Preventing Smallpox
To combat the deadliness of smallpox, people tried everything they could to prevent and cure the disease. Naturally, in ancient Africa and Asia, people prayed to the smallpox gods and goddesses in hopes that they might answer their prayers and save them from the disease. Later, during the medieval times, people believed that “like cures like” and so they would have people infected with the disease dress in red and surround them with as much red as they could find. The color red was significant because of the color of the pustules on an infected person. As might be expected, this also failed to cure anyone of the disease. However, this folklore may have led to the invention of a technique that was successful in inoculating someone of the disease.
The first academic record of someone referencing variolation appeared in 1675. Variolation is the practice of scraping off matter from the pustules of an infected person and rubbing it on an uninfected person. This inoculated the uninfected person and gave them protection from the disease. This practice was eventually discovered by Lady Mary Montague, the wife of the British ambassador to Turkey. While in Turkey, she met a doctor by the name of Emmanuel Timoni, who practiced variolation. Having survived smallpox, Lady Mary Montague had her children variolated and she returned to England, she publicly promoted the practice and was able to convince the Princess of Wales, Caroline, to try variolation. Caroline was initially skeptical of the practice, so she had several trials to test the effectiveness of the practice. First, they offered six prisoners going to be hanged the option to be variolated and go free or die. The prisoners chose variolation and all survived and never suffered from the disease. Not satisfied, Caroline had six orphans in St. James Parish variolated. This demonstration was also successful. The reception to this, however, was met with resistance from the clergy as the act of variolation was an action against the will of God. One problem with variolation is that the person who is variolated is still contagious and if not careful, can easily spread it to vulnerable people and there was a mortality rate around 2%. In the Americas, Cotton Mather learned about variolation from an African slave and from a report written by Emmanuel Timoni to the Royal Society of London. Together with Zabdiel Boylston, they variolated 242 Bostonians after a smallpox epidemic that had a mortality rate of 15%. Mather and Boylston found a variolation death rate of around 2.5%, similar to Timoni. During the Revolutionary War, Washington had his troops variolated and was able to take control of Boston from the British, who were not variolated. Eventually, all soldiers in the military were variolated and no longer suffered from smallpox. Variolation was the first attempt at preventing smallpox that actually worked.
In the late 18th century, people started to notice that those who tended to cows never contracted smallpox. They believed that people who contracted cowpox would be protected from smallpox. Farmers who came in contact with cowpox would develop a mild reaction to the disease but would only suffer a few blisters. Once exposed to cowpox, people would not contract smallpox upon exposure. Edward Jenner experimented with this concept and spent many years taking a small drop from a pustule and rubbing it on the skin of an uninfected person and later directly expose them to smallpox. This technique proved to be very reliable and safer than variolation. The advantage of vaccination is that it is safer to use with a lesser mortality rate and it does not put anyone else at risk of infection. By the turn of the century, vaccination was a worldwide practice. Vaccines were being produced by infecting calves with cowpox and collecting lymph. The lymph could then be used to vaccinate a vulnerable person. Vaccinations have since proved time and time again that they are the best way at preventing disease.
The social impact of Jenners vaccination was not unlike the hesitance people express towards vaccinations today. Benjamin Waterhouse was an American physician and professor at the Harvard Medical School who advocated for the “Jennerian Technique”. Waterhouse was able to convince Thomas Jefferson to write a law that encouraged people to get vaccinated, however, Waterhouse had political enemies who wanted him removed from Harvard and were successful in repealing the vaccination law. The hesitance towards vaccinations led to more epidemics and an increasing number of deaths due to smallpox. Eventually, when public schooling became mandatory, vaccination could be enforced by making it mandatory for kids to be vaccinated to attend school. In 1902, the Supreme court ruled that it was legal for states to require people to be vaccinated if doing so would protect the public from a dangerous communicable disease. Unfortunately, more and more people today are refusing to get vaccinations and are making it easier for diseases to spread, despite all of the knowledge we have on vaccinations.
In the late 1960’s, a program was started to begin the eradication of smallpox and by 1980, the World Health Organization declared smallpox to be extinct. The program was successful due to surveillance and containment. The strategy was to find every reported case of smallpox and vaccinate everyone in the surrounding area who could potentially get the disease. The last reported case of naturally occurring smallpox was in 1977. However, once this program was finished, everyone had to figure out what we were going to do with the vaccines. Some people wanted all of the vaccines and samples of smallpox to be destroyed while others wanted to keep the samples and hold them in an undisclosed secure location so that we have access to the vaccine in the future if need be. It was decided that the vaccines and samples would be kept. However, people stopped getting the smallpox vaccine after it was eradicated and the only people in the U.S. who get vaccinated are members of the military. This leaves those who were born after the eradication vulnerable to a potential terrorist attack if smallpox was used to attack a city. To combat this possibility, the U.S. has a system ready to disseminate vaccinations to the public. The eradication was certainly a highlight in human history.
All information was taken from “The Power of Plagues” by Irwin Sherman and class discussion