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> Date: Tue, 30 May 1995 08:16:50 EDT > From: Timothy Bratton <email@example.com> Having joined this list only in late May, I missed April's discussion about smallpox and the American Indian, and have read about it retroactively in the logs. As somebody who has written upon this topic ("The Identity of the New England Indian Epidemic of 1616-19," _Bull. Hist. Med._ 62 : 351-83), I can only address some loose ends. 1. Several writers complained about the lack of a detailed _medical_ book about the nature of the smallpox virus and its various modes of transmission. I would recommend Cyril W. Dixon's _Smallpox_ (London: J. & A. Churchill, Ltd., 1962), which might be found in major medical school libraries. Dr. Dixon ran smallpox clinics in India and England, and had first-hand observational knowledge of the disease. Since smallpox has been extinct officially since 1980, Dixon's book may well remain as one of the last great clinical studies of this disease. He noted (page 172) that there were _four_ possible routes of infection: a. The major path, acquisition of the virus through the respiratory tract. b. _Accidental_ inoculation through skin lesions. Whereas smallpox acquired through the nose is deadly, it did not usually manifest such severe symptoms when it invaded the body through cuts or scrapes in the epidermis. c. Dust from pulverized skin scabs could be inhaled. However, since scabs were usually from people who had _survived_ smallpox, they contained weakened or dead virus, which had been attacked by the survivor's immune system. This was the principle behind inoculation, practiced both by the Chinese and the Turks. The physician would grind up smallpox scabs taken from a recovered patient and blow them up the nose of the person requesting inoculation through a straw. The theory underlying this procedure was that the second person would contract only a mild case of smallpox, since the virus was presumably attenuated. However, if the recipient lacked a strong immune system or if the virus were not noticeably weakened, he or she might develop a severe case of smallpox. d. Smallpox could be injected deliberately under the skin. Thus blankets laden with pus or fomites _could_ transmit smallpox to Indians, although this would not have been as effective a mode of transmission as the purely respiratory route. However, Amerindians had virtually no resistance to smallpox; as Dixon and the Stearnses pointed out, they contracted (on a scale of 1 to 9) the second most lethal manifestation of the disease, malignant confluent smallpox, with pustules running together, loss of blood plasma, stripping of the skin, hemorrhaging, and a case-mortality of 70-80%. Inoculations carried out on Indians tended to give them the full-blown disease; for example, an attempt to protect thirty squaws at Fort Union from the smallpox epidemic of 1837 by inoculating them with scabs from Caucasian survivors killed all the women instead! Only with the introduction of Jenner's cowpox vaccine was smallpox among Amerindians brought under control. Weak though the virus in blankets may have been, it might have been virulent enough to induce smallpox in a group with little natural immunity. Smallpox had broken out at Fort Pitt while Bouquet and Ecuyer were corresponding. Most people knew that an attack of smallpox conferred lifelong or at least long-term immunity; had British soldiers who had recovered _recently_ from smallpox been assigned to redistribute the blankets and handkerchief, they could have handled the infected materials with some degree of safety. Using a handkerchief was especially diabolical, since the recipient might well have used it on his own nose, introducing the virus directly into the respiratory system. 95% of all Europeans expected to catch smallpox over the course of their lifetimes (Fernand Braudel, _Capitalism and Material Life_, p. 43), and it is quite possible that most of the garrison at Fort Pitt already had contracted the virus in the past, making Ecuyer's experiment a little less dangerous. Bouquet wrote to Sir Jeffrey Amherst (cited in the Stearnses, pp. 44-45) that he would "take care not to get the disease myself." I might add that while I am inclined to believe that Amherst and Bouquet _might_ have intentionally infected the local Indian tribes around Fort Pitt, this does _not_ appear to have been the general policy of either the British (and later, American) governments. As other correspondents have pointed out, Pres. Jefferson sent "kinepox" (cowpox) on the Lewis and Clark Expedition to protect any Indians they met en route from smallpox, but the vaccine had lost its effectiveness by the time they sought to employ it. During the Great Plains epidemic of 1837, traders like J. Halsey tried to _prevent_ Indians from visiting forts while the disease was raging, to no avail. Given that the trading posts depended upon good economic relationships with the surrounding tribes for profits, spreading smallpox deliberately among their customers would not make sense. 2. Mary Beth Norton asked how long the virus could live outside of the human body. Dixon, page 304, recorded that smallpox scabs stored in cotton at room temperature, a relative humidity of 55-75%, and in indirect sunlight still were viable after 18 months. Thus the virus does not appear to survive, even under optimal conditions, for more than two years. He asserted (p. 396) that there was no evidence for the virus lurking in graves, although linen and scabs might survive for a time in vaults above ground. The Stearnses, page 36, recorded a cemetery in Quebec which harbored victims of the epidemics of 1650 and 1708. After the cemetery was disturbed in 1854 in order to build sewers, smallpox broke out in its neighborhood, but this was probably just a coincidence. 3. The contagion theory of smallpox was quite old, although it had to compete with miasmatic and other theories of origin. Hopkins, _Princes and Peasants_, page 28, says that Gilbertus Anglicus, in his _Compendium Medicinae_ (c. 1240), may have been the earliest author to claim that smallpox was contagious. Girolamo Fracastoro (1478-1553), in his _De contagione et contagionis morbis et eorum curatione_ (1546), argued that measles and smallpox were clearly diseases spread by "small seeds" (_seminaria_) attached to infected objects. The popularity of the contagious nature of smallpox was attributed to the work of Jean Baptiste van Helmont (1578-1644) and Hermann Boerhaave (1668-1738). Indeed, because smallpox is an illness dispersed _only_ by human beings, the evidence that it was spread by contagion was stronger than for diseases such as plague or malaria, where insect vectors were involved. 4. Geoffrey Marks and William Beatty, _Epidemics_ (N.Y., 1976), p. 166, gave a radically different account of the epidemic among the Mimac(k) Indians in 1746-47 than that posted by Geoffrey Plank on 18 April. Prof. Plank provided a version in which the French blamed the English for infecting these Indians with virus-laden clothing. Marks and Beatty asserted that the malady was _typhus_, not smallpox, and that it was brought by the French, who established a field hospital near Halifax when epidemic typhus broke out in the French navy. After the fleet departed, the Mimacks descended upon the abandoned site and picked up lice-laden clothes, blankets, and other linens, resulting in an epidemic which all but eliminated that tribe. Which side was telling the truth here? Does anybody out there have access to primary sources that might settle the issue? 5. Mary Beth Norton (again) raised the question of how many people were needed to bring a smallpox epidemic from Europe to the colonies. I addressed this issue in my article, mentioned above. Given that it takes about a dozen days for an infected person to reach the viremic stage where he can pass on variola to others via the respiratory route, under ideal conditions with strictly one-to-one transmission among a susceptible population and a voyage of 69 days (the _Mayflower_ took only 66 days to reach Cape Cod), smallpox could have crossed the Atlantic with as few as six consecutive shipboard cases. There were at least two cases recorded in which smallpox broke out on ships after leaving England and was still on board by the time the boats reached New England -- the _Talbot_ (1630) and the _New Supply_ (1638), which took 69 days to land at Boston. Again, see my article for the details. 6. I must disagree with Hal Rothman's contention that "the eradication [of smallpox] is no longer entirely successful or complete" (posting of 21 April, 1995). Smallpox is carried _exclusively_ by human beings; there is no other host in which it can reside naturally. Cowpox and horsepox are very closely related to smallpox -- indeed, they may have originated when people with smallpox handled these animals -- but they have changed their character enough that they are relatively harmless to humans, otherwise Jenner could not have developed the cowpox vaccine. The strategy of the World Health Organization was to _isolate_ smallpox victims so that the disease could not be passed on to others. As a result, the chain of transmission was broken when the last case was reported and quarantined in Somalia in 1980, and the virus is extinct except for any medical research samples and specimens maintained (alas!) by the Russian and American military. However, Prof. Rothman has a valid concern; _because_ smallpox is technically extinct, nobody is being vaccinated for it anymore. Should smallpox escape, either intentionally or accidentally, from a medical facility, it _would_ attack a "virgin soil" population, and the consequences would be staggering. There were plans afoot to destroy _all_ smallpox samples on Dec. 31, 1993, but a group of scientists were trying to block this measure because (a) they were uncomfortable with the forcible extinction of a biological species, and (b) the smallpox virus might be needed for the study of related virii. I do not know what was the final resolution of this conflict. If all samples _were_ destroyed, then smallpox _is_ truly extinct. Dixon denied that smallpox "mutated" significantly; the type of manifestation that it takes in humans appears to be correlated to the strength of the victim's immune system. 7. Lesley Wischmann's posting (20 April, 1995), in which he wondered why infected buffalo robes from dying Indians sent to St. Louis in 1837 did not trigger an epidemic among Caucasians, can be explained. First, the population of St. Louis presumably had prior exposure to smallpox, so that much of the citizenry already was immune. The robes would have taken weeks or months to reach St. Louis, so that any viable virii would have been weakened or killed by exposure to sunlight and air. I imagine that trappers and traders would have cleaned up the robes somewhat, since nobody would have purchased an obviously fouled robe. As mentioned above, inhalation of scab dust was not as effective a means of contracting the contagion as direct inhalation of live virus. Yes, St. Louis _was_ lucky to escape a major smallpox epidemic, but in retrospect we can speculate _why_ the city was fortunate. This would be confirmed if a smallpox epidemic had taken place in St. Louis a year or two _before_ the Great Plains epidemic of 1837; most of the city would have acquired immunity from the earlier event. 8. Elizabeth Nuxoll mentioned contemporary town interracial meetings in which minorities accused Caucasians of having waged deliberate biological warfare against them in the past. First, people like Bouquet, Amherst, and Ecuyer appear to be exceptions to the rule. Secondly, Amerindians themselves _might_ have used similar tactics against Europeans had they possessed any native pathogens to which the latter lacked immunity. Oppressed Aztecs ground smallpox scabs into bread for their Spanish masters and threw the bodies of their dead into Spanish wells, hoping to exact revenge against their foreign overlords [I know this account is somewhere in my notes; I'll provide the citation later]. The Indians were demoralized when their masters failed to contract the malady, probably because the latter had contracted milder cases years before. With the possible exception of syphilis -- and the jury is still out on the origins of that disease -- Amerindians lacked a single major epidemic disease that would have created a "virgin soil" outbreak among Europeans. Nor can Columbus and his successors be blamed for having deliberately introduced Old World epidemics among virgin New World populations; indeed, given the state of contemporary medical knowledge, what European physician could have anticipated the impact that illnesses which he took for granted would have on a new continent? This has been a very provocative and interesting discussion; I haven't had this much fun in ages! Thanks for your perceptive and fascinating remarks; did you know that the combined discussion prints out to 21 pages of single-spaced text? I look forward to any replies and comments. Dr. Timothy L. Bratton firstname.lastname@example.org Department of History/Pol. Science work: 1-701-252-3467, ext. 2022 6006 Jamestown College home: 1-701-252-8895 Jamestown, ND 58405 home phone/fax: 1-701-252-7507