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Smallpox: The Disease
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Medicine Through Time – Jenner and the Smallpox Vaccine, 1749-1823
In this course, Dr Robert Gaynes (Emory University) looks at smallpox and Edward Jenner’s development of the smallpox vaccine. In the first module, we focus on the disease smallpox, its origin and its symptomatic progression. In the second module, we look at the history of smallpox, focusing in particular on its impact on South America and the leading figures of Europe. In the third module, we then turn to consider the early influences of Edward Jenner, taking a closer look at the first methods of treating smallpox and how Jenner’s vaccine emerged as a more successful alternative. In the fourth module, we look how Jenner came to discover that cowpox provided immunity against smallpox, before in the fifth module considering the reception of the smallpox vaccine in England and abroad. In the sixth and final module, we look at the impact that the smallpox vaccine has had, especially with regard to the eradication of smallpox.
Smallpox: The Disease
In this module, we look at smallpox the disease, focusing in particular on: (i) the symptomatic progression of smallpox; (ii) how smallpox was described by an eighteenth century physician to develop in a patient; (iii) how smallpox was described by the American historian, Frank Snowden, to develop in a patient; (iv) the severe consequences of smallpox, including facial scarring and blindness; and (v) the mortality rates of smallpox, according to age, ethnicity, and other factors.
Hello. My name is Dr Robert Gaines.
00:00:05I'm professor emeritus of medicine at the Emory University
00:00:08School of Medicine and an infectious disease physician.
00:00:12In this course, I'm going to be talking about Edward Jenner
00:00:16and the discovery of one of the greatest contributions
00:00:19medicine has ever made to humanity.
00:00:22The discovery
00:00:25of vaccination
00:00:26in this course will talk about the disease. Smallpox,
00:00:28then go into it's horrifying history.
00:00:32Then talk about the early influences of Edward Jenner
00:00:35and how those influences shaped the discovery of smallpox.
00:00:38Vaccination
00:00:42will then turn to the reaction in genders lifetime to this discovery and finally,
00:00:44the impact of smallpox vaccination in eradicating the disease.
00:00:49Smallpox
00:00:54To begin with, we'll talk about smallpox, the disease
00:00:56the disease was,
00:00:59and I used the word in the past tense because it is the only human disease
00:01:01that has been eradicated from the face of the Earth.
00:01:06The disease was caused by a virus called the variola virus.
00:01:09It usually entered the body through the respiratory tract,
00:01:14either the nose or the mouth,
00:01:17and after a person was exposed,
00:01:19there would be a period of time when there would be no symptoms.
00:01:21That period called the incubation period for smallpox was about 12 days.
00:01:26The first symptoms would appear after the incubation period,
00:01:32and those symptoms would be a high fever,
00:01:36a feeling of generally unwell called Malays, often a headache.
00:01:39And what's called extreme prostration,
00:01:44where you're so fatigued and it's difficult to even lift your head off the pillow.
00:01:46After four or five days of the fever,
00:01:52a rash would appear on the face and on the legs and arms, less so on the trunk.
00:01:54That rash would initially be flat,
00:01:59and it would be distributed,
00:02:02as I mentioned on the face and usually on the arms and legs and again,
00:02:03a little bit on the trunk,
00:02:08which distinguished it from other diseases such as chickenpox.
00:02:09During the next 10 days, the rash would Eve, all
00:02:13going from flat to flu,
00:02:16would filled with cellular debris in what was called pustules.
00:02:18About one centimetre
00:02:22in size,
00:02:23they would appear all over the body at the same time and then eventually evolve.
00:02:25If the patient survived,
00:02:29death would usually occur
00:02:32in that 10 days after the rash appeared.
00:02:34If the patient survived, the rash would turn into scars,
00:02:37disfiguring the patient and often causing blindness.
00:02:41Now that time course
00:02:45is a very superficial description of the disease smallpox.
00:02:48To understand the agony that occurred,
00:02:53I'm going to paraphrase a description by an 18th century physician,
00:02:56I paraphrase, because his description is not for the faint of heart.
00:03:01So after four or five days, when the rash begins to appear,
00:03:07the patient would have a general aspect of someone
00:03:10who's gone through a long and exhausting struggle.
00:03:13His face would have lost all expression.
00:03:17Respiration was gasping or sighing.
00:03:20The patient would toss about
00:03:24complaining of agonising pain first in the chest, then in the back, then in the head,
00:03:26then in the abdomen.
00:03:32The patient would experience increasing difficulty swallowing
00:03:34and talking because the lesions that appeared on
00:03:38the body also appeared in the digestive track,
00:03:41including the throat.
00:03:43By the sixth day of the rash plus begins to form in those flat rash marks, raising them
00:03:45the patient would feel much worse. At this point,
00:03:52this is often the point.
00:03:55We're death occurred because of what was called circulatory collapse.
00:03:56This is when the fluids that would normally be in
00:04:00one's bloodstream begin to leak out into the tissues.
00:04:03The pustules,
00:04:07as they're now called would begin to fill with yellow fluid and cellular debris,
00:04:07a process that would take a couple of days,
00:04:13and they would be fully matured on about the eighth day of the rash.
00:04:15The patient would feel dreadful at this point.
00:04:19The fever has risen.
00:04:21The eyelids, the lips, the face that tongue are now tremendously swollen.
00:04:23Another unpleasant part of this disease was a terrible,
00:04:28sickly smell that went with smallpox.
00:04:32Physicians claim that it was impossible to describe but overpowering.
00:04:35By date, nine or 10 large areas of the skin would begin to peel off,
00:04:40leaving tissues raw and exposed and extremely painful.
00:04:46This contributed to the frightening appearance and misery of the patient.
00:04:50And if the patient survived by Day 12 or 14 of the rash, scabs would begin to form,
00:04:55where the pustules had been,
00:05:01leading to one final torment of this disease
00:05:02intolerable itching.
00:05:06Much of the scabs that occurred in patients who
00:05:08survived smallpox was not just from the disease,
00:05:10but from the scratching
00:05:13that the patient had.
00:05:14In the 18th century. Smallpox left almost everyone with facial scarring
00:05:16and was the leading cause of blindness When the scarring occurred around the eyes.
00:05:21Donald Hopkins, who worked on the eradication of smallpox,
00:05:27was asked what is the worst disease
00:05:30that humanity has ever faced? And this is what he wrote.
00:05:33And I'm quoting here
00:05:37in the suddenness and unpredictability of its attack
00:05:38in the grotesque torture of its victims
00:05:42in the brutality of its lethal or disfiguring symptoms
00:05:45and in the dread that it inspired
00:05:49smallpox is the worst disease to ever affect humanity.
00:05:51It is unique among human diseases.
00:05:55The mortality of smallpox overall was about 30%
00:05:58in
00:06:03Europe, Asia and Africa.
00:06:03But there were some variations around this 30% figure.
00:06:06If a child less than a year got smallpox, mortality was much higher around 60 to 70%.
00:06:10If the smallpox pustules were so frequent on a body that they touched each other,
00:06:18so called con fluent mortality could also be 60 or 70%
00:06:23if the pustules never actually formed so called malignant bulb.
00:06:28Smallpox mortality was 90% and if there was bleeding from all of this,
00:06:31particularly internally, death was a certainty
00:06:36
Cite this Lecture
APA style
Gaynes, R. (2022, September 26). Medicine Through Time – Jenner and the Smallpox Vaccine, 1749-1823 - Smallpox: The Disease [Video]. MASSOLIT. https://massolit.io/courses/medicine-through-time-jenner-and-the-smallpox-vaccine-1749-1823/edward-jenner-early-influences
MLA style
Gaynes, R. "Medicine Through Time – Jenner and the Smallpox Vaccine, 1749-1823 – Smallpox: The Disease." MASSOLIT, uploaded by MASSOLIT, 26 Sep 2022, https://massolit.io/courses/medicine-through-time-jenner-and-the-smallpox-vaccine-1749-1823/edward-jenner-early-influences