History Of Smallpox Research Articles

Cognitive and ethical reasons for the dissident movement in epidemiology

The article discusses several fundamental reasons for the emergence of such a significant phenomenon as the anti-vaccination movement. An attempt is made to classify these causes. The theory of the phases of the vaccination cycle by Robert Chen is presented. The theory of cognitive simplicity and the creation of illusory patterns to strengthen psychological control over a stressful situation was developed by Moscow anthropologist Alexandra Arkhipova. The decision to refuse vaccination is often accompanied by an inability to rank the risks and trust in pseudoscientific rumors. The level of distrust of citizens in government and healthcare, and, conversely, excessive trust in populist personalities, is also a significant reason for dissent in epidemiology. The article provides numerous examples from the history of smallpox, cholera and coronavirus epidemics. In conclusion, the article considers the problem of trust and mutual responsibility in society.

Smallpox complications

Smallpox, the first disease eradicated through a global vaccination programme, might have shaped human evolution by its high lethality 1 Riedel S Edward Jenner and the history of smallpox and vaccination. Proc (Bayl Univ Med Cent). 2005; 18: 21-25 Crossref PubMed Google Scholar (mortality 20–60%). The emergence of monkeypox, a related disease caused by an orthopox virus, has renewed interest in smallpox. Potential complications of monkeypoxMonkeypox is an emerging infectious disease that was initially recognised in 1958 but was not seen outside of Africa until 2003. It is caused by an orthopoxvirus, related to the smallpox virus, and presents with a pustular rash after a viral prodrome. A worldwide outbreak beginning in May, 2022, and affecting over 26 000 people to date, was declared a public health emergency of international concern by WHO on July 23, 2022.1 This outbreak has largely affected men who have sex with men, and has shown atypical presentations, including skin lesions without prodrome, predominantly anogenital or oropharyngeal lesions, and proctitis. Full-Text PDF

Viking smallpox diversity

Smallpox Humans have a notable capacity to withstand the ravages of infectious diseases. Smallpox killed millions of people but drove Jenner's invention of vaccination, which eventually led to the annihilation of this virus, declared in 1980. To investigate the history of smallpox, Muhlemann et al. obtained high-throughput shotgun sequencing data from 1867 human remains ranging from >31,000 to 150 years ago (see the Perspective by Alcami). Thirteen positive samples emerged, 11 of which were northern European Viking Age people (6th to 7th century CE). Although the sequences were patchy and incomplete, four could be used to infer a phylogenetic tree. This showed distinct Viking Age lineages with multiple gene inactivations. The analysis pushes back the date of the earliest variola infection in humans by ∼1000 years and reveals the existence of a previously unknown virus clade. Science , this issue p. [eaaw8977][1]; see also p. [376][2] [1]: /lookup/doi/10.1126/science.aaw8977 [2]: /lookup/doi/10.1126/science.abd1214

Vitiligo Iridis: A case report

To report an unusual case of vitiligo iridis.We examined a 55 year old woman attending our OPD with diminution of vision. Upon examination, we found multiple greyish-white circular spots on the anterior surface of the iris with punched out margins in the left eye. She also had a history of small pox in the past.Vitiligo iridis is a rare sequelae of Variola (small pox) infection. There are a few causes like surgical trauma, chronic iridocyclitis, chronic glaucoma, etc., which can cause iris atrophic patches but Variola infection is the most common cause of vitiligo iridis presenting with focal areas of iris atrophy.Even though the small pox has been eradicated, the patients of the elderly age group might present with the incidental findings of vitiligo iridis, which may or may not be associated with elevated intraocular pressure. Vitiligo iridis can present as a complication of a number of conditions. Hence, finding out the probable cause becomes of great importance to help prevent misdiagnosis as an unrelated cause of focal or multifocal iris atrophy. This can in turn help further management of the underlying cause.

The epidemic of smallpox in Northeastern Siberia and the first attempts to prevent it

Smallpox is one of the most dangerous human infectious diseases in the world, which claimed an estimated half a billion lives [1]. Smallpox reached the territory of Northeastern Siberia in the middle of the 17th century. It was spread by people from the European part of the Russian Empire. The devastating epidemics of smallpox led to the verge of extinction of entire tribal communities and small ethnic groups, especially in the Arctic. The article analyzes literary and archival materials on the history of smallpox and folk remedies used for the prevention of smallpox in the territory of Northeastern Siberia, particularly in Yakutia.

Ontology-Based Vaccine Adverse Event Representation and Analysis.

Vaccine is the one of the greatest inventions of modern medicine that has contributed most to the relief of human misery and the exciting increase in life expectancy. In 1796, an English country physician, Edward Jenner, discovered that inoculating mankind with cowpox can protect them from smallpox (Riedel S, Edward Jenner and the history of smallpox and vaccination. Proceedings (Baylor University. Medical Center) 18(1):21, 2005). Based on the vaccination worldwide, we finally succeeded in the eradication of smallpox in 1977 (Henderson, Vaccine 29:D7-D9, 2011). Other disabling and lethal diseases, like poliomyelitis and measles, are targeted for eradication (Bonanni, Vaccine 17:S120-S125, 1999).Although vaccine development and administration are tremendously successful and cost-effective practices to human health, no vaccine is 100% safe for everyone because each person reacts to vaccinations differently given different genetic background and health conditions. Although all licensed vaccines are generally safe for the majority of people, vaccinees may still suffer adverse events (AEs) in reaction to various vaccines, some of which can be serious or even fatal (Haber et al., Drug Saf 32(4):309-323, 2009). Hence, the double-edged sword of vaccination remains a concern.To support integrative AE data collection and analysis, it is critical to adopt an AE normalization strategy. In the past decades, different controlled terminologies, including the Medical Dictionary for Regulatory Activities (MedDRA) (Brown EG, Wood L, Wood S, et al., Drug Saf 20(2):109-117, 1999), the Common Terminology Criteria for Adverse Events (CTCAE) (NCI, The Common Terminology Criteria for Adverse Events (CTCAE). Available from: http://evs.nci.nih.gov/ftp1/CTCAE/About.html . Access on 7 Oct 2015), and the World Health Organization (WHO) Adverse Reactions Terminology (WHO-ART) (WHO, The WHO Adverse Reaction Terminology - WHO-ART. Available from: https://www.umc-products.com/graphics/28010.pdf ), have been developed with a specific aim to standardize AE categorization. However, these controlled terminologies have many drawbacks, such as lack of textual definitions, poorly defined hierarchies, and lack of semantic axioms that provide logical relations among terms. A biomedical ontology is a set of consensus-based and computer and human interpretable terms and relations that represent entities in a specific biomedical domain and how they relate each other. To represent and analyze vaccine adverse events (VAEs), our research group has initiated and led the development of a community-based ontology: the Ontology of Adverse Events (OAE) (He et al., J Biomed Semant 5:29, 2014). The OAE has been found to have advantages to overcome the drawbacks of those controlled terminologies (He et al., Curr Pharmacol Rep :1-16. doi:10.1007/s40495-016-0055-0, 2014). By expanding the OAE and the community-based Vaccine Ontology (VO) (He et al., VO: vaccine ontology. In The 1st International Conference on Biomedical Ontology (ICBO-2009). Nature Precedings, Buffalo. http://precedings.nature.com/documents/3552/version/1 ; J Biomed Semant 2(Suppl 2):S8; J Biomed Semant 3(1):17, 2009; Ozgur et al., J Biomed Semant 2(2):S8, 2011; Lin Y, He Y, J Biomed Semant 3(1):17, 2012), we have also developed the Ontology of Vaccine Adverse Events (OVAE) to represent known VAEs associated with licensed vaccines (Marcos E, Zhao B, He Y, J Biomed Semant 4:40, 2013).In this book chapter, we will first introduce the basic information of VAEs, VAE safety surveillance systems, and how to specifically query and analyze VAEs using the US VAE database VAERS (Chen et al., Vaccine 12(10):960-960, 1994). In the second half of the chapter, we will introduce the development and applications of the OAE and OVAE. Throughout this chapter, we will use the influenza vaccine Flublok as the vaccine example to launch the corresponding elaboration (Huber VC, McCullers JA, Curr Opin Mol Ther 10(1):75-85, 2008). Flublok is a recombinant hemagglutinin influenza vaccine indicated for active immunization against disease caused by influenza virus subtypes A and type B. On January 16, 2013, Flublok was approved by the FDA for the prevention of seasonal influenza in people 18years and older in the USA. Now, more than 3years later, an exploration of the reported AEs associated with this vaccine is urgently needed.

History of Smallpox and Its Spread in Human Populations.

Smallpox is considered among the most devastating of human diseases. Its spread in populations, initiated for thousands of years following a probable transmission from an animal host, was concomitant with movements of people across regions and continents, trade and wars. Literature permitted to retrace the occurrence of epidemics from ancient times to recent human history, smallpox having affected all levels of past society including famous monarchs. The disease was officially declared eradicated in 1979 following intensive vaccination campaigns.Paleomicrobiology dedicated to variola virus is restricted to few studies, most unsuccessful, involving ancient material. Only one recent approach allowed the identification of viral DNA fragments from lung tissue of a 300-year-old body excavated from permafrost in Eastern Siberia; phylogenetic analysis revealed that this ancient strain was distinct from those described during the 20th century.

History and eradication of smallpox in Turkey

Istanbul and Ankara connections in the history of smallpox. During the 600years of Ottoman history smallpox was ever-present alongside other epidemics such as plague and cholera. The prox- imityoftheAnatolianplateautoSouth-westernAsiaandmajortrade routeswhereitisbelievedtohaveoriginatedfromwasprobablythe reason for its presence in Asia Minor since ancient times. Written recordsbeforethe15thCenturyarescarceanddetailsofthedisease in the Empire remain under-documented. Even after the 15th Century, record-keeping was inadequate due to a lack of under- standing of infectious disease control and its importance in public health. The Ottoman Empire was represented at the First Interna- tional Sanitary Conference in Paris (1851), which ended without any successful resolution to disease control. At the 13th Interna- tionalSanitaryConference(1926),smallpoxandtyphuswererecog- nised as diseases to be controlled with quarantine measures 1 . Most documents related to the disease in the empire date back to 19th Century. While disease prevention and Jenner type vaccination started during the collapse of the empire, full eradication occurred only after the foundation of the Republic of Turkey.

‘Defying providence’: a salutary new look at the history of smallpox

Arthur W Boylston, Defying Providence. Smallpox and the forgotten medical revolution. Charleston, SC: CreateSpace, 2012; 282 pp. ISBN 978-1478232452 ‘Defying Providence tells the story of the many men and women who wrestled with their consciences to turn inoculation from a primitive folk practice into the most powerful weapon against smallpox in the 18th century.’ (p.10) Until the 18th century, the outcome of a smallpox infection was fated by providence. Between 10% and 20% of the infected died and, among the survivors, many remained stigmatized in their flesh and appearance for the rest of their lives. Plague had been public enemy number one of the 17th century. When its cyclic and deadly recurrences began to ebb, smallpox became the new scourge, a disease that killed princes and peasants alike. Lady Montague, who had had her children inoculated against smallpox in Turkey in 1718, popularized the technique in England. Still, it was a risky practice responsible for some deaths. Was inoculation more dangerous than a natural smallpox infection? Opinions were split until mortality among the inoculated and that of the naturally infected was compared. Inoculation reduced mortality by a factor of 10 in the 1720s, both in the UK and in North America. With this information the practice amplified. Many country doctors adopted it. In 1768, one of them noticed that some people working in farms did not have the usual clinical reactions following a smallpox inoculation. They seemed resistant. Many farm workers had previously contracted cowpox. This news spread among doctors, not among milkmaids. Could artificial inoculation of cowpox confer immunity against smallpox? Jenner’s brilliant idea led to the vaccine revolution, and finally the end of smallpox: ‘without inoculation the cowpox effect could not have been discovered. There was no folk tradition.’ The myth remains that the beautiful complexion of milkmaids spared from the disfiguring effects of smallpox ignited Jenner’s imagination, but it was likely the resistance to inoculation among farmers that opened the door to ‘vaccines’. A less-known aspect of the forgotten medical revolution of the 18th century is its impact on the American Revolution. General George Washington gave the landmark mandate to inoculate the colonial army. In America, the colonial and the English armies were not equally susceptible to smallpox. Most English soldiers were immune from previous infection or inoculation, while Washington’s troops, highly susceptible, were killed 10 times more by the disease than from combat. In 1777, surmounting defiance from state and army hierarchy, the Congress approved the plan to systematically inoculate its soldiers. The act was implemented during the next two consecutive years. ‘Thereafter,’ writes Boylston, ‘the threat to the revolution from smallpox was over. Inoculation became as much a part of soldiering as a musket […] Americans would have certainly lost the revolution without it because most American colonists had had little previous exposure to the virus, and therefore no immunity to it. When smallpox spread through susceptible soldiers, the force always disintegrated.’ (p.212). Still, inoculation had already weathered excessive hindrances; delays in inoculating the troops preparing to reach Quebec resulted in Canada remaining British. The style in Defying Providence is scholarly in its precision, paying attention to details, and citing primary sources extensively. But Boylston also has an undeniable ability for storytelling and suspense building. The result reads like a brilliant tale in which the practice of inoculation, after helping modern medicine forge its first research and conceptual tools, was later denigrated as dangerous and unacceptable when the public health preference shifted to vaccination. Smallpox was the main health scourge when the conditions for a science of epidemics (an epidemiology) began to exist. Boylston can therefore trace in these illustrious decades of the 18th century the early manifestations of comparative studies, ancestors of controlled trials, and of what came to be known as evidence-based or evidence-informed medicine. Defying Providence is a precious book about ‘one of medicine’s finest hours’, at the crossroad of the history of diseases, of medicine, and of epidemiology.

Alexandre Reydellet, Navy surgeon (1793-1859): a life devoted to fighting smallpox at Reunion Island

After reviewing the history of smallpox throughout the world and of the techniques used to try to prevent it (variolation and then Jenner's vaccine), we describe the epidemics that reached in the Indian Ocean between 1729 and 1859. Alexandre Reydellet, a Navy surgeon under Naoleon, arrived in Réunion in 1815 and stayed until his death in 1859. His energetic vaccination campaigns and their results are depicted.

Smallpox: New Perspectives Regarding Risk Assessment & Management

Although official stockpile of smallpox are limited to two sites, everlasting rumors of bioterrorism use of this virus make its risk assessment controversial. After a quick overview of the history of smallpox and its current situational analysis, the author presents his own vision regarding likelihood of smallpox weaponization and new trends regarding its risk management. In particular, four scenarios on how to get hold of smallpox samples are discussed as well as the following steps of potential deliberate release in light of feasibility from the terrorist standpoint. Following, early detection strategies are overviewed with a special focus on their respective limitations. Then up to date therapeutic armamentarium, including drugs under development is detailed. In conclusion, the author exposes a surprising paradox regarding the potential use of smallpox as an agent of bioterrorism by Al-Qaeda terrorists and alike.

Killing a Killer: What Next for Smallpox?

Now that the 20th century has passed into the domain of history books, we can retrospectively begin to assess the relative contributions that the many advances in the realm of infectious disease have actually made to public health in general. At the top of this virtuous list will surely be the discovery of antibiotics in the 1930s and the use of vaccination to eradicate smallpox as an extant human disease in the 1960s and 1970s. As clearly pointed out in a recent book by D. A. Henderson, one of the leaders of the global smallpox eradication program, this task of ridding Homo sapiens from the curse of this ancestral disease was neither easy nor without controversy [1]. In fact, the history of the many consequences of smallpox on humankind reads like a long litany of human misery and calamitous events, but is juxtaposed with the more noble accomplishments that began with the discovery of vaccination by Jenner in 1798 and culminated with the World Health Organization (WHO) certifying the world free of smallpox in 1980 [2]. With this singular accomplishment, as many as 60–100 million individuals who would have been predicted to die of smallpox have been spared from a truly gruesome death. Nevertheless, as is intimated by the timeline in Table 1, which summarizes the history of smallpox and the orthopoxvirus that caused the disease (variola virus), the narrative of smallpox did not stop with its eradication as a pandemic human disease. Instead, we find ourselves still wrestling with an issue that intermingles public health policy, philosophy, national security, and bioterrorism, and affects our perceptions of research ethics with extreme pathogens in general. It boils down to a not-so-simple question: What exactly should the Victor do with the Vanquished? Table 1 History of Smallpox: Timeline of a Serial Killer. In 1980, this question seemed simpler than now. Following the smallpox eradication, all declared stocks of the live variola virus were rounded up and distilled into two WHO-approved repositories, now residing at the Centers for Disease Control (CDC), Atlanta, United States of America, and at Vector, Novosobirsk, Russia. WHO convened a standing committee to oversee these repositories and issue regulatory approval for any research studies that utilized the live virus stocks at the two sites, with the tacit assumption that the only justifiable long-term fate for these stocks was an autoclave. Then, the revelation that variola virus had been covertly weaponized and stockpiled by the Soviet military [3],[4] led to escalating waves of mistrust and suspicion amongst politicians, government officials, scientists, and health policy experts alike [5]. Factions then formed, with the two sides collectively promulgating an agenda that was either pro-destruction or anti-destruction, and cogent arguments were made by members of both camps as to why the declared stocks of variola virus should be maintained or not [6]–[8]. In the meantime, the member states holding the declared stocks of live virus (i.e., the US and Russia) held their own internal deliberations of what to do next, in a kind of pas de trois with the WHO that continues to this day. In the case of the US, input was sought from the Institute of Medicine (IOM), which has struck two expert committees (the first issued its report in 1999, and the second committee report was released in July 2009 at http://www.iom.edu/Reports/2009/LiveVariolaVirusContinuingResearch.aspx; [9]) on the scientific rationale for any further research that would require live variola virus. It is expected that these two IOM reports will be factored into the US decision as to how to respond to any future request from WHO (expected in 2011), following a vote of member states of the World Health Assembly on the specific issue of whether the declared live variola virus stocks held at both sites should now finally be destroyed.

Priority, Invisibility and Eradication: The History of Smallpox and the Brazilian Public Health Agenda

This article describes three periods in Brazil's modern history when governmental action was (or was not) taken against smallpox: first, when smallpox control became a priority in the Brazilian sanitary agenda from the nineteenth century to the beginning of the twentieth century; second, when it was rendered politically invisible during decades when greater attention was given to yellow fever and malaria control; third, when it reappeared at the centre of Brazilian health policy in the 1960s until its eventual eradication in 1973. Smallpox control in the latter two periods is suffused with paradox. For example, evidence suggests that the nearly fifty-year absence or lack of policies and agencies to deal with smallpox actually favoured the mobilization of local, national and international resources once the eradication programme was launched in 1966; these new approaches were accelerated from 1969 until the completion of eradication in 1973. Equally paradoxical, it was during the specific context of the military regime after 1964 that the Brazilian health system developed the capacity to mobilize existing but dispersed resources and flexibly to innovate, incorporate, and adapt new policies. Another important element in this period was institutional learning based on other vertical programmes such as the malaria eradication campaign. Although the Brazilian smallpox eradication programme was constrained by international agencies and by bilateral co-operation with the United States, the period after 1964 offered opportunities for the realization of a new and wide-ranging national health capacity including the creation of a national system of epidemiological surveillance and a national childhood immunization programme. It also saw the empowerment of young physicians who would later come to occupy key positions in Brazilian public health and in international health organizations.

Smallpox in Africa during Colonial Rule

The history of smallpox in Africa during colonial rule is a relatively neglected subject. This is not because of ignorance or obscurity but in some ways just the opposite: it is thought that there is little more to be learned about it. To be sure, vaccination campaigns during colonial rule were one of the earliest and most extensive public health programmes that Europeans bragged about as evidence of the advantages of colonial rule: “an appreciable agent of propaganda”, is how one French colonial medical officer described smallpox vaccination.1 The mass campaigns used mostly African personnel and produced effective results. Moreover, at the end of colonial rule and beginning of independence, smallpox gained worldwide attention when the World Health Organization (WHO) launched its smallpox eradication programme. Now the colonial measures were criticized as not going far enough, and data on epidemics and prevalence were the subject of much study as measures were taken which successfully eliminated the scourge in the 1960s and early 1970s. Since then, the magisterial volume by the principal leaders of that effort, Frank Fenner, and his co-authors, has been taken as more or less the last word on the subject, not just in Africa but worldwide. This is appropriate, to a large extent. The sections on Africa in the volume, and another by one of their collaborators, Donald Hopkins, are thoroughly documented, based on a large amount of evidence, and certainly the starting point for anyone wishing to revisit the subject.2 But these authors have a particular point of view, given their involvement in the campaign, which minimizes earlier efforts. Hence the chapters on colonial rule focus primarily on the epidemiology of smallpox, with little about attempts to prevent or respond to epidemics when they occurred.3 This study focuses on the efforts at smallpox control and prevention from the 1920s to the end of colonial rule in West, Central and East Africa. These were by far the earliest and for a long time the largest efforts at introducing Western medicine to Africa. To the extent they succeeded, even though not completely, they were a model for further public health efforts, including the WHO eradication campaign. To the extent that they failed, the campaigns offer a lesson for contemporary efforts to reduce, let alone eradicate, diseases in tropical settings. In addition to showing the extent of smallpox vaccination in colonial Africa, this study also examines assessments at the time about the effectiveness of such attempts at control and prevention and the wider context in which they were undertaken. It supports the most important lesson drawn by those involved in the WHO eradication campaign: that only a worldwide and comprehensive effort could succeed in eliminating the periodic epidemics that plagued places such as Africa. Without sufficient vaccination protection, even if a particular colony had no new cases for a number of years, isolated cases or smallpox brought in by travellers from outside eventually reached small pockets of those unvaccinated, with devastating results. That did not mean authorities before 1958 did not try, and those efforts show significant success in containing and eliminating outbreaks when they occurred. After the eradication of smallpox, there were great hopes of eliminating other contagious diseases.4 This not only failed to occur but new diseases, such as HIV/AIDS, have emerged which means we are back in a situation of trying to control and eliminate diseases, much as colonial authorities attempted in the first half of the twentieth century in Africa. A re-examination of their efforts is therefore warranted.

Christopher Booth, John Haygarth FRS: a physician of the Enlightenment (1740–1827), Memoirs of the American Philosophical Society, vol. 254, Philadelphia, American Philosophical Society, 2005, pp. xv, 169, illus., $60.00 (hardback 0-87169-254-6).

Biography of the so-called “great men” of medicine has frequently been disparaged by academic historians—especially when the author is a retired clinician. This has often been justified, as some of the works are mere collections of readily available facts with no synthesis and little understanding. Whiggish hagiography is easy to write. But good biography is important. Those who would try to understand the fundamental trends of the past and interpret them for today must know about the protagonists and be able to rely on accurate scholarship about them. The skills that the experienced clinician biographer brings to the work are very similar to those he used with his patients. The collection of primary source material (clinical examination, x-rays and pathology results), formulating the hypothesis (diagnosis) and then testing it (the treatment and follow up) is little different to the technique of a trained historian. Haygarth was a “great man”. A true child of the Enlightenment, he had a wide circle of correspondents and friends including William Cullen, John Fothergill, Sir Joseph Banks, William Heberden and, across the Atlantic, Benjamin Waterhouse. He became an extremely busy physician in Chester, where he demonstrated that it was easier to put ideas into practice than in London. Thus he formulated a plan, which was in a great measure successful, to eradicate smallpox in the town by inoculation. Later, he wanted to extend the plan nationwide, but nothing came of it, and shortly afterwards vaccination was promoted. On the basis of his own experiments, he believed that fever was contagious. He set up fever wards for the poor in the local infirmary, and this work laid the conceptual foundations for isolation hospitals. At the age of fifty-eight he retired from clinical practice and went to Bath, the city of Jane Austen, Edward Jenner and Caleb Hiller Parry. For some years the Bath Philosophical Society met in his house. He turned his attention to literary work based on the mass of clinical notes he had made. This led to further publications on fever, rheumatism, and, possibly unwisely, he entered into the virulent controversy in Philadelphia as to whether what we now call yellow fever was endemic or imported from the Caribbean. Perkins' Tractors had become the fashionable cure-all among the valetudinarians in the town, and Haygarth exposed Perkins as a fraud and made sure that the deception was widely exposed. True to the spirit of the age, he engaged in philanthropy. A devout Anglican, he was always interested in education for the poor and, having been a governor of the Blue Coat School in Chester, he proposed that a similar scheme could be introduced in every parish in England at very little cost. In his later years his other great interest was in devising and setting up the Bath Provident Institution as a savings bank for the benefit of the thrifty and industrious. This study is not only a delight to read, but it will be of great value to many researchers. Anybody looking at the genesis of the understanding of fever, medicine in small town Georgian England, the history of smallpox, the transatlantic passage of medical knowledge, education for the poor and the start of the Friendly Society Movement will find something of value. Those interested in Booth's previous work on the medical connections of the Yorkshire Dales will not be disappointed. The book is well produced and impeccably referenced. Booth, a true clinical historian, has made his case that Haygarth's name should be placed “alongside the great pioneering philanthropists of the age”.

The Life and Death of Smallpox (review)

Reviewed by: The Life and Death of Smallpox Jeffrey Koplan Ian Glynn and Jenifer Glynn. The Life and Death of Smallpox. Cambridge: Cambridge University Press, 2004. x + 278 pp. Ill. $25.00 (0-521-84542-4). Smallpox is a disease whose time has come and gone and then come back yet again. From the official declaration of eradication in 1979 to the mid-1990s, study of and reflection on the disease was largely limited to medical historians and a few virologists. With increasing concern about potential bioterrorist agents, smallpox included, and the recurrent rumors and anecdotes of potential unaccounted-for caches of the lethal virus, the press and the public, public health researchers and government officials, intelligence agencies and pharmaceutical manufacturers have all developed a renewed interest in this pathogen. The Life and Death of Smallpox provides a relatively pithy primer on the biology and history of both the disease and the vaccine. It is clearly written and contains considerable information. The general reader looking for an overview might turn here and gain some insights. However, the authors seem to have relied on a small number of oft-referenced sources; they only superficially address some key policy issues and recent events; and they offer no new insights about them. For the reader interested in the history of smallpox, it is best to seek Donald Hopkins's book The Greatest Killer.1 For the clinical aspects of smallpox, the disease, see C. W. Dixon's text, Smallpox.2 For details of the eradication effort, see the series of country-specific volumes produced by the World Health Organization. For consideration of more recent smallpox vaccination policy, see the report of an Institute of Medicine committee, The Smallpox Vaccination Program.3 The first several chapters cover the histories of first the disease and then the discovery and dissemination of vaccination. The chapters are organized chronologically, and within each era they address events and individuals in many parts of [End Page 385] the world. Thus, the reader is taken from England to Scotland to France to New Zealand to the Crimea to the U.S. Civil War within two pages in chapter 10. The resulting narrative is filled with information, and because there is no easy way to present such multinational, multimillennial material, the reader may occasionally feel a bit jet-lagged. One attribute of this book is its more extensive coverage of smallpox and vaccination in England. There are many interesting anecdotes and facts—from references to smallpox in the works of great British novelists, to learning that Josiah Wedgwood (of pottery fame) was the grandfather of Charles Darwin. But some interesting and relevant historical elements are not included. George Washington is mentioned as having "an acute awareness of the danger of inoculated smallpox" (p. 88), for example, but there is no mention that his face was pockmarked due to an infection acquired in Barbados in 1751. Chapters on the recent history of the eradication effort and on the issues of smallpox and bioterrorism suffer from a reliance on limited sources (the IOM report is not referenced) and a lack of critical analysis. Many individuals who played critical roles in smallpox eradication have been ignored or undervalued. In the late 1960s and early 1970s David Sencer, the director of the then Communicable Disease Center, made key decisions in resource allocation and prioritization that provided crucial support to the global effort. The role of the U.S. Agency for International Development is not discussed. The authors do not mention that the WHO during the smallpox eradication campaign used as a justification for the program their belief that this agent was very unlikely to be used for bioterrorism. In addition, the story of eradication could be considerably enhanced by including more of the perspectives of the local participants in programs for which most of the histories have been provided by a few international participants. Such a book has yet to be written. The discussion of recent smallpox-vaccination policy decisions also suffers from little political context. The IOM committee report questioned the scientific credibility of the promulgated policy. The role of the USSR in advocating early for the eradication of smallpox and then later stockpiling...

The history of smallpox

The history of smallpox, from its probable origin 3000 to 6000 years ago to its worldwide eradication in 1978, is a fascinating story. A feared infection, even today, smallpox has caused the deaths of millions of people and disfigured many. This article describes the possible origin of the infection and traces its progress throughout the world. The introduction of inoculation with material from smallpox lesions and vaccination using cowpox virus is described. The World Health Organization's successful smallpox eradication program in the 1960s and 1970s is described. Personal experience of this program in Bangladesh in 1973 is outlined, as is the laboratory escape of the major smallpox virus in Birmingham in 1978. The possible use of the smallpox virus as a biological weapon is discussed.

Edward Jenner and the History of Smallpox and Vaccination

(2005). Edward Jenner and the History of Smallpox and Vaccination. Baylor University Medical Center Proceedings: Vol. 18, No. 1, pp. 21-25.

Treating Patients With Smallpox in the Operating Room

Recent events around the world have emphasized the need for health care facilities to prepare to deal with biological threats, including smallpox. At Walter Reed Army Medical Center, Washington, DC, administrators recognized the need for a policy on handling patients with smallpox in the OR and asked a group of students to create a template policy for care of patients with smallpox in need of surgery. This article provides a brief history of smallpox, concerns surrounding smallpox today, and smallpox characteristics with which perioperative personnel should be familiar, as well as a guideline for treating patients in the OR who have smallpox.

Objectifying Uncertainty: History of Risk Concepts in Medicine

The issue of risk has become so common in contemporary medicine that social scientists speak of a veritable ‘‘risk epidemic’’ in the medical literature since the 1960s (Skolbekken, 1995). The use of the term ‘‘risk’’ implies a specific strategy of dealing with uncertainty based on calculations of probabilities (Short and Clarke, 1992a,b: 317–318). Probabilitybased logic helps medicine ‘‘to approach the uncertainties of diagnosis, therapy, and prognosis, and the clinical judgment that lies at their heart’’, as medical sociologist Renee Fox (2000: 410–411) points out. This strategy of objectification can be traced back to the Enlightenment period, and by the end of the 18th century, mathematical and quantitative methods were being applied quite frequently in order to create certainty in medicine (Magnello and Hardy 2002: iv). Historically, however, the idea of risk has emerged in an economic context. It referred to the danger of losing money in business, especially on loans, in gambling and in insurance (Gigerenzer et al., 1989: 20–26). The earliest link to health issues can be seen in life insurance companies that needed to decide on the conditions under which they would accept applicants for a policy. Already the first life insurance company, the Equitable in England, charged extra premiums in 1762 for applicants with gout, hernia and no history of smallpox (Rothstein, 2003: 61–62). As a basis for their policy, the companies used mortality tables. The technique of drawing up mortality tables goes back to vital statistics, which used records of births and deaths in a locality or country to provide knowledge about the statistical regularity of health conditions within populations. This tradition started with the bills of mortality that were published in 1562 by the city of London to keep track of plague deaths as a warning of a major outbreak (Gigerenzer et al., 1989: 20–21). In the 16th century, the London merchant John Gaunt began to apply his commercial accounting practices to mortality lists. The resulting tables were published in 1662 under the title ‘‘Natural and Political Observations Made Upon the Bills of Mortality’’. They enabled a systematic comparison between past and present mortality numbers, parishes and city quarters, as well as death causes and gender specificities. This type of argumentation was found persuasive by British physicians and subsequently applied to medical questions (Rusnock, 2002: 40–50). Within the emergent commercial and consumer culture of the period, counting and accounting came to be the preferred method of assessment in many different areas, among them medicine. The British hospital and dispensary movement, for example, induced doctors and lay sponsors to count recovery and death rates within these institutions and to calculate success rates of specific cures. Broadening their perspective beyond the traditional individualistic approach of medicine, doctors and administrators now focused on the well-being of the whole population or specific groups within it – such as the laboring poor, soldiers, women, children, rather than on individual patients. This applies to the evaluation of clinical experience too: An analysis of British medical journals from 1733 to 1829 shows the gradual reduction in dependence on single case reports and a growth in the publication of larger series, some of which were even analyzed by what can be called proto-statistical methods. In 1747, the British Navy physician James Lind (1736–1812) conducted his famous experiment on the treatment of scurvy amongst sailors, a procedure that can be interpreted as an early type of