The story of smallpox

07 March 2016

Interview with

Dr Mary Dobson, University of Cambridge

There's a disease dubbed the Angel of Death, which has wiped out millions Edward Jennerthroughout history. Thankfully, it's also famous for becoming the first disease humanity ever managed to eradicate. Georgia Mills spoke to medical historian Mary Dobson to get the story of smallpox.

Georgia - I wanted to hear the story of how smallpox went from being one of the world's deadliest diseases to being one of sciences greatest success stories.  So, I went to meet medical historian and author of the book "Murderous Contagion," Dr Mary Dobson at Cambridge University Farm to find out about this disease...

Mary - It really was a devastating disease.  People would be covered in horrible pustules; they would be exceptionally painful; some would die from a hemorrhagic fever; probably a third of those who contracted smallpox would die;  survivors could be pockmarked for the rest of their lives and, I think, an unknown, not often mentioned is blindness, so again, those who survived could be blind for life.

Georgia - With such a frightening prognosis, smallpox left a significant mark on history. British historian Lord Macaulay made this observation in the 1800s.

"The smallpox was always present, filling the churchyards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it had 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 the objects of horror to the lover..."

It affected rich and poor alike, knowing no class boundaries. Ramses V, Abraham Lincoln and even Mozart all contracted smallpox, so how did people try and avoid this dreaded disease?

Mary -  I think smallpox is an interesting case because people were aware that it was contagious, so prevention was one of trying to avoid being close to a contagious person.  Bloodletting was the cure for almost everything in the old days, right up to the mid nineteenth century.  It would have done very, very little good for anyone suffering from smallpox.  So, not a lot that they could do but numerous old remedies are concocted...

Georgia - I think I read one that was powdered horse manure...

Mary - Yes, powdered horse manure is one of those good old fashioned remedies -  anything from garlic to alcohol or herbs.  Around the 10th century in China it was said that they removed scabs from the drying pustules of a smallpox patient, pounded them into powder and then blew a few grains into the nose of people who had not had the illness...

Georgia - Ewh...

Mary - Yes, and one of the things that amuses me is: up the right nostril for a boy and the left one for a girl...

Georgia - Of course...

Mary - Who knows why!

Georgia - This idea of infecting healthy people intentionally with small parts of the virus did actually work to some extent but what came next in the fight against smallpox changed everything - the vaccination.  And it's at this point we meet a key player in the story - the humble cow - or rather we met about 30 of them including one very bold character who wanted to join in with the interview.

It's trying to eat the microphone! No, no...  

But what do cows have to do with the smallpox vaccine?

Mary - Well - you could actually say vaccination.  The word vaccination is from vacca which is the Latin for cow.  The discovery of vaccination which is credited to Edward Jenna in 1796 is because he took up a local story that milkmaids who contracted something called cowpox, possibly from infected udders of cows, were immune to smallpox.  And, after some years, he took a very, very brave decision to try out an experiment and there was a young girl, a milkmaid, Sara Nelms who had cowpox.  So he took from one of her pustules from cowpox some of the matter and he then used the son of his gardener, a young boy called James Phipps, and he scratched some of the pus into James Phipps.  Six weeks later, he inoculated smallpox virus (living virus) into James Phipps to see whether the cowpox had indeed protected him, and the result was James Phipps did not get smallpox.

Georgia - Cowpox was a similar virus to smallpox but much let dangerous so, once this boys immune system learnt to recognise it, smallpox no longer held a threat.  Ladies and Gentleman... the world's first vaccine.  After initial rejection from his peers at the Royal Society, Jenna's ideas took off and vaccines made their way all across the world. Starting in Gloucestershire, ending up in Europe, Russia and making it all the way to the Far East.  But, even though these vaccines saved millions, people were still contracting the disease right up until the 1900s.

Mary - So, in the 1960s, we've got about 10-15 million people contracting smallpox a year - probably about 2 million deaths.  So the World Health Organisation took this as a very serious threat.  There was a vote and it only went ahead by two votes to embark on an intensified ten year smallpox eradication programme. Initially, they started with mass vaccinations, so the idea was to just vaccinate everybody.  A new technique was freeze-dried vaccine, which was good for tropical climates and, actually, South America was free by 1972, but Africa and Asia were formidable barriers.  I look back and reading the accounts of those dedicated workers who crossed jungles, rivers, reached outlying rural communities to try and vaccinate communities.  It is an incredible story and they were heroic - absolutely heroic. It was also a campaign that transcended ideological and political boundaries.  It was during the cold war and, actually, the U.S. and the Soviet Union fully cooperated so I think that was really interesting.

1979 - The World Health Organisation based in Geneva announced eradication.  A momentous, absolutely momentous timing and one of the perhaps saddest and ironic twists to the smallpox eradication success is that in 1980, it's eliminated from the list of world infectious diseases.

1981 - a year later, we hear of the first cases of HIV Aids.  I find it really very sad that juxtaposition between this incredible success story and the sadness with which the HIV Aids story broke in the 1980s.

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