A Not So Small Case of The Pox
A Journey from Early Treatment to Eradication
One of the deadliest and most disfiguring diseases in history, smallpox has made a large impact on history, and society, as we know it. Smallpox has killed hundreds of millions of people, and has left even more disfigured sense the diseases was thought to have originated around 10,000 BCE. It is thought that humans acquired smallpox from a pox-like disease of domesticated animals in one of the newly agricultural settlements of Asia or Africa. Scientists have observed smallpox like skin rashes on Egyptian mummies dating back to around 1100 to 1580 BCE. Scientist have also found medical records from Asia that show evidence of smallpox in China dating back to 1122 BCE, and in India dating back to 1500 BCE. The earliest indisputable description of smallpox however dates back to 4th Century CE China. There were also definite descriptions of smallpox written in records from 7th century CE India and Mediterranean, and 10th century CE Southwest Asia, suggesting that pandemic smallpox originated in East Asia.
Before understanding different methods of treatment for the disease, it is helpful to understand how the disease works. There are four different types of smallpox. The most common form of smallpox, accounting for over 85% of all cases, is Ordinary Smallpox. The first stage lasts approximately 4 days, and includes a high fever and flu like symptoms. The second stage, the eruptive stage, comes after the fever subsides. Rash lesions develop starting on the face and extremities, and then spreading throughout the body in a centrifugal pattern. The lesions will progress from mascules, to papules, to vesicles over a 4 to 5 day period. After around 6 to 7 days, the pustules will become round, tense, and deep within the skin. Crusting of the scabs will take place approximately 9 days after the initial symptoms, and they will began to fall off around 14 days after. The second type of small pox is commonly known as Modified-type smallpox. This occurs in people who have already been vaccinated. In Modified-type smallpox the first, flu like, stage of the disease lasts as long as in ordinary type, but once the skin lesions appear the disease starts to speed up. There also may be fewer lesions then those seen in ordinary smallpox. The third type of small pox is known as malignant smallpox. This is a rare form of smallpox characterized by blood poisoning. This form of smallpox is unlike ordinary smallpox because the lesions develop slowly, merge together, and remain flat and soft. The finally type of smallpox is Hemorrhagic smallpox. Hemorrhagic smallpox is different from ordinary smallpox due to its shorter incubation period, more sever flu like symptoms, and development of essentially hemorrhaging pustules, that appear black or purple. (“Centers for Disease Control and Prevention”, 2016) As one could imagine these symptoms were often deadly, and caused disfigurements in those who survived the disease.
Epidemics of smallpox arose regularly in Europe throughout the 17th and 18th centuries. Smallpox was also introduced to the Americas by European conquerors and settlers, killing off native populations of Indians located in the Americas. Although Europeans did not fully understand the disease, they understood that the disease was contagious, and that they needed to separate victims of the disease. Little could be done for these victims. Early records show reporters of different medical practices such as bloodletting, leeches, fasting, laxatives, purgatives, diuretics, sweat therapy, cool therapy, and red light therapies. Many people also plead and prayed to the gods. Other then these unhelpful practices, the only hope society had was to prevent outbreaks from happening. (“Encyclopedia Britannica”, 2018)
In Asia, doctors developed a technique that is known as variolation, or inoculation. As a way of preventing the spread of the disease, doctors would take one of the scabs off of a person who had smallpox, and blow these scabs into the nasal cavity of people who had not yet contracted smallpox. When this was done individuals would contract a mild version of the disease. Once the patient had recovered from this milder form of the disease, the patient would be immune to smallpox. (“Courtesy of the National Library of Medicine”, 2002) As variolation spread, doctors would also place the infected scab onto the healthy person’s skin, rather then putting the scab in the person’s nasal cavity. Variolation became a common practice throughout Africa, India, and China. In 1717 Lady Mary Montagu, the wife of the British ambassador, visited Constantinople, and learned about the practice of inoculation. Lady Mary Montagu decided to bring this idea back to England, and tested inoculation, by inserting smallpox under the skin, on several prisoners and orphans. Once the treatment was proven effective in all of the patients she tested, she decided the treatment was safe and had the whole royal family inoculated. (“Courtesy of the National Library of Medicine”, 2002) Lady Mary Montagu, who many admired and looked up to, became a strong advocate for inoculation. Inoculation became popular in Europe, and was often used as a social event, where wealthy people would host large inoculation parties where everyone would come together and inoculate each other. After inoculating each other, the people would essentially stay quarantined in the house together until the mild symptoms of the disease wore off, because it was still an active, and contagious virus. At the same time Lady Mary Montagu discovered inoculation in Europe, Cotton Mather discovered inoculation in America. Cotton Mather learned about inoculation from one of his slaves, named Onesimus. Onesimus had been inoculated in Africa, and he told Mather about the beneficial practice. Onesimus showed Cotton Mather its effectiveness by inoculating his own son. Once Cotton Mather realized the effectiveness of the practice, he spread the idea throughout America. (“Encyclopedia Britannica”, 2018) Although some religious groups and doctors opposed variolation, statistics show that it was effective in comparison to not inoculating at all. Data shows that the risk of death from small pox was around 1 in 5 to 6, or around 20% for people who were not inoculated. The statistic for death from inoculation was around 1 in 100, or 1 %.
In 1796 a surgeon named Edward Jenner discovered the first smallpox vaccine. For many years Edward Jenner had heard tails about milkmaids who were naturally protected from smallpox after they had been infected with cowpox. Jenner concluded that cowpox could not only protect people from smallpox, but it could also spread from person to person, as a deliberate mechanism for protection. Jenner decided to test his theory in May of 1796. Jenner used a dairymaid named Sarah Nelms who currently had fresh cowpox lesions on her hands. Using this matter, he inoculated his 8-year-old son, James Phipps. Phipps developed a mild fever and discomfort for approximately 9 days, and by the 10th day he felt better. In July of 1796 Jenner inoculated his son again, this time with smallpox, and no disease developed. Jenner concluded that this could be used to protect society from smallpox, and essentially created the first vaccine. (Riedel, 2005)
There were many objections to the idea of vaccination. From a societal standpoint, some objected to using vaccination due to the fact that inoculators would lose money. Others thought that smallpox was nature’s way of reducing the poor population. There were also religious oppositions to the idea, stating that vaccinating the population interferes with God’s plan. There were also scientific oppositions and questions about the safety of the vaccine, the fact that the source of the vaccine was an animal disease, and the fact that the duration of immunity from the disease is unknown. There was also an increase in the possibility of spreading other disease through contaminated needles. At the time vaccination began, practitioners were not as educated as they are today. Because of this, there are many examples of large groups of people contracting diseases, such as hepatitis and syphilis, because of the practice of vaccinating people in large groups, and not properly cleaning the equipment after the fact.
With the success of the smallpox vaccination came research on finding vaccinations and medications for other infectious diseases. Government polices on vaccination also came about do to the success of the smallpox vaccine. The success with vaccinations came with a realization that certain diseases could be eradicated, and epidemics could be stopped. Governments started compulsory vaccinations, where communities would be required by law to be vaccinated in order to receive, or participate in, certain government benefits. This was a great success for countries that participated in compulsory vaccination programs. However, as with any requirement made by law, there are certain groups of people who find this unethical. Many of these unethical issues have to do with religious or philosophical beliefs people have with vaccination. A current example of this is with the HPV vaccine, which girls age 11 to 12 are required to take. Many believe that this vaccine, which protects against a sexually transmitted disease, goes against beliefs of abstinence. (“The College of Physicians of Philadelphia”, 2018) Although a handful of society is against compulsory vaccination, the pros out way the cons when it comes to vaccinating the population and providing herd immunity for the ones who are unable to be vaccinated.
One of the biggest successes that came along with vaccination was the eradication of smallpox. The eradication of smallpox is one of the most famous eradications in medical history. Smallpox was eradicated on May 8, 1980, 2.5 years after the last documented naturally occurring case of smallpox. In 1966 the World Health Assembly voted on a budget to eradicate smallpox. Mass vaccination programs were set in place for many western countries. Although it was not possible to set these vaccination policies in place in developing countries, surveillance and containment were done in an attempt to eradicate the disease in those areas. Ring vaccinations were done to isolate those who had smallpox, and vaccinate those around them. Hospital practices were also changed in an attempt to limit the spread of smallpox in hospital, which at one point played a major role in outbreaks of smallpox. (Strassburg, 1982) The fact that smallpox is not a zoonotic disease also helped in the eradication of the disease, because we did not have to worry about animal vectors when curing the disease. By the end of the 20th century, smallpox had been eradicated, and society was saved from one of the biggest microscopic nightmares in history.
References
“Smallpox.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 5 Dec. 2016, www.cdc.gov/smallpox/clinicians/clinical-disease.html.
Britannica, The Editors of Encyclopaedia. “Smallpox.” Encyclopædia Britannica, Encyclopædia Britannica, inc., 31 Jan. 2018, www.britannica.com/science/smallpox.
“Smallpox: Variolation.” U.S. National Library of Medicine, National Institutes of Health, 30 July 2013, www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html.
Riedel, Stefan. Proceedings (Baylor University. Medical Center), Baylor Health Care System, Jan. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/.https://www.historyofvaccines.org/content/articles/ethical-issues-and-vaccines
Strassburg, Mark A. “The global eradication of smallpox.” American Journal of Infection Control, Mosby, 29 Mar. 2005, www.sciencedirect.com/science/article/pii/0196655382900037?via%3Dihub.