The Land of Desire: French History and Culture
64. Louis Pasteur and The History of the Vaccine
January 21, 2021
“I think my hand will tremble,“ – Louis Pasteur
Episode 64: “Louis Pasteur and the History of the Vaccine”
Transcript
Bienvenue and welcome back to The Land of Desire! I’m your host Diana, and I’d like to start by wishing all of you a very, very happy New Year! I know it’s been a tough winter, but there are better days ahead of us. As many of you know, I’ve always been a huge epidemiology nerd, and I’ve struggled to restrain myself in the past because I know that most of my audience really doesn’t want to hear about diseases even when we aren’t going through a major pandemic. Fair enough. So I’m excited for an excuse to turn back to my favorite subject, but I promise, in a happy, optimistic way. If 2020 was the story of a disease, 2021 is looking like the story of its cure. This week, we’re taking a look at one of the greatest French inventions of all time. Along the way, we’ll encounter Catholic masses for dogs, the worst cruise you’ve ever heard of, and a man who came a bit too close to becoming a true mad scientist, Louis Pasteur. We’re at a turning point in medical science, so what better time to look back at how far we’ve come? This week, join me for a closer look at the history of the vaccine.
On July 4, 1885, a nine year old boy named Joseph Meister was attacked by a dog near his home in the city of Alsace. As he cowered and shielded his face with his tiny hands, the dog lunged at him again and again, biting him. A nearby bricklayer heard the screams and managed to beat the dog back with a pair of crowbars, but not until Joseph sustained fourteen bites on his thighs, legs and his hand. Joseph’s mother rushed him to the local doctor, who applied carbolic acid to the wounds, but the two adults looked at one another with a terrible fear. Joseph was at risk for one of humanity’s deadliest diseases, a disease scary enough to inspire not one but two terrifying mythical monsters, a disease with a nearly 100% fatality rate, a disease which guaranteed the worst of all 19th century fates: an ugly death. Joseph was at risk for rabies. Joseph’s mother, beside herself with worry, asked the doctor what else could be done. The doctor must have known Joseph was in dire straits, because he made a radical suggestion: take the boy to Paris, he said. There’s a scientist there, a famous scientist, who thinks he may have a solution. Joseph, still in unbearable pain, accompanied his mother to the train station at once, and within 48 hours of the attack, they found themselves in one of the strangest buildings they’d ever stepped inside: this was the laboratory of the great Louis Pasteur, and it was filled with rabid dogs.
In the long, strange cultural history of humans and diseases, rabies has always held a unique space in our minds – more specifically, in our amygdala, which controls fear. We’ve had rabies for just about as long as we’ve had domesticated dogs, and just about every ancient set of laws we can find has some sort of rule about how to handle wild dogs, rabid dogs, dogs who bite, and people who are bitten by dogs. The first known victim of rabies appears in a cuneiform tablet from ancient Mesopotamia, written about four thousand years ago. The ancient Greeks referred to lyssa, or a wild violence, while the Romans spoke of rabere – or “rage” from which we may get the word “rabies”. Over the centuries, across civilizations, the same disease appears again and again, and one thing in particular stands out: humans have always, it seems, known exactly where rabies comes from. Take a moment to appreciate that. Even during periods of time when diseases were the whims of god, justice for your sins, or the mysterious and unknowable slights of fate, rabies alone had a clear cause and effect. We didn’t have germ theory, we didn’t have microscopes, but there was one infection pathway that humans have pretty much always understood: mad dog bites man. Man goes mad. Mad dog and mad man die. The end. As it turns out, that wasn’t the entire story – it looks like rabies first made its way into bats, and then the bats found their way to the dogs, but again, in a world where you got smallpox because Zeus was in a bad mood or you lusted after your neighbor’s wife, let’s give the ancients credit where it’s due.
Over the centuries, the preventative measures and treatments for rabies grew accordingly sophisticated and complex. In ancient times, a bit of fur from the dog in question would be laid on top of the bite wound – remember that next time you fix yourself a mimosa because you need a little “hair of the dog” to cure what ails ya. By the middle ages, an apothecary would put together a salve of salt, vinegar, garlic, nettles, leeks, chives, and olive oil. It was utterly useless but I bet it tasted spectacular. But as always, when you want something to be done in an unnecessarily elaborate way, nobody can do a better job than the kings of France. Obsessed with la chasse, or ‘the hunt’, French kings and aristocrats spared no expense when it came to their game animals – and the dogs they used to track them. Each year, aristocrats would have their new hunting dogs shipped to the Church of St. Menier les moret, where the very confused canines would find themselves surrounded by monks chanting prayers, singing masses, and lighting candles in hopes that the dogs would be protected from “the madness of the blood.” If you think a candlelit mass for dogs sounds eerie and macabre, wait until you see what humans come up with next.
Take a moment to consider the progression of rabies in a human victim. At first, there might not be any symptoms at all. Rabies is unlike most diseases in that it avoids the superhighway of the human bloodstream, which moves germs around efficiently – but is monitored by the highway patrol officers of the immune system. Instead, rabies takes a different approach, traveling through the human nervous system. This takes awhile, and in the days and even weeks after a victim is bitten, they may experience nothing worse than a bad flu. But once rabies reaches the brain stem, the terrible collapse begins: patients lose their minds. They’re delirious, they’re scared, they’re hallucinating. Above all, they’re furious, raging and pulling at their restraints. Patients don’t sleep. They don’t understand human speech. And most spectacular of all, they develop hydrophobia: an agonizing fear of water. Within days of the symptoms’ arrival, the patients die. They always die. It was and is a horrifying disease. Even today, fewer than 20 patients have ever recovered from rabies after the symptoms show up, and you don’t want to know how doctors have to treat them. But keeping those facts in hand, think about this:
A human receives a bite from a bat, and soon he finds himself transformed. He doesn’t sleep at night. He becomes afraid of irrational things. The villagers call him a vampire, and the only way to kill him is to cut off his head.
What about this: a human receives a bite from a wolf, and soon he finds himself transformed. It can take weeks for the changes to show. He doesn’t sleep at night. He is beset with fits of rage, and when he’s consumed with his madness, he’s no longer human but a wild animal. He must be hunted down and killed.
If you thought the Twilight books were ubiquitous, that’s nothing on the vampire and werewolf culture of 16th, 17th and 18th century France. You may think of the period of time between the Renaissance and the Revolution as a golden age of discovery and knowledge, but it was also a golden age for mythological monsters. Between 1520 and 1630, as many as 30,000 French men and women were accused of being werewolves. In 1530, a group of young men were attacked by wolves, and one man managed to slice the ear off of one of the beasts. The next day, the local tavern wench showed up missing part of her ear – you can see where this is going. Nearly fifty years later, on the other side of the country, one town formally authorizes its residents to track down a werewolf using “pikes, halberts, arquebuses and sticks”. Meanwhile, the hysteria was fueled by actual rabies outbreaks, mostly concentrated within the remaining wolf populations of France. In 1749, a rabid wolf bit 70 people. Ten years later, another wolf bit 17 people. Ten years later, another wolf bit 40 people. No wonder the werewolf and vampire fads stayed fresh in everyone’s imaginations. At no point in the following century did this mania die down, continuing on into the 18th century when, as Voltaire wrote, “nothing was spoken of but vampires, from 1730 to 1735.” Time had done little to curb France’s fears of rabies – they’d only changed shape in the imagination. By the 19th century, vampires and werewolves were a thing of the past, but that didn’t mean social attitudes had entered the so-called “Age of Reason.”
In an age where you could be killed by smallpox, polluted air, getting run over by streetcars, getting run over by carriages, getting run over by horses, duels, or childbirth, French people in the 1800s were completely obsessed with rabies. Rabies felled about 25 French people each year back then, which means you literally have a better chance of getting killed by lightning than rabies. But the civilized men and women of 19th century France couldn’t abide the thought of descending into an animal state – of losing control over your limbs, your hunger and thirst, your sexual urges, and finally, your mind. Rabies was filed away with other notorious conditions like nyphomania – terrifying and titillating in its base nature. As one historian phrases it, “It was a concern with the effects of bourgeois repression that went into the articulation of the illness, its symptoms as well as its etiology.” The line between man and nature seemed thin, and one trend of the age seemed to erase that line even further.
In the 18th and 19th centuries, something shifted in European domestic life: dogs became pets. Oh, the aristocrats loved their hunting dogs, but they were dogs with jobs, the loyalty and affection was a bonus. But by the 1700s, even middle class families might keep lapdogs, which lived inside, ate inside, climbed up on furniture, climbed up on laps, even licked humans on their faces! Perhaps it’s not a coincidence that right at the same time we were getting closer to dogs than ever before, we became hyper-aware of the danger that could always be hiding right inside their adorable furry bodies. Oftentimes, owners were unwilling to admit that danger even when it stared them in the face. They’d bring their beloved laptogs to the vet, snarling and foaming at the mouth, all while the owners insisted that their beloved Fifi never left their third floor apartment. Soon, the French began forgetting the oldest known truth about rabies – that it spreads through bites. “Mais non,” the owners would sniffle. “It is not possible, she has never left the salon!” They began to insist on a phenomenon called “spontaneous rabies”. Recalled one veterinarian: “Madame owned a dog of an exceptionally small breed…He became rabid; she brought him to see me. The lady in question never took her cheri outside, except in her arms; his little paws had never tread the pavements of Paris.” Naturally, it soon turned out that Madame had been leaving her little dog in the courtyard on a regular basis to do his business, during which time he’d been attacked by a local terrier. Over and over again, Parisian pet owners found their tame little Pekineses and pugs transformed into snarling beasts. Rabies was no longer a disease of the huntsman or the peasant, doomed by their low class stature to live in the wilderness, close to animals. With the widespread adoption of pets, rabies was now a disease of the bourgeois – and it went from an ancient taboo to a modern hysteria. In the midst of national panic, the French turned to their greatest hope: the nation’s preeminent scientist, Louis Pasteur.
By the 1880s, Louis Pasteur enjoyed national fame in multiple scientific disciplines. He had a wide range of interests, but the one common trait among them? Tiny things. Louis was one of the world’s first microbiologists, though the world hadn’t come up with that term just yet. He knew the world was full of organisms and molecules too small to see with the naked eye, and he wanted to know how deeply they shaped the world around us. His research into food spoilage was so groundbreaking, the milk and eggs in your fridge right now are probably labeled “Pasteurized”, meaning they’ve been heated enough to kill bacteria. He also figured out that bacteria was responsible for a silkworm disease which was hobbling the French silk industry. After his experiments in industrial sanitation, Pasteur wanted to take his career in a new direction, focusing on the most mysterious – and important – tiny things known to the world at that time: germs.
Scientists and philosophers kicked around the idea of germs since the Middle Ages, but it wasn’t until Louis Pasteur came along that germ theory really got put to the test in a rigorous, repeatable way. As my fellow epidemiology nerds will know, a famous cholera outbreak in London in 1854 pit ‘germ theory’ scientists against those who believed in ‘miasma theory’ – that bad air was itself the cause of disease. According to miasma theorists, a bad smell didn’t just indicate that something dangerous might be nearby, the bad smell was the dangerous thing. In the 1850s, Louis Pasteur conducted a series of experiments to disprove miasma theory once and for all, showing how so-called “spontaneous” bacterial growth was impossible. Boiled broth would never grow bacteria, no matter how much air you passed in front of it. The germ theory showed that diseases were caused by things – as the veterinarian had discovered, dogs didn’t spontaneously become rabid. If tiny things could induce infection, could other, similar tiny things prevent infection? To learn more, Pasteur turned his attention to one of the more puzzling breakthroughs of the previous century: Edward Jenner’s smallpox preventative.
Before the 18th century, there was only one way to protect yourself against smallpox: give yourself a smallpox infection, pray for the best, and survive it. Once you made it through, people knew, you wouldn’t get infected a second time. Throughout Asia and the Middle East, people practiced inoculation, in which you’d scratch someone’s skin a bit and rub it with some pus from a smallpox victim. By rubbing the pus onto a superficial wound, the infection was more likely to be mild, and you were more likely to survive it. But it was more or less the same idea: to survive smallpox, you had to get smallpox, and you had to live. It was by no means foolproof, and many people did not survive the treatment, including one of the heirs to the British throne. Still, it was a 2 percent fatality rate instead of a 30 percent fatality rate. But it was very expensive, and mostly off limits to anyone besides aristocrats. In the 1790s, a British scientist named Edward Jenner noticed that milkmaids seemed naturally immune to smallpox, and wondered whether it had anything to do with the fact that cows suffered from a similar disease named (you guessed it) cowpox. Maids who survived cowpox didn’t contract smallpox. Jenner tested his theory on an 8 year old boy by deliberately infecting him with cowpox, which produced a gnarly fever but that was about it. Later, when Jenner tried inoculating the boy using the traditional method, he was completely immune to smallpox. It was a huge medical breakthrough – a relatively safe, genuinely preventative measure against smallpox! The only thing was…nobody knew why it worked. For that, the world would need to wait the length of 100 years and one very fortuitous vacation.
In 1879, Louis Pasteur found himself surrounded by a group of unbelievably healthy chickens. He was in the middle of researching chicken cholera, a disease which is just as fun for chickens as it is for humans. He’d been growing the cholera cultures in chicken broth, and then, in a rather cannibalistic way, he’d injected the chicken-broth cultures into the chickens to infect them with cholera. Ironically enough for a man who’d figured out why things spoiled, one of Pasteur’s chicken broth cultures went bad, and the chickens he injected never got sick. A few days later, he tried again with a fresh new batch of cholera germs, but no matter what he did, the chickens who had received the so-called “bad batch” never came down with cholera. The spoiled cultures were weak enough to keep the chickens from getting seriously sick, but still enough for their immune systems to figure out how to fight off cholera. This was Pasteur’s first clue.
You know when you come back from PTO and realize you completely forgot to do that important thing for your boss before turning on your out of office? Sometimes that turns out for the best. In 1879, Pasteur told his assistant to infect a new batch of chickens, he was on his way out for a holiday. The assistant forgot, and then he went on holiday. When the assistant got back to town, he realized what he’d done, freaked out, and hastily injected the chickens with the cholera cultures. But lo and behold, the chickens got a little sick, made a full recovery, and displayed complete immunity afterwards. Before long, Pasteur was able to produce a reliable preventative treatment for chicken cholera, to the gratitude of poultry farmers across the country. In tribute to the cows, or vacca, who had inspired Edward Jenner’s similar discovery, Louis Pasteur gave a new name to this treatment: vaccine.
It was one of science’s great lightbulb moments. Diseases were caused by bacteria, and if you could weaken the bacteria just enough, it would teach your body how to fight off that disease at full strength. That was why Edward Jenner’s cowpox treatment worked. The only question was, how could you reliably produce weak enough germs? For the next few years, Pasteur continued working on other livestock diseases, but eventually, he knew it was time to tackle the big one: could he come up with a reliable way to prevent all kinds of different diseases in humans? He knew where to begin. After all, this was 19th century France! If there was one cure that everyone wanted, it was a cure for that dreaded disease: rabies. Pasteur’s assistant, Emile Roux, wrote that “If Pasteur chose it as an object of study, it was above all because…to everyone’s mind rabies is the most frightening and dreaded malady.” But that might not have been the only reason for his focus. As an eight year old boy, Pasteur witnessed the horror of rabies himself. Living in a quiet village near a large forest, one year reports of a wild wolf began circulating, and the men of the village went out to hunt it down. Little Louis saw one victim brought back to the village blacksmith. The blacksmith picked up a red-hot poker and with a sizzle of hot iron against flesh and dog saliva, he cauterized the poor man’s wounds. It wasn’t enough: all in all, no fewer than 8 of young Louis’s neighbors died of rabies in that outbreak. Little wonder that he was willing to devote so many years to finding a cure.
In 1880, Pasteur and his assistant, Emile Roux, began researching possible rabies treatments for dogs. They began culturing rabies not in chicken broth, but in live rabbits. He’d use a rabbit to infect another rabbit, on and on, twenty times, until he could consistently infect rabbits with rabies in their spinal cords. Remembering the chicken broth left out before that fateful vacation, Pasteur took fragments of rabies and exposed them to air for varying lengths of time, letting the cultures dry out. The more the cultures dried out, the less virulent they became. Normally, when he was working on chicken cholera, Pasteur could stick the culture on a slide and look through a microscope to see just how much bacteria was still kicking around after exposure. Rabies, as it turned out, didn’t work that way. What Pasteur didn’t know was that rabies is not caused by bacteria at all – it’s caused by a virus, ten million times smaller than a bacteria, and much too small to see with a 19th century microscope. He had to rely on cause and effect and consistent results to figure out what worked. Now that he’d figured out how to create weakened rabies, he had to test it out. For this, the mad scientist was going to need dogs. A lot of dogs.
M.J. Bourrel, a former army veterinarian who was also probing the mysteries of rabies, had a lot of mad dogs to spare. He’d been studying rabies for nearly two decades, in which time he’d been able to figure out that dogs transmitted rabies through their saliva, which infected the wounds left by their teeth. He began filing down the dog’s teeth so they couldn’t break the skin, but that was as much progress as he’d made. In 1880, Bourrel’s own nephew got bit by one of the dogs, and died in rabid agony a few days later. Bourrel sent over a pair of rabid dogs, and I do not envy that delivery driver’s task one bit. Pasteur and Roux would have plenty more where that came from – 1880 saw a huge outbreak of rabies among Parisian dogs, and soon veterinarians and kennel owners across the nation knew to send any suspect animals to the crazy distinguished Monsieur Pasteur. For years, the men operated on the dogs, taking samples from mad dogs, infecting healthy dogs, and trying desperately to stay out of harm’s way. Not wishing to follow the example of M.J. Bourrel’s unfortunate nephews, Pasteur and Roux knew they had to be careful. As Roux’s niece remembered, “They bent down around a table. A large dog was tied down on it, its muscles contracted and its fangs bared. If the animal…caused them to make a false move, if one of them had cut himself with his scalpel, and if a small piece of the rabid spinal cord had penetrated into the cut, there would have been weeks and weeks filled with the anguished question: will he or will he not come down with rabies? They were no longer just researchers absorbed in the meticulous work of their laboratory; they were pioneers, adventurers of science.” One Swedish physician watched as Pasteur held a glass tube in his mouth and two laboratory assistants wearing gloves held a rabid bull-dog down so Pasteur could get his face closer. As Emile Roux’s niece remembers, “At the beginning of each session a loaded revolver was placed within their reach. If a terrible accident were to happen to one of them, the more courageous of the two others would put a bullet in his head.” Through these brave attempts, Pasteur and Roux eventually developed a treatment protocol for dogs which satisfied them. By administering weak, aged cultures first, and then following up with stronger and fresher cultures over the course of the next two weeks, dogs could develop immunity to rabies. That wasn’t all – using the same treatment, even dogs who had already been bitten could be saved from rabies, as long as they received the shots quickly enough. Pasteur had already performed this protocol on over 50 dogs, when he received a letter from the emperor of Brazil, wondering whether he would ever have a treatment for humans:
“Until now I have not dared to attempt anything on men, in spite of my own confidence in the result and the numerous opportunities afforded to me…I fear too much that a failure might compromise the future. I think my hand will tremble when I go on to Mankind.” One year later, Pasteur would have his chance, and his hand would not shake.
On July 6, 1885, Joseph Meister limped into the office of Louis Pasteur. Joseph’s mother was beside herself – with fourteen bites, surely her son was doomed. If Monsieur Pasteur had any treatments, no matter how dangerous, anything was better than the fate he now faced! This wasn’t enough to convince Emile Roux, who noticeably opted out of the human experiment. Pasteur was nervous too, and not just for little Joseph’s sake. Pasteur may have been an eminent scientist, but he was no physician, and treating the boy himself would result in fines and perhaps prison. Instead, he consulted with two nationally renowned physicians, who agreed that any experimental treatment was justifiable in light of the alternative, and agreed to assist. While Louis Pasteur prepared the cultures, the two doctors performed the injections. “On 6 July, at 8 o clock in the evening, sixty hours after the bites of 4 July, and in the presence of the doctors, we inoculated into a fold of skin over young Meister’s right hypochondrium half a syringe of the spinal cord from a rabbit dead of rabies, dried for fifteen days.” Over the next ten days, the doctors administered a total of 13 injections. When Joseph wasn’t getting poked and prodded, he spent his time playing with the laboratory menagerie of chickens, rabbits, guinea pigs and mice. But Pasteur himself was nervous. As the treatments continued, the doses grew stronger and stronger. “My dear children,” wrote Pasteur’s wife in a letter, “your father has had another bad night; he is dreading the last inoculations on the child. And yet there can be no drawing back now! The boy continues in perfect health.”
On July 16th, Pasteur administered the final, fateful dose. This culture was only one day old – dangerous enough to infect any healthy person. As Pasteur’s father-in-law remembered, “Cured from his wounds, delighted with all he saw, gaily running about as if he had been in his own Alsatian farm, little Meister, whose blue eyes now showed neither fear nor shyness, merrily received the last inoculation, in the evening, after claiming a kiss from ‘dear Monsieur Pasteur’ as he called him, he went to bed and slept peacefully. Pasteur spent a terrible night of insomnia; in those slow dark hours of night when all vision is distorted, Pasteur, losing sight of the accumulation of experiments which guaranteed his success, imagined that the little boy would die.”
But Joseph Meister lived. One full month passed since his attack, without a single symptom. And a few months later, when a 15 year old shepherd received a bite from a rabid dog, he traveled to Monsieur Pasteur’s laboratory, and he lived, too. Just like the dozens of dogs before them, the boys were immune to rabies – even after being bitten. That fall, Louis Pasteur and his team presented their findings to an astonished Academy of Sciences. As one of the two eminent physicians reported to the crowd that day, “Hydrophobia, that dread disease against which all therapeutic measures had hitherto failed, has at last found a remedy.” They hadn’t simply created a treatment to help victims recover – they’d created a way to prevent a disease altogether, a way that could be applied to endless other diseases just as terrible and deadly. Louis Pasteur had created the world’s first live human vaccine.
Pasteur’s achievement went even further than that. His vaccines were the last irrefutable proof that germ theory – not miasma – was responsible for human diseases. His results were so spectacular, the opposition could only tip their caps. As one doctor wrote shortly after Pasteur’s presentation to the Academy, “From the heights of our settled situations, we should no longer laugh at bacilli and culture media. Those who cultivate them already deserve our respect for the services that they have given mankind; for us, the old guard of the medical profession, they must also inspire salutory fear and a determination to be useful. We must march with the times. The coming century will see the blossoming of a new medicine: let us devote what is left of this century to studying it. Let us go back to school and prepare the ground for an evolution.”
If there’s one thing we’ve all come to understand on a personal level these past few weeks, it’s that it’s one thing to make a vaccine, and another thing entirely to administer it. Vaccine supply chains have always been a problem – they’re finicky, fragile, and prone to disruptions. Back in 1803, Spanish officials desperately wanted to get Edward Jenner’s cowpox vaccine to their colonies in South America. Smallpox was having an apocalyptic impact on indigenous populations, with a fatality rate of up to 50 percent. But any cowpox samples dried out over the course of the long ocean journey. Spanish officials came up with a creative, macabre solution. Rounding up 24 young orphans and a few physicians, the Spanish government turned a ship into a petri dish. They infected two of the orphans with smallpox before setting off on their journey. After a few weeks, the boys developed sores, which the onboard physicians would then use to infect the next pair of boys, and on and on. In exchange for food, passage, and a chance at a better life, not to mention immunity from a terrible disease, the orphans became drug mules of a sort. The supply chain was incredibly tenuous, and it only barely worked: by the time the ship landed, only one boy had only one sore left – but that was enough. Within two months, the team of physicians had vaccinated 12,000 people in Venezuela, before branching off to Colombia, Peru, and Bolivia to vaccinate 200,000 more.
Nearly 100 years later, back in Paris, Louis Pasteur’s office faced the opposite problem: instead of venturing out into the world, the world came to them. All of a sudden, as word spread that the famous doctor had a cure for rabies, every anxious Parisian knocked on their door, begging for a vaccine. Pasteur’s laboratory was hardly a waiting room, but he managed to vaccinate 80 people by the end of that first year. Meanwhile, his assistants created a rudimentary production line, arranging their vials into a meticulous order to ensure every vaccine dosage was consistent and accurate. One morning, Pasteur received word that a boat of recently bitten American children had just arrived in town. Back in New York, a famous doctor had written a editorial, announcing that “were it my misfortune to be bitten by a rabid dog, I would board the first Atlantic steamer, go straight to Paris and, full of hope, place myself immediately in the hands of Pasteur…Let us prove to the world that we are intelligent enough to appreciate the advance of science and liberal and humane enough to help those who cannot help themselves.” When the boys returned to America, successfully vaccinated, they were miniature celebrities, and everywhere they went, Pasteur’s vaccine grew more and more legendary. As one historian writes, the vaccine was a breakthrough in the way Americans thought about medicine altogether: “It created a new expectation that medicine can and should change, that progress is to be expected.” But that progress needed infrastructure, and Pasteur’s little laboratory was bursting at the seams.
In 1887, Louis Pasteur launched the ultimate healthcare GoFundMe: a fundraiser for the establishment of an institution which would provide ongoing rabies treatment, and continue research into the development of future vaccines. Around the world, donations poured in, including one from none other than little Joseph Meister. On November 14, 1888, he finally opened the doors of the Pasteur Institute. For more than a century, the research staff of the Pasteur Institute made their own contributions, including cures for diptheria, snakebites, the plague, and more. Meanwhile, the hospital wing of the Pasteur Institute carried on the work of rabies vaccinations and treatment, Also working within those walls was Joseph Meister, who spent his life in the company of the laboratory animals he’d loved as a child, working as a janitor until his death at the outbreak of World War II. Today, post-exposure prophylaxis regimens, like those given to Joseph Meister, are administered to over 20 million people around the world each year. There hasn’t been a case of rabies in France since 1998. Today, France is officially declared “rabies-free.”
As we look forward to the year ahead, know that the COVID-19 vaccination campaigns won’t be smooth or steady – they never are, and there’s never been one conducted at this scale before – not even close. But whether it’s 24 brave boys crossing the sea and saving a quarter of a million lives on the other side, or whether it’s an assembly line of scientists painstakingly measuring thousands of vials with 19th century technology, or whether it’s an international consortium of state of the art factories operating at max capacity, the results are worth the wait. Rabies is preventable. Smallpox is gone. And soon, COVID-19 will be another disease we can guard against, antibodies circulating quietly and steadily while we walk out the door, to go to work, see our friends, and hug our families. I look forward to that day. It is coming soon.
Thanks for listening to The Land of Desire. You can follow the show on Facebook, Instagram and Twitter, and sign up for the free newsletter at http://thelandofdesire.substack.com Be safe, my dear listeners, we’re almost through this. I wish all of you a happier, healthy new year. Until next time, au revoir.
Further reading:
Sources:
Subscribe to the newsletter
Support the Show
Join the Discussion
Happy New Year! The Land of Desire is BACK with an exciting – and hopeful – story to set us off on the right track in 2021. Your happy host gets to indulge her love of epidemiology a little bit without leaving you depressed in the middle of a pandemic (she swears). This week, we’re taking a look at one of the greatest French inventions of all time. Along the way, we’ll encounter Catholic masses for dogs, the worst cruise you’ve ever heard of, and a man who came a bit too close to becoming a true mad scientist, Louis Pasteur. We’re at a turning point in medical science, so what better time to look back at how far we’ve come? This week, join me for a closer look at the history of the vaccine.
Episode 64: “Louis Pasteur and the History of the Vaccine”
Transcript
Bienvenue and welcome back to The Land of Desire! I’m your host Diana, and I’d like to start by wishing all of you a very, very happy New Year! I know it’s been a tough winter, but there are better days ahead of us. As many of you know, I’ve always been a huge epidemiology nerd, and I’ve struggled to restrain myself in the past because I know that most of my audience really doesn’t want to hear about diseases even when we aren’t going through a major pandemic. Fair enough. So I’m excited for an excuse to turn back to my favorite subject, but I promise, in a happy, optimistic way. If 2020 was the story of a disease, 2021 is looking like the story of its cure. This week, we’re taking a look at one of the greatest French inventions of all time. Along the way, we’ll encounter Catholic masses for dogs, the worst cruise you’ve ever heard of, and a man who came a bit too close to becoming a true mad scientist, Louis Pasteur. We’re at a turning point in medical science, so what better time to look back at how far we’ve come? This week, join me for a closer look at the history of the vaccine.
On July 4, 1885, a nine year old boy named Joseph Meister was attacked by a dog near his home in the city of Alsace. As he cowered and shielded his face with his tiny hands, the dog lunged at him again and again, biting him. A nearby bricklayer heard the screams and managed to beat the dog back with a pair of crowbars, but not until Joseph sustained fourteen bites on his thighs, legs and his hand. Joseph’s mother rushed him to the local doctor, who applied carbolic acid to the wounds, but the two adults looked at one another with a terrible fear. Joseph was at risk for one of humanity’s deadliest diseases, a disease scary enough to inspire not one but two terrifying mythical monsters, a disease with a nearly 100% fatality rate, a disease which guaranteed the worst of all 19th century fates: an ugly death. Joseph was at risk for rabies. Joseph’s mother, beside herself with worry, asked the doctor what else could be done. The doctor must have known Joseph was in dire straits, because he made a radical suggestion: take the boy to Paris, he said. There’s a scientist there, a famous scientist, who thinks he may have a solution. Joseph, still in unbearable pain, accompanied his mother to the train station at once, and within 48 hours of the attack, they found themselves in one of the strangest buildings they’d ever stepped inside: this was the laboratory of the great Louis Pasteur, and it was filled with rabid dogs.
In the long, strange cultural history of humans and diseases, rabies has always held a unique space in our minds – more specifically, in our amygdala, which controls fear. We’ve had rabies for just about as long as we’ve had domesticated dogs, and just about every ancient set of laws we can find has some sort of rule about how to handle wild dogs, rabid dogs, dogs who bite, and people who are bitten by dogs. The first known victim of rabies appears in a cuneiform tablet from ancient Mesopotamia, written about four thousand years ago. The ancient Greeks referred to lyssa, or a wild violence, while the Romans spoke of rabere – or “rage” from which we may get the word “rabies”. Over the centuries, across civilizations, the same disease appears again and again, and one thing in particular stands out: humans have always, it seems, known exactly where rabies comes from. Take a moment to appreciate that. Even during periods of time when diseases were the whims of god, justice for your sins, or the mysterious and unknowable slights of fate, rabies alone had a clear cause and effect. We didn’t have germ theory, we didn’t have microscopes, but there was one infection pathway that humans have pretty much always understood: mad dog bites man. Man goes mad. Mad dog and mad man die. The end. As it turns out, that wasn’t the entire story – it looks like rabies first made its way into bats, and then the bats found their way to the dogs, but again, in a world where you got smallpox because Zeus was in a bad mood or you lusted after your neighbor’s wife, let’s give the ancients credit where it’s due.
Over the centuries, the preventative measures and treatments for rabies grew accordingly sophisticated and complex. In ancient times, a bit of fur from the dog in question would be laid on top of the bite wound – remember that next time you fix yourself a mimosa because you need a little “hair of the dog” to cure what ails ya. By the middle ages, an apothecary would put together a salve of salt, vinegar, garlic, nettles, leeks, chives, and olive oil. It was utterly useless but I bet it tasted spectacular. But as always, when you want something to be done in an unnecessarily elaborate way, nobody can do a better job than the kings of France. Obsessed with la chasse, or ‘the hunt’, French kings and aristocrats spared no expense when it came to their game animals – and the dogs they used to track them. Each year, aristocrats would have their new hunting dogs shipped to the Church of St. Menier les moret, where the very confused canines would find themselves surrounded by monks chanting prayers, singing masses, and lighting candles in hopes that the dogs would be protected from “the madness of the blood.” If you think a candlelit mass for dogs sounds eerie and macabre, wait until you see what humans come up with next.
Take a moment to consider the progression of rabies in a human victim. At first, there might not be any symptoms at all. Rabies is unlike most diseases in that it avoids the superhighway of the human bloodstream, which moves germs around efficiently – but is monitored by the highway patrol officers of the immune system. Instead, rabies takes a different approach, traveling through the human nervous system. This takes awhile, and in the days and even weeks after a victim is bitten, they may experience nothing worse than a bad flu. But once rabies reaches the brain stem, the terrible collapse begins: patients lose their minds. They’re delirious, they’re scared, they’re hallucinating. Above all, they’re furious, raging and pulling at their restraints. Patients don’t sleep. They don’t understand human speech. And most spectacular of all, they develop hydrophobia: an agonizing fear of water. Within days of the symptoms’ arrival, the patients die. They always die. It was and is a horrifying disease. Even today, fewer than 20 patients have ever recovered from rabies after the symptoms show up, and you don’t want to know how doctors have to treat them. But keeping those facts in hand, think about this:
A human receives a bite from a bat, and soon he finds himself transformed. He doesn’t sleep at night. He becomes afraid of irrational things. The villagers call him a vampire, and the only way to kill him is to cut off his head.
What about this: a human receives a bite from a wolf, and soon he finds himself transformed. It can take weeks for the changes to show. He doesn’t sleep at night. He is beset with fits of rage, and when he’s consumed with his madness, he’s no longer human but a wild animal. He must be hunted down and killed.
If you thought the Twilight books were ubiquitous, that’s nothing on the vampire and werewolf culture of 16th, 17th and 18th century France. You may think of the period of time between the Renaissance and the Revolution as a golden age of discovery and knowledge, but it was also a golden age for mythological monsters. Between 1520 and 1630, as many as 30,000 French men and women were accused of being werewolves. In 1530, a group of young men were attacked by wolves, and one man managed to slice the ear off of one of the beasts. The next day, the local tavern wench showed up missing part of her ear – you can see where this is going. Nearly fifty years later, on the other side of the country, one town formally authorizes its residents to track down a werewolf using “pikes, halberts, arquebuses and sticks”. Meanwhile, the hysteria was fueled by actual rabies outbreaks, mostly concentrated within the remaining wolf populations of France. In 1749, a rabid wolf bit 70 people. Ten years later, another wolf bit 17 people. Ten years later, another wolf bit 40 people. No wonder the werewolf and vampire fads stayed fresh in everyone’s imaginations. At no point in the following century did this mania die down, continuing on into the 18th century when, as Voltaire wrote, “nothing was spoken of but vampires, from 1730 to 1735.” Time had done little to curb France’s fears of rabies – they’d only changed shape in the imagination. By the 19th century, vampires and werewolves were a thing of the past, but that didn’t mean social attitudes had entered the so-called “Age of Reason.”
In an age where you could be killed by smallpox, polluted air, getting run over by streetcars, getting run over by carriages, getting run over by horses, duels, or childbirth, French people in the 1800s were completely obsessed with rabies. Rabies felled about 25 French people each year back then, which means you literally have a better chance of getting killed by lightning than rabies. But the civilized men and women of 19th century France couldn’t abide the thought of descending into an animal state – of losing control over your limbs, your hunger and thirst, your sexual urges, and finally, your mind. Rabies was filed away with other notorious conditions like nyphomania – terrifying and titillating in its base nature. As one historian phrases it, “It was a concern with the effects of bourgeois repression that went into the articulation of the illness, its symptoms as well as its etiology.” The line between man and nature seemed thin, and one trend of the age seemed to erase that line even further.
In the 18th and 19th centuries, something shifted in European domestic life: dogs became pets. Oh, the aristocrats loved their hunting dogs, but they were dogs with jobs, the loyalty and affection was a bonus. But by the 1700s, even middle class families might keep lapdogs, which lived inside, ate inside, climbed up on furniture, climbed up on laps, even licked humans on their faces! Perhaps it’s not a coincidence that right at the same time we were getting closer to dogs than ever before, we became hyper-aware of the danger that could always be hiding right inside their adorable furry bodies. Oftentimes, owners were unwilling to admit that danger even when it stared them in the face. They’d bring their beloved laptogs to the vet, snarling and foaming at the mouth, all while the owners insisted that their beloved Fifi never left their third floor apartment. Soon, the French began forgetting the oldest known truth about rabies – that it spreads through bites. “Mais non,” the owners would sniffle. “It is not possible, she has never left the salon!” They began to insist on a phenomenon called “spontaneous rabies”. Recalled one veterinarian: “Madame owned a dog of an exceptionally small breed…He became rabid; she brought him to see me. The lady in question never took her cheri outside, except in her arms; his little paws had never tread the pavements of Paris.” Naturally, it soon turned out that Madame had been leaving her little dog in the courtyard on a regular basis to do his business, during which time he’d been attacked by a local terrier. Over and over again, Parisian pet owners found their tame little Pekineses and pugs transformed into snarling beasts. Rabies was no longer a disease of the huntsman or the peasant, doomed by their low class stature to live in the wilderness, close to animals. With the widespread adoption of pets, rabies was now a disease of the bourgeois – and it went from an ancient taboo to a modern hysteria. In the midst of national panic, the French turned to their greatest hope: the nation’s preeminent scientist, Louis Pasteur.
By the 1880s, Louis Pasteur enjoyed national fame in multiple scientific disciplines. He had a wide range of interests, but the one common trait among them? Tiny things. Louis was one of the world’s first microbiologists, though the world hadn’t come up with that term just yet. He knew the world was full of organisms and molecules too small to see with the naked eye, and he wanted to know how deeply they shaped the world around us. His research into food spoilage was so groundbreaking, the milk and eggs in your fridge right now are probably labeled “Pasteurized”, meaning they’ve been heated enough to kill bacteria. He also figured out that bacteria was responsible for a silkworm disease which was hobbling the French silk industry. After his experiments in industrial sanitation, Pasteur wanted to take his career in a new direction, focusing on the most mysterious – and important – tiny things known to the world at that time: germs.
Scientists and philosophers kicked around the idea of germs since the Middle Ages, but it wasn’t until Louis Pasteur came along that germ theory really got put to the test in a rigorous, repeatable way. As my fellow epidemiology nerds will know, a famous cholera outbreak in London in 1854 pit ‘germ theory’ scientists against those who believed in ‘miasma theory’ – that bad air was itself the cause of disease. According to miasma theorists, a bad smell didn’t just indicate that something dangerous might be nearby, the bad smell was the dangerous thing. In the 1850s, Louis Pasteur conducted a series of experiments to disprove miasma theory once and for all, showing how so-called “spontaneous” bacterial growth was impossible. Boiled broth would never grow bacteria, no matter how much air you passed in front of it. The germ theory showed that diseases were caused by things – as the veterinarian had discovered, dogs didn’t spontaneously become rabid. If tiny things could induce infection, could other, similar tiny things prevent infection? To learn more, Pasteur turned his attention to one of the more puzzling breakthroughs of the previous century: Edward Jenner’s smallpox preventative.
Before the 18th century, there was only one way to protect yourself against smallpox: give yourself a smallpox infection, pray for the best, and survive it. Once you made it through, people knew, you wouldn’t get infected a second time. Throughout Asia and the Middle East, people practiced inoculation, in which you’d scratch someone’s skin a bit and rub it with some pus from a smallpox victim. By rubbing the pus onto a superficial wound, the infection was more likely to be mild, and you were more likely to survive it. But it was more or less the same idea: to survive smallpox, you had to get smallpox, and you had to live. It was by no means foolproof, and many people did not survive the treatment, including one of the heirs to the British throne. Still, it was a 2 percent fatality rate instead of a 30 percent fatality rate. But it was very expensive, and mostly off limits to anyone besides aristocrats. In the 1790s, a British scientist named Edward Jenner noticed that milkmaids seemed naturally immune to smallpox, and wondered whether it had anything to do with the fact that cows suffered from a similar disease named (you guessed it) cowpox. Maids who survived cowpox didn’t contract smallpox. Jenner tested his theory on an 8 year old boy by deliberately infecting him with cowpox, which produced a gnarly fever but that was about it. Later, when Jenner tried inoculating the boy using the traditional method, he was completely immune to smallpox. It was a huge medical breakthrough – a relatively safe, genuinely preventative measure against smallpox! The only thing was…nobody knew why it worked. For that, the world would need to wait the length of 100 years and one very fortuitous vacation.
In 1879, Louis Pasteur found himself surrounded by a group of unbelievably healthy chickens. He was in the middle of researching chicken cholera, a disease which is just as fun for chickens as it is for humans. He’d been growing the cholera cultures in chicken broth, and then, in a rather cannibalistic way, he’d injected the chicken-broth cultures into the chickens to infect them with cholera. Ironically enough for a man who’d figured out why things spoiled, one of Pasteur’s chicken broth cultures went bad, and the chickens he injected never got sick. A few days later, he tried again with a fresh new batch of cholera germs, but no matter what he did, the chickens who had received the so-called “bad batch” never came down with cholera. The spoiled cultures were weak enough to keep the chickens from getting seriously sick, but still enough for their immune systems to figure out how to fight off cholera. This was Pasteur’s first clue.
You know when you come back from PTO and realize you completely forgot to do that important thing for your boss before turning on your out of office? Sometimes that turns out for the best. In 1879, Pasteur told his assistant to infect a new batch of chickens, he was on his way out for a holiday. The assistant forgot, and then he went on holiday. When the assistant got back to town, he realized what he’d done, freaked out, and hastily injected the chickens with the cholera cultures. But lo and behold, the chickens got a little sick, made a full recovery, and displayed complete immunity afterwards. Before long, Pasteur was able to produce a reliable preventative treatment for chicken cholera, to the gratitude of poultry farmers across the country. In tribute to the cows, or vacca, who had inspired Edward Jenner’s similar discovery, Louis Pasteur gave a new name to this treatment: vaccine.
It was one of science’s great lightbulb moments. Diseases were caused by bacteria, and if you could weaken the bacteria just enough, it would teach your body how to fight off that disease at full strength. That was why Edward Jenner’s cowpox treatment worked. The only question was, how could you reliably produce weak enough germs? For the next few years, Pasteur continued working on other livestock diseases, but eventually, he knew it was time to tackle the big one: could he come up with a reliable way to prevent all kinds of different diseases in humans? He knew where to begin. After all, this was 19th century France! If there was one cure that everyone wanted, it was a cure for that dreaded disease: rabies. Pasteur’s assistant, Emile Roux, wrote that “If Pasteur chose it as an object of study, it was above all because…to everyone’s mind rabies is the most frightening and dreaded malady.” But that might not have been the only reason for his focus. As an eight year old boy, Pasteur witnessed the horror of rabies himself. Living in a quiet village near a large forest, one year reports of a wild wolf began circulating, and the men of the village went out to hunt it down. Little Louis saw one victim brought back to the village blacksmith. The blacksmith picked up a red-hot poker and with a sizzle of hot iron against flesh and dog saliva, he cauterized the poor man’s wounds. It wasn’t enough: all in all, no fewer than 8 of young Louis’s neighbors died of rabies in that outbreak. Little wonder that he was willing to devote so many years to finding a cure.
In 1880, Pasteur and his assistant, Emile Roux, began researching possible rabies treatments for dogs. They began culturing rabies not in chicken broth, but in live rabbits. He’d use a rabbit to infect another rabbit, on and on, twenty times, until he could consistently infect rabbits with rabies in their spinal cords. Remembering the chicken broth left out before that fateful vacation, Pasteur took fragments of rabies and exposed them to air for varying lengths of time, letting the cultures dry out. The more the cultures dried out, the less virulent they became. Normally, when he was working on chicken cholera, Pasteur could stick the culture on a slide and look through a microscope to see just how much bacteria was still kicking around after exposure. Rabies, as it turned out, didn’t work that way. What Pasteur didn’t know was that rabies is not caused by bacteria at all – it’s caused by a virus, ten million times smaller than a bacteria, and much too small to see with a 19th century microscope. He had to rely on cause and effect and consistent results to figure out what worked. Now that he’d figured out how to create weakened rabies, he had to test it out. For this, the mad scientist was going to need dogs. A lot of dogs.
M.J. Bourrel, a former army veterinarian who was also probing the mysteries of rabies, had a lot of mad dogs to spare. He’d been studying rabies for nearly two decades, in which time he’d been able to figure out that dogs transmitted rabies through their saliva, which infected the wounds left by their teeth. He began filing down the dog’s teeth so they couldn’t break the skin, but that was as much progress as he’d made. In 1880, Bourrel’s own nephew got bit by one of the dogs, and died in rabid agony a few days later. Bourrel sent over a pair of rabid dogs, and I do not envy that delivery driver’s task one bit. Pasteur and Roux would have plenty more where that came from – 1880 saw a huge outbreak of rabies among Parisian dogs, and soon veterinarians and kennel owners across the nation knew to send any suspect animals to the crazy distinguished Monsieur Pasteur. For years, the men operated on the dogs, taking samples from mad dogs, infecting healthy dogs, and trying desperately to stay out of harm’s way. Not wishing to follow the example of M.J. Bourrel’s unfortunate nephews, Pasteur and Roux knew they had to be careful. As Roux’s niece remembered, “They bent down around a table. A large dog was tied down on it, its muscles contracted and its fangs bared. If the animal…caused them to make a false move, if one of them had cut himself with his scalpel, and if a small piece of the rabid spinal cord had penetrated into the cut, there would have been weeks and weeks filled with the anguished question: will he or will he not come down with rabies? They were no longer just researchers absorbed in the meticulous work of their laboratory; they were pioneers, adventurers of science.” One Swedish physician watched as Pasteur held a glass tube in his mouth and two laboratory assistants wearing gloves held a rabid bull-dog down so Pasteur could get his face closer. As Emile Roux’s niece remembers, “At the beginning of each session a loaded revolver was placed within their reach. If a terrible accident were to happen to one of them, the more courageous of the two others would put a bullet in his head.” Through these brave attempts, Pasteur and Roux eventually developed a treatment protocol for dogs which satisfied them. By administering weak, aged cultures first, and then following up with stronger and fresher cultures over the course of the next two weeks, dogs could develop immunity to rabies. That wasn’t all – using the same treatment, even dogs who had already been bitten could be saved from rabies, as long as they received the shots quickly enough. Pasteur had already performed this protocol on over 50 dogs, when he received a letter from the emperor of Brazil, wondering whether he would ever have a treatment for humans:
“Until now I have not dared to attempt anything on men, in spite of my own confidence in the result and the numerous opportunities afforded to me…I fear too much that a failure might compromise the future. I think my hand will tremble when I go on to Mankind.” One year later, Pasteur would have his chance, and his hand would not shake.
On July 6, 1885, Joseph Meister limped into the office of Louis Pasteur. Joseph’s mother was beside herself – with fourteen bites, surely her son was doomed. If Monsieur Pasteur had any treatments, no matter how dangerous, anything was better than the fate he now faced! This wasn’t enough to convince Emile Roux, who noticeably opted out of the human experiment. Pasteur was nervous too, and not just for little Joseph’s sake. Pasteur may have been an eminent scientist, but he was no physician, and treating the boy himself would result in fines and perhaps prison. Instead, he consulted with two nationally renowned physicians, who agreed that any experimental treatment was justifiable in light of the alternative, and agreed to assist. While Louis Pasteur prepared the cultures, the two doctors performed the injections. “On 6 July, at 8 o clock in the evening, sixty hours after the bites of 4 July, and in the presence of the doctors, we inoculated into a fold of skin over young Meister’s right hypochondrium half a syringe of the spinal cord from a rabbit dead of rabies, dried for fifteen days.” Over the next ten days, the doctors administered a total of 13 injections. When Joseph wasn’t getting poked and prodded, he spent his time playing with the laboratory menagerie of chickens, rabbits, guinea pigs and mice. But Pasteur himself was nervous. As the treatments continued, the doses grew stronger and stronger. “My dear children,” wrote Pasteur’s wife in a letter, “your father has had another bad night; he is dreading the last inoculations on the child. And yet there can be no drawing back now! The boy continues in perfect health.”
On July 16th, Pasteur administered the final, fateful dose. This culture was only one day old – dangerous enough to infect any healthy person. As Pasteur’s father-in-law remembered, “Cured from his wounds, delighted with all he saw, gaily running about as if he had been in his own Alsatian farm, little Meister, whose blue eyes now showed neither fear nor shyness, merrily received the last inoculation, in the evening, after claiming a kiss from ‘dear Monsieur Pasteur’ as he called him, he went to bed and slept peacefully. Pasteur spent a terrible night of insomnia; in those slow dark hours of night when all vision is distorted, Pasteur, losing sight of the accumulation of experiments which guaranteed his success, imagined that the little boy would die.”
But Joseph Meister lived. One full month passed since his attack, without a single symptom. And a few months later, when a 15 year old shepherd received a bite from a rabid dog, he traveled to Monsieur Pasteur’s laboratory, and he lived, too. Just like the dozens of dogs before them, the boys were immune to rabies – even after being bitten. That fall, Louis Pasteur and his team presented their findings to an astonished Academy of Sciences. As one of the two eminent physicians reported to the crowd that day, “Hydrophobia, that dread disease against which all therapeutic measures had hitherto failed, has at last found a remedy.” They hadn’t simply created a treatment to help victims recover – they’d created a way to prevent a disease altogether, a way that could be applied to endless other diseases just as terrible and deadly. Louis Pasteur had created the world’s first live human vaccine.
Pasteur’s achievement went even further than that. His vaccines were the last irrefutable proof that germ theory – not miasma – was responsible for human diseases. His results were so spectacular, the opposition could only tip their caps. As one doctor wrote shortly after Pasteur’s presentation to the Academy, “From the heights of our settled situations, we should no longer laugh at bacilli and culture media. Those who cultivate them already deserve our respect for the services that they have given mankind; for us, the old guard of the medical profession, they must also inspire salutory fear and a determination to be useful. We must march with the times. The coming century will see the blossoming of a new medicine: let us devote what is left of this century to studying it. Let us go back to school and prepare the ground for an evolution.”
If there’s one thing we’ve all come to understand on a personal level these past few weeks, it’s that it’s one thing to make a vaccine, and another thing entirely to administer it. Vaccine supply chains have always been a problem – they’re finicky, fragile, and prone to disruptions. Back in 1803, Spanish officials desperately wanted to get Edward Jenner’s cowpox vaccine to their colonies in South America. Smallpox was having an apocalyptic impact on indigenous populations, with a fatality rate of up to 50 percent. But any cowpox samples dried out over the course of the long ocean journey. Spanish officials came up with a creative, macabre solution. Rounding up 24 young orphans and a few physicians, the Spanish government turned a ship into a petri dish. They infected two of the orphans with smallpox before setting off on their journey. After a few weeks, the boys developed sores, which the onboard physicians would then use to infect the next pair of boys, and on and on. In exchange for food, passage, and a chance at a better life, not to mention immunity from a terrible disease, the orphans became drug mules of a sort. The supply chain was incredibly tenuous, and it only barely worked: by the time the ship landed, only one boy had only one sore left – but that was enough. Within two months, the team of physicians had vaccinated 12,000 people in Venezuela, before branching off to Colombia, Peru, and Bolivia to vaccinate 200,000 more.
Nearly 100 years later, back in Paris, Louis Pasteur’s office faced the opposite problem: instead of venturing out into the world, the world came to them. All of a sudden, as word spread that the famous doctor had a cure for rabies, every anxious Parisian knocked on their door, begging for a vaccine. Pasteur’s laboratory was hardly a waiting room, but he managed to vaccinate 80 people by the end of that first year. Meanwhile, his assistants created a rudimentary production line, arranging their vials into a meticulous order to ensure every vaccine dosage was consistent and accurate. One morning, Pasteur received word that a boat of recently bitten American children had just arrived in town. Back in New York, a famous doctor had written a editorial, announcing that “were it my misfortune to be bitten by a rabid dog, I would board the first Atlantic steamer, go straight to Paris and, full of hope, place myself immediately in the hands of Pasteur…Let us prove to the world that we are intelligent enough to appreciate the advance of science and liberal and humane enough to help those who cannot help themselves.” When the boys returned to America, successfully vaccinated, they were miniature celebrities, and everywhere they went, Pasteur’s vaccine grew more and more legendary. As one historian writes, the vaccine was a breakthrough in the way Americans thought about medicine altogether: “It created a new expectation that medicine can and should change, that progress is to be expected.” But that progress needed infrastructure, and Pasteur’s little laboratory was bursting at the seams.
In 1887, Louis Pasteur launched the ultimate healthcare GoFundMe: a fundraiser for the establishment of an institution which would provide ongoing rabies treatment, and continue research into the development of future vaccines. Around the world, donations poured in, including one from none other than little Joseph Meister. On November 14, 1888, he finally opened the doors of the Pasteur Institute. For more than a century, the research staff of the Pasteur Institute made their own contributions, including cures for diptheria, snakebites, the plague, and more. Meanwhile, the hospital wing of the Pasteur Institute carried on the work of rabies vaccinations and treatment, Also working within those walls was Joseph Meister, who spent his life in the company of the laboratory animals he’d loved as a child, working as a janitor until his death at the outbreak of World War II. Today, post-exposure prophylaxis regimens, like those given to Joseph Meister, are administered to over 20 million people around the world each year. There hasn’t been a case of rabies in France since 1998. Today, France is officially declared “rabies-free.”
As we look forward to the year ahead, know that the COVID-19 vaccination campaigns won’t be smooth or steady – they never are, and there’s never been one conducted at this scale before – not even close. But whether it’s 24 brave boys crossing the sea and saving a quarter of a million lives on the other side, or whether it’s an assembly line of scientists painstakingly measuring thousands of vials with 19th century technology, or whether it’s an international consortium of state of the art factories operating at max capacity, the results are worth the wait. Rabies is preventable. Smallpox is gone. And soon, COVID-19 will be another disease we can guard against, antibodies circulating quietly and steadily while we walk out the door, to go to work, see our friends, and hug our families. I look forward to that day. It is coming soon.
Thanks for listening to The Land of Desire. You can follow the show on Facebook, Instagram and Twitter, and sign up for the free newsletter at http://thelandofdesire.substack.com Be safe, my dear listeners, we’re almost through this. I wish all of you a happier, healthy new year. Until next time, au revoir.
Further reading:
- “Louis Pasteur’s risky move to save a boy from almost certain death” Dr. Howard Markel, PBS Newshour.
- “The Promise of mRNA Vaccines” Diana Kwon, The Scientist.
Sources:
- Rabid: A Cultural History of the World’s Most Diabolical Virus – Bill Wasick, Monica Murphy
- Illness as Metaphor and AIDS And Its Metaphors – Susan Sontag
- “The first live attenuated vaccines” Caroline Barranco, Nature Research.
- Alberer M, Gnad-Vogt U, Hong HS, Mehr KT, Backert L, Finak G, Gottardo R, Bica MA, Garofano A, Koch SD, Fotin-Mleczek M, Hoerr I, Clemens R, von Sonnenburg F. Safety and immunogenicity of a mRNA rabies vaccine in healthy adults: an open-label, non-randomised, prospective, first-in-human phase 1 clinical trial. Lancet. 2017 Sep 23;390(10101):1511-1520. doi: 10.1016/S0140-6736(17)31665-3. Epub 2017 Jul 25. PMID: 28754494.
- “22 Orphans Gave Up Everything to Distribute the World’s First Vaccine” Sam Kean, The Atlantic.
- Velasco-Villa A, Mauldin MR, Shi M, et al. The history of rabies in the Western Hemisphere. Antiviral Res. 2017;146:221-232. doi:10.1016/j.antiviral.2017.03.013
- Kete, Kathleen. “La Rage and the Bourgeoisie: The Cultural Context of Rabies in the French Nineteenth Century.” Representations, no. 22, 1988, pp. 89–107. JSTOR, www.jstor.org/stable/2928412. Accessed 21 Jan. 2021.
- Historical Perspective of Rabies in Europe and the Mediterranean Basin A.A. King, A.R. Fooks, M. Aubert, A.I. Wandeler (Eds.). OIE, Paris, 2004.
- “The Rabies Vaccine Backstory” Catherine Offord, The Scientist, June 1 2016.
- Smith, Kendall A. “Louis pasteur, the father of immunology?.” Frontiers in immunology vol. 3 68. 10 Apr. 2012, doi:10.3389/fimmu.2012.00068
- The first rabies vaccination in humans, Rino Rappuoli, Proceedings of the National Academy of Sciences Aug 2014, 111 (34) 12273; DOI: 10.1073/pnas.1414226111
- Hansen, Bert. “America’s First Medical Breakthrough: How Popular Excitement about a French Rabies Cure in 1885 Raised New Expectations for Medical Progress.” The American Historical Review, vol. 103, no. 2, 1998, pp. 373–418. JSTOR, www.jstor.org/stable/2649773. Accessed 21 Jan. 2021.
- Rappuoli, Rino. “Inner Workings: 1885, the first rabies vaccination in humans.” Proceedings of the National Academy of Sciences of the United States of America vol. 111,34 (2014): 12273. doi:10.1073/pnas.1414226111
Subscribe to the newsletter
Want more French history and pop culture in your life? Subscribe to the Land of Desire newsletter. The revamped newsletter comes in two flavors: free and paid. Free subscribers receive one newsletter per quarter; paid subscribers receive at least one newsletter per month. Subscribe to the newsletter here.
Support the Show
There are so many ways to support the show! First and foremost, sign up for a paid subscription to The Land of Desire newsletter or contribute via Patreon. If you’re a paid subscriber, chime in on our Substack discussion threads whenever a new newsletter is sent out!
But that’s not all: you’re always welcome and strongly encouraged to ask questions on the show’s Facebook page or through Twitter! And of course, you can contact me directly here. Thank you so much for listening to the show. Until next time, au revoir!
Join the Discussion
- Join our Substack discussions
- Like us on Facebook
- Follow us on Twitter (so many GIFs)
- Follow us on Instagram (find out when new episodes go live)
The post 64. Louis Pasteur and The History of the Vaccine appeared first on The Land of Desire.
San Francisco, California
A French History and Culture Podcast
Visit Podcast Website
RSS Podcast Feed
Subscribe
Share
Add to MyCast