Sunday, October 9, 2011

Immuun wordt immune

In 'Immuun' worden grote en kleine onderwerpen uit de immunologie belicht en waar mogelijk in zijn sociale context geplaatst. Immuun gaat veranderen: Immuun wordt Immune.

Because of my transition to an international oriented institute, Roosevelt Academy in Middelburg, Immuun Blogspot will change its format and continue in English. The first issue of the 'Immune Blogspot' deals with how Zeeland, and in particular Middelburg became immune. This has been described by Dr. de Man in the Netherlands Journal of Medicine nr. 50 of December 30th, 1882. The original publication is in Dutch and can be found here.

Dr. de Man provides a detailed analysis of the mortality rates in Middelburg, the capital of the province of Zeeland, feared by everyone in the rest of the Netherlands ( “ . . door gansch Nederland weleer en nog altoos zóó gevreesde Zeeland.”). His analysis covers the period from 1792 until 1881, which for immunology is a most relevant period because it includes the discovery of smallpox vaccination by Edward Jenner in 1796. The smallpox vaccine was first used in Zeeland quite soon after Jenners discovery, namely in 1804 and the results were really impressive: in 1792 there were 137 deaths from smallpox in Middelburg , in 1822 'just' 7 per 10,000. De Man apologizes for being unable to provide exact data on the population of Middelburg, which fluctuated greatly during that period. As an approximation he multiplied the number of births per year by 30. Smallpox vaccination was continued until 1980, when smallpox was completely vanished from Zeeland and the rest of the world. Mortality rates of other infectious diseases also were high, but De Man found it hard to obtain reliable data because cause of death often was not specified on the death certificates or totally unreliable. In 1847, 50 military died from a feverish disease apparently because they were homesick, according to their death certificate. It is estimated that typhoid fever, malaria as well as pneumonia were the major causes of death, each contributing between 300-500 deaths per 10,000 per year. The reduction in mortality rates of typhoid fever and malaria during that period where not due to the introduction of effective vaccines. Unfortunately, those vaccines were not available at that time and are not even available today. Improvements in nutritional status, of sanitary conditions, and discovery of quinine all contributed to reduction of the burden of these diseases. Childhood mortality rate in Middelburg was as high as 10-15% up to 1840. In that time the children were not treated by the doctors, only the adults. While this may sound incredible, it reflects the spirit of that time that limited resources should not be wasted on children. Fortunately times have changed.

The same issue of the Netherlands Journal of Medicine of 30th December 1882 continues with a paper on clitoridectomy (defined by the WHO as genital mutilation) as an effective form of treatment of female hysteria. Times have changed indeed.