St Pauls and the plague

I'm coming to the end of my fascinating six months working at the Hospital for Tropical Diseases. Last week in the build-up to Christmas, there was the annual round of Christmas parties, present-giving and HTD Christmas quiz. One interesting fact that stayed with me from the quiz was about the church in Covent Garden: the (less famous) St Pauls church

The beautiful classical portico of the church is one of the designs of the great 17th century architect Inigo Jones (of Welsh family, born in London, trained in Italy), which was achieved in spite of rather than with the support of his sponsors. Jones was commissioned by the Earl of Bedford to build a residential square (now Covent Garden) along the lines of an Italian piazza. The Earl felt obliged to provide a church in the square and he warned Jones that he wanted to economise. He told Jones to simply erect a "barn" and Jones's oft-quoted response was that his lordship would have "the finest barn in Europe". These days, I've heard that the portico is a good spot for meeting pretty Welsh journalists ...

So where does this relate to tropical medicine ? The church was completed in 1633 and consacrated in 1638, and less than 30 years later, in 1665-6 London was to suffer one of the most severe bouts of infectious disease in it's history. St Pauls church served as burial spot for the first "official" case of plague in London in that outbreak: Margaret Ponteous was buried in the churchyard on 12 April 1665. An estimated 100,000 further Londoners fell victim to the "Great Plague", approximately 20% of the population.

The plague raged in London for 18 months, King Charles and his retinue fled the city and most professionals (including doctors) followed suit. In the absence of the interference from ignorant medics, public health measures such as collective disposal of bodies and isolation of cases eventually brought the epidemic under control, and by the time of the Great Fire in September 1666, the plague was already past its peak. Although it was never realised (at the time) that rats and fleas were acting as vectors for the disease, the rebuilding of central London after the Fire included many permanent legislative changes that indirectly limited the rat population: proper sewerage and banning of thatched roofs (a favourite rat habitat!). In 1997, the Globe Theatre needed a special permit for it's roof!

So, Margaret Porteous, RIP in St Pauls Church. Perhaps the severity of the plague outbreaks in London eventually led, via the Broad Street pump and the Dreadnought Unit to the creation of the Hospital for Tropical Diseases and the School of Tropical Medicine?

PhD project

I'm in a slight PhD limbo zone at the moment - I know I'd like to do one at some point in the next few years, but the what, when and where are all still slightly uncertain. I've currently got a tentative project proposal sketched out, but have no idea if this will evaporate with the first blast of things going wrong ...

I'll put the current idea on the table, sometimes laying it all out helps with the decision. It is all to do with the use of vaccines against a type of bacteria called streptococcus pneumoniae, which (as you might guess from the name) is commonest cause of bacterial pneumonia : see below.



There are two conjugate-type vaccines on the market at the moment : Prevenar (for under 2 years) and Pneumovax II (for over two years. The main difference between the two vaccines is the number of serotypes (strains) of the s.pneumoniae against which it protects: prevenar has 7 whilst pneumovax has 23.

So the thrust of my PhD would be to look at whether it mightbe possible to get some of the protective effects of these vaccines (either type) to transfer from a mother to a new-born baby by giving the vaccine around the time of birth. The protective antibodies and cells might then transfer across the placenta and in the breastmilk in sufficient quanitities to confer some protection.



Gambia would be a useful setting to try out this kind of work because of the very high rate of transmission and carriage of the this particular bacteria, and the low rate of HIV wohich would be a major counfounding factor in much of southern/eastern Africa.

So, in some ways it seems a good project to commit to... as one person told me, "if you're going to spend several years of you life trying to answer one question, you should be sure that it is a question that it is worth asking". Perhaps everyone doing a PhD should be asking themselves that question ?

But my concerns are 1) I'm not a paediatrician 2) I haven't fully gone through the ethical implications of the work. I was at an Amnesty International lecture last week where one (rather shrill) journalist railed against the evils of westerners trying out drugs on unsuspecting third world populations. I don't think I agreed with her, but it did make me think...

Tropical medicine ward

Am now working on the "tropical medicine" firm in UCLH. We got a good crop of interesting infections from around the world at the moment, with a speical emphasis on insect-transmitted diseases at present.

So I thought I'd present the insects that have caused the illnesses and a little about them...

First


The distinctive black+white aedes mosquito, common in many rural areas as it likes to breed in clean still water (your rooftop watertank ideal). This transmits dengue (which our patient has, we think), yellow fever also. Quite an attractive beast, and probably much more dangerous to you that things much more tradtionally scary...


Next


This is sandfly. They are actually really tiny and silent fliers, so people usually aren't aware of bites. They transmit leischmaniasis in Meditteranean, Middle East, India and Carribean. We mainly see it in British army types who have been doing their jungle warfare training in Belize. That disease gives horrible ulcers




This last beasty comes from closer to home - it is a hard tick and one of these bit our patient in near Amersham, just north west of London ! Unfortunately she has developed Lyme Disease. This is more common in Eastern Europe, Scandinavia and eastern US seabord, not terribly well known in UK, but much feared!