Vaccination: Smallpox Smallpox is a deadly infectious disease caused by the Variola virus, which at one

4.1.1 Vaccination: Smallpox Smallpox is a deadly infectious disease caused by the Variola virus, which at one

time caused more than 10% of all the deaths in the world and killed an estimated 400,000 Europeans each year during the eighteenth century, including over 80% of infected children. It is also a symbol of one of the greatest successes in modern medicine, and in 1979 was declared by the World Health Organization to be eradi- cated. This amazing turnaround was accomplished by the development of the first vaccine. Early variations on the vaccine were possible because the Variola virus occurred in two forms: a major form with an overall mortality rate of 30–35% and a minor form with only a 1% mortality rate.

A form of inoculation against smallpox was performed in Asia and Africa, and spread to Europe later. This practice of inoculation was introduced in England by Lady Mary Montagu who observed its practice by Turkish physicians in Constantino- ple around 1716. She learned to take liquid from a smallpox blister in a mild case, and carried it in a nutshell to inoculate her family in London. This practice spread among the royal families of Europe. In America, Cotton Mather learned about the African practice of inoculation from a Sudanese slave, and inoculated many people in Boston in 1721. Voltaire in France also advocated inoculation. Inoculation in the East was historically performed by blowing smallpox crusts into the nostril. The European method involved taking material from a smallpox pustule on a mildly infected person and rubbing the material into a scratch on the skin of the person on the receiving end. This method was called variolation, and conferred upon the recipi- ent a much milder case of smallpox and thereby immunity from the more deadly major form of smallpox. However, with this method patients still contracted the smallpox infection although in a minor form. This resulted in many weeks of sickness as well as fasting, purging, bleeding, and isolation as was the custom at that time.

Edward Jenner (1749–1823) was a surgeon and general practitioner in England. As a child, he went through the ordeal of variolation. He first received recognition and was elected a fellow of the Royal Society in 1788 for his observa- tions on cuckoos and their habit of stealing other birds’ nests and pushing their eggs and fledglings from the nest. As an adult physician, he heard that milkmaids who had contracted the much milder sickness of cowpox became immune to smallpox. This piece of folk wisdom had never been tested definitively. In 1796, Jenner treated a milkmaid named Sarah for cowpox. Later, he obtained parental permission to inocu- late 8-year-old James Phipps, by taking fluid from a cowpox pustule on Sarah’s hand and putting it on two scratches on the boy’s arm. Seven days later, James complained of mild discomfort but completely recovered. A month later, Jenner inoculated James on both arms with fresh material taken from a smallpox pustule. James developed blisters within a few days where he had been inoculated, but showed no sign of disease. Jenner was able to demonstrate with a series of 23 subjects that immunity to smallpox had been achieved by this procedure of inoculation with cowpox.

Jenner was convinced that he had discovered a great boon to mankind, and he called this vaccination. He drafted a paper for the Royal Society that was rejected, so he published the results privately in 1798. Cowpox vaccination proved to be effective in preventing smallpox and was far safer than smallpox inoculation, and

121 spread throughout the world with great speed. In 1840, the British government ban-

4.1 PREVENTION

ned variolation with smallpox, and provided vaccination with cowpox free of charge. This was one of the first times in human history when a medical doctor had something truly effective to offer the patients, besides high sounding theories and advice on healthy habits. Now there are vaccinations for a wide range of diseases including rabies (Pasteur 1885), tuberculosis, polio (Salk 1953), diphtheria, cholera, typhoid, whooping cough, and influenza. Since 1980, smallpox has been an eradi- cated disease and remains only in laboratories in the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.