The Free Economic Society and the Battle against Smallpox: A “Public Sphere” in Action

Abstract

Convinced that a demon caused their misery, and aware that survivors did not sicken again, the villagers applied an irritating substance to their bodies, stimulating a pock-like appearance. When the disease continued to take its toll, guards stationed themselves at the entrance to their community, arrows drawn, bows taut.' Thus, Doctor A. Komin, a zemstvo physician, described the reaction of a stricken Siberian people to smallpox. Though Komin meant to illustrate how poverty and ignorance could inhibit modem medical care, the Siberians' response had merit. It demonstrated a rough understanding of the principle of immunity and an apparent receptivity to a preventive act-both critical ideas in the evolution of medicine's first preventive inoculation. Even for the better developed areas of Western Europe and America, eradicating smallpox, a disease that killed millions and maimed countless others, was a long, arduous task. For the Russian Empire, even modest advances were likely to be difficult. Its size, classic underdevelopment, pervasive poverty and illiteracy, and fragmentary medical infrastructure would seem to doom most efforts against any epidemic disease, once one was rooted in the scattered population. Nevertheless, Russia did mount an effective preventive smallpox program before World War I, playing a role in one of the central dramas of world public health. The awareness that smallpox conferred immunity on its victims had first led to a procedure called variolation (after the Latin for smallpox). Practitioners of the art inoculated healthy persons with tiny amounts of pustule material from an active case; some subjects inhaled the matter. Variolation carried significant risks, but other than quarantine, offered the only available protection until the late eighteenth century. In 1796, Edward Jenner provided an alternative to variolation when he demonstrated that vaccination with a relatively benign disease, cowpox, also granted immunity to smallpox. Jenner's remarkable