Evolutionary Medicine

Small-pox

Stories of small-pox are interwoven in historical migrations and wars. The disease changed the course of history by killing generals, kings and decimating enemies. Several historical figures allegedly had skin diseases and distinctive marks left behind by smallpox. For example, the Egyptian Pharaoh Ramses V died of an acute small-pox illness in 1150 BC ¹⁰. While looking at mummified remains it was discovered in 1898 that markings on his face and neck resembled typical small-pox lesions. Other places where similar outbreaks existed were 1346 BC Hitters, 595 BC Syracuse, 490 BC Athens, 48AD China, 583 AD Korean Peninsula and 585 AD in Japan. A typical writer describing small-pox would document sores on the head, face and trunk, which spread all over the body if not treated. The disease often involved famine and starvation since diseased people became unable to work on their respective farms to cultivate or prepare food.

Small-pox is caused by variola virus. The virus first infects cells in the mouth and nose, and then spreads to mucous membranes and travels to lymph nodes. Then the virus gets in the blood stream and moves throughout the spleen, liver and lungs. In these locations, the virus replicates producing a large infectious viral population. The incubation period is between twelve to seventeen days from initial exposure. Here the virus invades the blood again which ends the incubation period and the person becomes very ill. By now the patient typically has a high fever, muscle pain, abdominal pain, and vomiting for symptoms. Then the virus continues to spread to the skin causing eruptions for three to four days. First a rash appears, and then raised skin filled with fluids becomes evident, and the lesions contain infectious virus.

A person infected with the small-pox virus can infect others anytime after the rash appears, and when scabs are falling apart. The virus can contaminate clothes and linen for several months after the initial incident. It was documented that in the Sung Dynasty from 960 to 1280 dried small-pox scabs were inhaled as a preventative measure, because the (hopefully) dead virus would cause the immune system to protect against live virus in the event of later infection ¹¹ This was called variolation. Much later, a physician named Edward Jenner and a farmer named Benjamin Jesty compared small-pox to cow-pox and used fluid from cow-pox as a vaccination for small-pox, because it was determined that the immune system could be successfully primed to protect against small-pox virus if it first saw cow-pox virus. ¹² Several influential people opposed Jenner's work. Lord Bryon thought people would start to look like cows, as a result. In contrast, President Thomas Jefferson congratulated Jenner for his research.

This work was followed by Benjamin Waterhouse a Harvard Professor who focused his energies to use the cow-pox virus to vaccinate against small-pox, thus protecting humans from getting the disease. In 1783 he received a sample of cow-pox virus and used it for additional research. Jefferson was so pleased with Jenner's work he sent it with Merriweather Lewis and William Clark when they explored the Louisiana Purchase to use if necessary. Shortly after that expedition the fourth president, James Madison signed into legislation a law encouraging vaccinations. However, due to his religious affiliations of being a Quaker, Waterhouse was against mass use of vaccinations which led to him being dismissed from his post at Harvard. Then the climate in Washington repealed vaccinations as a law in 1820 and epidemics of small-pox and related deaths continued to rise in United States ¹³. Over 150 years later in 1950 the Pan American Sanitary organization was determined to conquer small-pox in America. In 1970 almost all small-pox was eliminated in the US. From 1953 to 1966, the World Health Organization proposed a small-pox eradication program in two steps. The first was to test all vaccines to ensure safety and effectiveness. Then the second step was to reduce the number of small-pox outbreaks. Years later Africa, Asia, Brazil, Ethiopia were all a part of the eradication of small-pox.