Small pox
 

[B][B][U]Smallpox description [/U][/B]
Smallpox was probably the greatest single incentive towards the precipitation of modern western science and to the onset of the field of immunology. Smallpox has been with us for as long as we have historical records. It is a virus, called the variola virus, that possibly mutated from cattle to be capable of infecting humans. It is suggested that as humans became less nomadic and settled into sedentary farming practices, the cattle domesticated for food were probably the contact point for transfer of the smallpox agent.

There are several substrains of smallpox, some more virulent than others. Typically the death rate from infection with smallpox was around 25%, a three in four chance of survival. However, more aggressive strains pushed the death rate to around 40% in some outbreaks. With no defense against this threat it is perhaps not surprising the ancient world became very fatalistic and were resigned to the fact of infection. Smallpox was part of life, and death.

Symptoms of smallpox infection first included a fever, headache, a feeling of perpetual weakness and exhaustion associated with joint pain. After several days the visible signs of smallpox developed. First a rash and then development of skin blisters. In severe cases the blisters became so dense as to coalesce into giant pustules. If the individual survived the pustules left scars or "pocks". Death was slow, painful and probably came as a relief for those who were severely affected. Those who were weaker, the very young and the very old died swiftly.

We rarely hear about smallpox today. It is no longer a threat to the human race. So much so that vaccination against it is no longer required. The last infection of smallpox was recorded in 1977 and currently the only known sources of small pox are languishing in two laboratories, one in the US and one in Russia. The final chapter of the smallpox saga is bing written right now. The World Health Organization will decide whether the two research laboratories should destroy their smallpox stocks. The final decision on its destruction will come any day now.

[B][U]Human history of smallpox and the birth of modern science [/U][/B]
Arguably the person who brought variolation to Europe was Lady Mary Wortly Montagu. As an aristocrat she was no stranger to court of King George I and as a resident of London in the early 1700s she was at considerable risk of contracting smallpox. Smallpox was no respecter of social status and Lady Montagu was infected but recovered with permanent pocked skin and loss of hair from the scarring. Soon after her recovery her husband, Edward Wortly, Montagu was posted to Constantinople (Istanbul) as ambassador. While there, Lady Montagu learnt of smallpox inoculation as practiced by Turkish physicians. The transfer of smallpox as a form of controlled infection had expanded west from China along the traditional trade routes to Constantinople. The technique was called variolation. This was derived from the name of the infective agent which is the variola virus. The risk of death from variolation was around 2%, a risk but a considerable improvement on the death rate for uncontrolled infection.

Clearly impressed and with her own experiences uppermost in her mind, Lady Mary had her son inoculated with smallpox. Her son survived and despite regular exposure to smallpox epidemics never (that we are aware of) became infected again. On her return to London the publicity her actions caused came to the attention of many physicians and ultimately the Royal Family. Although the medical practitioners were extremely resistant to the idea, King George decided that his children should be inoculated. However, first he wanted to see the effects and dangers of inoculation for himself. In 1721 Six volunteer condemned prisoners were inoculated with pus from a smallpox infected individual. The notion that using humans in experimental trials may be unethical was unheard of at the time. The prisoners were in effect the property of the King at that time. Fortunately, all the prisoners survived the inoculation and their prize was a full pardon and release from prison. Further experiments were conducted for the Royal Family including the inoculation of orphans (Originally the Royal Family wanted an entire orphanage inoculated. Again, they were seen as crown property!). Eventually the Royal Family was convinced and Princess' Amelia and Caroline were inoculated and survived. The reporting of the Royal Family's use of variolation resulted in a wave of copy cat inoculations in the aristocracy.

However, variolation was still limited in its use. The practice met resistance because the general population were not prepared for this scientific advance. There was still a risk of death, variolation could potentially spread the disease as inoculated people were temporarily carriers for smallpox and the greatest resistance came from the church who condemned the practice as heathen and immoral. In the US the resistance may have stemmed in part from racism. Inoculation was known to have been practiced by slaves. In essence society had not developed to the degree of scientific and social sophistication required to make the jump in comprehending how variolation might work and why its use may have been an advantage. This is a problem that has dogged medical developments to this day and we will touch on the subject again
[B][U]Edward Jenner [/U][/B]

Enter stage left Edward Jenner. Contrary to popular belief Jenner was not at first interested in smallpox and did not consciously set out to make any medical advance. He was interested in the possibility that animal diseases may spread to other species and possibly humans. This made Jenner something of a social pariah. His ideas went against popular belief and the church. Also, he was not medically qualified which gave him a low social status in the eyes of the medical community.

Jenner believed that cow pox was derived from horses and from there it was a small step to the idea that smallpox was derived from cowpox. We know little about Jenner's development of thought but it would seem that he arrived at the notion that smallpox and cow pox were related and that inoculation with cowpox might confer resistance to smallpox. He was well aware of the practice of variolation and he was also aware of the belief in the rural community that infection with cowpox led to immunity against smallpox.

In 1796 Jenner, collected pus from cowpox sores on the hands of milkmaid Sarah Nelmes and inoculated eight year old James Phipps. Phipps developed a fever but nothing more. Then Jenner inoculated Phipps with pus from active smallpox. The boy developed no reaction to the smallpox inoculation. Jenner conducted several similar successful experiments but met with resistance when trying to publish his work. Eventually Jenner had to publish his experimental results at his own expense. At first derided and laughed at, with the suggestion that cowpox inoculation would make people grow horns, the idea was taken up by a few enlightened physicians. Their confirmation of Jenner's observations gradually led to acceptance of "vaccination". Cowpox is the result of the "vacca" virus. Hence the term "vaccination" (Vacca is Latin for cow).

Vaccination was adopted over variolation. Its advantages were clear. Conference of resistance to smallpox without risk of death as was possible with variolation. Within fifty years of the discovery most European countries had initiated compulsory vaccination. Success was at first highly variable depending on the strain of cowpox virus used and how it was applied. Without knowledge that they were dealing with a virus, vaccination techniques developed through trial and error. That pus which seemed to confer greater resistance was propagated in cattle and collected. The "booster shot" also developed when it was realized that resistance to smallpox through vaccination was not always life long.

The enforced programs were probably the significant factor in spread of vaccination over variolation. The same reasons for resistance to variolation were still present in the general population. However, the medical community had developed to the extent that its influence had the ear of the politicians. While vaccination programs may have led to greater social maturity in acceptance of scientific principle it still did not provide a suitable environment for development of an understanding that the human body may have a defense system against infection. Jenner, never attempted to explain why or how vaccination might work, it just did and that was good enough.[/B]