SMALLPOX

Smallpox is an acute infectious disease caused by the variola virus. It appears in many forms, some which are very mild and others that are usually fatal. Although the disease has been eradicated since 1977, during the eighteenth century, smallpox became one of Europe's most feared diseases, usually appearing in cycles of between five to seven years. Symptoms include headache, high fever, and vomiting; after the fever subsides, red spots appear that become filled with pus. Scabs formed by the drying out of the pustules fall off between one and three weeks later, leaving permanent scars. Some survivors were left blind by the disease and nearly all were disfigured to some degree.

It is hard to say whether deaths from smallpox actually increased or merely became more visible following the retreat of plague from western Europe. Yet there is some evidence to suggest that epidemics—like those that ravaged Europe in the 1750s—became more common as commercial and agricultural revolutions united hitherto remote populations.

inoculation and vaccination

More attention began to be paid to the best means of treating and preventing the disease. Early in the century, the practice of inoculation—the use of the dried crusts of smallpox pustules to induce a mild form of the disease—was introduced into Europe from the Middle East. The practice could confer lifelong immunity but it was risky and many of those inoculated died, either from smallpox or some other infection introduced by the inoculator's lancet.

The appeal of inoculation was understandably limited. Most enthusiasm was shown by the aristocracy, which dreaded scarring from smallpox as something that adversely affected marriage prospects and, hence, the continuation of their dynasties. Outside the royal courts the practice thrived only where it was actively promoted by private individuals, such as improving landlords and philanthropic doctors. Inoculation was never embraced by the state and there is little evidence that it contributed materially to the stabilization of mortality that occurred in many European countries during the eighteenth century.

The advent of vaccination, by contrast, made an enormous difference. Pioneered by an English doctor, Edward Jenner (1749–1823), vaccination was based on the observation that milkmaids who contracted cowpox in the course of their work were seldom afflicted by the more serious disease, smallpox. In 1796 Jenner designed an experiment to test this, inoculating a local boy with cowpox and then with smallpox; he found that no symptoms of smallpox appeared. Further experiments confirmed these findings, and Jenner's new technique of "vaccination" was rapidly accepted by many medical practitioners and statesmen, including the French emperor Napoleon I and Thomas Jefferson. Indeed, many European states were quick to promote vaccination as a way of preventing costly and unnecessary deaths, and it soon became compulsory among key groups such as soldiers and sailors. Within a decade or so after Jenner's discovery, some local authorities in Britain were demanding vaccination before administering poor relief, while states such as Bavaria made it compulsory for those entering apprenticeships.

Thereafter, compulsory vaccination spread to other sections of the population, but with some national differences. One might expect authoritarian states to have proceeded more rapidly than others, but this was not always the case. Britain, which was famed for its liberalism, was quicker to introduce vaccination than was autocratic Prussia, for instance. In 1840 Britain was the first country to ban inoculation, and in 1853 it passed an act making vaccination compulsory within three months of birth. Prussia felt no need to follow suit at that time because its provisions for voluntary vaccination were so extensive.

opposition to vaccination

Yet vaccination had numerous detractors. Its supporters found it difficult to explain the fact that some of those who had been vaccinated were still susceptible to smallpox. Such cases were comparatively few but they were sufficient to raise doubts about the efficacy of the operation among the public; at least until the introduction of revaccination later in the century. Infection was another serious problem. Multiple incisions were made with lancets and lymph from a previously vaccinated child was rubbed into them. This arm-to-arm method carried with it the risk of infection with diseases like erysipelas—a problem that was overcome in the 1880s and 1890s with the widespread use of lymph harvested from cows and the addition of glycerine, which killed many bacterial infections.

As vaccination was promoted more aggressively by the state, rumors abounded that governments were seeking to poison the lower classes or to "brand" them like cattle. There were also protests against the fines imposed on those who refused to bring children for vaccination. Nor was opposition confined to the working class. Concerns were expressed generally about compulsory vaccination as an infringement of civil liberties, while in some countries, especially Germany, advocates of holistic medicine argued that vaccination was unnecessary and unnatural, as it violated the integrity of the human body.

Opposition to vaccination grew in the face of more concerted efforts to prevent the disease, in the wake of the dreadful epidemic that afflicted Europe in the early 1870s. The epidemic appears to have begun in France immediately before the war with Prussia, and it spread via French prisoners of war to Prussian civilians. Claiming the lives of around half a million people, the epidemic spurred newly unified Germany to introduce compulsory vaccination and revaccination in 1874. The act provoked considerable resistance, and petitions amounting to over thirty thousand signatures were sent to the Reichstag. Many in France also wished to move toward compulsion, especially in view of the fact that the Prussian army (in which vaccination had been compulsory since 1834) suffered fewer than three hundred deaths from smallpox by comparison with over twenty-three thousand among French troops. Yet political conditions in the new Third Republic prevented the passage of such legislation until 1902.

Despite widespread resistance to compulsion, anti-vaccinationists won few victories. Only in Britain did they enjoy some success and then because their demands were moderate—the introduction of opt-outs for those who refused vaccination on grounds of conscience. Most European countries experienced a marked decline in smallpox mortality between 1880 and 1914. The disease continued to be a major cause of death only in Russia, Spain, Italy, and Portugal, which had poorly developed systems of vaccination. Other countries experienced falls in mortality consistent with the dates at which legislation was enacted and the rigor with which it was enforced. For example, in 1910 Russia suffered 400,000 recorded deaths from smallpox and Spain 37,000, whereas France had 11,000 and Germany only 386. The disruption caused by World War I inevitably led to an increase in smallpox deaths throughout Europe, with the worst epidemics occurring in countries such as Russia and Italy. Many central and western European countries also experienced epidemics but they were able to prevent the widespread devastation that had followed the war between France and Prussia in 1870. In these countries, smallpox was increasingly perceived as an alien disease, associated either with immigrants from eastern Europe, or with "reservoirs" of infection in Europe's Asian and African colonies.

See alsoJenner, Edward; Public Health; Science and Technology.

bibliography

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Harrison, Mark. Disease and the Modern World: 1500 to the Present Day. Cambridge, U.K., 2004.

Hopkins, Donald R. The Greatest Killer: Smallpox in History. Chicago, 2002.

Porter, D., and R. Porter. "The Politics of Prevention: Anti-Vaccinationism and Public Health in Nineteenth-Century England." Medical History 32 (1988): 231–252.

Razzell, Peter. The Conquest of Smallpox: The Impact of Inoculation on Smallpox Mortality in Eighteenth Century Britain. Sussex, U.K., 1977.

Mark Harrison