All in Her Head by Elizabeth Comen

Author:Elizabeth Comen [Comen, Elizabeth]
Language: eng
Format: epub
Publisher: HarperCollins
Published: 2023-12-14T00:00:00+00:00

Chapter 8

Defense

Immune

Self-Sabotage

Blame not the stars; ’tis plain it neither fell

From the distempered Heav’ns; nor rose from Hell,

Nor need we to the distant Indies rome;

The curst Originals are nearer home.

Whence should that foul infectious Torment flow

But from the banefull source of all our wo?

That wheedling charming sex, that draws us in

To ev’ry punishment and ev’ry sin.

—Girolamo Fracastoro, 1530

In 1847, a Hungarian physician named Ignaz Semmelweis was struggling to solve an infuriating and tragic problem. Women on the maternity ward in the hospital where he worked were dying in droves from puerperal fever, a type of sepsis that occurs after childbirth. Semmelweis tried and failed several times to determine the cause of the fever, which seemed only to afflict women who were attended to by the hospital’s (male) doctors, but not those who gave birth under the care of midwives—or even in the street. He wondered: Was it the position in which they gave birth? (It wasn’t.) Or perhaps the fever was somehow triggered by the presence of the priest who walked the ward each time a woman died, followed by an attendant ringing a bell? (This, too, was ruled out, although the other maternity patients no doubt appreciated the cessation of this disruptive and macabre ceremony.) But after the death of a colleague from puerperal fever—a colleague who had never set foot near the maternity ward but had been working in the autopsy lab—Semmelweis had a crucial realization.

The doctors were going from dissecting cadavers in one part of the hospital to assisting births in another . . . without washing their hands.

Fifty years before the introduction of germ theory into the scientific community, Semmelweis had stumbled onto what remains a key tenet of contemporary public health nearly two hundred years hence: the importance of hand hygiene to curb the spread of disease. But his campaign to persuade his fellow physicians to wash their hands with a chlorine solution before assisting births, while effective, was also short-lived and poorly received—in large part because nobody actually understood yet just how the immune system worked.

The immune system is first and foremost our body’s defense against infection, springing to action in the presence of disease-causing microorganisms that don’t belong. Everything that makes it such a misery to be sick—the pain and inflammation of an infected wound, the runny nose and rattling cough when you have a respiratory virus—is also evidence of the immune system at work, trying to expel the foreign invader. But contemporary immunology understands that this system exists in a delicate balance, one in which an overzealous immune response can be its own sort of problem. A deficient immune system is bad, but so is a dysfunctional one, in which the body’s defenses go hyperactive and attack its own tissues as if they were foreign organisms. The latter scenario produces a variety of autoimmune disease—the body attacking itself—including multiple sclerosis, Hashimoto’s thyroiditis, rheumatoid arthritis, diabetes mellitus type 1, and systemic lupus erythematosus.

In the scheme of things, and as compared with other systems, the immune system remained the least understood for the longest time.

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