So Grantville has fought its first major enemy and won an overwhelming victory. It has defeated the greatest scourge in the history of mankind. They took a risk, and decided to go with the aggressive, but in the end safest, route and everyone in the community has been variolated aside from the youngest babies who will undergo the procedure by age two. Herd immunity should function to keep those little ones safe to begin with. A procedure has been set in place to continue the practice on incoming refugees to keep it that way. This would involve a quarantine for the set period (about two to three weeks) while they are building up their immunity.
After beating smallpox, the medical professionals of Grantville can congratulate themselves and after a great sigh of relief start to lose sleep again over the many other diseases they face.
Plague and other nasty bacteria vaccines
Herd immunity in Grantville will be very high to those diseases we in the modern era are almost all immunized against. Measles, mumps, rubella, polio, pertussis, tetanus and diphtheria would not be a problem to start with. But diseases which currently are virtual unknowns in the developed world, such as typhus and plague, will find up-timers fertile ground if ways to protect them are not designed. Even with quarantines, eventually one or another of these diseases will hit. Making antibiotics would be trying to cure the disease after it hits and there will be plenty of cases where up-timers will need those drugs when they won't even know what is hitting them. But for several well-known diseases it would be possible to make whole-cell vaccines and provide immunity. These whole-cell vaccines would be less safe than current vaccines and would likely have more side effects, but they would work. From a community perspective, the safety they would provide would by far override the side effects, such as fever or sore arm at the injection site.
Using very basic bacteriology techniques, presented in any introductory bacteriology book, the bacteria causing the most dangerous diseases could be isolated, verified and grown. Many of these diseases have very clear symptoms. Samples can be taken from carriers of the diseases among the refugees or from the nearby towns. In these samples, the bacterium causing the disease would be present. These will be grown, isolated and a single type of bacterium selected. This bacterium would have characteristics similar to those described in the medical textbooks as to what the disease bacterium looks like. Finally, however horrible it may sound, it would be used to infect healthy animals, likely mice or rats. (This is an application of Koch's postulates.)
Once it is verified that this bacterium does cause the disease, it can be prepared for the vaccine. These bacteria can be grown in a large batch, isolated and heat-killed. It is easy to verify whether or not any bacteria survived. These "dead" bacteria are tested to see if they are truly dead by growing them. It is then tried out on another batch of animals. If the animals get sick, go back and repeat the process. If the animals don't get sick, the animals will then be challenged with the real live bacterium and see if they now survive. Once the effectiveness is ascertained, these dead whole-cell bacteria can be used for vaccinations.
There are reasons why using these whole dead bacteria cell vaccines would work. Bacteria have special components on their cell walls. These are related to the sugar people put in their coffee or tea but are chemically a bit different. Our immune system can tell this difference and responds very strongly when exposed to these kinds of sugars. That is why these whole cell vaccines would be able to provide very good protection. Standard vaccinations against plague, typhoid, and typhus would seem entirely obvious. These are especially necessary for people who need to dwell away from Grantville in large cities such as Amsterdam, Venice, Rome, Paris and London.
"Normal" vaccines
How would the Ring of Fire world go about regenerating the vaccines we are using currently? Would it be necessary? Would it be possible and what would it take?
Measles is a disease virtually everyone would get as a child prior to the vaccine against it. It kills about one in a thousand infected children. The symptoms begin with a cough, a rash, runny nose and fever. It often progresses to severe dehydration and five percent of children get pneumonia. The measles vaccine is given as a combination shot with mumps and rubella (German measles). Measles at the time of the Romans was a much more virulent disease and was known to kill at a similar rate to smallpox. People have either adapted or it has adapted to people to be more "benign."
Measles, polio, mumps, rubella and varicella (chickenpox) vaccines all consist of weakened viruses created in the lab. The easy option would be to save some of the vials that Doc Adams likely has and use it as a starter to culture these weakened viruses. Otherwise, to make the vaccines, a sample needs to be taken from the throat of an infected child, cultured in tissue culture in the lab in human or animal cells; historically this was done in chicken embryo cells or human embryonic connective tissue cells.
In the Ring of Fire universe, it may be a while before tissue culture (sterile growing of cells in petri dishes) that could produce these weakened virus strains will be possible. But when it does become possible, a very similar route will lead to a very similar result. By culturing these viruses in tissue culture, they become adapted to living under those conditions. Only those viruses which adapt, literally change their genetic blueprints to function better in tissue culture, will survive. When this is done to generation after generation of viruses, the viruses lose their ability to replicate and survive well in people. They are then ready to function as much weakened sparing partners for the children's immune systems to train themselves on. Given the effort and up-timer knowledge, making these vaccines in a crude form would be feasible within five to ten years of the Ring of Fire.
Hib (Haeamophilus Influenzae B), MenC (Neisseria meningitidis) and pneumococcal vaccines are against three different bacteria which cause either encephalitis or meningitis. The vaccines for these diseases may be among the hardest to reproduce. They are made by linking the special sugar groups which the pathogens have in their cell walls to a carrier protein. This combination allows children under the age of two to make, and to continue making, active antibodies against these sugars, which children are not able to do without the carrier protein. There is, however, a possibility of using a whole-cell vaccine again. Whether this would work well enough for the under-two age group is a question they would have to determine the answer to themselves.
DTaP (Diphtheria, Tetanus and acellular Pertussis vaccine) is a difficult case. This is actually a trivalent vaccine, that is, one which protects against three different pathogens by providing corresponding immunogens. The simple aspect would be to create a whole-cell pertussis vaccine. The tougher parts are tetanus and diphtheria. In both tetanus and diphtheria, the bacteria are not targeted, but rather the toxins these bacteria produce. It is the toxins which even in minute quantities damage human cells or nerves and can kill when these bacteria infect people. Usually these bacteria have trouble growing in people because we use oxygen and it is present in our tissues. Both of these two bacteria species are obligate anaerobic bacteria, meaning that they live only under conditions without oxygen. That would make it difficult to culture them without developing some equipment for it first. If that gets done, making the vaccine is relatively easy. The toxins are produced by the bacteria and expelled into the media they are grown in. The bacteria can be filtered out, the toxin inactivated by formaldehyde and the toxoid (inactivated toxin) concentrated. This would be very dangerous because these toxins are extremely deadly.
Other Vaccines
Making a rabies vaccine in a crude form similar to that of Pasteur is not very difficult. It involves infecting a rabbit, letting it get sick and then killing it, extracting the spinal cord, and letting it dry. The drying kills the virus and then bits of this can be injected many times over many days.
The flu vaccine, on the other hand, would be very difficult to produce. It is likely they would choose to go for more readily available and more likely targets first because it requires much more i
nfrastructure to make effective flu vaccines.
Tuberculosis is a major killer. In 1632, it killed three times as many people in London than did smallpox. The current vaccine for tuberculosis is not used in the U.S.A. or Holland, but is employed virtually everywhere else and has been used since 1921. It does not appear to prevent tuberculosis in people but it prevents the most deadly form of the disease in young children about eighty percent of the time. This vaccine is made from bovine (cow) tuberculosis bacterium. When it was originally made by Calmette and Guérin, they weakened this bacterium by continuously culturing it in the lab for thirteen years.
Conclusions
Would people from Grantville use vaccines now that they are back in the 1630s? Personally, I can't see how they couldn't. It would go with their spirit to go out and try to conquer these diseases just as much as they set out to make themselves and their neighbors safe from Tilly's mercenaries. They are already armed with much knowledge: of the scientific method, the germ theory, statistics, epidemiology and even the nature of the enemies they are fighting. They would have it in their own hands. It is a choice to make between living in fear or actively fighting the demon who feeds that fear. Would the vaccines they would develop be as safe as they are now? Not likely. There is just so much less testing that could be possible with what they have. It is very likely that in this process there will be mistakes made and lives lost. But overall, the tally will be so many lives saved, not just in Grantville, but wherever they manage to teach that dying of certain diseases is a choice, not a certainty.
References
The Dutch Republic, Jonathan Israel. Oxford University press. 1995.
Introduction to Bacteria: for students of biology, biotechnology & medicine, Paul Singleton. Chichester; New York : Wiley, 1992. 2nd ed.
When Plague Strikes : the Black Death, Smallpox, AIDS, James Cross Giblin, New York : HarperCollins, 1995.
The Speckled Monster: a historical tale of battling smallpox, Jennifer Lee Carrell. New York : Dutton, 2003.
Vaccines: What You Should Know, Paul A. Offit and Louis M. Bell. New York : Chichester : Wiley, 2003 .3rd ed.
Health, Disease and Society in Europe, 1500-1800; A source book, Peter Elmer and Ole Peter Grell eds. Manchester University Press, 2004.
The Conquest of Smallpox, Peter Razzell. Caliban books 1st ed. 1977. 2nd ed. 2003
Online Resources
http://www2.sunysuffolk.edu/westn/people.html , life of the people in the early modern era
http://en.wikipedia.org/wiki/Scientific_method
http://en.wikipedia.org/wiki/Louis_Pasteur
http://www.sciencemag.org/cgi/content/summary/291/5512/2323
http://www.medicalnewstoday.com/medicalnews.php?newsid=47385 , UK vaccination schedule
http://www.dur.ac.uk/anthropology.journal/vol13/iss1/casiday/casiday.html , http://www.cdc.gov/NIP/vacsafe/research/lancet.htm
http://www.geocities.com/issues_in_immunization/fearmongers/opposition_to_immunization.htm vaccine scares in the 20th century.
http://www.lrb.co.uk/v26/n13/penn01_.html , fraud and media in causing disruptions in vaccine coverage
ALL ROADS LEAD. . . .
By Iver P. Cooper
A seventeenth-century visitor might well think that all roads lead to Grantville, not Rome, because down-time roads pale by comparison. "Captain Gars," riding on Route 250, noted its "perfect flatness," and considered it to be "the finest road he had ever seen in his life." (1632, Chap. 57). Rebecca Abrabanel likewise was amazed by the "incredible perfection" of the first up-time road she saw (1632, Chap. 5).
Those roads give Grantville a tremendous strategic military advantage, a force multiplier. "Moses and Samuel [Abrabanel] soon realized that the striking power of the Americans, dependent as it was on their dazzling motor vehicles, was somewhat limited in range. But anywhere within reach of the rapidly expanding network of roads surrounding Grantville, they had little doubt that the Americans could shatter any but Europe's largest armies."
Highways are also important economically. Adam Smith wrote: "Good roads . . . by diminishing the expense of carriage, put the remote parts of the country upon a level with those in the neighborhood of a town. They are upon that account the greatest of all improvements." (EB).
It should be noted that in the early seventeenth century, long-distance overland travel is mostly by packhorse or packmule, not by wagon, because of the poor quality of the highways.
Not everyone will be in favor of improving roads. Innkeepers may fear that travelers will pass their hotel by and go on to the next town. Landowners in some parts of Europe have the right to collect whatever falls from a wagon onto the road, and therefore are perfectly happy to see them overturn. (Forbes, 524) They may also not like to see the central authority exercised more vigorously in their locale, thanks to the improved access.
What roads exist may deteriorate as a result of weather conditions, heavy traffic, and neighbors who figure that it is easier to mine stone from the road than from a distant outcrop. And if the road nonetheless attracts business, then that will in turn attract highwaymen to prey upon travelers.
Up-Time Resources
Grantville is based on the town of Mannington, West Virginia. That is one of four states in which there is no county or township ownership of highways. Hence, the West Virginia Department of Transportation is responsible for the maintenance of over 91% of the public roads in the state. ("West Virginia Highways") The District 4 headquarters is in Clarksburg, and there is a "superintendent" for Marion County. The history section of the City of Mannington website notes that "a WV Department of Transportation garage is located in Mannington which assures that our highways are the first to be taken care of during bad weather." For what is in that garage, see the "Road Construction Equipment" section.
However, the city of Mannington also has a Street/Water Superintendent, and presumably a street crew, responsible for the public roads not under state control.
The Grid indicates that Grantville has a "Streets and Roads Department," with eleven up-time employees. It is possible that most of these were originally employees of the WVDOT garage, but were quickly incorporated into the municipal government shortly after the RoF.
Of the "S&R" up-timers, two are listed as "heavy equipment operators," and another two as trainees. Then we have a dump truck driver, a maintenance scheduler, an equipment maintenance manager, a retired road maintenance man, a street foreman, and a record keeper (and an eleventh employee whose position is not stated).
Another six up-timers are listed as former employees of the state highway department.
* * *
The West Virginia Division of Highways classifies state roads by surface type as follows: (A) primitive, (B) unimproved, (C) graded and drained, (D) soil surfaced, (E) gravel or stone, (F) bituminous surface treated, (G) mixed bituminous, (H) bituminous penetration, (I) asphaltic concrete, (J) concrete and (K) brick (see Roadbuilding Addendum, www.1632.org, Appendix 1 for definitions). I have identified types A, B, C, D, and E, as well as paved roads representing one or more of types F–H, in the vicinity of Mannington, West Virginia (list of roads in Appendix 2). These roads presumably have Grantville equivalents.
According to the map in the 1632 RPG Sourcebook, twenty-one roads were cut by the Ring of Fire. Some of these will, coincidentally, be readily linkable to the surrounding German road network. Others will lead into the middle of nowhere. The latter roads may nonetheless serve a useful purpose; modern pavement structure can be studied there.
If these "orphan" roads don't include all of the important road types, then some judicious trench-digging (and subsequent repair) may be helpful for teaching roadbuilding and repair techniques to down-time apprentices.
Canon only identifies one up-time highway as being active in post-RoF Grantville. Route 250 runs by the high school, and in its vicinity parallels Buffalo Creek. It is described as a "well-built two lane highway," surfaced with asphalt, on which it is possible to drive up to
fifty miles an hour.(1632, Chap. 2).
Named Grantville streets in Canon include Main (Goodlett, "The Merino Problem," 1634: The Ram Rebellion), Turnbull (Mackey, "The Essen Steel Chronicles, Part 1: Crucibellus," Grantville Gazette, Volume 7), Clarksburg (home of the Inn of the Maddened Queen)(Id.), and High Street (government offices)(DeMarce, "In the Night, All Hats Are Grey," 1634: The Ram Rebellion).
Several down-time roads have been given "official status." According to canon, that means that they are "invariably widened and properly graded. Graveled too, more often than not." "Route 26" is a north-south road passing just west of Eisenach. Two miles to the north of the town, it is crossed by "Route 4" (1632 chap. 52). We also know that the road from Grantville to the (fictional) Imperial City of Badenburg has been improved. (Huff, "God's Gifts," Grantville Gazette, Volume 2). As of Eddie's trip, "the main road to Magdeburg was slated for improvement as an urgent priority," but had yet to undergo its makeover. (Weber, "In the Navy," Ring of Fire).