The red areas spread into blotches across the face and arms, and within hours the blotches broke out into seas of tiny pimples. They were sharp, feeling not itchy, and by nightfall they covered the face, arms, hands, and feet. Pimples were rising out of the soles of the feet and
on the palms of the hands too. During the night, the pimples developed tiny blistered heads, and the heads continued to grow larger, rising all over the body at the same speed, like a field of barley sprouting after the rain. They hurt dreadfully, and they were enlarging into boils. They had a waxy, hard look, and they seemed unripe. Fevers soared abruptly and began to rage. The rubbing of pajamas on the skin felt like a roasting fire. By dawn, the body had become a mass of knob like blisters.
They were everywhere all over, but clustered, most thickly on the face and extreme. The inside of the mouth and ear, canals and sinuses had pustulated. It felt as if the skin was pulling off of the body, that it would split and rupture. The blisters were hard and dry, and they didn't leak. They were like ball bearings embedded in the skin, with a soft, velvety feel on the surface. Each pustule had a dimple in the center. They were
pressurized with an opalescent puss. The pustules began to touch one another, and finally they merged into confluent sheets that covered the body like a cobblestone street. The skin was torn away across the body, and the pustules on the face combined into a bubbled mass filled with fluid, until the skin of the face essentially detached from its underlayers and became a bag surrounding the tissues of the head. Tongue, gums, and hard palate were studded with pustules, the mouth dry.
The virus had stripped the skin off the body, both inside and out, and the pain seemed almost beyond the capacity of human nature to endure.
Hi, Hi, Welcome to episode three of this podcast Will Kill You.
This week we're talking about smallpox.
Clearly that was smallpox.
Yeah, it's horrifying, Oh my god. And that quote was from The Demon in the Freezer by Richard Preston.
Wow.
So how about a little something to take the edge off.
Yeah, let's take that edge off.
What are we drinking this week today?
We're drinking smallpox on the rocks. That's gross.
Yeah, I don't know if I want to drink that anymore.
It's you know, it takes the edge off.
Yeah, sure, sure. What's in smallpox on the rocks?
Basically, it's a whiskey sour.
Sign me up. That's pretty signed up.
It's if you'd like to drink along at home, you can make your own smallpox on the rocks by mixing two ounces of.
Your favorite whiskey wood.
That's the Kentuckians.
That's my plug.
She's she would know, you know, like she does know.
But you know, let's go with bourbon and the juice of.
Half a lemon, which is literally every recipe and I looked it up. It's about three tablespoons of lemon juice. That's the juice of.
No, that's that's a juice of a whole lemon.
You're right, So it's one and a half tablespoons of lemon.
I maybe more is better. We did it one and a half tablespoons per two ounces of bourbon and about.
A half a teaspoon of sugar. Shake it up over ice, drink it on the rocks.
Cheers, cheers.
I wonder what that sounded like. I don't know. It was good better clinking glasses. Yeah, let's define a few words for this week. What are the words that we're gonna be defining this week.
Let's start with endemic.
So, in terms of disease, endemic is a disease that is regularly found among a particular people or in a certain area. So, for example, there are certain areas of the world where malaria is considered endemic, and if you see malaria in those areas, that's sort of normal. Whereas if you were to see malaria outside of those areas, that would be considered an epidemic or an outbreak.
Gotcha, all right. Next one is bio terrorism.
Bioterrorism is pretty straightforward. It's essentially just terrorism that includes the release of a biological toxic agent. That's it, clear clear to me, clear as day.
Clear as day. Let's talk about what a reservoir is.
So a reservoir for disease is a long term host of a pathogen that often do not show symptoms or have sort of subclinical infections. So in leprosy, we talked about armadillos armadillos are reservoirs for the leprosy bacteria.
Eradication.
Eradication is a fun one, a happy one. It's a happy one. So eradication of a disease, according to the CDC, is the permanent reduction to zero of worldwide incidents of infection caused by a specific agent that is the result of deliberate efforts in order to eradicate that disease to the point where intervention measures are no longer needed to control that disease. There are two diseases in the world that have been eradicated, Aaron, What are those diseases?
Oh, smallpox, that's the topic of today. And actually the other one, which you may not have heard of, it's called render pest and it is a disease of cattle yep, both domestic and wild, so ungillates, ungillates, and they're both gone. So cool, awesome, go, and hopefully hopefully soon polio, guinea worm, some of the other diseases will be also on that list thanks to the Carter Foundation. Right, it's the Carter Foundation,
is it? I don't know, it's Jimmy Carter. Cool. Jimmy Carter's doing a lot of work for eradication.
That's awesome for.
Those Yeah, he's awesome. Now that we've defined those terms, let's jump into the biology. Aaron, tell me all about smallpox.
I'd love to Aaron. Okay, so smallpox, this one is a doozy, no lie, this is I know.
I mean we were already hit pretty hard at the beginning of this episode.
Just starting us off with a bang. So here are the basics. Smallpox is a virus. Uh, it's a DNA virus. So if you remember influenza was an RNA virus, right, this is a little bit different. It is in a family of viruses known as the pox viruses. And I feel the need to tell you that chicken pox is not a pox virus.
That's an important clarification.
It really is. Chicken pox is caused by a herpes virus. So it's a totally different family of viruses. But there are a ton of other pox viruses besides smallpox. There are pox viruses that infect basically every vertebrate that you can think of. There is monkey pox, turkey pox, gerbil pox, camel pox, dolphin pox, snake, there's crocodile pox, kangaroo.
I think I think we get the point.
Yeah, literally that that wasn't even the whole list. What about fish, Well, there's dolphin pox. Dolphins aren't fish.
My gosh, are you serious? There actually is, actually is dolphin pox.
That's not a lie. And then yeah, I mean reptiles can get various poxes snake pox, so I think there could be.
Fish pox is probably a really old family of virus.
Yes, there are also insect pox viruses, and those are gnarly because insects don't have skin, so they basically turn into a giant ball of pox jelly. It's gnarly.
I want to I want to google that. You should. Let's let's post a picture of insect infected by some sort of POxy.
It's just gonna be go, just do so. Small Pox itself has two major forms, Variola major and Variola minor, that are basically named because major is a major problem. Minor was a minor problem. We're not really going to get into the distinction for this episode. Most of what you hear about in terms of the statistics about this disease have to do with Veryola major. Okay, even though there are pox viruses that can infect tons of other vertebrates,
smallpox itself is an exclusively human specific virus. It likely jumped into humans from some type of rodent we don't know exactly what kind really. Yeah, it's most closely related to a rodent pox virus, and this likely happened around the time of the agricultural Revolution about ten thousand years ago, but estimates really vary on that. It's not exactly clear
when this first happened. But the reason that we think it likely was around the agricultural Revolution is because math models have shown that this virus needs a really large human population size in order to sustain itself.
So, but not just human population size, but human population density.
Exactly, exactly, Yes.
Okay, that's right.
Okay, So let's get into the disease itself. Yes, we've already heard a little bit. It's just gonna get worse better, I don't know, probably worse, yeah, and also better. I mean it'll get worse and then it will get better.
We're not sure where we're gonna end up.
Well, we'll find out. So smallpox has an incubation period, which, if you remember from the last episode, is the time from when you're exposed to when you show symptoms is about twelve days ten to fourteen days, but twelve days on.
Average, that's a long time.
It's a pretty long time. The one good thing, and I really think this is the only good thing about the smallpox virus no joke, is that it does not tend to be infectious until you start showing symptoms, and you are the most infectious. That is, you're shedding the most virus when you have some of the more severe symptoms, which are well, let's get into it, the progression of the disease. So it starts off with fever and body aches and sometimes vomiting. And this is not just a
typical fever in body aches. This is you are too sick to continue on with your daily activities, and this generally lasts for about two to four days. After that, you'll get a rash and redness that generally starts on the face, especially in your mouth and on your tongue. Oh no, yeah, so inside your mouth you'll get that may break open and these sores are literally filled with viral particles.
Oh yeah. So then when somebody is nursing you and being like, oh, let me make you feel better, right, and you turn to them and cough a little bit.
Yeah, So it's important. This is a respiratory virus. So this is shed by breathing, coughing, et cetera. So, yeah, if you're infected all up in your mouth and then you're coughing on the people trying to help you, Bobo's Harley, my gosh. So then the rash will spread to your body, to your arms, to your legs. Unlike leprosy, this starts sort of in the middle of your body and then spreads outwards.
Right, Okay.
This stage generally lasts around four days, and it is the most contagious part of this infection. Then you start to get these lesions, these sores that are filled with fluid. They can become really firm, and like you described earlier, they get this characteristic dimple in the center. Then you'll move on to the pustular rash and scab. Oh stage stop please, I can't stop. I just can't. This is described as peas under the skin, right, it's so disgusting.
They're sharply raised, they're firm to the touch. This lasts for about ten days.
This is a long days.
This is a long infection.
Ten days of pea pimples.
Yes, And after about five days they'll start to crust over. And I also want to point out that these sores are literally covering your entire body, your entire body, confluent, yeah, all over, confluent whatever, all over your body, these scabs, and then eventually they'll begin to scab, and then they'll fall off, and you continue to be infectious until the last scab has fallen off your body. That's if you survive that.
Long, and not only are you infectious, but your scabs are too.
Exactly, so, if you imagine, like I mean today we have when when was the vacuum invented?
The vacuum? Yeah, oh gosh, like the early nineteen hundred.
There you go. So imagine that you're cleaning up after your you know, family member who is sick, and they're dropping scabs all over the place, and then you go to vacuum them up, and now you're spewing scab dust into the air and then you breathe it in. That's real.
Or for instance, I just made that up. Blankets. Yeah, you'll talk a lot about that. Yeah, I'll get into that.
So, yeah, that's if the person survives all this, they're contagious for that entire time.
It's and how many people did survive this.
In general, the mortality rate is about twenty to forty percent, usually considered about thirty percent, so on average, about one in three people infected with smallpox will die.
Oh my god.
Now it gets a little bit worse.
No, what I just.
Described was the progression of what is called ordinary smallpox.
Ordinary, that's the ordinary version. So that's if you were lucky. This is the most this is the baseline.
This is the baseline exactly. So some people who were vaccinated this is the good version, would end up with what's called modified smallpox, which is basically a less severe form. But a large number of people, not a large number, about five to ten percent of cases would be what's called malignant. These have a longer prodrome period, which is the period at the beginning when you just have like a fever and a mild rash. So they'd have a longer period of that.
So it's not like they would be infectious longer.
Not necessarily no, But then when they started to get a rash, the pustules that they would get were slower growing, and they would stay flat rather than being raised, and their skin would stay This is a quote from the CDC Soft and velvety ew is that yucky?
What do you what does a velve What does velvet skin feel like?
I don't know, but it doesn't sound good.
I don't think it's touching our faces.
I need to put lotion on. Yeah, but this form of the disease is almost always fatal. And what's really sad is about seventy two percent of the malignant cases we're in children. Oh yeah, there's a worse one too. The even worse one, how yeah, is called hemorrhagic small pots.
Oh okay, that's how yeah.
So hemorrhagic meaning bleeding out essentially, so instead of just forming these pustubles under the skin, you would literally just bleed underneath your skin. You'd bleed into your eyes.
And your skin would slough off.
Your skin would just be like puddles of blood like your whole skin. You bleed into your eyes to the point where the whites of your eyes would turn black because they're just full of dried blood. You could even get this might be getting too gnarly, but you could even get your bleeding so much that in your capillaries blood is clotting as it's leaking out, so you have just blood clots and blood everywhere in your body, and
it's described as very thick and very dark. You would bleed out of all of your mucous membranes, out of every orifice.
People would turn purple yes exactly because there would be so much skin exactly.
This is about two percent of cases overall, but somewhere between three and twenty five percent of all fatal cases. So this, as you can imagine, was almost always fatal.
Was do you know anything about why a case would become hemorrhagic versus.
You know, I tried to find information about that, and I really couldn't find good explanation.
Makes sense that there weren't. Yeah, I don't know.
If it's just immune related, that's what I would guess, but I don't really know. Another thing to make all of this that much worse is that people infected with smallpox. You can imagine that if you're infected with a disease that makes you this sick, you're probably not aware of what's going on because your body is just in overload. But with smallpox, you stay weirdly, very conscious and aware of everything that's happening to you.
That would be horrible, I think.
Isn't that your actual worst nightmare.
It's one of them. Personally, I have a lot of worst nightmare.
It's gnarley. Gnarley is the word of my read Yeah, the most in my notes.
Yeah.
So that's smallpox in a nutshell.
Okay, So now that we have a let's call it baseline understanding of just how awful this disease can be.
I really, I have to be honest, I did not know just how horrible this disease was until I really started reading about it. It is beyond anything that I could have imagined.
It's really scary.
It's terrifying.
Let's hear more more, Let's hear about how terrifying it was for people throughout history.
Let's learn. I want to learn it all.
So, like you said, the smallpox's iris probably made the leap from domesticated animals or rodents. As it turns out, about ten thousand years ago estimates.
Rodents were like when we domesticated animals, It's like we practically domesticated rodents by accident because they were living in all of like the grains and things that we started storing. So we had huge booms in rodent populations.
Ex the same time, scientists aren't exactly sure which animal it came from, but it probably originated in the same place geographically that agriculture and livestock domestication took off, which is the river valleys of Africa and India. And we actually see our first physical evidence of smallpox from around fifteen hundred to one thousand BC, what in Egyptian mummies whose preserved skin shows telltale pock marks from the disease.
Oh my god, you can see the pock marks on mummies actual, like on actual mummies.
Yeah, we're gonna post a picture.
Oh my god, that's so cool.
It's really cool. Smallpox is what we refer to as a crowd disease. In order for the virus to successfully establish in a population, there needs to be enough people in close contact with one another so that it can be transmitted and maintained. Otherwise it'll just blow through population or village and.
Die out right because it just kills people like yeah, ooh, I hope that snap got sounded.
Yeah. Yeah. So it's no coincidence that smallpox started spreading globally just as human population size took off thanks to farming from India and northern Africa. It spread east and west to China, Greece, Rome, et cetera. Around one hundred AD, smallpox caused a devastating epidemic in the Roman Empire, and
this epidemic was called the plague of Antonius. Ooh yeah, Like with the nineteen eighteen pan flu pandemic, soldiers returning home were probably responsible for facilitating the spread of the smallpox virus, always them soldiers. And at the height of this particular epidemic, two thousand people died daily in Rome. Oh my wow. Yeah, this is really bad. I feel like there wasn't that many people in Rome.
Well that's the thing.
Some historians actually suggest that smallpox, along with malaria, contributed to the fall of the Roman Empire. I love information like that, I know, because no one really talks about the role of infectious disease in history, or they do, but it's not I feel like it's not.
As it's not as big of a deal as like and then the three hundred people came and they the people now or whatever.
Yeah, yeah, it's all about to talk about it.
It all comes back to infectious disease people. That's the point of what we're trying to teach you here.
Yeah, it is after wreaking havoc in Rome, smallpox made its way to the rest of Europe, probably through the Huns or returning crusaders around like the twelfth and thirteenth century. Were the crusaders?
Okay, I was going to say, like, I don't know, Yeah, I know, I know.
I had to look it up. The Crusaders. Yeah, that's sure a time that happened well in either case. As global population continued to grow, smallpox epidemics grew more frequent and more intense, and in many areas it became endemic. There's a word callback more of a childhood illness. Okay, let's talk about Yeah, and he serious, because here comes one of the most for me, classic small pox periods
of history. One of the things that history teachers in high school at least tend to gloss over here in the US is the devastating impact that small packs and other Old World diseases had on the native North and South American populations.
This is where it gets really depressing.
Yeah, it's gonna be that way for a while. Yeah yeah, buckle up.
Buckled your history teacher, have another have just drink.
Drink up. Here's the time bottoms up. It's not yet. It's just gonna get worse. Your history teacher may have forgotten to tell you how smallpox blankets were given to Native Americans intentionally by invading Europeans in an often successful attempt to deliberately infect them with this devastating disease.
Like smallpox blankets, as in some white dude was like, hey, yo, I got a blanket. I'm gonna rub it all around a person with smallpox and then I'm going to give it. That means that they knew enough to know that this disease was transmitted.
Ugh, you sound like you want a direct quote.
I do, thank you.
I'm happy to provide. In the War of seventeen sixty three between England and France for control of North America, the British troops were asked, could it not be contrived to send the smallpox among those disaffected tribes of Indians. We must, on this occasion used every stratagem in our
power to reduce them. That's a direct quote. And wait a second, it's not done yet, because there was a return letter from the ranking British officer who said, quote, I will try to inoculate the Indians with some blankets that fall into their hands and take care not to get the disease myself. What that really happened? Even in the instances when it's not entirely clear how deliberately smallpox is spread, like whether it was deliberate.
Or not, sounds pretty deliberate.
Oh yeah, I mean yeah, for instance, in that case is certainly deliberate. But still Europeans definitely use smallpox to their advantage. Yeah. Take for instance, Spanish conquistador Hernando Cortes. He along with around six hundred men or so, landed in the Yucatan Peninsula around fifteen twenty one and headed to the Aztec capital city of tanoche Tutlan which is now Mexico City, to try to take over the Aztec Empire.
He and his fellow conquistadors were soundly defeated in their first fight with the Aztecs, and they expected to lose again when the inevitable second blow would come, but it never came. A little confused and apprehensive, yeah that's what I wrote, and tired of waiting, the Spanish stormed the city. Once inside, they found that smallpox had devastated the city. Oh my god, Cortes and his men had probably all been exposed to smallpox's children, and so the disease didn't
affect them. Seeing this furthered the belief among the Aztecs that the invading Spanish were gods, a belief that the Spanish did nothing to discourage.
And wow, that's so sad.
It is it is? And that is how Cortes and his band of around five hundred, six hundred concuistadors toppled the twenty five million people strong as Tech Empire. That was it. That was the end of the Aztec Empire for all intents and purposes. Oh my god, this is mirrored I I just in the fall oh of the Inca Empire.
This is a really depressing episode.
Yep, the Inca Empire, which was mainly in Peru and Ecuador in South America. This time when Pizarro, so this is another Spanish conquistador and his one hundred and twenty eight are you really men? When they arrived, they found an already decimated empire, as smallpox had preceded their arrival. And they found these huge structures, these huge towns, these huge buildings, and they looked around and thought, there's there's no way that these few people could have actually done
this what has happened? Right, because the people were starving because they were dying of smallpox, and then they had no one to take care of them. It was I mean, no one to take care of the field, no one at farm. So even if you survived smallpox, you had no food.
Right.
It was absolutely terrible, terrible, terrible.
I think I'm going to cry.
Well, we're not done.
You're gonna get more depressing, Okay.
I mean because we have to talk about North America.
Oh yeah.
Historian Elizabeth Fenn tracks a massive smallpox epidemic in North America in the late seventeen hundreds, coinciding with the time of the American Revolution. In her book Po's Americana, she describes British soldiers who were more protected from smallpox infection because inoculation was more popular in England than it was in the US at the time anyway, so she describes British soldiers and officers deliberately trying to infect American soldiers where inoculation wasn't as widely accepted.
So is this where they were started to decide that all is fair in love and war. Theyre like, we're just gonna I mean, it's always been fair, all fair in war. But also you're like, I'm not going to try and actually fight you. I'm just gonna get you sick, Like get come on, man, that's.
Not that's not cool. Bioterrorism.
It's not bioterrorism. That's what it is.
You're right by bio warfare at the very least. Yep yep, she described. And so this, this smallpox epidemic that she describes around the late seventeen hundreds, was not isolated to the colonial states at the time, so the areas of New England and the Eastern seaboard. It spread across the country.
And this, as you said, American Revolution, right.
So seventeen seventy in the years she describes her seventeen seventy seven to seventeen eighty five. Okay. The reason, or one of the reasons is that smallpox was so devastating for native North and South American populations is because these were completely naive. They had never been exposed to smallpox before.
And so for instance, the Spanish conquistadors had been probably exposed as children, or the English they over across the board had lower mortality rates ranging around thirty whereas some to read about it, some Native American groups had mortality rates upwards of ninety percent, one hundred percent. I mean, it was unbelievable.
But like, one of the ways that they figured out how to end up with the vaccines is that if people were exposed to other forms of pox viruses by living with other animals, then they could even if they never got smallpox, if they were exposed to another form of pox virus might have had some sort of immunity, which is why you saw lower mortality rates in the European population.
This is a nice little segue, yeah, into talking about inoculation and vaccination ooh, and their relevance to the fight against smallpox.
Yeah.
Inoculation as a practice had been around for hundreds of years in certain cultures and regions, such as among groups in Western Africa and Turkey. Okay, but Western medicine had ignored the practice, chalking it up to old wives tales and uneducated nonsense.
So can you explain what inoculation is?
Sure? Inoculation is the practice of taking material, so usually like pus or skin from a person who had active smallpox infection. Yeah, taking that and then injecting it or inserting it in some way into an individual who had never been exposed to smallpox.
Basically like exposing them directly exposed to them infectious gunk.
But through a non but through a root, which was not as common.
Right, because it's a respiratory virus. Right.
And so what was the usual outcome of inoculation was a mild smallpox infection. The majority, the vast majority of patients who were inoculated survived.
Okay, So the.
Mortality rate for innoculation was two point five percent.
Wow, that's a lot lower than twenty to forty percent, right.
So you were way better off becoming inoculated lower. Yeah, And so you you had a mild infection and you generally recovered without any scars or pock marks. However, during the time that you did show symptoms of your mild smallpox infection, you were infectious to others, and so it was still really a dangerous practice in some ways.
Okay, that makes sense.
Inoculation was not very popular then in Western cultures, so in Europe, in parts of Europe, and in North America. Okay. But then around the same time in the early eighteenth century, which is the early seventeen hundred, I.
Was gonna ask, because I'm the worst at those okay numbers.
Two people on two different continents, one a high born woman in England whose name was Lady Mary Montague, and the other a reverend in colonial Boston named Cotton Mather. Yeah, Cotton, good old Cotton Mather. Where did you say he was Boston?
Oh? That wasn't of a good Boston accent.
I just I wonder how that name fell out of style. Anyway, these two took note of these practices and tried to bring them to the places they lived. The story goes that lady was a beautiful, popular.
Woman, aren't they all?
And then she got smallpox at twenty six, oh, baby, which left her pock marked eyelash lists.
That's if you are a woman, especially at that time.
I mean, I forget about it. Thank god. She's already married, Oh, thank god, and horribly fearful of the disease, which had killed her favorite brother in the same epidemic. Wait, her favorite, Yeah, that's from the book.
She had like an outward You can't have an outward favorite.
That's not I mean, okay, whichever brother is listening to this, you're my favorite.
That's rude.
She moved with her husband to Turkey, where she saw that smallpox wasn't viewed with the same terror as it was in England. There she first encountered innoculation, the practice, like we said, of grafting a bit of small pox after active smallpox into an unexposed person.
Okay, so she got smallpox before she learned what inoculation was. Yes, okay, got it late.
Mary immediately saw the enormous potential of inoculation and ordered her children to be inoculated.
Yeah me too. Oh yeah.
Upon her return to England, she tried to popularize it, but most doctors and the general public were horrified. Yeah. One they figured that actively giving yourself a disease was basically suicide, I mean and crazy.
It sounds pretty crazy, sounds pretty crazy crazy.
And two that this was going against the will of God.
Oh gotta bring God into it at some point.
Because if God wanted you or your kids to die of smallpox.
Then so she had wow yep.
To combat some of this incredibly stupid nonsense, Lady Mary and a few pro inoculation doctors designed an experiment in which they would inoculate a bunch of people who had never had smallpox to show to the public and also themselves, because they weren't entirely sure that inoculation was safe practice.
I hope that they got perm who they chose, Oh, let me guess prisoners U huh and uh children maybe not kind of children, foster children, orphans, orphans, orphans, Ye, prisoners and orphans, prisoners and orphans. Always at the end of the short.
Stan medical ethics was not a practice at this No. Well, regardless, the experiment worked, which is good. At least. A somewhat similar sequence of events occurred in Boston, except that there was no formalized experiment on repressed populations, just people going up to this doctor named you ready for this doctor zab deal? Oh geez Boylston, Boyleston.
Yeah, it was a terrible but also very appropriate.
Occasion, the early seventeen hundred.
Boyleston studying smallpox.
And and asking and asking him to inoculate them.
Okay, so, at least in this case it was willing volunteer.
For the most part.
It's gotta be the first time that the US has done it, right A just kidding, I don't know.
I mean, who knows. He did catch a lot of flak, though, for inoculating people because it was also hugely unpopular and actually survived several assassination attempts.
Oh wow. Interesting.
Eventually the numbers couldn't be ignored. Inoculation carried a mortality rate of two point five, while, like you said, natural infection was upwards of thirty yep. Inoculation became pactchually popular throughout the eighteenth century, but was dethroned by vaccination in seventeen ninety three. Ooh, you're probably somewhat familiar with this story,
or at least the name of its star. Edward Jenner Eddie was just going about his life as a country doctor Eddie when he noticed that milk maids who had once been infected with cowpox never got smallpox. So cowpox is a much milder infection in humans with basically no chance of mortality.
Because I'm guessing that it is a virus that general infects cows.
You're right about that.
Oh, I'm so good at the guessing.
He decided to try to take some of the puss of an active infection of cow pox and then put it into the skin of a completely unexposed person to cow or smallpox.
Interesting. So it's kind of like an inoculation, but with a different virus, a more mild virus, more mild form.
Okay, cool, and Jenner tried this out on eight year old farm hand James Phipps. Hello, medical ethics board, where are you still? No?
James was like, he's choice.
You Uh, but was Jenner supposed to just sit around and wait for smallpox to come to James Phipps. Nope, smallpox would come to James via Jenner, who directly exposed him. Luckily, for James and the rest of the world, his previous exposure to cow pox fully protected him.
Awesome.
Yeah, it's really I mean it's actually a huge step.
Hold on, wait he so he gave James Phipps, poor little kid, cow hand, stuck him with cowpox, and then he exposed him his smallpox.
Yeah. Wow, that's awful. I'm so glad it worked. Yeah, I also so is James. Jenner decided to call this practice vaccination vacca, meaning cow in Latin. Yeah, so that's where vaccination comes from. It's pretty cool.
That is awesome. So literally the word vaccination that we use now for all vaccines, all vaccines is because of smallpox.
Yes, vacca that is so cool. Yeah, Like inoculation vaccination took a little bit to catch on, but once it did, it spread faster than the smallpox virus around the world.
That was a really good one.
Thanks, and enabled doctors to eradicate this disease which had plagued humanity for millennia, which brings us to yeah, eradication, eradication. The gold stuff are on the story, the bright shining moment to lift you up. I think for most of us, smallpox feels ancient, like a thing of I don't know, history, like the sixteen hundreds, I mean when when Columbus came over. Like, it feels so far removed from where I am in terms of thinking about people who are actually infected by it.
But did you know that in the twentieth century smallpox killed over three hundred million people? Oh my god, that's more, yeah, than all twentieth century wars combined World War One, World War two, Vietnam War, so many wars, and also more than the nineteen eighteen flu.
It's also the population of the United States of America. Yeah, Like, there's what three hundred and fifty something, three hundred million people that was in the twentieth century alone. Huh, oh my god.
Now thankfully though, it is a thing of the past. Yeah, smallpox death toll in the twenty first century zero so far, But I'm getting ahead of myself. In nineteen sixty six, the World Health organization the WHO proposed a plan to eradicate smallpox and put D. A. Henderson in charge of
carrying it out. Over the next twelve years, thousands of people traveled to some of the world's most remote corners, living in extremely challenging conditions and working in conflict ridden countries to administer smallpox vaccine in an attempt to eliminate it completely. And it worked. The last natural case of smallpox infection occurred in Somalia on October thirty first, nineteen seventy seven, over forty years ago this month. This wow, well, next.
Time, not anymore.
Yeah, And it happened in a twenty three year old cook named ali Mao Mahlen who had actually once worked as a smallpox vaccinator despite never having been vaccinated himself.
Wait, so he worked administering the smallpox vaccine to people never vaccinated, and then was the last natural.
Case of That's isn't that funny?
That is really funny, I did not know that.
Yeah. Once news of his infection reached the WHO, a team was sent to vaccinate the around ninety people who had come into contact with him.
Isn't that crazy?
Ninety people that he came.
In contact with before they were able to be like, oh man, we need to stop isolate this person.
Luckily, he survived the infection and no more cases emerged. The world was declared smallpox free on May eighth, nineteen eighty. And this guy, actually Ellie, went on to work very hard for the Carter Foundation to eliminate polio. Oh wow, but he died last year of malaria.
Oh that's sad.
Sorry, he was sixty three, he was Oh that's so young.
Oh God.
I wish the story of smallpox could end here, But I have a sad story to share. Oh remember how I said Molin was the last natural case of smallpox.
Yeah?
I used that qualifier because there was another case after his. What in England? Come On August eleventh, nineteen seventy eight, a medical photographer, Janet Parker became ill and started showing signs of smallpox.
It turns out in England.
In England, what, Yeah, that's ridiculous oh, did just listen on It turns out she had used a phone booth in a building which shared an air duct with a smallpox research lab, and some of the virus must have escaped threw the duck into the booth where she inhaled it. Yeah, she and her mother both came down with smallpox, and possibly her father, but he died of a heart attack before symptoms appeared. Oh my god, her mother made it, Janet did not. The scientist whose lab it was, doctor
Henry Bedson, committed suicide. Oh, this whole ordeal.
Oh my. The person who was the one in the building studying smallpox when he heard he felt responsible.
Oh I'm sorry to end on a side note.
Yeah, what the heck? He could have stopped it. Eradicated? But smallpox is.
Gone mostly Yeah, at least it remains the only human infectious disease to have been eliminated.
Wow.
Though I'm hopeful that those words will be wrong within a few years when polio and guinea worm are gone.
Wouldn't that be great?
Yeah? So aaron smallpox is eradicated. Does that mean we don't have to worry about it?
Oh?
Hell no? Oh no, no, I'm also really worried about it.
No, yeah, uh no, lie me too. Basically, we're all forked.
I read something in one of the books about how a Russian scientist defected to the US after he had been working in a lab whose goal it was to make a more virulent vaccine resistance strain smallpox. Yeah. This was in the eighties. Yeah, and this it turns out that this lab had not been listed on any register as to the remaining places that smallpox was supposed to be held. So, in case you don't know, smallpox is officially on paper at least exists in two labs, one in the US.
Right, two specific buildings. One the building is called Corpus six. It's at Vector, which is a research institution in Russia. The other place that it exists on paper is in the Maximum Containment Laboratory at the Center for Disease Control in Atlanta in the United States. Those are the only two places in the world on paper that smallpox virus exists.
But you're a fool if you believe that that's the only that those are the only places it is because North Korea, right definitely has smallpox.
I have a whole list of a bunch of.
Reantries, not where that worried about France.
But you know, I'm worried about France. I don't know why I'm said, people, I'm just worried about every Let's see India, Pakistan, China, Israel, Iraq, North Korea, Iran, possibly China, possibly Taiwan, possibly France. Yeah, dude, that's a whole lot of countries.
I mean, who's gonna go, Oh, yeah, here's all the smallpox, right wink.
So everyone the World Health Organization, back when they were sort of trailblazing on this eradication effort, they were getting really close to eradicating the disease, they started sort of strongly suggesting that everyone who was doing research on smallpox either destroy their stores of the vaccine or send them to the US and Russia.
There was a date around nineteen ninety five when everyone was supposed to have just either actually, okay, sorry, So prior to nineteen ninety five, all all these countries were supposed to have sent their samples to Russia or the US exactly, and then in nineteen ninety five there were Russia and the US were supposed to destroy samples.
And so basically what has happened is every few years since then there is a convention and people decide should we destroy everything or should we wait a few years for research purposes? And that has literally been what has happened every few years until this day. Those stores still exist, people maybe are still doing research. It's really hard to find any information about what type of research might be happening.
Well, they certainly were following nine to eleven. Yeah, well, but actually during yeah, for and during so but since since nine to eleven, since the anthrax scare, smallpox has been considered to be one of the more viable threats for in terms of bioterrorism. Yep, because it is so fatal, it is so infectious, or at least infectious enough, and it can be dispersed very easily. Right, it's airborne, airborne, it's airborne, and so it's it's a really interesting ethical issue.
It is because because there's no more smallpox in the world, right, do we continue how do we justify the continued research funds, research animals?
Yeah, And at this point, really the only reason that it is quote unquote justified to keep these stores of smallpox virus is because of the threat of bioterrorism, and so we need to be able to develop vaccines, we need to be able to do research. But then that is only because we think that there are other people out there doing research to potentially make this a weapon.
And well so, but there are like that has been verifle.
Well yeah, but that's the thing is I mean, it's it's not like it's just one person or one entity that's doing that and then everyone else is just trying to defend against it, right, It's it's likely everyone who is doing research on how to weaponize it. I mean, we uh, this is just us talking, but I mean this is also logic.
I think it's I think it's a very real fear that this could be weaponized because there was research done on mousepox to have and so a group of researchers in Australia manipulated the mousepox virus to defeat the vaccine so that vaccinated mice died or were susceptible to mousepox virus. And that is very easy. That could be very easily done with smallpox as well.
And the other thing is that the smallpox vaccine is extraordinarily imperfect. Imperfect is sort of a nice word to use for it. Currently today, about twenty percent of people would not be eligible to be vaccinated for the smallpox vaccine.
Right, So before you go jumping to your doctor and trying to get a hold of smallpox vaccine, first of all, it's not gonna happen.
They're never.
Second of all, you may not be eligible.
So anyone with exzema or who lives in a householder who has family members with egzma is not eligible to get the vaccine. Pregnant or if you live in a house with babies, you cannot give it. What else, if you're a moutocompromised, Yeah, if you have any sort of autoimmune disease, or are on chemotherapy, or have HIV, or honestly, if you probably live in a household with an immunal compromise person. Because the thing is that the current vaccination
for smallpox is another virus. It is not a modified, killed form of the smallpox virus. It is a live, active, different virus that they inject you with under your skin that actually causes a viral infection. It's just very localized to one pak essentially.
Right. So you've probably seen the scars.
Yes, and that I used to actually think that that scar was because the way that they injected the vaccine was like a big idea too, That's what I thought.
So there are things that are vaccine guns they use, So did you.
See that, Well, but that's what I used to think that the scar is from.
Well, but it's it's because it's because that's the way the pope.
There was an actual poc there.
And actually this reminds me one of the things that makes smallpox such a good candidate for eradication. There are multiple reasons. One, you can easily tell who has been vaccinated or not judging from the smallpox scar that they have or the vaccination scar. The second is that the vaccine itself, when freeze dried, has really long or has really high longevity, and it's really stable, and so you can transport it to these tropic countries where there tend
to be a lot of more cases of smallpox. And the third is that there is no known animal host reservoir. You reservoir, and so even so, for instance, if you eliminated it entirely from here humans, if it still could infect animals or was or animals were a reservoir for it, right, it means that you could still potentially humans could still potentially be exposed. Right.
That's why there are so many diseases that, as much as we would like to eliminate them, it's nearly impossible
because there are animal reservoirs for so many diseases. The other thing about the smallpox vaccine, besides the fact that about twenty percent of the population could not be vaccinated in case of an outbreak, is that, though there are probably swaths of the population that were vaccinated either as children or I double checked with my brother in law, some active duty military people also get vaccinated, depending on where they I don't know if it's what branch of
the military they're in, or if it's where they're going to be sent to, but they are also given the vaccine. But immunity tends to only last about four to five years, so if you were vaccinated a few years ago or when you were a child, you're no longer immune essentially, So if there were any sort of outbreak that happened today, sorry, yeah it is you no good.
I mean, it could be the case that you have a lesser infection, like a lesser.
Possible you might end up with this sort of mixed form or whatever. Is that what it's called modified modified. You might end up with the modified form, but still pretty gnarly.
I think our point is, how scared should you be of smallpox? Pretty scared?
Really really forkin scared. Seriously, I didn't even.
I mean, I mean, I think I think it's smallpox, despite having been completely eradicated, is so important and so relevant for today for a number of reasons, one of which is bioterrorism right, the other which is the vaccine scare, which I don't want to get into the whole nitty gritty on oh, vaccines are bad for you.
We're gonna get too angry at this time of night. I think, if yeah, yeah, get into that.
But I think it is really fascinating to see these parallels between yeah, vaccination when it was first introduced and nowadays, and the pushback against that and the reasons why. And I think that the absence of diseases, such a visible diseases such a smallpox, ye, really lead people to forget how important vaccination actually is.
That's the thing is it's really easy when you're so far removed. The thing that I think is so crazy is that not a single physician in the world who has been trained since the late nineteen seventies, has ever seen a case of smallpox ever? And hopefully they never ever ever.
Will hopefully, But oh, I think it's incredible.
It is absolutely incredible because the thing is, like I mean, I'm in medical school right now, we have never talked about smallpox. Besides to say that this is a disease that has been eradicated, we never talked about the symptoms in depth.
Don't worry, it's eradicated. The gotcha, right?
And so to think that if there were to be even if you don't think about it from a sort of large scale bio terrorism aspect, if you just think of what if a few particles somehow got out.
In a lab accident, such as happened to Janet Parker exactly.
And so I mean, if something like that were to happen, could we even diagnose it in order to contain it?
Oh?
Isn't that scary? I thought of that while doing all this research.
Is there a movie that is smallpox?
Not that I know of.
There should be screenwriters, get on this.
Yeah, are you hearing this? Guys? This is a great This is scarier than the movie Contagion, Oh way scarier. Yeah, So if we were at one point, we talked about doing a sort of threat level on all of these episodes, like terror threat level orange or whatever.
This threat level. Wear a diaper because you're about to pee your parts. Yeah we have no scale.
No scale. Yeah we don't have a scale.
But in reality, yeah, be really scared. Smallpox is awful.
It's really terrifying.
But wait, we've been using the wrong verb tense. Smallpox was awful.
It was thank goodness, thank goodness, thank you World Health Organization.
It's actually amazing what they accomplished.
It really is. We should let people know if they'd like to read more, because some of these books are really amazing. Got a list, I've got a hit me with them.
If you want to know more about inoculation and the development of inoculation as a practice in England and the US, you should read The Speckled Monster by Jennifer Lee Carroll. If you are interested in the nitty gritty of the epidemic that happened in North America from seventeen seventy seven to seventeen eighty five, you should check out Pox Americana by Elizabeth Fenn. Smallpox The Death of a Disease by D. A. Henderson, is a book penned by the leader of the eradication
effort himself, and it is an amazing book. It is really great.
Also, don't you have a signed copy of that?
I do, I know, I got it all got it like a books Amazon, and it's sign so thrilled.
By literally the person who was the reason that we were able to eradicate this disease, Da Henderson props.
The other book that I think you should read is called The Demon in the Freezer and it's by Richard Preston. It reads like a movie script. It is really exciting. It's more about the eradication effort of smallpox and then anthrax in terms of bioterrorism. It's a little dated, but it's really still really good. The Power of Plagues by Irwin Sherman. It's a compilation book with chapters on different diseases or on different topics in terms of plagues and
epidemics throughout history, and all of those are great. We recommend them, so if you're interested read more. Yeah, check it out, check it out, fact check us.
That'd be fun. If we're wrong, let us know, man.
Yeah, we would love to hear yeah, because we're just doing this for fun.
Yeah, it's very fun, it is.
And so what's happening next week? Speaking of more fun, I.
Don't know what is happening next week. Colra Coolera, Yeah, oh man, that's gonna be fun.
Colra is gonna be good. Get ready for some good John snow Puns, The.
King of the North. That was my first attempt.
The King of Coolera.
We'll work on it.
Yeah, we've got a long way to go.
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PWK. Why that's it? All right?
I think that's it.
Yeah, all right, everyone wash your hands.
Yeah. Fealthy animals