Amboceptor

Microbiological, virological, bacteriological, immunological, medical, epidemiological, historical, anecdotal

Yellow fever stops at the Miami airport.

staining-mosquitoes-before-liberating

Initially, new infectious diseases could spread only as fast and far as people could walk. Then as fast and far as horses could gallop and ships could sail. With the advent of truly global travel, the last five centuries have seen more new diseases than ever before become potential pandemics. The current reach, volume and speed of travel are unprecedented, so that human mobility has increased in high-income countries by over 1000-fold since 1800. Aviation, in particular, has expanded rapidly as the world economy has grown, though worries about its potential for spreading disease began with the advent of commercial aviation. [1]

Podcasts are great. But in the world of science podcasts, many are simply boring because there is only one person talking, or one person interviewing another person. Unless it’s slickly produced and edited (the Nature or Science Times podcasts), I’ll quickly lose interest.

It’s better when the podcast is three or four people who know each other, having a conversation. This is is the format of the TWi[X] series, particularly the flagship This Week in Virology. TWiV co-host Dickson Despommier, though not a virologist, contributes a big-picture point of view when the show leaves its territory of basic lab science and moves into epidemiology and patterns of disease outbreaks. Here’s his lecture on how West Nile arrived in North America and spread from state to state, energized by a very hot summer at the Bronx Zoo.

More than once I recall Dr. Despommier pointing out that though it’s all well and good to model how a epidemic might spread by looking at the day-to-day movements of people and mosquitoes, the most powerful and mobile disease vector is… the airplane.

That fact has become ever more clear with the SARS and West Nile outbreaks, as we used genetic analysis to track them across the continents in real time. But you might be surprised at how long ago people recognized the airplane as a challenge to disease control.

* * *

80 years ago, yellow fever was the archetypal mosquito-transmitted disease. Particularly as the disease was endemic in some parts of the world (e.g. South America), but not in others (e.g. North America), despite both places being home to the vector, Aedes genus mosquitoes. A 1934 article [2] coauthored by Henry Hanson, veteran of battles against yellow fever on three continents, points out that dengue fever (also transmitted by Aedes) had reappeared in Florida after an eleven-year absence, and yellow fever could do the same at any time.

dengue-1922-1934-tampa-miami

Hanson and coauthor T. H. D. Griffitts go on to chide the cities of Florida and Georgia for their complacency in providing countless unsupervised water vessels in which the mosquitoes can reproduce.

Practically every urban community in the South has its array of artificial containers, from flower vases to catch basins, cuspidors and discarded automobile tires, producing Aedes aegypti. For example, the city of Tampa in eight weeks reported finding 1,091,823 containers (potential mosquito “hatcheries”). Of these, larvae were found in 20,864, or approximately 2 per cent. This was an unusually dry season (average rainfall of 1 1/2 inches a month for this period). It is interesting to note that in Miami for a like period only 56,598 potential breeding containers were reported, with 38,401, or 68 per cent, of the total actually breeding.

So I made an error above. The vessels aren’t quite “countless”. There are 1,091,823 of them in Tampa, give or take a dozen.

Though concerned that yellow fever could reach North America (again), Hanson and Griffitts are more concerned about India. The disease is only known in jungle areas of Brazil, Colombia and Bolivia (they claim); by comparison, Africa is its ancestral “home” and India, fairly nearby by plane, is virgin territory for yellow fever epidemics.

Today there is a feeling of concern … that Old World territory, where the vectors abound and where yellow fever has never before stalked, may experience widespread and devastating epidemics. One infective mosquito traveling in an airplane from the home of yellow fever (Africa) to India could be the spark to start the conflagration.

Thus there was considerable surveillance for mosquitoes and infected passengers at airports worldwide.

The earliest article I can find specifically discussing airplanes as disease vectors is from 1930, the first [3] of two identically titled 1930s editorials in the American Journal of Public Health. I don’t know if the international rules discussed here were enacted, but they show awareness that quarantine and disinsectization measures developed for ocean travel need to be multiplied and intensified to cope with passenger aircraft. Click for a bigger view.

airplane-and-yellow-fever-1930

* * *

For the purpose of determining whether or not mosquitoes are carried in airplanes, and, if so, to what extent, the distance of such transportation, the species of mosquitoes, and the type of planes on which they are carried, the United States Public Health Service began, on July 23, 1931, the inspection of all airplanes from tropical ports arriving at the airports of the Pan American Airways System at Miami. [4]

An anecdote from less than a year later illustrates how the search for mosquitoes had become a normal part of a plane’s arrival in the U.S. from South America.

A very Normal Rockwell scene of mosquito inspection. From LIFE Magazine, 5/27/40.

A very Normal Rockwell scene of mosquito inspection. From LIFE Magazine, 5/27/40.

The story of “the first international aerial hitchhiker” is as follows.

Paul Kaiser, 25, tried to immigrate from Czechoslovakia to America via a circuitous route. First, he got to the German port of Bremen, from which he sailed to Colón, Panama on an ocean liner. Sneaking into the nearby Canal Zone airport, he climbed into the baggage compartment of a “big 22-passenger Commodore plane”. The plane first landed in Barranquilla, Colombia, where he was not detected. It then landed in Kingston, Jamaica, where he was not detected. Finally, after Kaiser had spent 2 days without food, he landed in Miami. However, in Miami “a very thorough inspection is given every plane for mosquitoes, for there is always danger of the deadly yellow fever mosquito surviving the short trip and landing in the United States, a most undesirable immigrant”. Check out the April 1933 issue of Flying magazine for more details.

A few months earlier, T.H.D. Griffitts (coauthor of the aforementioned Henry Hanson article) performed the first experiments on mosquito transport by aeroplane. These were published in late 1931, in an enjoyably conversational article in Public Health Reports [4].

Dr. Griffitts, you don't really have to describe the experiments you WANTED to do but then decided were unnecessary.

Dr. Griffitts, you don’t really have to describe the experiments you WANTED to do but then decided were unnecessary.

T.H.D. Griffitts (and J.J. Griffitts — his son?) start out by describing all the mosquitoes observed on normal commercial flights between July and September of 1931. Most were Culex quinquefasciatus, but several other species were observed including Aedes aegypti. In fact, a later Griffitts paper [5] indicates that the historic first mosquito discovered on a Miami-bound plane was Aedes aegypti. (It’s somewhat confusing that the insect apparently arrived on a “ship from San Salvador, El Salvador”, but I think that at this time the word “ship” could be used for aircraft. And San Salvador is definitely not a port city.)

Griffitts also put mosquitoes on three planes departing from San Juan, Puerto Rico, and looked for them upon arrival in Miami. Today it takes 2.5 hours to fly from SJU to MIA, but in 1931 they stopped at three other airports along the way and the average travel time was over 10 hours. A total of 100 mosquitoes were labeled with eosin dye (to distinguish them from non-experimental and Miami-resident mosquitoes). 22 were observed upon arrival in Miami, after 1,250 miles of flying, opening of doors and hatches, loading and unloading of luggage, etc. It seems obvious that the insects can be imported… but these experiments prove it.

* * *

Eight years after 1930′s “The Airplane and Yellow Fever” editorial, the American Journal of Public Health published another one [5], describing the policies for infectious mosquito control in Khartoum, Miami, and “the French Colonies and Mandates”.

As the 1930s progressed and India remained devoid of yellow fever, public health doctors kept amplifying their alarms about how devastating such an epidemic would be. From the 1938 editorial:

greatest-menace-in-the-world-today

75 years after that was published, yellow fever still hasn’t swept through India.

In 1938, the number of people who’d been vaccinated against yellow fever was less than a hundred thousand, mostly in Brazil. It had taken a long time to make a vaccine strain of YFV that was weak enough that it could be given as a live vaccine, but the 1938 trial (run by the Rockefeller Foundation) was successful, and in 1942 the number of people vaccinated was over 10 million. For his two decades of work on the vaccine, which along the way required multiple basic science breakthroughs for it to be manufactured in large quantities, Max Theiler of Rockefeller University received the 1951 Nobel Prize in Physiology or Medicine. Read more here [6] about Theiler’s story; read more here [7] about the many problems and hurdles that were overcome to end up with a safe vaccine. (I think the second one is open-access and the first one isn’t.)

Within a decade, though complications from the vaccine were common and the virus stayed endemic in the tropics, Theiler’s YFV vaccine had eliminated yellow fever as a source of large-scale epidemics.

* * *

Coda: As early as the airplane was recognized as a vector for disease… it was harnessed as a weapon against disease.

From a 1932 report in Science (8), Joseph Ginsburg of the New Jersey Agricultural Experiment Station explains how large regions of standing water that previously were inaccessible to mosquito control workers can now be reached by plane, so that the surface can be coated with larvicidal pyrethrum or oil.

cheesequake-killing-film

 

* * *

1. Tatem AJ, Rogers DJ, Hay SI (2006). Global transport networks and infectious disease spread. Adv Parasitol 62:293-343.

2. Griffitts THD, Hanson H (1934). Significance of an epidemic of dengue. JAMA 107(14):1107-1110.

3. Editorial (1930): The airplane and yellow fever. Am J Public Health 20(11):1221-1222.

4. Griffitts THD, Griffitts JJ (1931). Mosquitoes transported by airplanes: Staining method used in determining their importation. Public Health Rep0rts 46(47):2775-2782.

5. Editorial (1938): The airplane and yellow fever. Am J Public Health 28(9):1116-1118.

6. Norrby E (2007). Yellow fever and Max Theiler: The only Nobel Prize for a virus vaccine. J Exp Med 204(12):2779-2784.

7. Frierson JG (2010). The yellow fever vaccine: A history. Yale J Biol Med 83(2): 77-85.

8. Ginsberg JM (1932). Airplane oiling to control mosquitoes. Science 75(1951):542.

 

Taiwau Bozu: The bald geisha plague of 1901

The strange disease which has produced so much hilarity came, it is said, from Formosa; and a person may conclude that he has been attacked by it when he gets up in the morning and finds a hitherto hairy poll as bare as a billiard ball. No other symptoms make their appearance. It is bad enough for the Japanese gentlemen, but the ladies are quite terrified at the prospect of losing those coiled masses of glistening, jet-black hair which are often veritable works of art.hairless-japan

In this light-hearted style, English-language newspapers noted of an “epidemic of baldness” which afflicted the rapidly-modernizing nation of Japan in 1900 and 1901. The Sydney Daily Telegraph‘s unnamed Tokyo correspondent, writing in March 1901, goes on to rhapsodize about the “long raven locks”, the “shiny coils and bride-cake intricacies”, which rested on the heads of “singing girls of the well-known type of Rudyard Kipling’s ‘O-Toyo, ebon-haired, rosy-cheeked, and made throughout of delicate porcelain’,” before revealing that “in at least three or four cases” prominent Japanese ladies have had their heads rendered egg-like and their status in society thereby ruined.

The article gives the impression that a lot more men than women have been afflicted, but “[t]he strong point of a Japanese [man] does not by any means lie in his hair, which generally sticks up on his head as bristly and as stiff as the hairs on a blacking brush.” Thus our sympathy should be directed at the “singing girls” or “dancing girls” who so prize their raven tresses. And the Japanese, led by their one famous bacteriologist (probably Shibasaburo Kitasato, though Hideyo Noguchi would soon achieve similar fame) can surely deal with this problem.

The study of medicine is pursued with great ardor and success in Japan, which claims the honour of having produced at least one bacteriologist of international fame; and it is not surprising, therefore, that the doctors are studying the new disease with the liveliest interest. It should be no difficult matter to get hold of the pestilent little microbe that is the cause of all the trouble.

* * *

The mysterious plague apparently originated on the island of Formosa (now called Taiwan), which was under Japanese military occupation, following the island’s relinquishment by China under the Treaty of Shimonoseki. Formosa was a poor place at the time, compared to Japan, and a plausible source for a tropical disease.

Also in 1901, the London Spectator gave a more clinical report of the outbreak, courtesy of Berlin correspondent Louis Elkind, probably summarizing German press reports. Evidently “there was an epidemic of baldness at Chiba last year, and there has been an even more serious one quite recently at Osaka, the same province where, as it will be remembered, an extensive epidemic of plague … prevailed in the last months of 1899 and at the very beginning of 1900.”

The effects of the disease exhibit several interesting peculiarities. The bald patches are irregularly spread over the head, but the first large one generally appears on the crown and extends down the back of the head instead of forwards towards the forehead; thus it may be that the back of the head is quite bald and the front covered with hair — the opposite of the course of baldness as we know it in Europe. Then, also, men’s beards are ravaged in a peculiar manner. The left cheek, say, may be completely bereft of hair while the rest of the beard is as usual, as also is the moustache, which, fortunately, is but slightly affected by the disease.

* * *

Elkind’s report sounds more plausible than the Sydney correspondent’s chatter about ladies “shedding their ebony tresses — and shedding at the same time tears large as eggs”.

Utamaro (1753-1806), Kami-yui (Hairdressing)

Utamaro (1753-1806), Kami-yui (Hairdressing)

But did this really happen?

No, according to Dr. Stuart Eldridge, friend of Ulysses Grant and longtime contributor of short dispatches from Japan to the ASPH journal Public Health Reports. Eldridge’s obituary suggests an interesting career, including at age 28 being part of “the scientific mission to Japan under General Horace Capron,” and staying in Japan until his death 30 years later.

After updating Public Health Reports on Japan’s plague outbreak of 1899-1900, Eldridge sent in two brief reports about the bald geisha plague (Report #1, Report #2). Here’s the first.

eldridge-japan-1

No source is cited, but Eldridge thinks the disease is spread quickly, is spread by barbers, originated in Osaka (though the Spectator claims it was in Chiba first), and there is evidence for all these assertions though we don’t know yet whether the baldness is permanent.

However… one week later, Eldridge has consulted with the leader of Japan’s bacteriological efforts, and now doubts that the outbreak ever happened.

I have communicated with Professor Kitasato, thinking that, if it was of the importance and malignity ascribed to it by the newspapers and common fame, the institution under his charge would have already begun the investigation of the matter. Professor Kitasato informs me that so far he has been unable to obtain proper material for study, and that the cause of the malady has not been, as yet, ascertained. I am now somewhat inclined to believe that both the number affected and the severity of the disease have been greatly exaggerated, and that it may eventually prove that the ordinary cases of alopecia, always rather prevalent in Japan, and neither contagious nor particularly severe, have been magnified by newspaper sensationalism into something new and alarming.

At the same time Kitasato published an article in the newspaper Jiji Shinpo. Given his stature in Japanese medicine, I’m guessing this was a decisive blow against the local baldness hysteria. Kitasato’s thoughts were summarized by Albert Ashmead in American Medicine — after first giving a sample of that hysteria.

albert-ashmead-taiwau-bozu

“In some villages the hair of all the women in the place has fallen out. The people call the hair plague ‘Taiwau Bozu.’ The disease has robbed several dancing girls of their beauty. It is said to have been imported from Formosa, and the health authorities have gangs of men at work disinfecting the poor quarters of the towns. The hair plague seems to be spreading over a large area.”

Allow me to observe that Taiwau Bozu is not a new disease. The words mean Formosan Priest. All Buddhist priests in Japan have the head shaved, and thus one who is completely bald is said to look like a priest, in fact is called “priest.” … Dr. Kitasao says that “it is not the first time the disease has been epidemic in Japan. It does not come from Formosa, although the people think so. It is not very contagious. It is the same disease which occurs all over Europe, etc.” Inasmuch as the syphilis of Formosa is fiercer than the syphilis of Japan, and the syphilis of Europe is fiercer than that of Formosa, so Taiwau Bozu’s ravages differ in different countries.

… The disease is simply epidemic Tokuhatz-fizo (bald disease); Alopecia areata of specific origin (syphilitic), and it is contagious.

So according to the experts, we have a minor urban flare-up of secondary syphilis. (“The classic alopecia of secondary syphilis is patchy with a “moth-eaten appearance” and has been reported in up to 7% of patients.”) Possibly associated with the return of military forces from Taiwan (or Taiwau), as outbreaks of venereal disease sometimes are. Albert Ashmead’s interest in Japanese history lets him put the whole thing into perspective.

I add that in 1967, when the licensing of prostitution went into effect in Japan, the professions for women of “Geisha” dancing, tea-house and archery-gallery keeping, became crowded with prostitutes (more or less syphilitic) to evade the payment of the government tax. Then the hospitals of Tokio had to do with a great number of cases of syphilitic alopecia in no way different from the present outbreak

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Medical photography, Dorothea Lange style

There are six illustrations in this paper. The first two show the layout of the sinuses. The other four are haunting.

From M.H. Gill (1906), Diseases of the Maxillary Sinus, Yale Medical Journal XII(9):821-829:

maxillary-sinus-1

maxillary-sinus-2

maxillary-sinus-3

maxillary-sinus-4

These people (three adult men with abscesses and “a female aged ten” with cancer) got sick and came to St. Francis Hospital around 110 years ago. We hope they got better.

A 1711 treatise on venereal disease (Part V: Miscellany and Mercury)

With the end of the month of March, we end our series of posts on Dr. John Marten’s 1711 Treatise of the Venereal Disease.

In previous volumes, we’ve gone through as many lengthy, out-of-context quoted passages as anyone can stand. See Part II: Human Anatomy (“These Ova, or Eggs are not only found in the Testicles of Married Women, but also in Virgins, in the same manner as we find them in Pullets which will lay Eggs”);  Part III: Human Behavior (“To see an old Letcher, what more odious, yet what more common? How many Decrepit, Hoary, Wither’d, Bursten-belly’d, Crooked, Deaf, Toothless, Bald, Blear-ey’d, Impotent, Rotten Old Men, shall you see flickering upon the Women in almost every Place?”); and Part IV: Venereal Disease and Treatment (“it happens in Gonorrhæa’s, where the said Glandules receiving a Malign Impression and Inflammation from the Virulent Steems, do either transmit but little or no Mucus, or at least what is very crude, thin and acrimonious”).

Therefore, the lengthy passages in today’s post will be presented in some sort of context!mercury-the-third-part

First, it should be noted that A Treatise of the Venereal Disease is divided into three parts. The first chapter of the third part, between “Of the Return of the Hidden Pox” and “Of Mischiefs by Quacks, &c.” comprises 99 pages about mercury, with a tenuous link to venereal disease or any other elements of the book. Marten has clearly scoured all available medical literature for evidence that mercury is toxic. Here are a couple representative mercury anecdotes.

  • On mercury poisoning:
  • Petrus Apponensis, in his Book de Vener. Cap. 2. relates an unhappy Disaster that befel an Apothecary, who to quench his impatient Thirst in the Night, rashly took hold of a Bottle with Mercury, and upon a Mistake that it was Water, drank a rousing Draught of it, upon which he was found dead next Morning, though the greater part of the Quicksilver run thro’ him by Stool; his Body being dissected, they found his Heart and the Blood around it quite congealed. (p. 628)
  • On precautions against mercury poisoning:
  • To prevent or Remedy the Perniciousness of those Mercurial Effluvia, those Miners hold frequently Gold in their Mouths, whilst at work, which in some measure may relieve them, because holding it there for some time, it is chang’d from its yellow Colour to a whiteness like Silver; but by their constant working and drawing in the Particles at their Breath, it proves but a very insufficient Remedy. (p. 629)
  • On mistakes by the pharmacist:
  • [A] tender young child was order’d this Liniment to kill Lice. Take Mercurius Dulcis, one Dram; Mercurius Vitæ, one Scruple; Pomatum one Ounce; mix. But an unskilful Apothecary making a vile Mistake, put in Sublimate instead of Mercurius Dulcis; upon which the Head became so grievously tumefied and inflam’d, that the poor little Innocent must necessarily have perished, had not a Physician presently fomented it with a strong Lixivium; by the help of which proper Antidote, it soon recover’d indeed, but yet so as to lose all the Hair of its Head. (p. 638)
  • On carnival entertainment:
  • Wierus remarks, that a Juggler having made his Guts slippery with a good quantity of Butter, did Ordinarily, swallow down a great measure of Mercury, and voided it again immediately before the People without any hurt. (p. 679)

One symptom of mercury toxicity is excessive salivation. Some doctors in the 18th century used “salivation” as a treatment in itself, or as a way of purging the body to prepare for a more effective treatment. On page 657, Dr. Marten takes a very strong stance against this, having already pointed out plenty of incidents where people’s teeth or connective tissue are destroyed by excessive mercury ingestion.mercury-salivation-constantine

Some have been  Jaw-fallen on one side by rotting of the Ligament of the Juncture; and withstanding all this, says [a certain Surgeon], if a Patient apprehends danger in being Salivated, the Practitioner shall boldly tell him, it is as safe as a Bit of Bread, or the Food he daily eats.

But rather than I would be salivated (were I under the occasion) after the manner generally practised, I would as Constantine the Emperor said, when he was told, that there was no way to cure him of his Leprosie but by Bathing his Body in the Blood of Infants: Malo semper ægrotare quam tali Remedio Convalescere. I had rather always to be Ill, than by such a Remedy to recover; so say I as to the general method of Salivating.

 * * *

Now, on the lighter side…

On page 764, in one of Marten’s many, many attacks on doctors he deems incompetent (he calls quacks “Rascally Fellows”,  “Renegado Mechanicks”, “Pseudo-Chymical Empyricks”, “paultry deluding Fellows”, “Illiterate and Empirical Pretenders”, deceitful Intruders”, “the Pest of Humankind”, “those Monsters of Men, void of Honor and Honesty”, “deadly Enemies to Nature, and Bloody Hell-hounds”, &c.), we get a little poem in the voice of a French quack, in pidgin English. Though this and other passages about quacks are credited to “Hudibras”, I don’t think it’s from the mock-heroic late-17th-century poem by that name, as there are no search results for the phrase “Me be de Frenshman” or “de Cough, de Tissick”. Was the name “Hudibras” used by other satirists?

me-be-de-frenshman

Me be de Frenshman, profess Physick,
Me cure de Pock, de Cough, de Tissick,
De Ish, de Gout, de Asch in Bones,
And me Begar can cut your Stones.

Towards the end, the book gets looser and looser, throwing in doggerel like this, satire, and lengthy anecdotes intended as nothing more than jokes. Another poem puts forward the “Diamonds are a girl’s best friend” principle.

Provide whilst young, against you’r Old,
For then you’ll find no Friend but Gold,
For when decay’d, and once grown Poor,
‘Tis “out you nasty common Whore”.

And here’s a Q and A in verse, some “tough love” directed at the young gentleman frantic with rage after being “Clapt” by a mistress or prostitute, which must have been Dr. Marten’s most common type of patient.the-guinea-is-due

Question. Suppose when I’m Drunk,
I pick up a Punk,
She swears she is sound,
Which false soon I found.
And I swear I will give her a Guinea:
Since she did deceive me,
And in such a Plight leave me,
If I on demand,
Pay Guinea in Hand,
D’ye think I should be not a Ninny?

Answer. The Guinea is due,
And just Debt from you;
Your Promise does bind,
And what you did find,
Your Sense might have told you before;
And however you fare,
With your Rotten Ware,
We needs must aver it,
‘Twas due to your Merit,
And you had your agreement and more.

 * * *

Finally, there’s a 2 1/2-page anecdote from Sir Thomas Browne, which simply must be read in its entirety (it’s more legible here, in Browne’s collected letters). The upshot is that he went over to the house of a woman named Belinda who was always seen in fashionable boxes at the theater, and was the object of adoration for countless young rakes and blades. So he barged in, and she and her two flatmates were eating lunch in a state of undress, because the landlady was doing the laundry. This set him to thinking about the deceptiveness of appearances, and the thin veneer of social grace underlied by the stark truths of humanity, and he was morally disenchanted, however briefly, with the very concept of whoring. As would anyone after reading all thousand pages of A Treatise of the Venereal Disease.

a-letter-to-monsieur-h

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