An Enlightenment success story smallpox

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					                                                                         Disease handout 6a


An Enlightenment success story: smallpox

Smallpox
•One of the greatest killers of humans in history
–Where endemic – such as European cities in the 16-18th centuries – killed 3-10% of all
who died every year
•Variola major – produces violent symptoms, fatal in 30%+ cases
–The historical “smallpox”
•A viral, “herd” disease
–No animal or insect reservoir
–Mostly airborne transmission
–Can also be transmitted through the skin, scabs, pus shed by victims

Symptoms
•Incubation of 9-12 days
•Onset: high fever, headache, body aches, sometimes vomiting and convulsions
–In extreme cases, the disease produces massive hemorrhages almost immediately,
resulting in death
•Rash develops 2-5 days after onset
•Pustules develop after another few days
–Extremely painful
– If confluent, then fatal – if not, then victim will probably survive, barring secondary
infection
•Victims often left scarred, blind, infertile
•Contagious from a few days after onset until the skin is completely healed
Inoculation: an old tradition
•Also known as variolation (from the Latin variola, the word for smallpox
•Practice in Arab world, Africa, also in parts of Asia, from around 1000 CE
•Harvest a small amount of the pus from a pox, and introduce it into a cut in the skin of a
child; or, introduce dried material into the nose
–Gives the child a mild case of smallpox, and leaves him with lifelong immunity
Lady Mary Wortley Montague
•An English aristocrat, she was herself a victim of smallpox in 1715, and left quite
pockmarked
•Later, as wife of the British ambassador to the Ottoman Empire, she observed
inoculation in Constantinople
•Reported the practice in a 1717 letter to a friend
•Had her son inoculated in Turkey, and her daughter later in England

A controversial procedure
•Not everyone embraced inoculation in the 18th century
•Questions about its safety
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–The procedure did entail some risk
•Questions about its efficacy
–There is no way of proving that the reason a person does not get smallpox is because
they have been inoculated
•Questions about whether inoculation acts against God’s plan
–From the book of Hosea: "He hath torn, and he will heal us; he hath smitten, and he
will bind us up."

Jenner and Vaccination
•Edward Jenner – born and raised in the English countryside
•After studying medicine in London, Jenner returned to his hometown to practice
medicine – although he had better offers
Cowpox
•It had been known among “country girls” for over a century that those who caught
cowpox would not ever contract smallpox
•A painful rash, it could cause scarring
Jenner’s experiments
•In 1789, there was an outbreak of swinepox in Jenner’s region – and some people
developed rashes
•Jenner inoculated his infant son with material taken from a servant’s rash
•One year later, Jenner inoculated his son and servant with smallpox – and they had no
reaction
•Beginning in 1791, Jenner began to collect cases of people who had suffered from
cowpox and subsequently had no reaction to smallpox inoculation

•1796: Jenner infected a boy with cowpox
–Boy suffered a mild reaction
–Subsequent inoculation with smallpox produced no reaction
•Submitted paper detailing his result to the Royal Society
–It was rejected for publication because the evidence was thin
•1798: Jenner made the same experiment with 5 more children – with the same results
•Jenner published his results in 1798
•“it was as if an Angel’s trumpet had sounded over the earth”
•Results were subsequently confirmed by other doctors
•Although others had practiced inoculation before Jenner, he proved the link between
inoculation with cowpox (vaccination) and resistance to smallpox

Reactions to vaccination
•Jenner: “the annihilation of smallpox – the most dreadful scourge of the human race –
will be the final result of this practice.”
–Important advantage of vaccination: not contagious from person to person, unlike
inoculated smallpox
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•A French commentator, noting that 35% of all blindness in Europeans was due to
smallpox: “were {the prevention of blindness} its only result this alone would suffice to
render Jenner’s name immortal”
•Jenner received Parliamentary grants totaling £30,000 – making him a “millionaire”
•During the Napoleonic wars, Napoleon freed captured English prisoners in response to
petitions from Jenner

Opposition to vaccination
•Opposed by many who practiced inoculation – because it would reduce their business
•Opposed by some who viewed smallpox as a “natural” way to put a check on the growth
of the poorer classes
–Malthus’ work had been published the same year as Jenner’s work
•Opposed on religious grounds
•Opposed because cowpox was a disease of animals
–Offensive
–Connection between the two diseases not understood – while inoculation made some
sense


Problems with vaccination
•By the early 19th century, it began to become evident that vaccination did not confer
lifelong immunity to smallpox – which inoculation did
•Sometimes the vaccine virus was no longer active
•Because vaccination was practiced from person to person, vaccinees could be
accidentally infected with other diseases
–Syphilis
•After 1843, a method of propagating the virus in cattle was developed – so vaccinees
received it from “the source”


Nevertheless, vaccination was embraced…
•During Napoleonic wars, both British and French armies practiced compulsory
vaccination
•Britain: Vaccination acts of 1840, 1853, and 1867 made vaccination available and free –
but many resisted it
–Vaccination act of 1871 made it compulsory
–After 1898, law allowed for “conscientious objections”
•Germany, 1874: compulsory vaccination before age 2
•Russia: continued to have smallpox epidemics until after the Soviet Revolution
–Mandatory vaccination law signed after 1919

•Deaths from smallpox in London
                              th
– 7% of all deaths in early 18 century
                          th
–5% in first quarter of 19 century
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–1.5% in   third quarter of 19th century
•Sweden
–12,000 deaths from smallpox in 1800
–11 in 1822
•Denmark
–Disease eradicated between 1811-1818

Smallpox did not disappear from Europe
•There were major epidemics in 1824-29, 1837-40, and (most seriously) 1871-73
•England experienced its last smallpox epidemic in 1902
•France’s last epidemic in 1907
•WWI helped to fuel smallpox outbreaks in Russia, Poland, Austria, and Germany
•By the end of WWII, endemic smallpox was only present in Spain and Portugal
•Between 1950 and 1971, smallpox was introduced into Europe 49 times, with 958 cases
reported

Miscellaneous issues in 19th century European history

Scientific racism

Africans in America
•African slaves were both more resilient to certain diseases in America, and more
susceptible
•Africans tended to be better able to resist malaria and yellow fever – because both are
African in origin
–This was viewed as making African slaves “peculiarly suited for hard work in hot
places”
•Africans tended to be susceptible to many diseases that did not affect Europeans,
including leprosy
–Used by Europeans to justify the notion that Africans were “not quite human”
Scientific racism
•Based on the idea that man is differentiated into “higher” and “lower” races
•many “scientific” (actually, pseudo-scientific) ways of studying human differences in
order to determine superiority or inferiority
–shape, size of skulls in different “races”
•Used to justify the oppression of blacks in the US, non-Europeans, and Jews in Europe
Peter Camper
•Study published in 1792 proposed that the facial angle provided an indication of the
degree of “advancement” of man
•Very influential in 19th century racial theories
A 19th century German skull collection
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A key socio-economic theory: Thomas Malthus, An essay on the principle of population
(1792)

Theory based on a set of core principles
•Food is necessary for human existence.
•Human population tends to grow faster than the power in the earth to produce
subsistence
•The effects of these two unequal powers must be kept equal, or there will be a crisis
•Since humans tend not to limit their population size voluntarily ("preventive checks" in
Malthus's terminology – meaning, abstaining from sex), population reduction tends to be
accomplished through the "positive" checks of famine, disease, poverty and war
•Competition between individuals in society results in a “struggle for existence”
Human population tends to grow faster than the power in the earth to produce subsistence

The Industrial revolution and disease in the 19th century
“Industrial mentality”
 arose as a consequence of the Scientific Revolution
•Nature is mechanical
•Man is independent of Nature
•Man can control Nature
•Man can manipulate Nature
British industrialization
•1750: England produced 2% of global output of goods
•1860: England produced 20%
–½ of global output of cloth, iron goods
–2/3 of global output of coal
•First railways
–Most extensive network in Europe
The human impact
•Rapid urbanization
–Population of Manchester:
–1772: 25,000
–1851: 455,000
•English cities over 50,000 people
–1785: 3
–1855: 31
•Rapidity of urbanization meant no provision for sewers, garbage, water supply, etc.
–Increase in typhoid fever and other diseases
–First major cholera epidemic in Britain: 1832
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Population of European cities, 1750-1950
The London poor in the middle of the century

19th century: what should be the role of government
•Much of 19th century European political and social history was shaped by the
experiences of the French Revolution and Napoleonic Wars (1789-1814)
–Both French regimes gave the government a great deal of control over the rights and
actions of the individual
–Once these movements were defeated or marginalized, many felt quite suspicious of
government intervention in the lives of the people
–Emergence of three general political philosophies in Europe: liberalism, radicalism,
conservatism

“Liberalism” (1819): “Liberal” is that which is the characteristic of a free man (as
opposed to a slave)
•based in early ideals of the French Revolution
•government should be restrained by law (written constitution); parliamentary
•Protection of property and civil rights
•self-determination
•equality
•religious freedom
•based in intelligentsia, commercial classes
•America -- the quintessential “liberal” state
•POLITICAL CHANGE WITHOUT SOCIAL UPHEAVEL

Radicalism (1820)
•Inspired by the Radical French Revolution
•Social change through Revolution
•Proletariat-based
•Many different forms
–Republicanism: no monarchy; universal manhood suffrage; anti-clerical
–Socialism: planned economy designed to help the poor and the dispossessed
Conservatism (1835)
•Pro-monarchy
•Pro-church (whatever the established church was)
–Tended to associated morality with politics and social issues
•Suspicious of change; feared sudden change
•Social progress can only build on the past; a population unprepared for change will
suffer from it
•Reactionism: a form of extreme conservatism, typical in the more autocratic societies
The Columbian Exchange, revisited
The Irish Potato Famine
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The Irish Potato Famine, 1845-49
•By the late 18th century, the Irish peasantry had become dependant on the potato
–an food source native to America, it had been imported in the 16th century
–provided more nutrition per cultivated acre than any other crop in Europe
–half the population of Ireland depended exclusively on the potato for food
•Crop destroyed in every year from 1845-49
–accidental importation of a fungus from America
Government response
•Ireland ruled by the British
–society dominated by a pro-British (often Protestant) landlord class
–Ireland considered a food-producer for the British urban classes
•During the first year of the famine, the British government provided some relief
•a change of government in Britain brought in a Prime minister who wanted the Irish
famine addressed through the free market and by the Irish landlord classes
–An example of laissez faire, “hands off” governmental policies informed by liberalism

•Irish landlords were unable to provide sufficient poor relief because the peasantry was
unable to pay rents
•British government would only provide some relief
–soup kitchens (which were inadequate to address the scope of the problem)
–Peasants required to build roads while starving
–Import of American corn, which could not replace the nutrition of the potato
•Pellagra – a disease associated with a diet of corn
•At the same time, the Irish agricultural sector continued to export food to the British
marketplace
–Irish peasants could not afford this food
Impact on the population
•Many Irish farmers evicted because they failed to pay their rent
•Homeless, some families sought shelter in workhouses
•Others starved in the countryside
•Epidemics of cholera, typhus, both in the countryside and in the cities and workhouses

Starving children in Cahera, Ireland, 1847
A starving Irish family

Irish demographics
•1844: 8.4 million
•1851: 5 million
•1.1 million deaths from starvation and famine-related disease
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•1.5 million emigrated to the US, Canada, and elsewhere
–In the initial wave of emigration, 1/3 died during the voyage of starvation and disease –
“coffin ships”
–emigration continued through the 19th century
•1921 population of Ireland just half that of 1844
NOTES TO BE CONTINUED …

				
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