The End of Smallpox

Article excerpt

Derrick Baxby looks at the history of smallpox vaccination, how it was opposed by many, and how the disease was finally eradicated.

Anyone asked to define `conscientious objector' would undoubtedly describe someone refusing military service on religious or moral grounds. However the term entered English Law in 1898 to describe those who risked fines and imprisonment for refusing vaccination for their children. We now refer to measles and polio vaccines and the prospect of AIDS vaccines as a matter of course, but a hundred years ago there was only one common human vaccine -- that for smallpox -- introduced in 1798 by Edward Jenner (1749-1823). In 1967 smallpox was targeted for eradication, an achievement officially certified in 1980. The surviving stocks of the smallpox virus are scheduled for destruction this year. This, then, is perhaps an appropriate moment to examine the varied impact, particularly in Britain, of what Macaulay called `the most terrible of all the ministers of death'.

By the seventeenth century the pustular disease known as smallpox (so called to distinguish it from the `Great Pox' -- syphilis) was sufficiently familiar for its impact to be assessed. Plague was feared, but occurred in Britain only occasionally; smallpox was always present. In the words of Macaulay,

   tormenting with constant fears all whom it had not yet stricken, leaving on
   those whose lives it spared the hideous traces of its power, turning the
   babe into a changeling at which the mother shuddered, and making the eyes
   and cheeks of the betrothed maiden objects of horror to the lover.

Smallpox infected most individuals in populous areas eventually and killed 20 per cent or more. It was particularly severe in city children, killing one in three. The disease was spread to close contacts by air and not by vermin or contaminated water, so, although common in overcrowded conditions, it was not necessarily a disease of poverty or ignorance and attention has always focused on its famous victims. Smallpox was particularly evident in the family of Charles I and, through the death of Queen Anne's heir, William Henry, Duke of Gloucester aged eleven, ended the Stuart dynasty. Other royal victims included Joseph I of Austria, Louis I of Spain, Peter the Great and Louis XV. Prominent survivors included Elizabeth I, Louis XIV, Mozart and Abraham Lincoln who was incubating smallpox when he gave the Gettysburg Address.

Survivors were usually left scarred and as a result it became obvious that second attacks were very rare. This provided the first clue to prevention. In the 1700s Europeans in contact with the East learned that natural smallpox could be prevented by inducing deliberate infection, via the skin, which was often less severe. Introduced into Western society in 1721 by Lady Mary Wortley Montagu who had seen it in Constantinople, the method was called `inoculation' from the horticultural analogy; in oculum -- grafting a bud (`eye') onto another plant. For reasons still not fully understood, inoculated smallpox tended to be less severe, killing on average one in 200. Faced with the virtual certainty of catching severe, natural smallpox, many risked inoculation and successful inoculators became rich. For example, in 1768 Thomas Dimsdale visited Russia to inoculate Catherine the Great and was awarded 10,000[pounds sterling], a barony, and an annuity of 500 [pounds sterling].

Although particularly useful when epidemics threatened, smallpox inoculation could still sometimes kill (George III's son Octavius died following inoculation in 1783), while the mildest inoculated case could transmit fatal infection to other contacts. A safer alternative was needed. This was provided by Edward Jenner. Jenner is often regarded as a simple county doctor. However, he was well trained by the great surgeon John Hunter and was elected Fellow of the Royal Society in 1789 for demonstrating the murderous habits of the newly-hatched cuckoo. …