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Who invented medicine for plague: Current Research and Future Trends


Alexandre Yersin, the man who discovered the bacterium responsible for the plague

Swiss-born Alexandre Yersin joined the Institut Pasteur in 1885 aged just 22 and worked under Émile Roux. He discovered the plague bacillus in Hong Kong. A brilliant scientist, he was also an explorer and pioneer in many fields. Alexandre Yersin was buried in Nha Trang (Vietnam) and next to his grave there is a small temple that is always decorated with flowers and incense – a great honor for a foreign national.

Alexandre Yersin was an eminent Pasteurian. Born in Switzerland, he studied medicine in Germany before emigrating to France, as Paris was then at the forefront of clinical medicine with great practitioners like Corvisart, Laennec and Trousseau. Introduced to the Institut Pasteur by Émile Roux, he is closely linked to the latter’s discoveries (particularly regarding diphtheria). Alexandre Yersin worked at the brand new Institut Pasteur (opened on November 14, 1888) for two years before setting off for Yunnan in China in 1890. He never returned to Europe. After four years spent exploring the coast and hinterland of Annam, he was appointed by the French government to deal with the plague outbreak devastating Yunnan in China in 1894. Once in the country, and despite competition from the Japanese team, he discovered the agent responsible, Yersinia pestis, which he described as: “small stocky spindles with rounded ends”. He then conducted a great many scientific experiments, in very diverse fields, until the end of his life. He was an idealist and said the following of medical practice: “I am very happy to treat those who come to me asking for advice, but I wouldn’t like to make medicine my profession, what I mean is, I could never ask a patient to pay me for treatment. I consider medicine a calling, like priesthood.”


Biography of Alexandre Yersin

Portrait of Alexandre Yersin (1863-1943) aged 30 in 1893. Photographer – Author: Pierre Petit.
© Institut Pasteur – Musée Pasteur

  • September 22, 1863
    Born in Lavaux, in the Vaud canton of Switzerland.
  • 1885 – 1886
    Yersin arrived in France where he continued his studies at Hôtel-Dieu de Paris hospital. There, he joined the Institut Pasteur and was involved in vaccination sessions. He discovered the diphtheria toxin with Émile Roux in 1886.
  • 1890 – 1894
    He became a ship’s doctor for the Messageries Maritimes shipping company. He led three expeditions across the Annam hinterland.
  • June 5, 1894
    He was sent on a mission and reached Hong Kong. The plague had already caused 100,000 deaths in Canton that year.
  • June 20, 1894
    He isolated the plague bacillus Yersinia pestis, which bears his name.
  • From 1894 onwards
    He founded the Institut Pasteur in Nha Trang in 1895. He studied cattle breeding (to produce anti-plague serum) and growth of the Hevea brasiliensis, or the rubber tree. He acclimatized the cinchona tree, which enabled Indochina to meet its quinine needs during the Second World War. Alexandre Yersin was fascinated by everything – bacteriology, agronomy and astrology. He was the first person to own a car in Hanoi.
  • February 27, 1943
    He died in Nha Trang, even though he had just started learning Greek and Latin again.

Who Really Discovered What Causes The Plague?

In 1894, the Pasteur Institute sent bacteriologist Yersin to Hong Kong to investigate an epidemic of bubonic plague. The disease had already killed more than 40,000 people as it swept through southern China. Bubonic plague normally kills between 30% and 60% of its victims without treatment, but the 1894 outbreak proved to be an even more efficient killer, because at some point the pathogen had taken hold in a person’s lungs. When that person coughed, they spread airborne droplets of plague to everyone nearby — and untreated pneumonic plague is nearly always fatal.

What happened next, according to scientific legend, is that Yersin discovered the bacterial cause of bubonic plague while working alone in a straw hut — yet another quasi-mythical story of a lone, underdog scientist singlehandedly making a major discovery. But reality is usually more complicated. Yersin wasn’t the only scientist hunting bacteria in the middle of the Chinese epidemic, and he wasn’t technically even the first to discover the bacterium that now bears his name.

Rivalry In A Plague Year

Medical schools in Asia produced great bacteriologists and physicians, too, and the Japanese government sent one of them — Kitasato Shibasaburo — to help investigate the plague epidemic. This wasn’t the first time that Kitasato’s work had intersected with Yersin’s; both had studied under bacteriologist Robert Koch (along with Christiaan Eijkman), although Yersin spent only a couple of months with him before moving on to longer-term work with Louis Pasteur. And Yersin had helped Emile Roux discover the diphtheria toxin, a compounded secreted by Corynebacterium diphtheriae which finds its way into the cytoplasm of a host’s cell and blocks protein synthesis, causing the symptoms of diphtheria. A short while later, Kitasato and Emil von Behring developed a serum, made from the blood plasma of horses immunized against the disease, which neutralized diphtheria toxin. Diphtheria antitoxin is in the process of falling out of favor, in part because it causes potentially deadly side effects at a higher rate than many doctors are comfortable with, but the World Health Organization still considers it an essential medicine in the fight against diptheria. It earned Kitasato and von Behring nominations for the 1901 Nobel Prize in Physiology or Medicine, but in the end, only von Behring received the award — which perhaps foreshadowed the decades-long debate over the discovery of Yersinia pestis.

Kitasato arrived in Hong Kong on June 12, 1894, with a team of medical students and assistants. He already had a high-profile reputation in the field, and that won him a warm reception from the acting superintendent of Hong Kong’s Civil Hospital and Port Medical Officer, James Lowson. It also opened a lot of doors — specifically, doors to autopsy rooms where Kitasato got access to patients and tissue samples for study, as well as doors to quarters and laboratory space at Kennedy Town Hospital. He and his team were already poring over samples by the time Yersin arrived on June 15.

Yersin stepped onto the docks of Hong Kong, carrying his bag of lab equipment, already at a disadvantage; he was a French physician arriving in an English colony in the late 1800s, when tensions between the two countries were high, and he spoke no English. Denied any room to live or work at Hong Kong’s hospitals, Yersin and the single servant he brought with him reportedly built a straw hut for their workspace. It took several days to negotiate the access to patients and tissue samples that Kitasato had received right away.

Simultaneous Breakthroughs

On June 15, 1894, the same day Yersin arrived in Hong Kong, Lowson wired a report, some drawings, and some photographs of microscope slides to British medical journal The Lancet, reporting that Kitasato had identified the bacteria responsible for bubonic plague; that report appeared as an editorial note in the August 11, 1894 issue of the journal. On June 20, just a few days after Kitasato, Yersin, too, identified the bacterium.

Yersin described it as a rod-shaped microbe which didn’t move on its own, whose cell walls wouldn’t retain a violet dye called a Gram stain (Gram-negative bacteria like Y. pestis are often harder to treat beacuse they have an extra protective membrane that Gram-positive bacteria lack). Yersin was correct on all counts.

Kitasato’s description, though faster, was much less clear. He seemed to describe pairs of round bacteria called cocci in blood samples, but rod-shaped bacilli in tissue from the swollen lymph nodes, or buboes, that give the bubonic plague its common name. And in the initial report, The Lancet‘s editors seemed to have trouble deciding whether Kitasato’s images showed bacilli or cocci. Some historians have suggested that translation errors may be to blame for the vagueness of some of Kitasato’s descriptions; he almost certainly wrote the paper in Japanese or German, since his English was limited, and his descriptions may have suffered from the translation process.

But Kitasato’s report also described the bacteria moving on their own, unlike Yersin’s description, and he was still on the fence about whether the new pathogen would take a Gram stain. The two researchers also disagreed about how bacterial colonies formed and how the microbes grew in different conditions. At the time, bacteriologists wrote off almost all of these differences as minor and cheerfully accepted both reports as proof of simultaneous, independent discovery of a tiny organism that had already rewritten huge chunks of human history.

Dispute Over Credit

As the years passed, bacteriologists started to question Kitasato’s description of the bacteria he’d isolated from plague-infected blood and lymph back in Hong Kong. Some of his colleagues argued that he had actually been describing a pneumococcus, a type of round bacteria that cause many forms of pneumonia. Others argued that he’d been describing two different bacteria: one which was probably a pneumococcus and another which may actually have been bubonic plague. If Kitasato had either never cultured the plague pathogen at all, then all the credit should go to Yersin.

But what if he was looking at a mixture of plague and something else? Kitasato was most likely describing two different bacteria at once, but his descriptions of the rod-like plague bacillus were very close to correct, and he made his discovery a few days before Yersin. Should he still get credit for the discovery if he was only partially correct? Today, the general consensus is that the two scientists should share the credit.

Why does any of that matter today? Scientists still work under tremendous pressure to be the first to publish a result; in most fields, jobs and research funding depend on it. But in the rush to publish ahead of Yersin, Kitasato and Lowson published vague results from contaminated samples, and that cost Kitasato a lot of recognition later. It was Yersin, a little slower on the buzzer but ready with a more precise answer, who ended up with his name on one of the most famous bacteria in the world. And Sunday would have been his 155th birthday.

1897: A scientist tests a bubonic plague vaccine on himself – Jewish World – Haaretz | Israel news, COVID vaccine data, the Middle East and the Jewish World

On January 10, 1897, bacteriologist Waldemar Haffkine, an Odessa-born Jew who trained with Louis Pasteur at his institute in Paris, tested the vaccine he had created in record time to combat a bubonic plague epidemic in Bombay, on himself. He survived, and the vaccine went on to serve as the basis for a more refined formula that provided widespread protection from the disease. 

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It was not the first time that Haffkine, an Orthodox Jew, had used himself as a guinea pig before subjecting other humans to his remedies.

Vladimir Aaronovich Mordecai Wolf Chavkin (the Russian version of his name) was born on March 15, 1860, to Aaron Chavkin, a schoolmaster, and the former Rosalie Landsberg. As a child, he moved with his family to Berdyansk, a port city in eastern Ukraine, and he was educated both there and in Odessa, both part of the Russian empire.

As a young man, Haffkine was drawn to the revolutionary Narodnaya Volya group, but quit when it turned violent – it was this group that assassinated Czar Alexander II in 1881. He also belonged to the Jewish League for Self-Defense. While helping to defend Jews in Odessa during a pogrom in the early 1880s, he was injured, and also arrested for his activism. 

He was only released after the intervention of his mentor Elie Metchnikoff, Haffkine’s teacher at the Imperial Novorossiya University in Odessa. Metchnikoff, a zoologist and immunologist, later went on to win the Nobel Prize in Physiology or Medicine.

After finishing his doctorate, in 1884, Haffkine was invited to join the faculty of the university, on the condition – unacceptable to him — that he convert to Russian Orthodoxy. Instead, he worked as a researcher at the Odessa Museum of Zoology, before moving to the University of Geneva, in 1888, and then the following year to the Pasteur Institute, in Paris, where Metchnikoff now had a position. Within a year, Haffkine had been promoted from librarian to assistant to the institute’s director. 

Cholera arrives

In 1892, a cholera pandemic swept across both Asia and Europe, and Haffkine began work on a preventive vaccine for the disease. 

After testing his vaccine, made from attenuated cholera bacteria, by injecting himself with the serum , he was anxious to try it on a large group. With the permission of the British colonial authorities, he traveled to India in 1893. Although the Jewish European doctor and his injections were regarded with suspicion and even hostility by locals, Haffkine finally succeeded in proving the efficacy of the vaccine on a widespread population group. 

The next challenge, in 1896, came with an outbreak of bubonic plague. Haffkine worked on a vaccine in a frenzy, persisting even as two of his assistants quit from the pressure and a third suffered a nervous breakdown. It was this vaccine that he tested on himself on January 10, 1897.

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Five years later, 19 people in a single town in the Punjab contracted tetanus and died after inoculation with Haffkine’s plague vaccine, all having been treated with serum from the same bottle. The initial investigation into the disaster blamed Haffkine for faulty production procedures; he was relieved of his position as head of the Bombay Plague Laboratory, and left India. 

A full five years was required for the truth to be understood – that the person in the field administering the vaccine had contaminated its contents after opening the bottle. Haffkine was vindicated, and he returned to India. 

In the meantime, Haffkine, having experienced anti-Jewish hostility everywhere he lived, became devoted to the cause of resettling Jews in Palestine, and he approached the Ottoman sultan with a plan for purchasing land there for that purpose. The sultan was not interested. 

Haffkine remained in India until his retirement, in 1914, when he returned to France. In his later years, he became extremely observant religiously, and, in an attempt to convince others to follow a similar path, he wrote a book called “A Plea for Orthodoxy.” In 1929, he also established a foundation to promote Jewish education in Eastern Europe. 

Haffkine, who never married, lived his final years in Lausanne, Switzerland, where he died on October 26, 1930. 

Medieval Cures for the Black Death

The Black Death is the 19th-century CE term for the plague epidemic that ravaged Europe between 1347-1352 CE, killing an estimated 30 million people there and many more worldwide as it reached pandemic proportions. The name comes from the black buboes (infected lymph glands) which broke out over a plague victim’s body. The cause of the plague was the bacterium Yersinia pestis, which was carried by fleas on rodents, usually rats, but this was not known to the people of the medieval period, as it was only identified in 1894 CE. Prior to that time, the plague was attributed primarily to supernatural causes – the wrath of God, the work of the devil, the alignment of the planets – and, stemming from these, “bad air” or an unbalance of the “humors” of the body which, when in line, kept a person healthy.

Three Doctors Attend a Man with the Plague

Historical Medical Library of The College of Physicians of Philadelphia (CC BY-NC-SA)

Since no one knew what caused the disease, no cure was possible, but this did not stop people from trying what they could based on the medical knowledge of the time which came primarily from the Greek doctor Hippocrates (l. c. 460 – c. 370 BCE), philosopher Aristotle of Stagira (l. 384-322 BCE), and the Roman physician Galen (l. 130-210 CE) as well as religious belief, folklore, herbalism, and superstition. These cures – most of which were ineffective and some of which were fatal – fall roughly into five categories:

  • Animal cures
  • Potions, Fumigations, Bloodletting, Pastes
  • Flight from Infected Areas and Persecution of Marginalized Communities
  • Religious Cures
  • Quarantine and Social Distancing

Of these five, only the last – quarantine and what is now known as “social distancing” – had any effect on stopping the spread of plague. Unfortunately, people in 14th-century CE Europe were as reluctant to stay isolated in their homes as people are in the present day during the Covid-19 pandemic. The wealthy bought their way out of quarantine and fled to country estates, spreading the disease further, while others helped with the spread by ignoring quarantine efforts and continuing to participate in religious services and by going about their daily business. By the time the plague ended in Europe, millions were dead and the world the survivors had known would be radically changed.

Arrival of the Plague & Spread

The plague began to spread through the Mongol army between 1344-1345 CE.

The plague had been killing people in the Near East since before 1346 CE, but that year it grew worse and more widespread. In 1343 CE, the Mongols under the Khan Djanibek (r. 1342-1357 CE) responded to a street brawl in the Italian-held Crimean town of Tana in which a Christian Italian merchant killed a Mongol Muslim. Tana was easily taken by Djanibek, but a number of merchants fled to the port city of Caffa (modern-day Feodosia in Crimea) with the Mongol army in pursuit. Caffa was then put to siege but, at the same time, the plague began to spread through the Mongol army between 1344-1345 CE.

The Italian notary Gabriele de Mussi (l. c. 1280 – c. 1356 CE) was either an eyewitness to the siege or received a first-hand account and wrote of it in 1348/1349 CE. He reports how, as the Mongol warriors died and their corpses filled the camp, the people of Caffa rejoiced that God was striking down their enemies. Djanibek, however, ordered the corpses of his dead soldiers catapulted over the city’s walls and soon the plague erupted in the city.

It has been suggested by some modern-day scholars that the dead could not have infected the people of Caffa as the disease could not be transmitted by handling corpses but, even if that were true, many of these dead bodies – described as “rotting” – were most likely already in an advanced state of putrefaction and gases and bodily fluids could have infected the city’s defenders as they tried to dispose of what de Mussi describes as “mountains of dead” (Wheelis, 2).

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Spread of the Black Death

Flappiefh (CC BY-SA)

A number of the people of Caffa fled the city in four merchant ships which went first to Sicily, then Marseilles and Valencia, spreading the plague at each stop. From these ports, other infected people then spread it elsewhere until people were dying across Europe, Britain, and even in Ireland where ships from Europe had docked for trade.

Medical Knowledge

The physicians of the day had no idea how to cope with the outbreak. Nothing in their experience came anywhere close to the epidemic which killed people, usually, within three days of the onset of symptoms. Scholar Joseph A. Legan notes:

When the Black Death struck Europe in the middle of the 14th century, nobody knew how to prevent or treat the disease. Many believed they could cure it, but none of the bloodletting, concoctions, or prayers were successful. The overall intellectual framework of dealing with illness was flawed. The failure of medieval medicine is largely due to the strict adherence to ancient authorities and the reluctance to change the model of physiology and disease the ancients presented. (1)

None of Galen’s works – and little of others’ – were available in Latin or Greek to the European doctor who had to rely on Arabic translations which were then translated to Latin along with the Canon of Medicine of the Persian polymath Ibn Sina (also given as Avicenna, l. c. 980-1037 CE) whose brilliant work was often obscured by poor translations. Based on Galen’s works, primarily, the basis of medieval medicine was the theory of humors – that the four elements of earth, water, air, and fire are linked to bodily fluids of yellow bile (fire), blood (air), phlegm (water), black bile (earth) and each “humor” was associated with color, a certain taste, a kind of temperament, and a season of the year.

Portrait of Seven Notable Greek Physicians & Botanists

Lewenstein (Public Domain)

One’s health could also be affected by astrological alignment and, of course, by supernatural agencies such as God, Satan, diverse demons, and the “witchcraft” of marginalized peoples such as gypsies, Jews, and others considered “outsiders” who were thought to possess knowledge of the black arts. Scholar George Childs Kohn comments on the causes given for the plague:

The plague was attributed to any and all of the following: corrupted air and water, hot and humid southerly winds, proximity of swamps, lack of purifying sunshine, excrement and other filth, putrid decomposition of dead bodies, excessive indulgence in foods (particularly fruits), God’s wrath, punishment for sins, and the conjunction of stars and planets. Religious fanatics asserted that human sins had brought the dreadful pestilence; they roamed from place to place, scourging themselves in public…There was panic everywhere, with men and women knowing no way to stop death except to flee from it. (27-28)

There were many people, however, who did not take to flight but tried to find some means of fighting the disease where they were. Based on the medical knowledge of the time, folk cures which had been passed down for generations, Christian belief, superstition, and prejudice, the people tried any suggestion offered to defeat death.

Animal Cures

One of the most popular cures was the “Vicary Method”, named after the English doctor Thomas Vicary, who first proposed it. A healthy chicken was taken and its back and rear plucked clean; this bare part of the live chicken was then applied to the swollen nodes of the sick person and the chicken strapped in place. When the chicken showed signs of illness, it was thought to be drawing the disease from the person. It was removed, washed, and strapped back on and this continued until the chicken or the patient died.

An attempt at a cure was to find & kill a snake, chop it into pieces, & rub the various parts over swollen buboes.

Another attempt at a cure was to find and kill a snake, chop it into pieces, and rub the various parts over swollen buboes. The snake, synonymous in Europe with Satan, was thought to draw the disease out of the body as evil would be drawn to evil. Pigeons were used in this same way but why the pigeon was chosen is unclear.

An animal much sought after for its curative powers was the unicorn. Drinking a powder made of the ground-up horn of the unicorn mixed in water was thought to be an effective remedy and was also among the most expensive. The unicorn could not easily be caught and had to be lulled into submission by a young virgin maiden. Doctors who managed to procure the powder of a ground “unicorn horn” used it to treat snake bites, fever, convulsions, and serious wounds and so it was thought to work equally well with the plague. There is no evidence that it did, however, any more than the cures involving the chicken or the snake.

Potions, Fumigations, Bloodletting, & Pastes

The unicorn potion was not the only – or most expensive – cure offered to the nobility or wealthy merchant class. Another remedy was eating or drinking a small quantity of crushed emeralds. The physician would grind the emeralds with a mortar and pestle and then administer it to the patient as a fine powder mixed with either food or water. Those who could not afford to consume emeralds drank arsenic or mercury which killed them faster than the plague.

One of the best-known potions was Four Thieves Vinegar which was a combination of cider, vinegar, or wine with spices such as sage, clove, rosemary, and wormwood (among others) thought to be a potent protection against the plague. It allegedly was created and used by four thieves who were able to rob the homes of the dying and graves of the dead because the drink made them immune to the plague. Four Thieves Vinegar is still made and used today in the practice of homeopathic medicine as an antibacterial agent; though no one in the modern-day claims it can cure the plague.

17th-century Depiction of Plague Doctor

Paul Fürst (Public Domain)

The most popular potion among the wealthy was known as theriac. Legan notes, “it was very difficult to prepare; recipes would often contain up to eighty ingredients, and often, significant amounts of opium” (35). The ingredients were ground into a paste which was mixed with syrup and consumed as needed. Precisely what the ingredients were and why it worked, however, is unclear. Theriac in its liquid form was often referred to as treacle but it seems it could also be applied as a paste.

Aside from potions, clearing the air was considered another effective remedy. Since the plague was thought to spread by “bad air”, homes were fumigated with incense or simply smoke from burning thatch. People carried bouquets of flowers which they held to their faces, not only to ward off the stench of decomposing bodies, but because it was thought this would fumigate one’s lungs. It was this practice which gave rise to the children’s rhyme “ring around the rosy/a pocketful of posie/ashes, ashes, we all fall down” in reference to the practice of filling one’s pockets with flowers or sweet-smelling substances to keep one safely fumigated at all times. As the rhyme suggests, this was as ineffective as any of the other cures.

Bloodletting was a popular remedy for all kinds of illnesses & was well established by the medieval period.

It was also thought that one could fumigate one’s self by sitting close to a very hot fire which would draw the disease out by heavy sweating. Another technique was to sit by an open sewer as the “bad air” which was causing one’s sickness would gravitate to the “bad air” of the sewage of the stream, pond, or pit used for dumping human waste.

Bloodletting was a popular remedy for all kinds of illnesses and was well established by the medieval period. It was thought that, by drawing out “bad blood” which caused illness, health would be restored by the “good blood” that remained. The preferred method was “leeching” in which a number of leeches would be placed on the patient’s body to suck out the “bad blood” but leech-collectors were a highly-paid profession and not everyone could afford this treatment. For the less affluent, a small incision was made in the skin with a knife and the “bad blood” collected in a cup and disposed of. Another method along these same lines was “cupping” in which a cup was heated and applied upside down to a patient’s skin, especially the buboes, to draw the sickness into it.

Aside from theriac paste, doctors also prescribed a cream made of various roots, herbs, and flowers which was applied to the buboes one they were lanced. Human waste was also turned into a paste for the same purpose which no doubt led to greater infection. Since it was believed that clean urine had medicinal properties, people would bathe in it or drink it, and urine collectors were paid well by doctors for a clean product.

Flight from Infected Areas & Persecution

Those not wishing to bathe in urine, be smeared with feces, or try the other cures, left the affected region or city, but this option was usually only available to the wealthy. The Italian poet and writer Giovanni Boccaccio (l. 1313-1375 CE) describes the flight of ten affluent young people from Florence to a countryside villa during the plague in his masterpiece The Decameron (written 1349-1353 CE) where the characters tell each other stories to pass the time while the plague rages on in the city.

Giovanni Boccaccio & Florentines Who Have Fled from the Plague

Koninklijke Bibliotheek (Public Domain)

These types of people, and many others of all social classes, also tried curing the plague by striking at what they considered its source: marginalized groups who were considered outsiders. Kohn writes:

In places, the plague was blamed on cripples, nobles, and Jews, who were accused of poisoning the public wells and were either driven away or killed by fire or torture. (28)

In addition to those groups mentioned by Kohn, many others were also singled out who were in any way considered different and did not conform to the standards of the majority.

Religious Cures

That standard, for the most part, was set by the medieval Church which informed the worldview of the majority of the population of Europe at the time. Religious cures were the most common and, besides the public flagellation mentioned above, took the form of purchasing religious amulets and charms, prayer, fasting, attending mass, persecuting those thought responsible, and participating in religious processions.

The pope eventually put a stop to the public flagellations as ineffective and upsetting to the populace, but by that time, participants had spread the plague to every town or city they had visited. Processions, in which participants marched and prayed for mercy usually from a central point in town to the church or a shrine, did the same on a smaller scale as did public gatherings to hear mass.

Quarantine & Social Distancing

The only effective means of stopping the spread of the plague – though not curing it – was separating the sick from the well through quarantine. The port city of Ragusa (modern-day Dubrovnik, Croatia), at that time under the control of Venice, was the first to initiate this practice through a 30-day isolation period imposed on arriving ships. Ragusa’s population had been heavily depleted by the plague in 1348 CE, and they recognized that the disease was infectious and could be transmitted by people. Ragusa’s policy was effective and was adopted by other cities and extended to 40 days under the law of quarantino (40 days) which gives English its word quarantine.

The Plague by Arnold Bocklin

Arnold Böcklin (Public Domain)

Although quarantine and social distancing seem to have had a positive effect, governments were slow to implement the policies and people reluctant to follow them. Kohn writes:

The segregation of the sick was ordered in many cities but in some the quarantine practice and stations were put into effect too late, such as in Venice and Genoa, where half the people succumbed. (28)

Milan, on the other hand, imposed stricter measures and enforcement and had greater success in controlling the spread of the disease. The Milanese authorities tolerated no dissension among the citizenry in obeying the laws of quarantine, at one point completely sealing the infected occupants of three houses in their homes where, presumably, they died. In 1350 CE, they built a structure outside the city walls – the pesthouse – where plague victims were housed and caregivers could tend them. The plague doctors are famously depicted in cloaks and hats with beaked masks which were thought to protect the wearer by distancing the physician’s face – especially the nose and mouth – from the infected patient.


As the plague raged on, other measures were attempted such as washing money with vinegar, fumigating letters and documents with incense, and encouraging people to think positive thoughts as it seemed to become clear that a patient’s general attitude greatly affected the chances of survival. None of these proved as effective as separating the infected from the healthy but people still broke quarantine and continued the spread of the disease.

By the time the plague had run its course, over 30 million people – 30-50% of the population of Europe – were dead. The loss of population transformed European society, ending the feudal system, establishing wages for former serfs, and elevating women’s status in that many mothers, wives, and daughters survived the males of the family and assumed their roles.

Kohn notes that, “to many historians, the Black Death marked the end of the Middle Ages and the start of the modern age” (28). This conclusion is sound in that, afterwards, people’s disillusionment with the religious, political, and medical paradigms of the past inspired them to seek alternatives, and these would eventually find full expression in the Renaissance which lay the foundation for the world of the modern era.

This article has been reviewed for accuracy, reliability and adherence to academic standards prior to publication.

No. 123: The Black Death

Today, we survive the Black Death. The University
of Houston’s College of Engineering presents this
series about the machines that make our
civilization run, and the people whose ingenuity
created them.

The plague Yersinias
swept out of Asia in 1347. An
over-populated Europe had been damaged by 50 years
of famine. Now rats carried this disease off ships
in Genoa. In just four years it killed off 40
percent of the people in Europe. It took three
forms: “bubonic” plague hit the lymph system,
“pneumonic” plague attacked the lungs, and
“septicemic” plague assaulted the blood. But the
words “Black Death” encompassed it all.

After 1351, the Black Death went from the epidemic
phase, where the disease suddenly appears, to the
pandemic phase. During the so-called “plague
pandemic,” the plague settled into the local
environment and kept coming back every few years to
whittle away at the population. From the first
famines in 1290 until the plague pandemic began to
recede in 1430, Europe lost three-quarters of its
people. The Black Death is far and away the
greatest calamity our species ever suffered.

And what, do you suppose, was left in its wake?
Well, it unraveled the tapestry of the feudal
system. It left many survivors wealthy. Manual
labor became precious. Wages skyrocketed, and work
took on a manic quality. When death rides on your
back, time also becomes precious. Minutes seem to
count for something. The Church-centered world
before the plague had been oddly timeless. Now
people worked long hours, chasing capital gain, in
a life that could end at any moment. The first new
technology of the plague years was time-keeping –
mechanical clocks and hourglasses.

Medicine had been a function of the Church before
the plague. Physicians were well-paid,
highly-respected scholars. They spun dialectic
arguments far away from unwholesome sick people –
not unlike some of today’s specialists.
13th-century medicine, like the 13th-century
Church, had failed miserably in coping with the
plague. Both medical and religious practice now
shifted toward the laity. Medicine was redirected
into experimentation and practical pharmacology.
Medical books were now being written — not in
Latin — but in the vernacular, and by a whole new
breed of people.

Technology had to become less labor-intensive. It
had to become high-tech. For good or evil, the
plague years gave us crossbows, new medical ideas,
guns, clocks, eyeglasses, and a new craving for
general knowledge. And so the rainbow at the end of
this terrible storm yielded its pot of gold. The
last new technology of this ghastly 150 years was
the printing press. It finally melted what
Shakespeare had named the winter of our discontent.
It provided access to knowledge. And it started the
rebirth of Europe.

I’m John Lienhard, at the University of Houston,
where we’re interested in the way inventive minds

(Theme music)

Gottfried, R.S., The Black Death: Natural and
Human Disaster in Medieval Europe
. New York: The
Free Press, 1983.

McNeill, W. H., Plagues and Peoples. New
York: Anchor Book, 1976.

The Engines of Our Ingenuity is
Copyright © 1988-2018 by John H.

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Fourteenth-Century England, Medical Ethics, and the Plague | Journal of Ethics


In the 20th and 21st centuries, human immunodeficiency virus (HIV), severe acute respiratory syndrome (SARS), and the threat of bioterror attacks have raised questions about the role of the physician in response to epidemics. Modern medical ethics, with its precepts of beneficence, nonmaleficence, and respect for patient autonomy, focuses almost exclusively on the relationship between the doctor and patient. As a result, this ethical framework is less well-equipped to deal with the relationship of the physician to society as a whole. Personal autonomy is often at odds with public health ethics, which stress the needs of the population over the needs of the individual.

The emphasis on the personal over the public applies to physicians as well as to their patients. Indeed, in the face of modern epidemics, the concept of a “duty-to-treat”—although explicitly and forcefully stated in the professional codes of the 19th and early 20th centuries—has been in conflict with a physician’s autonomy in determining whom he or she will treat [1].

While the ethical challenges of today may be new, the threat of epidemic is not. It was present when, in 1354, Henry, first Duke of Lancaster and grandfather of Henry IV, began writing a devotional treatise. Composed of daily entries, Le Livre de Seyntz Medicines (The Book of Holy Medicine) is unique among medieval devotional literature in that it contains the most extensive known use of medical metaphors and imagery to describe religious experience. The book is a catalogue of Henry’s sins, expressed as various wounds and diseases, followed by a similar account of spiritual remedies in the form of common medieval medical treatments [2]. What ultimately moved Henry to write this work remains a mystery, but coming so soon after the first arrival of the Black Death in England in 1347, it is not hard to imagine that the swift and devastating mortality of the disease made an impact.

Life in a Time of Sudden Death

The first wave of the Black Death occurred between 1347 and 1351, arriving most likely from China, and killing approximately one quarter to one third of the European population within 2 years [3]. In some locations, historians estimate that as much as 60 percent of the population died. After this first onslaught, the plague remained endemic for the next 300 years, returning every so often to cull the population. While epidemics such as the Black Death were dramatic in their devastation, medieval life was accompanied by the constant fear of death. Even without the plague, the average life expectancy for women was about 29 years and for men, only 28. In such harsh times, the greatest fear of all was mors improvisa, an unexpected death coming before confession and forgiveness of sin [4]. This fear only increased during the plague when hundreds of thousands of people sickened and died, often within just a few days. It was also this fear which “gave rise to a genre of devotional literature designed to inspire good works and foster an appropriate sense of contrition in the reader” [5].

Henry’s text is one example of confessional works designed to invoke contrition. The first half of the Book of Holy Medicine is devoted to descriptions of his sins as wounds that afflict various parts of his body—the head, eyes, ears, nose, mouth, hands, and heart. Henry portrays himself as the patient and Christ as the physician. In one passage, he describes his sin as an open wound that needs treatment, saying,

“I could have helped myself and cut off the [festering] limb by true confession and repentance of the heart…I should have chastened my flesh and cut away, not only the fire of sin, but the heat of the flesh by abstinence and other hardships, so that the fire’s passage would have been cut off, so that it could have gone no further” [6].

In addition to spiritual healing, as a nobleman Henry of Lancaster would have had access to the best medical care, even though it would have been of little help in the face of the plague. In addition, the accidents, injuries, and diseases responsible for the short life spans of the time were largely beyond the scope of the medieval medical practitioner to cure. As a result, medieval physicians focused largely on prevention.

Medicine during the Middle Ages was conducted by a wide variety of practitioners, ranging from herbalists and conjurers to surgeons and university-trained physicians. Though there were some differences between medical training in Oxford and in Europe, they were largely similar with emphasis placed on theology and liberal arts for the first 7 years, followed by 3 additional years of study to obtain an “MD degree” [7]. Liberal arts training included the trivium(grammar, logic, and rhetoric) and the quadrivium (mathematics, music, geometry, and astronomy). As reflected in the trivium, reasoning, discussion, and debate were the skills most important to be learned. Further medical training was largely provided by set texts, mainly classic medical authors including Avicenna and Galen [7]. Some universities required clinical training with a physician (to be arranged by the student) and still others, particularly in Bologna and Montpelier in the early to mid-1300s, required attendance at an anatomical dissection. But the basis of becoming a physician rested on one’s ability to know the reasons for sickness and to know how illness fit into an intellectual theory about health. It was this intellectualism that was critical to distinguishing “the learned physician who knew the reasons for things [from] the hireling with a knack for healing” [7]. Many physicians had taken holy orders of some kind [8].

Surgery was a distinctly separate and, for the most part, lesser craft and was not widely practiced by physicians, owing in part to the manual labor necessary to perform it as well as to the blood loss inherent to the process. In fact, papal bull forbade clergymen from shedding blood for any reason, including surgical procedures. Following ancient Greek medical theories, university-educated physicians subscribed to the humoral theory of illness and strove to treat disease first by placing it within the appropriate intellectual framework and then by balancing the humors—phlegm (phlegmatic), black bile (melancholic), yellow bile (choleric), and blood (sanguine)—often through purgatives and enemas [4,5].

When Henry of Lancaster began writing his treatise, little was known about how the plague was spread. Multiple theories of its cause were held, from God’s vengeance to contagion to the established medical view that an individual’s susceptibility to plague stemmed from personal imbalance of humors [9]. Physicians stepped into the breach to provide support, medical advice and even spiritual counsel for those wealthy patients who could afford a full-time physician [4]. But, were physicians obligated by any overarching principles of professional ethics to treat the sick during this time of epidemic? Do today’s discussions of personal autonomy or public health ethics have any precedent in the deadly epidemics of the past?

The Medieval Profession of Medicine

In an attempt to discover ethical codes throughout history, some ethicists have proposed at least 3 conditions necessary for the development of a duty-to-treat ethic [1]. First, physicians would have had to recognize that they were at risk of becoming infected. Theories of contagion and polluted air as causative of disease were present in medieval times and gave rise to the prescription of strong smelling herbs and fumigation with pungent woods as ways to ward off plague [3]. However, the theory of infection and the identification of microorganisms would come many years later. Lacking effective treatments, physicians recommended personal hygiene (such as it was) and well-being as the cornerstones of prevention, with an emphasis on dietary prescriptions to balance the humors.

Second, establishment of a professional ethical code for epidemics requires an organized profession of medicine. With its multiple unlicensed practitioners, the practice of medicine during the mid-14th century was far from organized. The cohesive medical profession we know today simply did not exist in the Middle Ages—“Brewers who practiced surgery, abbots who delivered babies, friars who wrote medical books, a chancellor of the exchequer who doctored the king, a Cisterician surgeon—all were involved in healing, and all were involved in other pursuits” [10].

While the Hippocratic Oath was certainly known to medieval physicians, there is little evidence that it substantially influenced their practice [11]. The ethical principles of beneficence and nonmaleficence have been found in Hippocratic writings, although the actual precept of primum non nocerecannot be directly attributed to Hippocrates despite many attempts to do so [12]. Furthermore, the Hippocratic Oath did not set forth ethical principles for the event of an epidemic but focused instead on the patient-physician relationship. And even these principles were not universally acknowledged; during the medieval plague years, the prevailing wisdom was simple: “flee early, flee far, and return late” [13]. It has been noted that something of a duty-to-treat ethic did exist during this time, but it stemmed from the powerful Christian virtues of charity and service to the poor rather than from a sense of professional obligation [1]. These sentiments are certainly echoed in Henry’s Book of Holy Medicine as he consistently appeals to Christ the physician to heal him. “To you, [most sweet Lord] Jesus Christ, I come as to a doctor” [14].

Finally, a public expectation of the duty to treat is necessary for the ideal to take hold; there must be a “social contract” between physician and patient (or even physician and society) that such a duty to treat exists [1]. There is little evidence that such a social contract existed during the Middle Ages. What little expectation there may have been would have likely centered around the notion of the Christian duty to treat the sick.

The history of the medieval plague years throws into stark relief the ethical vacuum that doctors of the time had to fill on their own, falling back on religious convictions, personal compassion, or pragmatic concerns for self-preservation as the basis for their actions. Public expectations of physicians during epidemics are, even today, a point of some contention, with few explicit guidelines on a physician’s duties during an epidemic. Indeed, much of our current discussion of the ethics of epidemics arises from the uncertainty surrounding the responsibilities of either a single physician or physicians as a group during the time of an outbreak. Still, much in the history of medicine and in the social development of the physician remains unknown. In the face of limited evidence, we must remember,

Perhaps the most celebrated physician ever is Hippocrates yet we know literally nothing about him. Neither do we know anything concrete about most of the medical encounters there have ever been. The historical record is like the night sky; we see a few stars and group them into mythic constellations. But what is chiefly visible is the darkness [4].


  1. Huber SJ, Wynia MK.
    When pestilence prevails: physician responsibilities in epidemics.

    Am J Bioeth.


  2. Henry’s text is written in Anglo-Norman. For this paper, quotations are taken from EJ Arnould’s edition of the manuscript published by the Anglo-Norman Text Society. Henry of Lancaster. Le Livre de Seyntz Medicines (The Book of Holy Medicine). Arnould, EJ, ed. Oxford, UK: Anglo-Norman Text Society; 1940. No complete modern English translation of Henry’s work exists, but an excerpt has been translated into modern English in Bartlett AC, Bestul TH. Cultures of Piety: Medieval English Devotional Literature in Translation. Ithaca, NY: Cornell University Press; 1999:19-40.

  3. Porter R. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London, UK: Fontana Press; 1997:122

  4. Rawcliffe C. Medicine and Society in Later Medieval England. London, UK: Sandpiper Books Ltd; 1995. 1-28, 105-125.

  5. Rawcliffe C, 5. See also Hanley M. Medieval Themes and Topics.Available at: http://www.wsu.edu/~hanly/chaucer/coursematerials/humours.html. Accessed March 27, 2006.

  6. Henry of Lancaster, 165, lines 16-18, 21-27. Author’s translation.

  7. Porter R, 114.

  8. Porter R, 110.

  9. Porter R, 124-125.

  10. Getz F. Medicine in the English Middle Ages. Princeton, NJ: Princeton University Press; 1998:19.

  11. Davey LM.
    The oath of Hippocrates: an historical review.



  12. Smith CM. Origin and uses of primum non nocere—above all, do no harm! J Clin Pharmacol. 2005;45(4):371-377.

  13. Porter R, 123.

  14. Henry of Lancaster, 159, lines 1-5. Author’s translation.


Virtual Mentor. 2006;8(4):256-260.



The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

Author Information

  • Jessica Mellinger, MPhil is a third-year medical student at Northwestern University’s Feinberg School of Medicine. Prior to starting medical school, she studied the history of medicine as a Rhodes Scholar at Oxford University.

Plague was one of history’s deadliest diseases—then we found a cure

For hundreds of years, what caused plague outbreaks remained mysterious, and shrouded in superstitions. But keen observations and advances in microscopes eventually helped unveil the true culprit. In 1894, Alexandre Yersin discovered the bacterium responsible for causing plague: Yersinia pestis.

Y. pestis is an extraordinarily virulent, rod-shaped bacterium. It disables the immune system of its host by injecting toxins into defence cells, such as macrophages, that are tasked with detecting bacterial infections. Once these cells are knocked out, the bacteria can multiply unhindered.

Many small mammals act as hosts to the bacteria, including rats, mice, chipmunks, prairie dogs, rabbits, and squirrels. During an enzootic cycle, Y. pestis can circulate at low rates within populations of rodents, mostly undetected because it doesn’t produce an outbreak. When the bacteria pass to other species, during an epizootic cycle, humans face a greater risk for becoming infected with plague bacteria.

Rats have long been thought to be the main vector of plague outbreaks, because of their intimate connection with humans in urban areas. Scientists have more recently discovered that a flea that lives on rats, Xenopsylla cheopis, primarily causes human cases of plague. When rodents die from the plague, fleas jump to a new host, biting them and transmitting Y. pestis. Transmission also occurs by handling tissue or blood from a plague-infected animal, or inhalation of infected droplets.

Bubonic plague, the disease’s most common form, refers to telltale buboes—painfully swollen lymph nodes—that appear around the groin, armpit, or neck. The skin sores become black, leading to its nickname during pandemics as “Black Death.” Initial symptoms of this early stage include vomiting, nausea, and fever.

Pneumonic plague, the most infectious type, is an advanced stage of plague that moves into the lungs. During this stage, the disease is passed directly, person to person, through airborne particles coughed from an infected person’s lungs.

If untreated, bubonic and pneumonic plague can progress to septicemic plague, infecting the bloodstream. If left untreated, pneumonic and septicemic plague kills almost 100 percent of those it infects.

Infamous plagues

Three particularly well-known pandemics occurred before the cause of plague was discovered. The first well-documented crisis was the Plague of Justinian, which began in 542 A.D. Named after the Byzantine emperor Justinian I, the pandemic killed up to 10,000 people a day in Constantinople (modern-day Istanbul, Turkey), according to ancient historians. Modern estimates indicate half of Europe’s population—almost 100 million deaths—was wiped out before the plague subsided in the 700s.

Arguably the most infamous plague outbreak was the so-called Black Death, a multi-century pandemic that swept through Asia and Europe. It was believed to start in China in 1334, spreading along trade routes and reaching Europe via Sicilian ports in the late 1340s. The plague killed an estimated 25 million people, almost a third of the continent’s population. The Black Death lingered on for centuries, particularly in cities. Outbreaks included the Great Plague of London (1665-66), in which 70,000 residents died.

The cause of plague wasn’t discovered until the most recent global outbreak, which started in China in 1860 and didn’t officially end until 1959. The pandemic caused roughly 10 million deaths. The plague was brought to North America in the early 1900s by ships, and thereafter spread to small mammals throughout the United States.

The high rate of fatality during these pandemics meant that the dead were often buried in quickly dug mass graves. From teeth of these plague victims, scientists have pieced together a family tree of Y. pestis, discovering that the strain from the Justinian Plague was related to, but distinct from, other strains of the plague. 

Plague in modern society

Plague still exists in various parts of the world, popping up sporadically and followed actively by the World Health Organisation and Centres for Disease Control and Prevention. Most cases have appeared in Africa since the 1990s.

Between 2004 to 2014, the Democratic Republic of the Congo reported the majority of plague cases worldwide, with 4,630 human cases and 349 deaths. Scientists link the prevalence of plague in the Democratic Republic of Congo to the ecosystem—primarily mountain tropical climate. More recently, plague broke out in Madagascar in 2017, yielding more than 2,300 cases.

The United States, China, India, Vietnam, and Mongolia are among the other countries that have had confirmed human plague cases in recent years. Within the U.S., on average seven human cases of plague appear each year, emerging primarily in California and the Southwest.

Today, most people survive plague with rapid diagnosis and antibiotic treatment. Good sanitation practices and pest control minimise contact with infected fleas and rodents to help prevent plague pandemics.

Plague is classified as a Category A pathogen, because it readily passes between people and could result in high mortality rates if untreated. This classification has helped stoke fears that Y. pestis could be used as a biological weapon if distributed in aerosol form. As a small airborne particle it would cause pneumonic plague, the most lethal and contagious form.

Of conservation concern, federally endangered black-footed ferrets contract another form of the plague, sylvatic plague, from nearby prairie dogs. Plague can decimate prairie dog populations, which are a critical food source for black-footed ferrets. Scientists have started to administer a vaccine to prevent plague outbreaks in prairie dogs and black-footed ferrets.


Centres for Disease Control and Prevention: Plague
History.com: Black Death
Johns Hopkins: Centre for Health Security
National Institute of Allergy and Infectious Diseases: Priority Pathogens
Plague as a Biological Weapon
Plague: from natural disease to bioterrorism
U.S. Fish & Wildlife Service: Black-footed ferret
World Health Organisation: Plague

This story has been updated. It was originally published on August 20, 2019.

Russian scientist who saved the 20th century from plague and cholera. Who is he?

Let’s go in order. Vladimir Khavkin was born in 1860 in an Odessa Jewish family. His real name is Markus-Wolf. He received his primary education in the traditional Jewish cheder, after which he entered the gymnasium in Berdyansk.

Khavkin has always been distinguished by his ability to study. As a result, he became interested in biology and entered the Novorossiysk University, where he was the best student of Ilya Mechnikov, a bacteriologist and immunologist (for his work in 1908, Mechnikov received the Nobel Prize in Medicine).

It was difficult for a Jew to make an academic career in the Russian Empire at that time. Quotas for Jews imposed restrictions on admission and work in universities. In addition, Khavkin was constantly checked for reliability: in his youth, he was a People’s Will and was arrested three times on suspicion of subversive activities. The authorities did not allow Khavkin to enter St. Petersburg University.

As a result, he moved to Switzerland and began to build a career there. Mechnikov, who left the Russian Empire a little earlier, invited Khavkin to work as a privat-docent at the University of Lausanne.In 1889, Mechnikov managed to arrange his student in an even more prestigious place for a bacteriologist – the newly opened Pasteur Institute in Paris.

Despite the fact that at first Khavkin had to work as an assistant librarian, he was very happy. At the time, the Pasteur Institute was at the forefront of medicine and biochemistry. It was there that Khavkin received the cholera vaccine.

In Europe, they were afraid to use the vaccine (they fought with cholera with the usual quarantine), but official London nevertheless decided to try it, only on another continent – in India.At the time, she was under British rule.

Khavkin appeared there as a state bacteriologist in 1893 – and there his triumph begins. His vaccine literally saves millions of people. Cholera deaths fell by about 90% and morbidity by 70%.

True, at first Khavkin was almost killed by indignant Indians. They learned that the vaccine works only on healthy people, and it does not help sick people. When the locals came with sticks to smash Khavkin’s laboratory, he met them at the door, took off his shirt and injected himself with serum.This made a great impression on the uninvited guests. They no longer wanted to kill him and, just in case, they also took root.

Three years later, in 1896, Khavkin managed to cope with the outbreak of the plague in Bombay (now Mumbai). Khavkin’s Indian triumph was widely covered in the British press ( here you can read , for example, one of these articles), and this made the scientist a world star of medicine.

“Khavkin’s vaccinations are promising, but he is unpopular in Russia”

Vladimir Khavkin did not understand and did not accept the scientific world, but it was this doctor who created the first vaccines against cholera and plague.And in India, where he literally forcibly treated the inhabitants for these terrible diseases, the Central Research and Training Institute in Mumbai bears his name.

In one of his letters in 1897, Chekhov wrote to Suvorin: “As for the plague, will it come to us, nothing definite can be said yet … Khavkin’s vaccinations give some hope, but, unfortunately, Khavkin is not popular in Russia.”

In another letter, two years later: “The plague is not very scary. We already have vaccinations that have proven effective, which, by the way, we owe to the Russian doctor Khavkin.In Russia he is the most unknown person, in England he has long been called a great philanthropist. The biography of this Jew, so hated by the Hindus who almost killed him, is indeed remarkable. So, the plague as a disease is not particularly terrible. But she is terrible as a scarecrow, strongly influencing the imagination of the masses … “

Khavkin is really an outstanding biologist, the creator of the first vaccines against cholera and plague, a student of Ilya Mechnikov and Louis Pasteur. But even now his name in Russia will tell few people something …

Vladimir Khavkin was born in 1860 in Odessa. In 1884 he graduated from Novorossiysk University in his hometown. Soon, on the recommendation of his teacher Mechnikov, he moved to Europe, and in 1889 became an employee of the Pasteur Institute in Paris. Khavkin dealt with the protection of the human body from infectious diseases using serums and vaccines. By 1892, Vladimir Khavkin had created the first effective cholera vaccine. First I tested it on guinea pigs, then on myself.

After successful trials, Khavkin offered the vaccine to Russia, but the offer was rejected due to the doctor’s “revolutionary” reputation.The vaccine was abandoned in Spain and France. During this time, people died from the plague in many countries. The most difficult situation was in China and India, where the epidemic claimed hundreds of thousands of lives. Then the British Empire allowed Khavkin to try the vaccine in India, its colony.

The words about the hatred of the Hindus towards Khavkn, which Chekhov mentions, are true. The doctors were nearly stoned by local residents. Only when he took out a syringe and in front of everyone gave himself an injection 1 , it worked for some and people began to agree to vaccination.During the plague epidemic in 1896, many people declared that they would not go to the hospital, since “our mosque is a hospital” 2 . Khavkin asked for help from the colonial authorities, but all that helped him was a small office in the medical college 3 .

A person with great authority was needed. It turned out to be the 18-year-old imam of the Ismaili Muslims, Sultan Muhammad Shah Aga Khan III. It was he who began to help Khavkin. The prince had by this time received a versatile education; He considered Arabic and Farsi as his native languages, spoke English, French, Hindi and Urdu 4 .The young imam, being comprehensively educated, helped to look for ways to save people from the plague. The prince provided the Russian scientist with his mansion and everything needed for research 5 .

Khavkin worked for two years and achieved success in developing a vaccine. People were still afraid of vaccinations, but the situation began to change when the Aga Khan invited the leaders of his community and in their presence asked the professor to vaccinate him. Then he called on all Ismailis to follow his example 6 .This act of the prince became key. Thousands of Muslims were saved. And hundreds of thousands of Indians from other confessions began to trust Khavkin.

Plague vaccine has been shipped from India to various countries around the world. Khavkin proposed to Aga Khan to create a bacteriological laboratory in India. And take the Pasteur Institute as an example. The prince agreed and contributed to the development of the project 7 . This Mumbai institute is now the largest bacteriological and epidemiological research laboratory in South and Southeast Asia.Since 1925, the research center has been called the Khavkin Institute.

… In the Pamirs, once a distant outskirts of the Russian Empire, bordering India and Afghanistan, the epidemiological situation was relatively calm and they had not heard of Khavkin here. In his report dated March 10, 1897, the head of the Pamir detachment Kiveks writes that in order to avoid the spread of the plague, communication with Afghanistan is limited, since people there die from this infection every day, and medicines do not help 8 .

But Dr. Khavkin was connected with the Pamir by another circumstance. During his first trip to India, the local police became interested in him. Checked for a spy. It was when England and Russia were competing in Central Asia.

Khavkin was not a spy. He was a scientist who ended up spending over 15 years in India. Then he returned to Europe. Khavkin did not have a family, he did not leave offspring. All forces and thoughts are about the salvation of people. Vladimir Khavkin passed away in Lausanne on October 28, 1930.Shortly before his death, he wrote: “Work in India took the best years of my life …”

In Odessa and Berdyansk, streets are named after Vladimir Khavkin. The scientist’s archive is kept in Israel. In addition to medical articles, he wrote about the difficulties of income tax, a footnote to the writings of Balzac. He studied Sanskrit, Arabic, Hebrew and Dutch. This year marks the 160th anniversary of the birth of the scientist. The man who saved the lives of millions. Today the world is waiting for the followers of Professor Vladimir Khavkin, who will protect the world from a new epidemic.

The author would like to thank Alexander Duel, the great-grandson of Professor Khavkin’s brother, and Davlat Khudonazarov for help in preparing the material.

1. Markish David (2019). “MAHATMA. Free fantasies from the life of the most unknown person”. Novel. – M., Buki-Vedi. S. 103.

2. Gatacre William Forbes, Sir. (1897). “Report on the bubonic plague in Bombay, 1896-97” Bombay: Times of India Steam Press. P. 14-15. Accessible on the internet at https: // archive.org /.

3. Barbara J Hawgood (2007). “Waldemar Mordecai Haffkine, CIE (1860-1930): prophylactic vaccination against cholera and bubonic plague in British India” (PDF). Journal of Medical Biography. 15 (1) p. 9-19.

4. Davlat Khudonazarov (2015). “The favorite topic of his conversation was Russia and everything Russian …” Science and Religion [# 668] c. 28-33.

5. Marina Sorokina (2013) “Between Faith and Reason: Waldemar Haffkine (1860-1930) in India” // Western Jews in India: From the Fifteenth Century to the Present / Ed.By Wenneth X. Robbins, Marvin Tokayer. Delhi: Manohar, P. 161-178.

6. The Memoirs of AGA KHAN WORLD ENOUGH AND TIME, New York, 1954. p. 38.

7. The correspondence between Haffkine and the Aga Khan is in the Manuscript Division of the Upsala University, Sweden.

8. RGVIA, F. 1396, op. 2, d. 1492, p. 136.

Vladimir Aronovich Khavkin. The most unknown scientist in Russia

Category: Workshop of historians
Published: 11 August 2021
Views: 6507

In the photo: Vladimir Aronovich Khavkin

For centuries, cholera and plague were considered the most deadly diseases on the planet.In our time, these formidable diseases continue their march across the countries of the world, but of the total number of infected people, only a small part now dies.

a century and a half ago, entire villages and cities perished from them: the victims numbered in the millions all over the world. Find
many scientists tried to cause and stop the tragedy, but to create the first
preventive vaccines succeeded
only to the microbiologist from Russia Vladimir Aronovich Khavkin * The essay was prepared within the framework of the project “Russian Abroad.Great Compatriots “, the second volume of which is being prepared
to be published in 2022 by the Yauza publishing house ..

His method of “killed cells” of Vibrio cholerae
still forms the basis for the preparation of modern drugs to combat the disease.
The vaccine that stopped the plague, the scientist’s contemporaries called simply “Khavkin’s lymph.”

Human memory is selective, and many
the heroes of their time are then forgotten.Despite
for outstanding achievements in medicine and microbiology, the name of V.A. Khavkina rarely sounds in scientific
circles and is almost never mentioned in the world scientific literature. His example of self-sacrifice
and unlimited love for people is little known
and in our country. But the memory of this outstanding
a person is honored where he saved many lives –
in India. For over a hundred years in Mumbai (Bombay)
there is a research center wearing it
name, – Haffkine Institute, which continues
study of human immunity.

… On March 5, 1860, the youngest son was born in the large family of Aron Khavkin in Odessa. His
named in Jewish traditions – Markus-Wolf,
and later he took the name Vladimir. After a while, the family moved to Berdyansk,
where his father got a job as a teacher in a Jewish school.
Younger Khavkin began his education at the cheder
(Jewish National Junior School), then
entered the men’s gymnasium. There is almost no information about Vladimir’s childhood and youth,
but in rare memories, contemporaries noted his innate modesty, outstanding
mental ability and craving for science.

After graduating from high school in 1879, the young man went to Odessa, where he entered the natural faculty of Novorossiysk
university. He was lucky to learn from the best scientists of that time – I.I. Mechnikova, N.A. Umova,
THEM. Sechenov, A.O. Kovalevsky. Thanks to his abilities and hard work, Vladimir Khavkin
became a favorite student of Ilya Mechnikov. Under
his scientific guidance, the student got acquainted with the microworld and became interested in the biology of protozoa

The student life of a young man was not easy. Difficult times have imposed
your imprint on his destiny. Revolutionary sentiments in the student ranks led Vladimir
to the circle of Narodnaya Volya. For participation in the revolutionary organization Khavkin was arrested, held
in the Odessa prison. In 1881 he was expelled from
university and installed a policeman behind him
supervision that lasted for many years. Mechnikov
worried about his student. Soon thanks to
At the request of the professor, the former student was allowed to complete his studies as a student.And so in 1884 Vladimir Khavkin passed the exam as an external student
all final exams and defended a thesis
for the title of candidate of natural sciences.

It seemed that now it was possible to freely engage in your favorite science, but by this time his
the teacher and mentor left the country. Policeman
surveillance continued, and the “unreliable”
it was difficult for a young man to get a job on
a decent job. As a museum preparator, he received pennies, but the opportunity to continue his research activities was
more important.Finally weary of poverty
and the pursuit of the police Khavkin decides to leave his native Russia. In 1888 he moved
in Switzerland and gets a job as assistant professor at the University of Lausanne.

A letter from Ilya received soon from France
Mechnikov decided the further fate of Khavkin.
The scientist invited his student to move to Paris and continue his scientific activities at the Pasteur Institute, where research was
aimed at studying the causative agents of infectious diseases and creating life-saving
vaccines.With great enthusiasm Vladimir
accepted the mentor’s invitation. The position of assistant librarian was not prestigious
and low-paid, but in 1889 Khavkin enthusiastically began work in one of the most famous institutions in Europe – side by side with scientists,
recognized all over the world. Exactly
at this institute in 1885 Louis Pasteur applied
rabies vaccine, rescuing a boy bitten by dogs. Now here a young and talented Russian scientist begins his search
a life-saving cholera vaccine.

The year is 1889. The cholera epidemic covers new
territory. From India it spreads all over
the world, on ships penetrates Europe, through Turkestan approaches the borders of Russia … Vladimir
Khavkin stubbornly searches for the “weak point” of Vibrio cholerae. And here are the first successes! Dangerous microbe is weakened by heating! Experiments on rabbits passed
successfully. The vaccine is almost ready. Now it’s turn for
human. Vladimir decides to try it on himself.The scientist injects himself. As an organism
will react? What will happen next? Unknown …

All my feelings and observations after the injection
Khavkin writes down carefully. Success! In 1892
at the Louis Pasteur Institute young Russian
scientist Vladimir Khavkin was the first in the world to create
cholera vaccine. “Bravo to the Russian doctor!”
wrote the Parisian newspapers.

With the permission of the head of the institute, Vladimir first of all offers help
to the Russian authorities.Cholera at that time already
spread to the south of the country, taking away thousands
lives. But the proposal of the “unreliable
citizen ”was rejected. The Russian authorities did not dare to be the first to apply a vaccine not yet known to the world. Khavkin received a refusal from
government of France. European countries were skeptical about its discovery. Only in England was the scientist’s proposal considered. He was given
permission to conduct mass vaccinations among the local population of colonial India,
in which at that time an epidemic was raging.Business trip of the state bacteriologist
V. Khavkina was one of the administrative
measures of care for the population.

Doctor Chekhov was outraged by underestimation in Russia
discoveries of bacteriologist Khavkin:

“The plague is not very
scary. First, it will not capture
especially a large area, everything will be
keep on separate points,
secondly, as a devastating force it
no worse than diphtheria or abdominal
typhoid, thirdly, we already have vaccinations,
proved to be valid and by which
By the way, we owe it to the Russian
Dr. Khavkin, a Jew.In Russia, this is the most
an unknown person, in England his
has long been nicknamed the great philanthropist. ”

A.P. Chekhov. Letter to A.S. Suvorin.
August 19, 1899. Moscow.

In 1893, Khavkin goes to Calcutta
to fight cholera in the heart of India.
At the place of residence, a laboratory was organized for the production of cholera
vaccines. The population greeted the white doctor with apprehension and distrust. What methods did not use Khavkin and his
assistants: persuasion, bribery, threats …
But the most effective was the demonstration of vaccination by Khavkin on the very
yourself.He silently undressed and did
yourself an injection right in front of the incredulous Indians.

V. Khavkin makes Indian peasants
cholera vaccinations

Of course, for vaccination
not everyone agreed.
But over time, people
began to notice that vaccinated people get sick less often
and even less often die from it
ailment. Local rumors
population spread
with great speed. And after a while people began to
to come to doctors voluntarily.Through the jungle, village by village, village by village … Path
anti-cholera expedition took place first along the Ganges, then
through the valleys of the Indus. Vladimir Khavkin and his assistants vaccinated more than forty
thousand people in two years.

Severe working conditions, heat, poisonous snakes
and insects, conflicts with the local population,
malaria and other diseases are the price of salvation
human lives in India …

In addition to vaccination, in India, the scientist conducted constant monitoring of the vaccinated population.Even at the very beginning of his journey, he strongly doubted the effect of the vaccine. How will the vaccination be
affect people’s health in the future?
How long will the protective properties last?
The answer to these questions will appear only over time.
And Vladimir continued his scientific activities, observed the vaccinated, kept detailed records, trained Indian doctors.

Photo of the main facade of the Pasteur Institute building
in Paris

After successful work in India, Khavkin returns to Europe.He is admired, he reads
lectures, publishes scientific articles.

Soon a new one began in India
an epidemic, and Dr. Khavkin sets off again
to fight the invisible enemy – the plague, nicknamed the “black death”

In October 1896, Khavkin arrived in Bombay.
For his work, a small
laboratory and assigned assistants.
There was very little time. Plague was taking over region by region. An infected person died literally in three days.People in horror left their houses and left
from “plague” places.

V. Khavkin (center) with the staff of the Plague Control Laboratory, 1902

Work on a vaccine has begun. Every day for 12-14 hours
Khavkin spent in the laboratory in search of a weak point
the causative agent of the disease –
plague stick. Method,
which he used to create a cholera vaccine, for this
times didn’t work.Had
start all over again, with the study of a dangerous enemy. A bunch of
glass flasks with “infection”
(the name of the plague in translation from Latin) – living carriers of the “black death” – surrounded
people working here. Infected animals, corpses for research – all this in any
moment could kill scientists.

Some of Khavkin’s assistants could not stand it
nervous tension and went away.

And now the vaccine has passed a successful test for
rats.It is again the turn for experiments on humans. But
time is running out, finding volunteers is an unaffordable luxury. Khavkin does the same as
and earlier: tests the anti-plague vaccine for
yourself. Again a notebook and a detailed record of observations. The result is excellent! In just three months
in the winter of 1897, the vaccine was received.

For the first mass vaccination, the Bombay authorities allowed Khavkin to inject prisoners. It was supposed to be
mandatory measure, but Vladimir, as a true
a humanist brought up by Mechnikov, only volunteers were vaccinated.The result was excellent. Vaccinations began to be given to everyone.

In the photo: V. Khavkin, Bengal, 1896

In the spring of 1897, a delegation arrived in India
foreigners, including Russian doctors.
It was a great joy for Vladimir. Lot
for years he had not seen his fellow countrymen and had not heard his native language.
The researchers highly praised the work,
done by the creator of the anti-plague vaccine.
The recommendations sent to St. Petersburg said that “Khavkin’s lymph” really saves
life.But in response, a refusal came from Russia.

A.P. Chekhov, annoyingly commenting on this situation,
wrote in 1897 to the journalist A.S. Suvorin:

“As for the plague, will it come to us while
nothing definite can be said … Quarantine is not a serious measure. Some hope
Khavkin’s vaccinations are given, but, unfortunately, Khavkin is not popular in Russia; “Christians should
beware of him, as he is a Jew. ”

In the same 1897, Vladimir Khavkin was granted British citizenship and awarded the Order
Indian Empire.For his work on vaccination against cholera in 1909, the scientist was awarded the prize of the Paris Medical Academy.
He became an honorary member of many scientific societies.
in Europe, was an important guest at receptions. In India
Khavkin became a hero. Alien Explorer
called “Mahatma Khavkin” (“the great soul Khavkin”).

In 1915, Vladimir finally returned to Europe. His business trip lasted more than twenty years. During this time, thousands of lives have been saved.Khavkin has always believed in science. He devoted his best years to saving people, sacrificing family
happiness. Always alone. Closed, silent,

After retirement, Vladimir Khavkin became
fight for the rights of Jews around the world. He visited Jewish communities and settlements in other countries. Instead of scientific articles, Vladimir began to write
about the importance of religion for their people, about the problems of Jews in the world, about the preservation of Jewish traditions and language. One of the most famous publications
“Apology of Orthodox Judaism” reveals
the secret of Khavkin’s return to faith.In his will, Vladimir Aronovich left his entire fortune
to support talented Jewish youth
Of Eastern Europe.

In the photo: Bust of V.A. Khavkina near the building
Berdyansk State
Pedagogical University

Born in Russia, disciple of the best Russians
minds, he saved millions of lives, but at home
remained an outcast; for some reason even his
teacher I.I. Mechnikov did not mention Khavkin
in my memories.In 1926, he briefly
already arrived in Soviet Russia, visited everyone,
who remembered him, and said goodbye to his native Odessa.
In 1928, Vladimir Khavkin moved to Switzerland – to spend the last years of his life in peace.
He died in 1930 and was buried in Jewish
Lausanne cemetery.

Maria Malunova,
employee of the Institute of Plant Physiology
them. K.A. Timiryazev RAS


Soldiers of the invisible front.The history of mankind’s struggle against infectious diseases

On the history of Russian leadership in virology

The history of advanced domestic medical technologies was discussed at the RIO House

90,000 The man who defeated the black death. How Odessa citizen created vaccines against plague and cholera

At the end of July 1892, 32-year-old explorer Vladimir Khavkin was left with nothing. Outwardly, everything in his life looked not bad at all: he safely escaped the persecution of the Odessa police, fought off massive pressure to baptize him, emigrated to Paris, got a job at the most advanced scientific and medical center of that time, the Pasteur Institute, his teacher and mentor Mechnikov worked nearby. who, it seemed, all his life was engaged only in rescuing him from the most difficult troubles, supporting, pulling out, shaking off and putting back on the straight road.

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Only Khavkin’s dream cracked and crumbled, the dream that was his life core. Khavkin wanted to make a cholera vaccine. He seemed to follow the example of the greats – he did not know any sleep or rest, he was in a hurry, put on the most dangerous experiments on himself. But no. Feverish semi-underground work suffered a fiasco …

The first “conscious” vaccines in the history of mankind were made by Pasteur just 11 years before the described day (1881, chicken cholera and anthrax).

We, of course, have heard about Jenner’s smallpox vaccine (1796), but at the time of Jenner, there was still no data or theoretical generalizations in science that would allow us to understand what a vaccine is, how it works, and, accordingly, would allow to create another vaccine. Jenner just took advantage of random observation.

A hundred years later Pasteur already perfectly understood what he was doing – the introduction of a weakened pathogen forces the body to “prepare” for a meeting with a real, “fighting” microorganism.

In 1885 Pasteur made another vaccine against rabies. His colleague and enemy Robert Koch in 1890 tried to use the method and created a vaccine against tuberculosis (Tuberculin) – in a few years it will end in a huge scandal. It turns out that Koch’s tuberculin does not help, but, on the contrary, exacerbates the course of tuberculosis.

Anyway, in 1892 there were already, like, four vaccines against human diseases – smallpox, anthrax, rabies and, um, tuberculosis.A huge number of infectious diseases were still waiting for their vaccine, and of these the most socially dangerous was cholera.

In 1890, Khavkin took on it, as soon as he got access to scientific equipment as a new laboratory assistant to Emile Roux, Pasteur’s right hand.

Vladimir Aronovich Khavkin – researcher of Vibrio cholerae and creator of the cholera vaccine

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Vibrio Koch, also known as cholera vibrio, became the object of Khavkin’s research.This microorganism was described in 1854 in the secretions of patients with cholera Filippo Pacini, but then the theory of miasms reigned supreme in science, no one believed that bacteria could be related to human diseases, and Pacini’s discovery was safely forgotten (not that even about him at the peak knew a lot of people).


Life under a microscope. How a graduate of Mogilyanka became one of the founders of microbiology

Independently of Pacini, Koch isolated the same vibrio in 1883 from those who died of cholera in Calcutta.However, no matter how Koch tried, it was not possible to prove the pathogenicity of vibrio according to the four principles that Koch himself developed. If only because the vibrio resolutely refused to live in laboratory animals.

And in general the vibrio was some kind of frail. He died almost instantly in an acidic environment, and after all, cholera is an infection transmitted through the digestive tract, its causative agent must confidently overcome the acid storms of the stomach.

Then it turns out that in most people who drank infectious water, vibrio really dies in the stomach, but if the pathogen is extremely large (in an epidemic!) Or if the acidity of the gastric juice is reduced, some residual quantities of the pathogen have time to slip into the intestines and into its alkaline environment begin to multiply, causing cholera.

In 1892, however, this was not yet known. Mechnikov and Pasteur firmly believed that the Koch vibrio by itself does not cause cholera – some other factors or pathogens are needed. Perhaps their faith was also strengthened by the fact that the Vibrio was discovered by the German enemy Koch.

Mechnikov believed so firmly in the innocence of vibrio that soon, in 1893, he demonstratively drank a glass of water with cholera vibrios. Moreover, several other volunteers joined the demonstration. No one fell ill, except for one person who almost died of the most severe cholera.

This, however, only further strengthened Mechnikov’s conviction that cholera is a multifactorial disease.

When a cholera epidemic broke out in Paris in 1894, Mechnikov, together with volunteers, again began to drink water with cholera vibrios. One of the volunteers died. Only this death made Mechnikov stop his demonstrations.

In Khavkin’s experiments, Pasteur and Mechnikov did not like the idea of ​​a vaccine either. Yes, the father of vaccines criticized the idea of ​​a vaccine! Cholera as a disease unfolds in the intestinal lumen.How can a vaccine given subcutaneously affect something that might one day happen in the intestines?

And, not even in the intestinal wall, but in the lumen? All four vaccines known at that time worked against diseases inside the body, where blood has access.

Over the course of several years, Khavkin found a way to grow Vibrio cholerae on guinea pigs and even learned how to trigger pathology in these animals (not human cholera at all, but a fatal disease of Guinea pigs, undoubtedly caused by Vibrio cholerae).Naturally, ignoring the warnings of the luminaries, he hastened to make a vaccine (a suspension of weakened vibrios).

Further, it seems, it would be worthwhile to start experimenting with a different composition of the vaccine, to try it again and again on animals, on large numbers of animals, until conclusive results are obtained. But the seeming proximity of victory made Khavkin change the meticulousness and patience that he had demonstrated so far.

The results were, to put it mildly, not convincing.But to continue experimenting on guinea pigs, the galloping gallop Khavkin considered superfluous. He made a public announcement of the results and moved on to human experiments. Starting, naturally, with yourself.

It should be understood that in those days there were no requirements for how drugs and vaccines should be developed, there were no norms or special expectations. In fact, the time of release of a new development “to the people” depended only on the scientific meticulousness of the developer.

On July 18, 1892, Khavkin gave himself a subcutaneous injection of his vaccine.He noted only slight redness at the injection site and a short-term slight rise in temperature. On the twenty-fourth of July, Emil Roux introduced the “combat” variant of Vibrio to Khavkin. The reaction was more significant, but by the next day everything was back to normal. No disease developed – not human cholera, not that strange disease that killed the guinea pigs.


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The same result was obtained with three more volunteers (all young people from the Russian Empire).Khavkin hastened with a victorious report to Mechnikov and Pasteur. Those did not share his joy.

What exactly did Khavkin’s experiment prove? That his liquid is supposedly safe. Actually, that’s all. Is this liquid a vaccine, i.e. whether it is capable of preventing cholera remains unknown. After all, cholera is not transmitted through the skin, but when a person drinks contaminated water!

For some unknown reason, Khavkin did not take the most obvious, most demonstrative step – he did not drink a glass of water with Vibrio cholerae.Remembering Mechnikov’s experiments on himself, this would not prove anything either, but it would at least be logical, because it would imitate the real route of transmission of the disease …

That’s how Khavkin ended up at the end of July 1892 at the “broken trough” The father of vaccines Pasteur and the discoverer of immunity Mechnikov literally did not accept anything in his work – neither the choice of the microorganism, nor the results of experiments on animals, nor the results of experiments on humans. From their point of view, everything that Khavkin did was fundamentally wrong.There was no point in continuing.

If Pasteur’s criticism was purely scientific, “nothing personal”, then the criticism of Mechnikov was perceived by Khavkin much more difficult, precisely as “personal”. After all, it was Mechnikov who “discovered” Khavkin at the Odessa University. Mechnikov again and again excused him from accusations of ties with the People’s Will (and Khavkin was in fact connected with the People’s Will, moreover, precisely at the time when they killed the Tsar!).

Mechnikov saved Khavkin from trial when Khavkin, during the Jewish pogroms, organized a militant detachment of Jewish self-defense and was seized by the police with weapons in their hands.Mechnikov made sure that Khavkin, who was expelled from the university, was admitted to defend his dissertation. Mechnikov supported Khavkin when, fleeing the demands to be baptized, Khavkin left the Russian Empire, arranged for him no less than the Pasteur Institute. Such a person would not criticize so devastatingly if the work did not really require defeat.

Not to understand that the luminaries are right, Khavkin could not. That is why I felt myself at the “broken trough”. Rather, out of inertia, Khavkin asked the French authorities to allow human testing.They refused.

A cholera epidemic soon began in the Russian Empire (the same one that killed Tchaikovsky). Pasteur and Roux wrote a joint letter to the Russian authorities asking for permission to test Khavkin’s vaccine on 60 volunteers. Pasteur’s relations with the Russian authorities were excellent (it was in Russia that the first Pasteur station outside France opened), but the Russian authorities refused this request.

Nowadays, this would most likely be the end of the story. But those were the days of scientific romanticism, scientific heroism.There were authorities on hand, but rebels against these authorities were just as in demand. In this already seemingly ended story, someone named Hankin suddenly appeared.


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Periodically, immigrants from Russia came to Paris, who, succumbing to Khavkin’s unshakable enthusiasm, volunteered to try the vaccine on themselves.They brought their friends – for the same purpose.

One of these newcomer friends was in 1893 the English bacteriologist Ernest Hanbury Hankin (the forerunner of the discovery of bacteriophages). It was Hankin who turned out to be a happy “pass to life” for the vaccine.

Hankin published a report on Khavkin’s work in the British Medical Journal and spoke with the British Ambassador to France, former Viceroy of India Lord Dufferin (Frederick Dufferin).

A few months later, Khavkin was in London negotiating with the Minister for Indian Affairs.We agreed on this: Khavkin gets the right to test the vaccine on people in India (both the Indians and the British living there), vaccination in India will be a private affair of Khavkin himself and will be carried out at his expense or at the expense of private donations collected by him, all vaccinated must be volunteers.

In May 1893, almost a year after Khavkin was ready to give up everything, he arrived in Calcutta. And immediately met with wild resistance from the British doctors. Their arguments were surprisingly the same: intestinal disease cannot be prevented by subcutaneous injections, and the vaccine has not been proven effective in humans or even in animals.

But Hankin was also already in Calcutta, moreover, he was already in charge of the local bacteriological laboratory, so that this very laboratory was now the island in the middle of India, where the Hawkin vaccine was well received.

Cholera Vaccination Campaign in India. Kolkata, 90s of the 19th century.

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Until the end of 1893, Khavkin vaccinated about 10 thousand British and Indian soldiers.With the soldiers it was easier – they were more accustomed to relying on the decision of their officer than on their own opinion. There was no cholera epidemic, so all this vaccination has proven is that the vaccine is indeed safe.

In March 1894, Calcutta’s chief physician Simpson (in the future an ardent supporter of the Hawkin vaccine) surrendered. He considered that the vaccine was proven to be safe and suggested that the vaccine be tried in a suburb with persistent cholera. Then another suburb joined, then a district in a city, then the whole city, and then other cities.In 1893-1895. 42 thousand people were vaccinated, all voluntarily, all personally by Khavkin.

An independent statistical analysis carried out at the time by London specialists showed that vaccination did indeed reduce the incidence of cholera in those parts of the country where it was carried out.

The same analysis showed that the cluster effect of vaccination disappeared after a few months, but the effectiveness of the vaccination could be increased by increasing the vaccination density (percentage of vaccinated in the local community).

However, it was impossible to do a more massive vaccination – the vaccine was “live”, it was prepared on the spot, Khavkin traveled around India with a train of guinea pigs.

British authorities in India have concluded that Hawkin’s vaccination is, in general, an “ambulance”. It should be used when you need to get a quick, albeit transient effect. For reliable prevention of cholera, general hygiene measures are needed, for example, the purification of the waters of the Ganges.

Nevertheless, Khavkin received at his disposal a bacteriological laboratory in Bombay (this is associated with another Khavkin vaccine, against the plague.With this vaccine, he fought the plague epidemic in Bombay).

Vladimir Khavkin examines Indian children in Bombay. 90s of the 19th century.

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The laboratory was later transformed into a bacteriological institute (even later it was divided into two organizations, both to this day bear the name of Khavkin – Haffkine Biopharmaceutical Corporation and The Haffkine Institute for Training, Research and Testing).A whole staff of employees began to prepare the vaccine, and almost all doctors in India began to vaccinate.

In 1897 Queen Victoria awarded Khavkin the Order of the Indian Empire. Lister (the one who “the father of aseptic and antiseptic”) called Khavkin “the savior of mankind.” In 1898, during another cholera outbreak in the Russian Empire, the Khavkin vaccine began to be used at home.

In 1926-1927. Khavkin came to Soviet Odessa (and he didn’t like it there).The cholera vaccine and the plague vaccine are believed to have saved at least several tens of thousands of lives in India. Due to the difficulty of introducing general sanitary preventive measures in India, both vaccines remain the mainstay of infection control there to this day.

Original Source.

Published with the consent of the author.


Devastating pandemics and plagues have left a devastating mark on human history.Over the past two centuries, doctors have worked to create a preventive and curative vaccine against a deadly infection. Sometimes the trials of new drugs cost the ascetics their lives. In the second half of the twentieth century, new effective vaccines and antibacterial drugs appeared, which gave people hope for a complete deliverance from the “black death”. But in fact, the ground for the emergence of new plague epidemics still exists.

The Asian rat flea Xenopsylla chepsis transmits the plague bacillus from rats to humans.

Microorganisms – pathogens of the plague Yersina pestis under a microscope.

The creator of the world’s first plague vaccine, Vladimir Khavkin, is vaccinating the local population. Calcutta, 1893.

Sometimes the ‘black death’ served as a source of inspiration for poets, like the chairman of a feast during the plague, singing a hymn in honor of a terrible disease. Illustration by V.A.Favorsky to ‘Feast during the Plague’ by A.S. Pushkin, 1961.

This is how the 19th century Swiss artist Arnold Böcklin portrayed the ‘black death’.

Production of the Khavkin anti-plague vaccine. Bombay, late 1890s.

Scheme of transmission of the causative agent of plague from rodents to humans.

The spread of plague on the globe, 1998.

History of epidemics

The first reliable plague pandemic, which entered the literature under the name “Justinian”, arose in the 6th century during the heyday of the culture of the Eastern Roman Empire, during the reign of Emperor Justinian, who himself died from this disease.The plague came from Egypt. During the period from 532 to 580, it covered many countries. The epidemic spread in two directions: in the west – towards Alexandria, along the coast of Africa, and in the east – through Palestine and Syria to the territory of Western Asia. The plague went along trade routes: first along the sea shores, then deep into the states bordering the sea coast. It reached its peak, penetrating in 541-542 into Turkey and Greece, and then into the territory of present-day Italy (543), France and Germany (545-546).Then more than half of the population of the Eastern Roman Empire perished – almost 100 million people.

The second pandemic, known as the Black Death, came in the 14th century (1348-1351). Not a single state in Europe has escaped the invasion of infection, not even Greenland. This pandemic is well documented in many copyright sources. She opened a period of epidemics that did not leave Europe alone for five centuries. During the second pandemic, which covered almost all countries of the world, about 40 million people died on the globe.Dirt, poverty, lack of basic hygiene skills and overcrowding of the population were the reasons for the unhindered spread of the disease. The plague “moved” with the speed of a horse – the main transport of that time.

The tragic picture of the plague epidemic in 1348 in Italy was painted by Giovanni Boccaccio in the first novel of The Decameron: “Glorious Florence, the best city in Italy, was visited by a destructive plague … The bodies, which were brought to the churches every hour, did not have enough consecrated ground, then in the overcrowded cemeteries of the churches huge holes were dug and hundreds of corpses were lowered there.In Florence, as they say, 100 thousand people died … How many noble families, rich inheritances, huge fortunes were left without legal heirs! How many strong men, beautiful women, charming young men, whom even Galen, Hippocrates and Aesculapius would have recognized as perfectly healthy, had breakfast with family, comrades and friends in the morning, and dined with their ancestors in the next world in the evening. ”

Indeed, during the years of the second pandemic, many famous people died from the disease: Louis IX (Saint), Jeanne of Bourbon – wife of Philippe Valois, Jeanne of Navarre – daughter of Louis X, Alphonse of Spain, German Emperor Gunther, brothers of the King of Sweden, artist Titian.

The nature of the disease remained unknown, but even then doctors understood that to stop the spread of the disease, it was necessary to separate the sick and the healthy. This is how the quarantine was invented. The word “quarantine” comes from the Italian “quaranta” – forty. In Venice in 1343, special houses were built for visitors, in which they were kept for forty days, under no circumstances going outside. Sea transport arriving from dangerous places were also ordered to stay in the roadstead for forty days.Quarantine was one of the first barriers to infection.

The third plague pandemic began at the end of the 19th century in the Chinese province of Yun-Nan. Spreading along the southern coast of China, by 1894 it reached first the city of Canton and then Hong Kong. The pandemic was rapidly gaining momentum. In six months, about 174 thousand people died. In 1896, the Indian city of Bombay was struck. In India alone, from 1896 to 1918, 12.5 million people died from the plague. The replacement of sailing merchant ships with steam-powered ships of greater power and speed contributed to the rapid spread of infection to other continents, causing outbreaks in port cities lying on major international shipping lines.Major plague epidemics occurred in South Africa, South and North America.

The “China” pandemic was very different from all previous outbreaks of the plague. First, it was a “port plague”, which in the overwhelming majority of cases did not penetrate deep into the mainland. Secondly, it was the “rat plague”, since ship and port rats were the source of its spread. Thirdly, it was mainly the “bubonic” plague. Complications of secondary pneumonic plague were rare. Realizing that the rats somehow spread the “port plague”, the quarantine doctors insisted that all mooring lines in ports and on ships have metal discs, which served as an insurmountable barrier to the migration of these rodents.

The “black death” has not spared Russia either. During the XIII-XIV centuries, she visited Kiev, Moscow, Smolensk, Chernigov. In Smolensk, out of all the inhabitants of the city, five people survived, who got out of the city, closed the city gates and left. In the XIV century in Pskov and Novgorod, the plague destroyed two-thirds of the population, and in Glukhov and Belozersk all inhabitants died out. This is how the ancient chronicler described the plague epidemic in Pskov in 1352: “And the old and the little ones, the men and women, all died with iron.And yet, whoever takes what from whom, in that hour dies incurably. But many will serve even the dying, and soon I will die without healing, and for that, for the sake of me, those who run away will serve the dying. ”According to the chronicles, in two years in the Pskov and Novgorod lands the plague claimed the lives of 250 652 people.

N. M. Karamzin in his work “History of the Russian State” wrote: “In 1349, an infection from Scandinavia came to Pskov and Novgorod. The disease was detected by glands in the soft parts of the body. A person coughed up blood and died on the next or third day.It is impossible to imagine such a terrible sight: young men and elders, spouses and children lay in coffins next to each other, numerous families disappeared in one day. Each priest in the morning found thirty or more dead in his church; they buried everyone together, and there was no place for new graves in the cemeteries: they buried outside the city in the woods … In a word, they thought that everyone should die. ” Grand Duke Simeon Ioanovich Proud with his brother George and seven children, Archbishop Vasily of Novgorod, Grand Duke Vasily Vladimirovich, Prince Yaroslav, his princess and son, the governor of the Moscow tsar Boyar Pronsky, Kazan Metropolitan Korniliy and Archbishop Pachomie of Astrakhan have gone into oblivion.

In 1718, Peter I, realizing the danger the plague poses, issued a decree: “Surround the villages infected with the plague with outposts and deny all communication with others, and burn the houses in which they died out with all their rubbish, even with horses and cattle … gallows, and who sneaks up secretly, hang up without writing off. Letters from couriers are accepted through fire, rewrite three (!) times and only send the last copy to the destination; deliver information about the sick under threat of loss of life and property. “On pain of death, it was forbidden to enter infected houses and take things from the sick.

By the beginning of the winter of 1770, the disease had spread to Moscow. During the Moscow epidemic, 130 thousand people died. In the midst of the plague epidemic, a “Commission for the Prevention and Treatment of Plague Infectious Ulcers” was created. At the end of the epidemic, the Commission instructed one of its members, the senior physician of the Main Land Hospital, Afanasy Shafonsky, to draw up a detailed report. A. Shafonsky fulfilled the task entrusted to him, and in 1775 the book “Description of a pestilence plague that existed in the capital city of Moscow from 1770 to 1772 with the application of everyone to terminate the then established institutions” was published.

And in the 19th century, the plague repeatedly visited the southern territories of Russia – the Astrakhan province, Odessa, the Caucasus, but did not spread from local temporary foci to the central regions. The last plague epidemic in Russia is considered to be the outbreak of its pulmonary form in the Primorsky Territory in 1921, which came from China. Since the 30s of the last century, the incidence of plague has sharply declined: both the number of cases and the number of countries in which cases of plague have been recorded have decreased.

But the disease did not recede at all.According to WHO annual reports, from 1989 to 2003, 38,310 cases of plague were reported in 25 countries in Asia, Africa and America. Eight countries (China, Mongolia, Vietnam, the Democratic Republic of the Congo, the United Republic of Tanzania, Madagascar, Peru and the United States) have human cases of plague almost every year.

In search of a cause

For a long time, doctors did not know how to save a patient from the “black death”. Disease spared neither the hungry, ragged crowd, nor the privileged and wealthy classes.Fasts and prayers did not help. The cause of the illness remained unknown.

In 1894, the best medical forces in many countries of the world were thrown into the fight against the third plague pandemic, which began in China. The Japanese government sent the doctor Shibasaburo Kitazato to China, and the French government sent Alexander Iersen. By this time, the causative agents of cholera, tuberculosis, anthrax and some other infections had already been discovered, but the microorganism that causes the plague remained unknown. Kitazato isolated microorganisms from the tissues of the deceased patient, which he considered the causative agents of the plague.Independently of the Japanese doctor, Yersen, having received a culture of microorganisms from those killed by the plague, at the same time discovered the plague bacillus in the corpses of dead rats. For a long time, it was believed in medical circles that the microorganisms found by the researchers were identical. But two years later, the Japanese bacteriologists K. Nakamura and M. Ogata with the pathologist M. Yamagawa established that the true causative agent of the plague is nevertheless the microbe isolated by A. Iersen, and the microorganism isolated by Sh. Kitazato belongs to the accompanying microflora.Ogata made a report on this at the International Congress in Moscow in 1896.

The microorganism that causes the plague disease – the plague bacillus – changed its taxonomic nomenclature several times: Bacterium pestis – until 1900, Bacillus pestis – until 1923, Pasteurella pestis – until 1970, and finally, finally, Yersinia pestis as recognition of the priority of the French scientist.

So, the causative agent of the plague was found, but it remained unclear how the disease spreads.

Before the onset of the third plague pandemic in China (in Canton), there was a massive migration of rats leaving their nests. For no apparent reason, in the daylight, they staggered like drunkards, made frequent high jumps on their hind legs, as if trying to jump out of somewhere, then made one or two circular involuntary movements, spat blood and froze. By the end of the “human” plague epidemic in the city, almost all rats had died out. Doctors realized that there was a direct link between rodent disease and the human plague pandemic.

In 1899, the famous Russian epidemiologist and microbiologist DK Zabolotny wrote: “Various breeds of rodents, in all likelihood, represent in nature the environment on which plague bacteria remain.” The assumption was verified in 1911, when a Russian expedition led by Zabolotny was sent to Manchuria to study and eliminate the pneumonic plague epidemic. Port rats were not found in the endless steppes. Nevertheless, the Mongols believed that the plague was transmitted from rodents to humans.The Mongolian name of the plague “tarbagane-ubuchi” directly indicated the connection of the disease with marmots – tarbagans.

In June 1911, student L.M. Isaev, working in Zabolotny’s group near the Sharasun station, noticed a large marmot, a tarbagan, with difficulty moving around. Isaev caught him, wrapped him in a raincoat and brought him to the laboratory. The plague microbe was isolated from the animal organs. The scientific discovery of Russian scientists was of world significance. It marked the beginning of epizootology and the theory of the natural focus of plague.Zabolotny’s formula: “epizootic among rodents – man – epidemic” – explained the reasons for many outbreaks of plague.

The first objective confirmation that the plague microbe can be transmitted from rodents to humans was obtained in 1912. Then in the northwestern Caspian region, mobile laboratories began to work under the supervision of D.K.Zabolotny and I.I.Mechnikov. A member of the expedition, doctor I. A. Deminsky, isolated a plague microbe from the organs of a gopher. Working with the resulting strain, I. A. Deminsky contracted the plague and died.

It became clear that rodents are, as it were, a natural reservoir of the plague pathogen. From the “owners” of the plague bacillus, a person can become infected directly when cutting animal carcasses and through “intermediaries” – fleas, as it was during the “port plague” in China. With the mass death of rats, fleas leave the dead bodies of rodents in search of new hosts. Tens of thousands of insects appear around humans, carrying a deadly disease.

In India, China, Madagascar, the plague is carried by synanthropic rats (Ratus ratus and Ratus norvegicus).Marmots – Tarbagans (Marmota sibirica) turned out to be the “repository” of plague in Mongolia, Transbaikalia and Altai, and the small ground squirrel (Citellus pigmaeus) is the culprit for the outbreaks of plague in the northwestern Caspian region.

Vaccination that saved humanity

Since the time of the first plague epidemics, practitioners have argued about whether it is possible to contract the plague from a sick person or not, and if so, in what way. The opinions were contradictory. On the one hand, it was argued that touching the sick and their belongings was dangerous.On the other hand, being close to the sick and staying in the infected area were considered safe. There was no clear answer, since rubbing the patient’s pus into the skin or wearing his clothes did not always lead to infection.

Many doctors saw a link between plague and malaria. The first experiment on self-infection with plague was carried out in the city of Alexandria in 1802 by the English physician A. White. He wanted to prove that the plague can cause an attack of malaria. White removed the purulent contents of the plague patient’s bubo and rubbed it into his left thigh.Even when a carbuncle appeared on his own thigh and the lymph nodes began to swell, the doctor continued to claim that he contracted malaria. Only on the eighth day, when the symptoms became apparent, he diagnosed himself with plague and was taken to the hospital, where he died.

It is now clear that plague is transmitted from person to person mainly by airborne droplets, therefore patients, especially the pneumonic form of plague, pose a huge danger to others. Also, the plague pathogen can enter the human body through the blood, skin and mucous membranes.Although the cause of the disease remained unclear for a long time, doctors have long been looking for ways to protect the terrible disease. Long before the beginning of the era of antibiotics, with the help of which today the plague is quite successfully cured, and vaccine prevention, they offered various ways to increase the body’s resistance to the plague.

An experiment carried out in 1817 by the Austrian physician A. Rosenfeld ended tragically. He assured that the drug, made from bone powder and dried lymph glands, taken from the remains of those who died from the plague, when taken internally, completely protects against the disease.In one of the hospitals in Constantinople, Rosenfeld locked himself in a ward with twenty plague patients, having previously taken the drug he advertised. Everything went well at first. The six weeks allotted for the experiment were ending, and the researcher was about to leave the hospital when he suddenly fell ill with the bubonic form of the plague, from which he died.

The experiment of the Russian doctor Danila Samoilovich ended more successfully. His colleague fumigated with poisonous powders the linen of a man who had died of the plague.After this procedure, Samoilovich put on underwear on his naked body and wore it for 24 hours. Samoilovich rightly believed that the “living ulcerative principle” (that is, in modern terms, the causative agent of the plague) should die from fumigation. The experiment was successful, Samoilovich did not get sick. So science a hundred years before the discovery of Yersen received indirect confirmation that the causative agent of the plague is a living microorganism.

The search for means of preventing and treating plague continued. The first medicinal anti-plague serum was prepared by Yersen.After the serum was injected into patients, the plague proceeded in a milder form, the number of deaths decreased. Before the discovery of antibacterial drugs, this vaccine was the main therapeutic agent in the treatment of plague, but in the most severe, pulmonary form of the disease, it did not help.

In 1893-1915, a student of Novorossiysk University, Vladimir Khavkin, worked in India. In 1896 in Bombay, he organized a laboratory in which he created the world’s first killed anti-plague vaccine and tested it on himself.The new vaccine had both therapeutic and prophylactic effects. After vaccination, the incidence dropped by half and the death rate by four. Vaccinations with the Hawkin vaccine are widespread in India. Until the 40s of the twentieth century, the Khavkin vaccine remained, in essence, the only cure for the plague. In 1956, 60 years have passed since the creation of the anti-plague laboratory (since 1925 – the Khavkin Bacteriological Institute). Indian President Prasad said in this regard: “We in India owe a lot to Dr. Vladimir Khavkin.He helped India to rid itself of plague and cholera epidemics. “

In our country, the development of live vaccines against plague began in 1934 with the receipt of a new vaccine strain at the Stavropol Research Institute of Plague Control at M.P. Pokrovskaya by processing the culture of the plague pathogen with bacteriophages. After testing the vaccine on animals, Pokrovskaya and an employee injected themselves subcutaneously with 500 million microbes of this weakened culture of the plague bacillus. The organism of the experimenters reacted sharply to the introduction of “foreign” microorganisms by raising the temperature, deteriorating the general condition, and manifesting a reaction at the injection site.However, after three days all the symptoms of the disease disappeared. Thus, having received a “start in life”, the vaccine began to be successfully used in the elimination of the outbreak of plague in Mongolia.

At the same time, on the islands of Java and Madagascar, French scientists L. Otten and G. Girard also worked on the creation of a live vaccine. Girard managed to isolate a strain of the plague microbe, which spontaneously lost its virulence, that is, it ceased to be dangerous to humans. The scientist named the vaccine based on this strain by the initials of the girl who died in Madagascar, from whom it was isolated, – EV.The vaccine turned out to be harmless and highly immunogenic; therefore, the EV strain is still used to this day for the preparation of a live anti-plague vaccine.

A new vaccine against plague was created by V.P.Smirnov, a researcher at the Irkutsk Research Institute of Plague Control in Siberia and the Far East, who participated in the elimination of 24 local outbreaks of plague outside our country. On the basis of numerous experiments on laboratory animals, he confirmed the ability of the plague microbe to cause a pulmonary form of the disease when infected through the conjunctiva of the eye.These experiments formed the basis for the development of conjunctival and combined (subcutaneous conjunctival) methods of vaccination against plague. To make sure of the effectiveness of the method he proposed, Smirnov injected himself with a new vaccine and at the same time infected himself with a virulent strain of the most dangerous, pneumonic form of plague. For the purity of the experiment, the scientist categorically refused treatment. On the 16th day after self-infection, he left the isolation ward. According to the conclusion of the medical commission, Smirnov suffered a skin-bubonic form of the plague.The experts stated that the vaccination methods proposed by V.P. Smirnov turned out to be effective. Subsequently, in the Mongolian People’s Republic, during the elimination of the outbreak of plague, 115,333 people were vaccinated using these methods, of which only two fell ill.

Health care against plague

The formation of the anti-plague system in Russia began at the end of the 19th century. In 1880, in St. Petersburg, on the Aptekarsky Island, an anti-plague laboratory was organized, organized on the initiative of Academician D.K. Zabolotny and Professor A. A. Vladimirov. Working with cultures of the plague microbe was dangerous and required isolation. Based on these considerations, in 1899 the laboratory was taken out of the city to the out-of-town fort “Alexander I”.

The departments of the St. Petersburg laboratory studied the microbiology of the plague microbe, the susceptibility of various animal species to it, the preparation of anti-plague vaccines and serums, and the training of doctors and nurses. For 18 years, within its walls were written articles on the microbiology of the plague, the authors of which were the plague doctors D.K. Zabolotny, S. I. Zlatogorov, V. I. Isaev, M. G. Tartakovsky, V. I. Turchinovich-Vyzhnikovich, I. Z. Shurupov, M. F. Shreiber.

In 1901, a well-equipped anti-plague laboratory appeared in Astrakhan. It was headed by N. N. Klodnitsky. In 1914, a congress on the fight against plague and gophers was held in Samara, at which the question of organizing a bacteriological institute with an anti-plague bias was raised. Such an institute was opened in 1918 in Saratov, where the laboratory was transferred from the Kronstadt fort.Now it is the Russian Research Anti-Plague Institute “Microbe”. Until now, “Microbe” remains the consultative and methodological center of Russia for especially dangerous infections.

In the USSR, a powerful network of anti-plague institutions with research institutes with subordinate stations and departments was created, which functions to this day. Annual observations of natural foci of plague ensure the country’s epidemiological well-being. Special laboratories in major seaports are studying strains isolated from ship rats on ships sailing from countries where there are still isolated cases of plague.

Unfortunately, the Central Asian Research Anti-Plague Institute with a network of anti-plague stations in active foci of Kazakhstan and the anti-plague service of other republics of the former USSR fell out of the unified anti-plague system. And in the Russian Federation, the scale of examination of plague foci has noticeably decreased. Abandoned collective and state farm lands are overgrown with weeds, and the number of rodents – potential carriers of the plague – is increasing. But the reasons for the periodic awakening and attenuation of natural foci of plague are still unknown.It is also necessary to take into account the fact that the new generation of doctors of the general medical network has never seen patients with plague and is familiar with this infection only from literary sources.

In general, the ground for the emergence of epidemic complications exists, and everything possible must be done so that the “black death” from the distant past does not become a disease of future generations.

“Science and Life” about vaccines:

Turbin A. Vaccine. – 1982, no. 7.

Marchuk G., Petrov R. Immunology and progress of medicine. – 1986, No. 1.

Zverev V. Vaccines from Gener to Pasteur. – 2006, No. 3.

The history of vaccination in Russia: from Catherine II to Sputnik V :: Life :: RBK Style

Smallpox was one of the most dangerous infectious diseases before the 19th century. Mortality from it reached 20-60% (among infants – up to 90%), and epidemics occurred regularly and spilled over from country to country.However, once having been ill with smallpox, a person received lifelong protection from the disease. It was this observation that opened the way for mankind to create vaccines.

Variation against smallpox: the first vaccine in Russia

Having come to America with the European discoverers, smallpox became the main reason for the disappearance of the Aztecs and Incas. In the 16th-17th centuries, Russian pioneers brought smallpox to the indigenous peoples of Siberia and the Far East – in these populations, the disease was much more deadly than among the Russians.Some tribes died out entirely from smallpox [1].

In Europe and Russia, one third of smallpox survivors lost their sight, and the majority received multiple scars on their skin. The French police in the 18th century even used the absence of pock marks on the face and body as a special sign.

Smallpox struck everyone – peasants, aristocrats, and monarchs. So, in 1730, this disease took the life of Peter II – the grandson of the Russian Emperor Peter I and the only male heir.

Smallpox vaccinations appeared in Europe and North America in the early 18th century.Although it is difficult to call this procedure vaccination in our usual sense: with the help of a lancet (the predecessor of the scalpel, after which the most authoritative American medical journal was named), the doctor made an incision in the patient’s arm and put liquid from a person’s smallpox vesicle there. Such an inoculation was invented in China back in the 10th century. Also, this method was used by the Turks, Arabs and African tribes, from whom the European slave traders and borrowed the idea [2]. This vaccination was called variolation.

Most of those vaccinated suffered a mild illness and received immunity.The mortality rate from this vaccine was 2–3.5%.

Smallpox vaccination scene from the American TV series “John Adams”. The wife of the protagonist and one of the most influential women in American history, Abigail Adams, was taken from smallpox with her children in 1776.

The date of the beginning of the use of vaccines in Russia is considered to be 1768.Then another smallpox epidemic was raging in the country. Empress Catherine II invited the famous British doctor and vaccine apologist Thomas Dimsdale to St. Petersburg. He first instilled in Catherine herself, then her son Paul, the future emperor, and other members of the royal family. The variolation went well: it is known that the empress spent several days in bed with mild colds.

After that, Russia began to create a system of mass vaccination against smallpox. In 1796, shortly before her death, Catherine even issued a decree on the compulsory variolation of the entire population.However, little came of this – the state did not have enough resources, and people were afraid of vaccinations.

Certificate of passing smallpox for admission to study. Issued on October 1, 1906 by the senior regimental doctor to a 10-year-old boy

In the 1790s, British physician Edward Jenner figured out how to make smallpox vaccinations significantly safer.He noticed that a person can become infected with vaccinia, but he never gets seriously ill. People who work with cows are often immune to smallpox.

The experiments that Jenner performed on peasant children confirmed the hunch: vaccinating with cowpox gives a person immunity from smallpox, while not causing serious complications. The vaccine was named vaccine – from the Latin vacca, cow. In 1801, the Jenner method began to be vaccinated in Russia.

Rabies vaccine

In the second half of the 19th century, medicine made a huge leap forward in understanding the origin of infectious diseases.Science owes many discoveries of that time to one person – the French scientist Louis Pasteur, who was the first to prove the huge role of bacteria in a variety of biological processes, from fermentation and decay to epidemics and digestion.

In the 1870s, Pasteur took up the study of viruses. Experimenting with chicken cholera and anthrax in animals, he proved the possibility of creating a vaccine from a pathogen. The scientist was able to weaken the live virus to such an extent that when administered to a person, it became safe, but the body still developed immunity in response to it.

In 1885, Pasteur created the second human vaccine for rabies. She helped those who were already infected. Those infected with rabies from all over the world began to come to the Parisian clinic of the scientist.

The Russian Empire became the first country to adapt the experience of Louis Pasteur – already in 1886 the world’s first “Pasteur station” began operating in Odessa, where people with rabies were vaccinated.Pasteur passed the vaccine to Russian doctors with several infected rabbits.

The Odessa Pasteur Station, where biologist Ilya Mechnikov and his student, physician Nikolai Gamaleya, worked, became the first national bacteriological research center.

In the late 1880s, the European scientific community began to harshly (and wrongly) criticize Louis Pasteur’s methods. Gamaleya, who actively collaborated with the French scientist and lived on the road between Paris and Odessa, helped defend his theory by speaking to a British scientific committee based on extensive statistics on rabies vaccination in Odessa.

Soon Pasteur stations began to open in other cities of Russia. Before the revolution, they existed on private money, the state did not spend resources on vaccinations. Only large and wealthy cities could afford the station – therefore the Moscow station served the whole of central Russia, and patients from Siberia and Central Asia came to Samara [3]. It was possible to fully provide all regions of the country with Pasteur stations only in the 1930s.

In Soviet times, Gamaleya became a prominent microbiologist, heading the Moscow Institute of Epidemiology and Microbiology, which today bears his name.In 2020, the Gamaleya Center has developed a vaccine against COVID-19 – Sputnik V.

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Vaccines against plague and cholera

At the turn of the 19th and 20th centuries, several effective vaccines against dangerous diseases appeared at once. Two of them – from plague and cholera, the world is indebted to Vladimir Khavkin, a student of Mechnikov.

Russia treated Khavkin cruelly – therefore, the name of the great doctor who saved hundreds of thousands of lives is now much more famous in Britain and India than in his homeland.

Khavkin graduated from Odessa University in 1884. The young scientist of Jewish origin wanted to do epidemiological research. However, after the assassination of Alexander II, the state intensified the persecution of Jews and deprived the devout Zionist Jew Khavkin of his professorship. The scientist refused the offer of the authorities to convert to Orthodoxy and left for Europe, where he could freely study science.

In 1892, Vladimir Khavkin created the first cholera vaccine, which he tested on himself.The doctor offered it to the Russian Empire, but was refused. At home, the doctor was very disliked – as Anton Chekhov wrote, because of his nationality [4].

In 1893, in agreement with the British government, Khavkin went to India (it was there that the worst cholera epidemics were raging), where he launched a mass vaccination program. In 1896, India was hit by a fierce epidemic of the bubonic plague, one of the last in history.The doctor quickly created an effective anti-plague vaccine. Today, the Central Institute of Immunology of Mumbai bears the name of Khavkin.

Khavkin’s plague vaccine from a dead virus has saved many lives, but its effectiveness has never been accurately described. The vaccine against plague with a live virus, the direct predecessor of those that are used today, was created by another undeservedly forgotten Russian infectious disease specialist Magdalena Pokrovskaya.

In the years after the Civil War, Pokrovskaya investigated outbreaks of plague and malaria in the southeastern regions of the USSR. In 1934, she worked at a plague control station in Stavropol, where, after many attempts to transform a living plague virus, she was able to create a working vaccine, which she successfully tested on herself.

During the Soviet-Finnish and World War II Pokrovskaya worked as a military doctor. At this time, she created a technology for treating severe infectious diseases using bacteriophages – special viruses that kill bacteria.

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Smallpox vaccination: an outbreak in Moscow in 1959-1960

In 1919, Vladimir Lenin issued a decree on compulsory vaccination against smallpox. Soon after the end of the Civil War, during which many infectious diseases raged, its spread was minimized, and by 1936 smallpox was completely eradicated on the territory of the USSR.

In 1959, an outbreak of smallpox occurred in Moscow.It was brought by the poster artist Alexei Kokorekin, who went on a business trip to India. Before the trip, he had to receive several vaccinations, including against smallpox – however, apparently, he asked the doctor to mark the vaccination without injecting the drug.

Smallpox virions (increased 370,000 times)

© Public Domain

Kokorekin died in agony just a few days after returning home.When the disease became known, Moscow was closed for military quarantine. For several days, Muscovites were limited in movement around the city. Law enforcement agencies were sent to search for everyone with whom the cartoonist had contact, and the Ministry of Health increased the production of vaccines many times over and began to vaccinate Muscovites and residents of the Moscow region.

This vaccination campaign has become one of the most effective in history, with almost 10 million people receiving the vaccine in just one month. Emergency measures helped to quickly stop the outbreak – 45 people became infected from Kokorekin, of whom, in addition to himself, two died.

Polio vaccine

After the terrible diseases of the Middle Ages and modern times, such as smallpox, dysentery, plague and cholera, were defeated, polio became the main problem.

This disease mainly affects preschool children. It disrupts the functioning of the spinal cord and nervous system, causing temporary paralysis and disruption of the limbs. In 0.5% of cases, the disease leads to permanent paralysis, and 5–10% of patients die from paralysis of the respiratory muscles [5].

The first three polio vaccines were introduced in the United States in the 1950s. It is curious that two of the creators are natives of Poland, and the third is a descendant of emigrants from there.

The first vaccine made from a “live” virus was developed in 1950 by Hilary Koprowski. It was effective, but the American medical authorities did not give permission for its mass use, as they feared “live” vaccines.

A few months later, Jonas Salk introduced the dead virus inoculation.His vaccine was registered and approved for mass vaccination in 1955. However, there was a terrible mistake: one of the drug manufacturers forgot to “kill” the virus, and about 120 thousand children received an injection of polio instead of being vaccinated. 56 of them were paralyzed, five died.

The third vaccine was introduced in 1954 by Albert Seybin, who worked with Koprowski. His vaccine was “live” and oral — it had to be drunk or eaten. Seibin was a little late: by the time he completed his research, America was already preparing for the massive Salk vaccination.

Maryana Voroshilova, Mikhail Chumakov, Lev Lukin and Anatoly Smorodintsev at the Sister Kenny Institute in Minneapolis, 1956

© Gettyimages

Before the war, poliomyelitis was rare in the USSR, but since 1949, the incidence began to rise sharply. In 1956, a delegation of Soviet doctors led by Mikhail Chumakov, director of the Institute for the Study of Poliomyelitis, visited the United States and met with Albert Seibin.The American scientist received an invitation to come to the USSR and organize the industrial production of his vaccine.

The Soviet authorities did not trust the “live” vaccine either. The son of Mikhail Chumakov, Konstantin, said that his father achieved the approval of the vaccine by calling First Deputy Prime Minister of the USSR Anastas Mikoyan from the office of a high-ranking official when he was absent. Chumakov assured Mikoyan that the vaccine was good, and he gave the go-ahead for mass production.

Mass vaccination began in 1959, and by the end of 1960 all Soviet citizens under the age of 20 had been vaccinated against polio.

In 1961, the polio epidemic began in Japan. The country bought the Salk vaccine from the United States, but it was in short supply, and many had doubts about its effectiveness. The Soviet vaccine, on the other hand, seemed to many to be the most successful. Everything got to the point that Japanese parents organized rallies, at which they demanded that the government organize the purchase of Seibin’s vaccines from the USSR.

The government agreed to the requirements and bought 13 million doses of the vaccine from the Soviet Union, which by that time had already completely coped with polio.

Compulsory vaccination in the USSR

From 1919 to 1980, every newborn citizen of the USSR was vaccinated against smallpox without fail. In 1925, mass vaccination of children against tuberculosis was introduced.

In 1958, the Preventive Vaccination Schedule was introduced, which continues to exist in Russia to this day.

In its original form, it consisted of vaccines for smallpox, tuberculosis, pertussis, diphtheria and polio. Later it included vaccinations against tetanus and mumps (mumps). Over the past 30 years, a number of vaccinations have been added to the calendar: against hepatitis B, hemophilus influenza, influenza, HIB infection.

National vaccination calendar in Russia

Eight compulsory vaccinations are given in Russia today.

There are also vaccinations that are given according to epidemic indications:

  • tick-borne encephalitis;
  • leptospirosis;
  • plague;
  • shigellosis;
  • rabies;
  • Q fever;
  • tularemia;
  • anthrax;
  • hepatitis A;
  • typhoid fever;
  • meningococcal infection;
  • rotavirus infection;
  • human papillomavirus;
  • cholera.

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90,000 Bubonic Plague: History, Treatment, New Threat

Before the world had time to get used to the coronavirus, a new attack burst out: in China, cases of bubonic plague were suddenly recorded. A terrible disease was confirmed in a cattle breeder in Inner Mongolia, an autonomous region in northern China, bordering Mongolia and Russia.According to the health committee of the city of Bayan-Nur, the infected man had previously been in the epidemiological focus of the bubonic plague. Now his condition is assessed as stable, and the third level of epidemiological prevention has been announced in the city. According to local authorities, there is a threat of the spread of the disease among local residents. As a precautionary measure, people are not advised to hunt wild animals, avoid rodent habitats that carry the plague, and immediately consult a doctor at the first cases of illness (especially at high temperatures).

In addition, two days before the described case in Western Mongolia (the Mongolian region bordering the Russian Republic of Altai), two infected with bubonic plague were identified at once. They turned out to be a 27-year-old man and a girl, whose age is unknown, doctors assess her condition as critical. It is reported that by the time the first symptoms of the disease appeared, the girl was in direct contact with at least 60 people, and indirectly with more than 400. According to local doctors, all potentially infected people were quarantined, and the city of Khovd, where all this happened, was closed for entry. and check out.

Is the world threatened by a new plague epidemic ? What are the symptoms of this disease and can it be cured? Read about this in our material.

What is bubonic plague and where did it come from?

The plague or, as it is often called in the literature, the “black death” is usually associated with the Middle Ages. Indeed, for that era it was a catastrophe of a universal scale. Plague claimed about 25 million human lives, its foci now and then arose all over the world – now in Europe, then in Asia, then in Africa.In the Middle Ages, with their almost complete lack of hygiene and a huge number of rodents in cities and villages, plague, as expected, became the most widespread. However, it appeared much earlier.

The causative agent of the plague is the plague stick (Latin Yersinia pestis). It was independently discovered in June 1894 by two scientists – the Swiss and French bacteriologist Alexander Yersen and the Japanese doctor Kitasato Shibasaburo. Fragments of the genome of the plague pathogen are found in fossil remains from the beginning of the 3rd to the beginning of the 1st millennium BC.NS.

Plague is an acute natural focal infectious disease, the main symptoms of which are fever, inflammation of the lymph nodes, lungs and other internal organs. Plague is often accompanied by the development of sepsis. The disease is characterized by high mortality and extremely high infectivity.

Photo: Wikipedia

Why is the plague “bubonic”?

There are two main types of plague – pneumonic and bubonic. Until the end of the 19th century, the disease was considered incurable and almost always meant death. Mortality with bubonic plague reached 95%, with pneumonic – almost 100%.

As a rule, the “black death” is understood as the bubonic plague – this form was most widespread during the Middle Ages. Fleas, parasitizing on rats and other rodents and capable of transferring to humans, most often become its carriers. The main symptoms of the bubonic plague are inflamed and painful lymph nodes, or “bubo”, from which it gets its name.They form on the human body after being bitten by a flea or, in some cases, from an infected rat or other animal.

Most often, buboes appear in the groin, neck or armpits. In addition, the disease is characterized by high fever, fever and pronounced intoxication. The incubation period for bubonic plague is 2–6, less often from 1 to 12 days.

We can also find traces of the bubonic plague in ancient medical sources (for example, several cases of bubonic plague in Libya, Syria and Egypt are found in descriptions of the 1st century AD).NS. and earlier), and even in the Bible. So, in the first book of Kings, the war of the Israelites with the Philistines is described, where the latter, having won another victory, seized the ark of the Lord’s covenant with the sacred relics of the Jews. However, to whatever city they brought the ark, it was immediately struck by a terrible disease:

“And the hand of the Lord over the Azotians was burdened, and He struck them and punished them with painful growths, in Azot and in its environs. 1 Sam. 5: 6 “.

How was plague treated in the Middle Ages?

With its high mortality rate, bubonic plague was not always a death sentence for humans: some people recovered spontaneously.However, this happened quite rarely. Bubonic plague was often complicated by plague pneumonia and became pulmonary, after which the infection could spread by airborne droplets. In a worst-case scenario, bubonic plague becomes septic, resulting in plague bacteremia. In this case, you can become infected both through direct contact with the patient’s body and through fleas.

Photo: Wikipedia

However, in the Middle Ages, nothing was known about this yet.The main method of combating the spread of infection was then fire. It was believed that at any stage of the plague, you can get infected by simply touching the belongings of a sick (or already deceased) person, so they tried to burn all his property as soon as possible. This, of course, did not solve the problem. There is no need to talk about finding the source of the disease: the Middle Ages were a time of superstition, witch hunts and belief in black magic, so the then inhabitants of Europe would rather believe in the curse of Satan or the wrath of God sent down to them from heaven than in carrying fleas and rats.

The methods of treatment were also quite exotic. Doctors of that time did not know many ways to fight the plague (more precisely, they thought that these actions could somehow help the patient). They opened buboes, bleed, which caused damage not only to the infected, but also to themselves (after all, the risk of infection increased significantly), and also used plasters from the entrails of birds and opium compresses.

True, we should still pay tribute to the doctors of that dark time: even then, doctors wore anti-plague suits.This famous image of the plague doctor is familiar to everyone who has ever chosen a costume for Halloween. The Anti-Plague Suit was a complete protection kit worn by physicians whose duty it was to treat plague patients. It included a cloak, trousers, gloves, boots, a hat and, of course, the famous beak-shaped mask, made of waxed leather. It was believed that she gave the doctor a resemblance to an ancient Egyptian deity and scared off the disease. But in fact, this “beak” had an important practical purpose: it protected the doctor from the terrible plague stench that filled the cities of Europe at that time.The tip of the mask was filled with strong-smelling herbs, and since the doctor constantly chewed garlic for prophylaxis, his “nose” had a double function – those around him were also protected from the doctor’s fetid breath. And so that the doctor would not suffocate from all this abundance of aromas, there were two ventilation holes in the “beak”. The doctor’s eyes were also protected by glass inserts. Thus, we can say that the plague doctor’s mask was quite a good prototype of a gas mask.

Photo: Wikipedia

How is bubonic plague treated today?

Fortunately, over time, medicine has advanced far, and even such dangerous and serious diseases as the plague are now treatable.Today mortality with bubonic plague with proper and timely treatment started is only 5-10%.

By the way, it was the bubonic form of the plague that doctors learned to treat first. The treatment of bubonic plague became possible after the invention of the first anti-plague vaccines and sera.

By the way, Russians can be proud: the world’s first vaccine against plague at the beginning of the 20th century was created by our compatriot, the Russian scientist Vladimir Khavkin. He developed his own drug from the temperature-killed plague sticks.A live plague vaccine was created and tested in 1934 by the Soviet bacteriologist Magdalena Pokrovskaya. But since the plague has a huge number of pathogenic strains, it is simply not possible to develop antibodies from each of them. Therefore, today the disease is treated with antibiotics. The first antibiotic that proved to be effective in the fight against plague and tuberculosis was streptomycin, discovered by the American microbiologist Zelman Waxman.

Thus, now the probability of dying from the plague is quite low, the most important thing here is to start therapy on time.Despite large-scale epidemics in the past, today no more than 2,500 people per year die from the plague, which is about 5-7% of all infected. Outbreaks of the disease periodically occur in countries in Asia, Africa and South America. Bubonic plague in Russia was last recorded in 2016 in Altai, and there have been no deaths for more than 100 years.

Plague vaccination: who is it given to?

Live plague vaccine is used today to prevent bubonic plague.This is a live culture of the vaccine strain of the plague microbe Yersinia pestis EV, dried by lyophilization (a method in which the drug is first frozen and then placed in a vacuum chamber, where the solvent is sublimated (sublimated)). Thanks to this vaccine, a person develops immunity to plague for up to one year.

Plague vaccination is indicated for children from two years of age and adults living in areas characterized by outbreaks of this disease.Also, vaccinations must be done for those who work with live cultures of the causative agent of the disease.

Vaccination is carried out once, various methods are possible – subcutaneous, cutaneous, intradermal, inhalation or oral. If the epidemic situation in the region is favorable, the next vaccination should be carried out no earlier than a year later, if there is a risk of infection – after six months. Vaccination can provoke various ailments in a person, such as headache, fever up to 38.5 ° C, nausea, vomiting.The side effect can last from 1 to 3 days.

The World Health Organization (WHO) does not recommend vaccinating the population against plague, the only exceptions are high-risk groups (for example, laboratory workers who are constantly at risk of infection, and health workers).

Are we facing a new plague epidemic?

Advisor to the Director of the Central Research Institute of Epidemiology of Rospotrebnadzor, Academician of the Russian Academy of Sciences Viktor Maleev, in connection with the latest news about those infected with the plague in China and Mongolia, said: there is no danger of the spread of bubonic plague in Russia.

“Plague is not a coronavirus, since there is a vaccine, you can get vaccinated, especially employees of the anti-plague service, they vaccinate themselves, the population of some separate areas vaccinate. And then, there is a cure for the plague. Isolated cases will not cause any spread, local doctors know how to deal with the plague. This is not a new infection, “the specialist said in an interview with RIA Novosti.

Maleev added that anti-plague institutes and stations are operating in Russia today, whose employees are catching gophers, marmots, mice and examining them for the presence of a pathogen.He also noted that since the plague is a natural focal infection, those infected in China and Mongolia probably ate marmots.