Hektoen International

A Journal of Medical Humanities

Pertussis—A new or ancient disease?

Pertussis is a respiratory disease characterized by the whoop, the sound made by patients during coughing fits, and popularly known as whooping cough. It may be a more ancient disease than is usually assumed. Mentioned in an ancient Chinese medical classic from before the first century, it was described during the Sui Dynasty by the Chinese imperial physician Yuanfang Chao as the “cough of 100 days” (ca. AD 600). Hippocrates in his Epidemics referred to a condition affecting mainly children and characterized by a violent cough causing breathing difficulties and sometimes death, and so did Celsus in Rome (ca. AD 40).

Around AD 1000, Avicenna living in Bukhara during the Persian Samanid dynasty also described in his Canon of Medicine a condition resembling whooping cough. In 1502, the Islamic physician Bahaodowle Razi wrote about two epidemics of pertussis occurring in the Iranian towns of Harat and Rey. He mentioned that the disease entered the lungs as a consequence of air pollution, precipitated by moisture in the air, and affecting children more often than adults. It caused a dry cough without much sputum, leading in severe cases to wasting, cyanosis, and death. For treatment he recommended ginger dissolved in water, claiming that this reduced mortality. Interestingly, it has been shown that ginger has some antibacterial activity on Gram-negative bacteria.

In Europe, the disease probably appeared in France in 1414. The earliest epidemic was described in 1578 by the French physician Guillaume de Baillou who lived from 1530 to 1616.1 Also known by the Latinized name Ballonius, he received his medical degree from the University of Paris in 1570, practiced in Paris, and became physician to King Henry IV. He wrote not only on pertussis but also on acute rheumatism and what may have been tuberculosis, constrictive pericarditis, and other epidemic diseases.

In Britain during the early 16th century, a disease known as chyne-cough, or in Scotland the kink, was also probably pertussis, and the terms whooping cough and chincough appeared in the London Bills of Mortality. In 1679, Thomas Sydenham named the disease pertussis, deriving its name from the Latin words meaning “intense cough.”

For centuries the disease recurred in the form of frequent epidemics, being particularly fatal in the newborn and young infants. Its cause was not discovered until the era of Pasteur and Koch, when illnesses were shown to be caused by bacteria and not by miasmas. In 1906, in Paris, Jules Bordet and Octave Gengou discovered a small Gram-negative ovoid bacterium in the sputum of a five-month-old child. Six years later they were able to culture it from the expectorate of Bordet’s son, Paul, using a particular medium, the “Bordet–Gengou” medium. It was later named Bordetella pertussis.

Soon after the discovery of the causative agent of pertussis, several vaccines of questionable efficacy were produced, but it was not until the 1930s that Pearl Kendrick and Grace Eldering developed an effective one, then combined it with diphtheria and tetanus toxoids to generate the first DTP combination vaccine. Initially, these vaccines made of inactivated B. pertussis bacteria caused adverse reactions, leading to the development of an acellular pertussis vaccine in the late 20th century by the Japanese scientist Yuji Sato.

Mass vaccination campaigns greatly reduced the incidence and mortality of pertussis in most parts of the world. Yet the disease has proven to be a resilient foe, with periodic outbreaks occurring even in regions with high vaccination coverage. As immunity following vaccination can decrease over time, boosters have been recommended for individuals coming in contact with newborn babies, even for parents and grandparents. For all, the conquest of pertussis represents yet one more triumph of the advances of medical science.

Further reading

  1. Ligon B. Pertussis: An historical review of the research and of the development of whole-cell and acellular vaccines. Seminars in Pediatric Infectious Diseases April 1998:9(2):168.
  2. Hassan Yarmohammadi et al. The First Report of Epidemic Pertussis by Bahaodowle Razi from the 15th Century Anno Domini. Iran Red Crescent Med J. 2015 Jul; 17(7): e13454.
  3. Guiso N. Bordetella pertussis and Pertussis Vaccines. Clinical Infectious Diseases Nov 2009;49(10):1565.

GEORGE DUNEA, MD, Editor-in-Chief

Spring 2024



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