SMALLPOX

SMALLPOX. The origin of smallpox is unknown. Smallpox is thought to date back to the Egyptian Empire around the 3rd century BCE (Before Common Era), based on a smallpox-like rash found on three mummies. The earliest written description of a disease that clearly resembles smallpox appeared in China in the 4th century CE (Common Era). Early written descriptions also appeared in India in the 7th century and in Asia Minor in the 10th century. (1)

Smallpox was a devastating disease. On average, 3 out of every 10 people who got it died. Those who survived were usually left with scars, which were sometimes severe. (2)

One of the first methods for controlling the spread of smallpox was the use of variolation. Named after the virus that causes smallpox (variola virus), variolation is the process by which material from smallpox sores (pustules) was given to people who had never had smallpox. This was done either by scratching the material into the arm or inhaling it through the nose. With both types of variolation, people usually went on to develop the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally. (3)

The basis for vaccination began in 1796 when an English doctor named Edward Jenner observed that milkmaids who had gotten cowpox did not show any symptoms of smallpox after variolation. The first experiment to test this theory involved milkmaid Sarah Nelmes and James Phipps, the 9 year-old son of Jenner’s gardener. Dr. Jenner took material from a cowpox sore on Nelmes’ hand and inoculated it into Phipps’ arm. Months later, Jenner exposed Phipps a number of times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise “On the Origin of the Vaccine Inoculation,” in which he summarized his discoveries and expressed hope that “the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice.” (4)

"Snake-oil" advertisement from 1861. Photo courtesy: Telegraph Herald

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s (the precise time remains unclear), the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus. (5)

The City of Dubuque spent $365.75 in July, 1848 to battle smallpox. (6) Records of smallpox in Iowa indicated that in 1899-1900, there were 4,792 cases with 24 deaths. The secretary of the state board of health, however, suggested that both numbers were more likely double those reported. Some places where smallpox had occurred had not reported and only seven counties reported having no cases. Increased awareness of the disease led to more students who had not been vaccinated being excluded from school. (7) It is known that 100 orphans at a Franciscan orphan asylum in Dubuque were sickened in 1900. According to a report at the time, at least four were expected to die. (8)

In 1902 the city health physician reported that for the year ending February 28, 1902, there were 308 cases of smallpox reported in the city. Of this, there were two deaths. (9) In September the board of health ordered the vaccination of all school children. In January the ordered vaccination extended to employers and employees of businesses and factories.

In June 1903 the report of the city health physician for the year ended February 28, 1903 indicated there were 69 reported cases of smallpox. (10)

Citizens were concerned in 1916 about the "detention hospital" at the foot of 17th Street operated in Dubuque for those diagnosed with smallpox. It was described in the Dubuque Telegraph-Herald as "worse than a barn" and was the subject of an appeal by the City of Dubuque Board of Health. (11) In April two patients in the last stages of the disease were removed by the order of Mayor Saul when the building was threatened by flooding. Attempts to find adequate housing met with objections of those living nearby. It was evening before shelter was found at a site unannounced. (12) The new detention hospital was rapidly nearing completion near EAGLE POINT in 1920. (13) See: PEST HOUSE

In 1920 a city commission was organized by the board of health, physicians were requested to report all cases of smallpox immediately, and bulletins were sent out advising people of the need to be vaccinated. (14) During that year, there were twenty-four reported cases and ninety-five families were quarantined at Christmas. (15) Leaving a residence while under quarantine was punishable by fine. (16)

In December 1921 City Manager Ossian E. CARR wrote to the police and fire department with pride that the city had not a single case of smallpox. He stated, however, that due to the fact that members of both departments came into contact with large numbers of people they would be required to be vaccinated unless they had received the vaccine within five years. Directions had been sent to hotels alerting them of the need to have employees be vaccinated. (17) Carr's report should have been questioned. City health records indicated that two cases were reported in December and twelve families were quarantined. (18)

In 1924 vaccination was still urged to prevent smallpox. In August only one mild case had been reported, but this person had been in contact with many others. Readers were reminded of the 226 people who died in Kansas of the disease in 1922 or than an estimated 60 million died during the 19th century. While voluntary vaccination might be considered the most ideal method, it had been shown that states and countries with strict vaccination laws had the least disease. (19)

In 1959, the World Health Organization (WHO) initiated a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from lack of funds, personnel, and commitment from countries, as well as a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks in multiple countries across South America, Africa, and Asia. (20)

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. This time, laboratories in many countries where smallpox occurred regularly (endemic countries) were able to produce more, higher quality freeze-dried vaccine. A number of other factors also played an important role in the success of the intensified efforts, including the development of the bifurcated needle, establishment of a surveillance system to detect and investigate cases, and mass vaccination campaigns, to name a few. (21)

By the time the Intensified Eradication Program began in 1967, smallpox had already been eliminated in North America (1952) and Europe (1953), leaving South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977). (22)

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Source:

1. "History of Smallpox," Centers for Disease Control and Prevention, Online: https://www.cdc.gov/smallpox/history/history.html

2. Ibid.

3. Ibid.

4. Ibid.

5. Ibid.

6. Oldt, Franklin T. and Patrick J. Quigley. The History of Dubuque County, Iowa, Chicago: Goodspeed Historical Association, 1890, p. 84

7. "State Board of Health," Dubuque Telegraph-Herald, October 10, 1901, p. 5

8. Hogstrom, Erik. "Germ Warfare," Telegraph Herald, November 10, 2008, p. 40

9. "Report for Year," Dubuque Telegraph-Herald, March 25, 1902, p. 5

10. "City Council," Dubuque Telegraph-Herald, June 12, 1903, p. 6

11. "Editorial," Dubuque Telegraph-Herald, December 3, 1916, p. 16

12. "Patients Removed From Hospital," Dubuque Telegraph-Herald, April 13, 1916, p. 12

13. "Officials View Sanitary Sewer," Dubuque Telegraph-Herald, August 2, 1920, p. 2

14. "City Commission Also Health Body," Dubuque Telegraph-Herald, April 27, 1920, p. 2

15. "Dubuque Free From Black Smallpox," Dubuque Telegraph-Herald,December 25, 1921,p. 9

16. "Violates Health Rules; Fined $5.00," "Dubuque Telegraph-Herald, December 21, 1920, p. 19

17. "Dubuque is Free From Smallpox," Dubuque Telegraph-Herald, December 16, 1921, p. 9

18. "Dubuque Free From Black Smallpox..."

19. "Fight Smallpox With Vaccination, Physician Urges," Telegraph Herald, August 1, 1924, p. 15

20. "History of Smallpox"

21. Ibid.

22. Ibid.