Adrian Stokes

Captain Adrian Stokes, (9 February 1887 – 19 September 1927) was an Irish physician and microbiologist and British Army soldier who worked as professor of bacteriology at Trinity College Dublin, and later as Sir Willian Dunn Professor of Pathology in the University of London at Guy's Hospital. He served in the Royal Army Medical Corps during World War I and was member of the Yellow Fever Commission in West Africa.

Stokes is most well known for his discovery of the virus (now named Orthoflavivirus flava) that caused yellow fever, the disease with which he died. He also discovered a bacterium Spirochaeta icterohaemorrhagiae (now called Leptospira interrogans), which causes epidemic jaundice (and other symptoms now collectively called leptospirosis), in rats which directly implied rodent control as the most important preventive measure. He developed nasal cannula used for giving oxygen through the nose.

Early life and education Stokes was born at Lausanne, Switzerland, to Henry John Stokes (1842 – 1920) and Mary Anne Macdougal (1843 – 1924). He was the youngest of eight children, among three brothers and five sisters. His father was an Indian Civil Service officer, the profession followed by his elder brother, Henry. His uncle (father's brother) Whitley Stokes was a noted Celtic scholar, and aunt Margaret Stokes, an antiquarian and writer, and his grandfather William Stokes and great grandfather Whitley Stokes both served as Regius Professor of Physic at Trinity College Dublin.

Stokes attended the St Stephen's Green School in Dublin for elementary education. In 1904, he won the John Robertson medal for an English essay. He entered Trinity College in 1905 studying history in the first year and then turning to medicine from the second year. He was secretary of the Dublin University Biological Association, which helped in maintain connections with the association and associated scientists throughout his career. In 1910, he graduated with degrees in Bachelor of Medicine, Bachelor of Surgery (MB BCh), obtaining first-class honours and winning the Bank's prize. He obtained Doctor of Medicine (MD) the next year. He returned home to become assistant to Alexander Charles O'Sullivan (1858–1924), professor of pathology at Trinity College, and part-time assistant physician at the Royal City of Dublin Hospital. Posted in France, he took with him his motorcycle using it as a mobile clinic for wounded soldiers in the battle field. Later, he used a friend's caravan for better equipment with which he served in the army till his demobilisation. He was promoted to Captain with which he was discharged in 1919. Stokes volunteered in the British Army. After a week of training and designation as Lieutenant in the Royal Army Medical Corps on 11 August 1914, he went to France "bringing along his own motorcycle—which he had had the wisdom to bring with him on proceeding to France," as Colonel Stevenson Lyle Cummins later reminisced. His motorcycle and later a friend's caravan were named No. 1 Mobile Bacteriological Laboratory. From 1 July 1915, he was stationed at the British-Canadian field hospital in Remy, northern France, but moved about in several places in Belgium during his service. His meticulous research, written in a personal letter to Cummins, was published in the British Medical Journal a year later.

One critical medical practice was the use of gas mask for oxygen given to the terminally wounded soldiers. Many soldiers died of an infection called gas gangrene when they were given oxygen life support. In August 1916, Stokes developed a simpler oxygen delivery tubes that can be loosely inserted in the nose, now called nasal cannula, which became universally used in all medical oxygen delivery.

In the spring of 1916, an epidemic jaundice broke out among the British and French soldiers. Which they called the "trench disease" became a serious concern as hundreds of soldiers were affected, Stokes took care of a soldier with the fatal disease, and from the autopsy samples, identified the causative agent as a spirochaete bacterium, Spirochaeta icterohaemorrhagiae. The disease was first described by physician Adolf Weil in 1886 in Germany, and was therefore known in medicine as Weil's disease. The bacterium was discovered and named by Japanese physicians Ryokichi Inada and Yutaka Ido with their colleagues from the First Medical Clinic of the Imperial University at Kyushu, Fukuoka, in 1915. Stokes was aware of the scientific history and the disease prevalence in various parts of the world which helped him in the correct identification of the disease and the pathogen. The bacterium was later renamed Leptospira interrogans, and with it the disease, leptospirosis.

With his senior medical officer, Captain John A. Ryle, Stokes reported his findings in the British Medical Journal and the BMJ Military Health in September 1916, with additional notes in The Lancet in January 1917.

However, the source of infection was still a mystery. In 1914, Inada and Ido had shown that the infection could be induced in guinea pigs by inoculating with an infected person's blood. Based on this information, Stokes suspected that rodents might be the carriers of the bacterium. In 1917, he found rats from the war trenches having the bacterium in their blood. He noted: "The rat dissecting was not all a bouquet of flowers, for the weather had become very hot and many of the corpses were far from fresh." With discoveries of the mode of transmission, by mosquitos (scientific name Stegomyia fasciata, later renamed Aedes egypti), and the causative agent in 1901, yellow fever became the first disease known to be caused by a virus. Mosquito control programmes led to suppression of the outbreaks within two years in Brazil. Inspired by these achievements, the Rockefeller Foundation organised several Yellow Fever Commissions in South America and Mexico in the 1920s. However, the nature of the virus was still unknown.

In 1913 and 1914, there was an outbreak of yellow fever in Nigeria. In 1920, the Rockefeller Foundation invited Stokes to help in its West Africa Yellow Fever Commission. The commission investigated several regions but found the disease as rare occurrence, not a single case was seen. The only suspected case Stokes noticed was a man in Lagos, who ran away into the jungle afraid of medical examinations. Led by Henry Beeuwkes of the Johns Hopkins School of Medicine, the commission team arrived in Lagos in June 1925. Noguchi's claim was based on an evidence he had discovered. In 1918, as part of the Yellow Fever Commission in Ecuador, he identified a bacterium which he called Leptospira icteroides from individuals with yellow fever. He demonstrated that infected blood sample inoculated in guinea pigs produced the disease. It was announced as "the discovery of the aetiological agent of yellow fever."

However, it was later realised that leptospirosis and yellow fever were prevalent together in Ecuador, that Noguchi's discovery could be a case of Weil's disease. The commission was far from achieving its specific task: "to attempt the isolation of the organism which causes the disease." The researchers used rhesus macaques from India, Brazilian marmosets, and chimpanzees to experiment on leptospiral infection, but in vain. To help resolve the issues, Beeuwkes invited Stokes to join the commission in April 1927.

On 30 June 1927, Stokes obtained blood samples from a 28-year-old man named Asibi and a 30-year-old woman named Felice, both of whom died of the disease a day before. The blood sample was injected into rhesus monkeys, guinea pigs and marmosets. The guinea pigs and marmosets remained healthy but the monkey (designated 253-A) developed the disease and died. Johannes H. Bauer performed experimental transmission on monkeys using mosquitos experiments; while Stokes and Hudson took turn examining the dead monkeys. as Hudson put it, "Noguchi's protagonist", on the leptospiral origin of the infection in Africa. Stokes calmly asked Scannell to examine his symptoms and then with a string of questions, ending with, "Are you ready now to agree, to admit that yellow fever is caused by a virus and not by leptospira?" Scannell firmly answered, "I believe you fellows are right." ) and the detailed report to the American Journal of Tropical Medicine and Hygiene on 25 January 1928, In 1932, Max Theiler and Eugen Haagen at the Rockefeller Institute were able to culture the Asibi's blood sample (then known as Asibi virus ). After continuous culture for five years, they developed a vaccine which Theiler named 17D. For the development of vaccine, Theiler received the Nobel Prize in Physiology or Medicine in 1951, the first and only Nobel Prize related to virus vaccine.

Awards and honours

Stokes was elected fellow of the Royal College of Surgeons in Ireland in 1912. He was awarded Distinguished Service Order (DSO) in 1918. He was made Knight of the Belgian Order of the Crown in 1918. He was awarded Order of the British Empire (OBE) in 1919. He was elected member of the Royal College of Physicians in London in 1924.