SmallpoxThe Devastation of the Variola Virus
...nd hemorrhagic Smallpox. In flat Smallpox, the skin remains smooth and does not pustulate, but it does darken until it looks like it is charred or burnt, the skin will crack, bleed and often slip off of the body in large patches or even sheets. In a case of hemorrhagic Smallpox also known as “blackpox” the symptoms are very severe, the victim will often have black, un-clotted blood oozing from the mouth and other parts of the body. The viral cells eat away the lining of the throat, the stomach, and the intestines, the rectum and the vagina and these membranes disintegrate. The blood vessels burst under the skin and the victim will bleed under their skin, which causes the skin to bruise. One of the most disturbing factors is that in this state the patient remains conscious in a paralyzed shock, aware of what is happening, but unable to do anything about it, the victim will remain in this state nearly up until the point of death. During the final phase of Smallpox know as intestinal bleedout, the lining of the intestines or the rectum slip off is then expelled through the anus, coming out in pieces or in lengths of tube, known as a ‘tubular cast’ when this occurs death is imminent. (Preston, 1999, 5) Vaccination (inoculation) Treatments for Smallpox are believed to have started centuries ago, many early civilizations in India, China, Africa and Latin America would designate a god or goddess of Smallpox and offer sacrifices, others believed by using the red color of the rash itself the disease could be cured. These civilizations adopted ‘red therapy’ which involved having the victim use only red blankets, drink red liquids and use only red instruments for treatment. Others used leaches to bleed out the ‘bad blood’. The Indians would use heat therapy, involving the use of sweat lodges, (which was very common for most ailments), after the use of the sweat lodge they would plunge into a cold lake or stream to purify the system, however they found that the use of this practice, raised the fever that accompanied Smallpox and these victims actually died sooner. The first medical process for combating Smallpox was Variolation (or inoculation) which involved inducing a mild amount of the disease into a patient, with a milder case they believed the victim would recover better and build immunity towards the disease. Ancient Chinese, Indian and African cultures had performed this for years by taking the dried up Smallpox scabs, grinding it into a powder and sniffing it or inhaling it. In the Middle East they took a small amount of the pus from a Smallpox lesion and inserted it into a cut on the arm of the person seeking protection. (Koplow, 2003, 16) A physician by the name of Edward Jenner is credited for the development of the first Smallpox vaccine. While Jenner was an apprentice he assisted in treating a dairymaid with a condition know as cowpox, it was believed that if a person had contracted cowpox, they were immune to the Smallpox virus. Jenner spent many years investigating and studying this theory. On May 14, 1796 his hard work and diligence finally paid off. Dr. Jenner took virulent matter from the pustule on the hand of a dairymaid by the name of Sarah Nelmes. He then inserted it through two small incisions into the arm of a healthy 8 year old boy, James Phipps. On July 1 a virulent dose of Smallpox was injected into the same arm and the boy appeared to have no symptoms of the virus and was considered safe from Smallpox. Dr. Jenner later named this form of protection vaccination, which is from the Latin word ‘vacca’, which means cow, at that time cowpox was called vaccina. Jenner’s works were published in 1798, and the news traveled quickly throughout the world. (Kennedy, Young, 2003, 19- 20) The eradication of Smallpox had begun. Global Smallpox Eradication Program In 1967 the World Health Organization, based in Geneva, Switzerland launched the Intensified Smallpox Eradication Program. The man who is most credited with the eradication of Smallpox is D.A. Henderson, who was the director of the WHO’s Smallpox Eradication Unit from the beginning of the program until the very last traces of the virus occurred. (Preston, 1999) The basis of the program was to rely almost entirely on mass vaccinations. The mass vaccination strategy had already proven successful in Western Europe, North America, Japan and other areas. (Hopkins 1989). In 1966 an outbreak occurred in Nigeria that made the WHO reconsider their actions, the Smallpox outbreak occurred in a religious group that did not believe in vaccinations. At this point the World Health Organization adopted the strategy of surveillance and containment to break the chain of Smallpox, even when less than half of the population was eventually vaccinated. (Hopkins, 1989) To achieve the large scale vaccinations they had problems finding a way to get abundant, reliable and potent supplies of the vaccine. They eventually discovered they were able to mass produce high quality freeze-dried vaccines, which had the potency and the stability that the WHO needed for the Eradication Program. (Hopkins, 1989) Not only was acquiring the vaccine itself a problem, but it was also a challenge finding a way to do the mass vaccinations in a way that was cost and time effective. In 1963, the U.S. National Communicable Disease Center tested a jet injector, which was hydraulic powered; it could do approximately 1,000 vaccinations per hour. This however was not the answer because it proved too expensive for house-to house vaccinations, especially in the more densely populated countries. The next technological advance was the bifurcated needle, a needle with two points. The freeze dried vaccine, required a new method of presenting single doses, it had to be reconstituted each time and dispensed in tiny quantities, and the traditional method of storing the liquid vaccine in capillaries was no longer possible. The bifurcated needle was developed by Benjamin Rubin, who used a sewing needle in which the loop end was ground into a fork which made the bifurcated prongs. They added a piece of wire between these two prongs to hold a constant amount of the vaccine by capillarity and provide the correct scarification. By 1960 the bifurcated needle had replaced traditional methods in most countries and by 1970 it was used worldwide. (Hopkins, 1989) The World Health Organization declared Smallpox officially eradicated in 1979, after 12 years of mass vaccinations and containment. It was reported the last naturally occurring case of Smallpox in the world appeared in Somalia in 1977. However ten months later a woman in Birmingham, England by the name of Janet Parker had contracted full-fledged Smallpox. Parker was a medical photographer (who had been vaccinated 12 years earlier). Her studio was at the Medical School of the University of Birmingham and in the same building as a Smallpox laboratory, even though it was upstairs and several rooms away. It was speculated that the virus worked its way upwards and into a ventilation duct and into a phone booth that she used. It was believed she spread the virus to family members and came in contact with approximately 300 people. The majority of these people were tracked down quarantined, vaccinated and monitored. (Koplow, 2003) At the age of 77 Parkers’ mother came down with Smallpox and managed to survive. In the midst of all of this the head of the laboratory from which the virus had escaped committed suicide, possibly from the guilt of the repercussions of the virus leak. Parker died on September 11, 1978 approximately one month after contracting the virus. Janet Parker was the last known death from Smallpox. (Fenn, 2001) In 1990 The World Health Organization’s advisory committee recommended that the majority of vaccine be destroyed. Nine and a half million...