Dark Winters . . .

#SmallPox #EdwardJenner #Immunology #AncientDisease #AnnaPerdue

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[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

For many centuries, smallpox devastated mankind. In modern times we do not have to worry about it thanks to the remarkable work of Edward Jenner and later developments from his endeavors. With the rapid pace of medical development in recent decades, the historic origins of immunization are often forgotten.

Unfortunately, since the attack on the World Trade Center on September 11, 2001, the threat of biological warfare and bioterrorism has reemerged. Smallpox has been identified as a possible agent of bioterrorism. Especially since the leader of the supposed free-world likes to bring up the Dark Winter from time-to-time. It seems prudent to review the history of a disease known to few people in the 21st century.

Edward Jenner is well known around the world for his innovative contribution to immunization and the ultimate eradication of smallpox. Jenner's work is widely regarded as the foundation of immunology—despite the fact that he was neither the first to suggest that infection with cowpox conferred specific immunity to smallpox nor the first to attempt cowpox inoculation for this purpose.

The origin of smallpox as a natural disease is lost in prehistory. It is believed to have appeared around early pre-history, at the time of the first agricultural settlements in northeastern Africa. It seems plausible that it spread from there to India by means of ancient Egyptian merchants.

The earliest evidence of skin lesions resembling those of smallpox is found on faces of mummies from the time of the 18th and 20th Egyptian Dynasties (1570–1085 B.C.). The mummified head of the Egyptian pharaoh Ramses V (died 1156 B.C.) bears evidence of the disease. At the same time, smallpox has been reported in ancient Asian cultures: smallpox was described as early as 1122 B.C. in China and is mentioned in ancient Sanskrit texts of India.

Smallpox was introduced to Europe sometime between the fifth and seventh centuries and was frequently epidemic during the Middle Ages. The disease greatly affected the development of Western civilization. The first stages of the decline of the Roman Empire (108 A.D) coincided with a large-scale epidemic: the plague of Antonine, which accounted for the deaths of almost 7 million people.

The Arab expansion, the Crusades, and the discovery of the West Indies all contributed to the spread of the disease. Unknown in the New World, smallpox was introduced by the Spanish and Portuguese conquistadors. The disease decimated the local population and was instrumental in the fall of the empires of the Aztecs and the Incas. Similarly, on the eastern coast of North America, the disease was introduced by the early settlers and led to a decline in the native population.

The devastating effects of smallpox also gave rise to one of the first examples of biological warfare. During the French-Indian War (1754–1767), Sir Jeffrey Amherst, the commander of the British forces in North America, suggested the deliberate use of smallpox to diminish the American Indian population hostile to the British. Another factor contributing to smallpox in the Americas was the slave trade because many slaves came from regions in Africa where smallpox was endemic.

Smallpox affected all levels of society. In the 18th century in Europe, 400,000 people died annually of smallpox, and one third of the survivors went blind. The symptoms of smallpox, or the “speckled monster” as it was known in 18th-century England, appeared suddenly and the sequelae were devastating. The case-fatality rate varied from 20% to 60% and left most survivors with disfiguring scars.

The case-fatality rate in infants was even higher, approaching 80% in London and 98% in Berlin during the late 1800s. The word variola was commonly used for smallpox and had been introduced by Bishop Marius of Avenches (near Lausanne, Switzerland) in 570 A.D. It is derived from the Latin word various, meaning “stained,” or from various, meaning “mark on the skin.”

The term small pockes (pocke meaning sac) was first used in England at the end of the 15th century to distinguish the disease from syphilis, which was then known as the great pockes. It was common knowledge that survivors of smallpox became immune to the disease. As early as 430 B.C., survivors of smallpox were called upon to nurse the afflicted. Man had long been trying to find a cure for the “speckled monster.”

During medieval times, many herbal remedies, as well as cold treatment and special cloths, were used to either prevent or treat smallpox. Dr. Sydenham (1624–1689) treated his patients by allowing no fire in the room, leaving the windows permanently open, drawing the bedclothes no higher than the patient's waist, and administering “twelve bottles of small beer every twenty-four hours”.

However, the most successful way of combating smallpox before the discovery of puncture treatment was inoculation. The word is derived from the Latin inoculare, meaning “to graft.” Inoculation referred to the subcutaneous instillation of smallpox virus into nonimmune individuals. The inoculator usually used a lancet wet with fresh matter taken from a ripe pustule of some person who suffered from smallpox.

The material was then subcutaneously introduced on the arms or legs of the nonimmune person. The terms inoculation and variolation were often used interchangeably. The practice of inoculation seems to have arisen independently when people in several countries were faced with the threat of an epidemic. However, inoculation was not without its attendant risks.

There were concerns that recipients might develop disseminated smallpox and spread it to others. Transmission of other diseases, such as syphilis, via the bloodborne route was also of concern. Inoculation, hereafter referred to as variolation, was likely practiced in Africa, India, and China long before the 18th century, when it was introduced to Europe.

In 1670, Circassian traders introduced variolation to the Turkish “Ottoman” Empire. Women from the Caucasus, who were in great demand in the Turkish sultan's harem in Istanbul because of their legendary beauty, were inoculated as children in parts of their bodies where scars would not be seen. These women must also have brought the practice of variolation to the court of the Sublime Porte.

Variolation came to Europe at the beginning of the 18th century with the arrival of travelers from Istanbul. In 1714, the Royal Society of London received a letter from Emanuel Timoni describing the technique of variolation, which he had witnessed in Istanbul. A similar letter was sent by Giacomo Pilarino in 1716. These reports described the practice of subcutaneous inoculation; however, they did not change the ways of the conservative English physicians.

It was the continued advocacy of the English aristocrat Lady Mary Wortley Montague that was responsible for the introduction of variolation in England. In 1715, Lady Montague suffered from an episode of smallpox, which severely disfigured her beautiful face. Her 20-year-old brother died of the illness 18 months later. In 1717, Lady Montague's husband, Edward Wortley Montague, was appointed ambassador to the Sublime Porte.

A few weeks after their arrival in Istanbul, Lady Montague wrote to her friend about the method of variolation used at the Ottoman court. Lady Montague was so determined to prevent the ravages of smallpox that she ordered the embassy surgeon, Charles Maitland, to inoculate her 5-year-old son. The inoculation procedure was performed in March 1718.

Upon their return to London in April 1721, Lady Montague had Charles Maitland inoculate her 4-year-old daughter in the presence of physicians of the royal court. After these first professional variolation procedures, word of the practice spread to several members of the royal family. Charles Maitland was then granted the royal license to perform a trial of variolation on six prisoners in Newgate on August 9, 1721.

The prisoners were granted the king's favor if they submitted to this experiment. Several court physicians, members of the Royal Society, and members of the College of Physicians observed the trial. All prisoners survived the experiment, and those exposed to smallpox later proved to be immune. In the months following this very first trial, Maitland repeated the experiment on orphaned children, again with success.

Finally, on April 17, 1722, Maitland successfully treated the two daughters of the Princess of Wales. Not surprisingly, the procedure gained general acceptance after this last success. [1] Now, this is an example of how it is supposed to work. How using a tried-and-true method to save lives as a means to do so. But in 1918, a strange treatment didn’t go so well.

[2] https://hail.to/toituosm/article/N3EFxXS

The 1918 Spanish Influenza pandemic killed up to 50 million worldwide. In New Zealand the death toll was just over 9,000 and in Dunedin 223 people perished. That would be the equivalent of 45,000 deaths nationally in 2020 and over 400 for Dunedin City. The fact that we have suffered nothing like those tragic numbers is a testament to excellent public health policies and good science.

Our forebears in 1918 lacked the resources we have today. The pressure inhalation sprayer on display at Toitu, was based on the idea that inhaling a zinc sulphate spray would provide protection against the influenza virus. In fact, it may have weakened resistance by damaging throat and lung tissue (it was more like inhaling bleach).

Dunedin’s inhalation chamber was set up in the old Post Office building on the corner of Water and Bond Streets on November 7, 1918. It was ‘a small room, relatively airtight, holding 20 or 30 persons, and the air was impregnated with the vapor of zinc sulphate. Each batch remained in the chamber for 10 minutes, and the persons treated were instructed to breathe through the nose at first, and then through the mouth.’

This sounds like a perfect way to spread infection – the opposite of social distancing - but thousands of people took advantage of the treatment each day. Additional chambers were established around the city to cope with the demand. The 1918 crisis was short and sharp in Dunedin; the first infections appeared in early November but by early December the pandemic was largely over. The main Dunedin inhalation chamber closed on December 12, 1918.