.
And he showed that this would reduce infection.
So, the person who advocated for Semmelweis was Oliver Wendell Holmes,
Sr., the father of the great Supreme Court justice in the United States,
who was an obstetrician who worked at Massachusetts General Hospital.
And he didn't repeat Semmelweis's experiments, but he believed them.
And he went around and spoke this up and certainly got clean hands
and washing hands as an integral part of the public health of hospitals.
Sadly, it's still a huge problem.
And I can you, in this hospital, at the NIH Clinical Center, a few years ago,
we had an epidemic of a multi-drug resistant klebsiella infection.
And it was clearly linked
to people not washing their hands in an aggressive enough fashion.
So, something as simple as washing hands is phenomenally important.
So, let me tell you a little more about surgery, more modern surgery.
I can't escape telling you about John Hunter,
who lived from 1728 to 1793, who really changed the nature of surgery.
He was a Scottish anatomist and a surgeon.
His older brother was an established surgeon.
And his mother didn't know what to do with him,
so she sent him to work with his brother.
And his brother, who was a surgeon, told him to go out and rob graves.
And he became --
they would take these corpses and teach anatomy to people who were interested.
And he became quite the skilled anatomist and, then, surgeon.
And one of the things he did is determine the nature of venereal disease.
And he actually inoculated himself
with the infected material from someone who had syphilis.
And he got syphilis and he eventually had heart damage from the syphilis.
There's a great book called, "The Knife Man." And if you're interested,
I suggest you read it.
It's a very colorful book about his life.
Anesthesia,
we can't mention without mentioning William T.G.
Morton, who was a dentist who lived from 1890 [sic] to 1868.
And he demonstrated that ether, which he called letheon, worked.
And he did a demonstration in 1846, October
16, 1846, at Mass General Hospital in Boston, demonstrating that surgery
could be conducted on a person while they're asleep with no pain.