Mothers were the Courageous Pioneers – Viral Battlefield

For centuries, smallpox devastated humankind. It lasted for so long, and was so severe, that I’m not sure we can even call it a pandemic. It was more like a forever-demic. Smallpox was a virus that was transmitted from person-to-person contact and saliva droplets in an infected person’s breath. It had an incubation period of 7 – 17 days and it is the only human infectious disease that we have ever eradicated. This is the story of who fought on the battlefield before the word viral was as viral as it is today. A story of courageous mothers who intentionally gave their children the smallpox virus from their own infected body. And figured out how to save their lives by using the enemy against itself. An enemy that could kill them within weeks. Or days. And lasted centuries.

Smallpox was the first Viral Sensation

Historically, the transition from inoculation to vaccination is attributed to Edward Jenner, therefore, the entire smallpox story is attributed to him (I shall correct this today). We can’t minimize the contribution he made to modern day immunizations, however, accounts of smallpox have been documented as far back as ancient Egypt.

The Egyptian pharaoh, Ramses V, likely died of smallpox. The marks are visible on his mummified body. The concept of intentionally infecting someone with a live virus in order to boost their immune response was developed, in part, by women. Specifically, the bravest women out there.

Mothers.

Truth Hurts

Mothers win. We’ll start there. Then we will move to how women win, even when their job is a milkmaid. And then we’ll loop the guys in toward the end, so they can take credit for this medical miracle (truth hurts but so does the patriarchy).

Viral Battlefield

Let’s begin with a quick summary of smallpox. It is the fucking worst. There are few, if any, illnesses that you can compare to smallpox. When I see people with scars from a smallpox vaccination, I want to give them a hug and 6 million dollars.

It stuck around for thousands of years and killed millions of people. Small, red spots. I have a fear of small, red ants. This is so much worse than that. It infected upwards of 300 million people. In Europe, during the 18th century, approximately 400,000 people died every year from the ‘speckled monster’. During this period of time, the case-fatality rate (number of fatalities out of total infected patients) varied between 20% to 60%. The case-fatality rate among infants was even higher; approaching 80% in London and 98% in Berlin during the latter part of the 18th century.

Mindful Mothers Moment

I’m going to take a moment here for the people in the back to mentally process the severity of this illness. Imagine you have a baby. There is a thousand year old pandemic ravaging the world. You get small pox. Your baby gets smallpox. There is a 98% chance your infant will die. And likely you will too. Then there is the very likely possibility that there are many children in the family. Infectious disease can be scary shit and it’s not fake news (the current biggest viral sensation next to COVID-19). I can’t imagine being a mother in the 18th century. My heart hurts when I remember that this isn’t a story; it was the norm.

Treatments for Smallpox. I’d rather die.

The first known death, as I mentioned, was Egyptian pharaoh Ramses V in approximately 1142 B.C. (also spelled Ramesses). He ruled Egypt for only a few short years and died quite young. There were many pharaohs named Ramses and had varying durations of rule over Egypt.

Ramses II was Pharaoh for over 66 years and lived into his 90s. He is known as Ramses the Great. I took this photo of his statue when I was visiting Egypt.

Although Ramses V died young and it is attributed to smallpox, he was a strong leader and helped reshape ancient Egypt in many ways.

As an aside, they say he had 200 wives, over 150 children and was over 6 feet tall. Basically, he had a lot of fortitude. Testicular and otherwise.

Super Spreaders

Invading armies spread smallpox through Africa and Europe. The ancient Egyptian merchants often traveled to India and so the virus spread. The Spanish brought it to Mexico where it killed a many people from the Aztec population. Smallpox was also reported in ancient Asian cultures, as early as 1122 B.C. and it is mentioned in Sanskrit texts of ancient India. It is a remarkable virus. Thriving for that long; it truly makes me question who is actually at the top of the food chain here.

Smallpox was treated by physicians and it was staggeringly unsuccessful. And disturbing. One physician, Dr. Thomas Sydenham (1624-1689), treated smallpox by keeping patients in a room with no fire, continuous open windows, not lifting the sheets higher than the patient’s waist and administering twelve bottles of small beer every twenty four hours. For severe cases, he released a couple litres of blood via bloodletting.

It’s just like it sounds. Draining blood. Arteries, veins; even amputations. Lots of people died. Lots.

It gets better. I’m sure there are people thinking ‘the beer doesn’t sound too bad, given that I’m fucked anyway and bleeding to death in this icy vortex of doom’. That’s what I thought too. Until I read that the physician would acidify the beer by adding diluted sulfuric acid. In addition to this acid brew, you engage in a bit of induced vomiting, which is explained to you as a ‘purge’ to release the toxins.

Your Prescription Includes

Let me summarize that treatment because I feel endlessly grateful for our health care system when I ponder this. You get smallpox. You’re sick as fuck. You have spots all over you, a fever; you’re mentally collapsing given that you’re likely facing your own mortality and your body is essentially on fire – fire ant style.

You see a doctor who leaves you alone in a room where you freeze your ass off and get drunk. Everyday as you vomit, the doctor drains blood from you. You are barfing, bleeding, have hypothermia and the Sulfuric Special Brew twelve times a day and somehow, this is going to cure smallpox.

This goes on for your entire illness, potentially weeks, if you are privileged enough to see a physician. You literally feel your molecules departing this earth. After getting shitfaced on sulfuric acid beer from hell, while in the icy cold weather, you either die from smallpox or some shred of your body magically remains disfigured…but alive. You’ll also most likely be blind for life and have obvious trauma symptoms from being locked in a fucking freezing room with no blanket and becoming an alcoholic. Withdrawal, frostbite, anemia and resentment ultimately end you in a few months anyway.

*Quick shoutout to the physicians of today*

Variolation

It doesn’t sound like an ideal health plan but it was the reality back then. Historians that have looked at vaccination have traced the medical innovation back to inoculation. Inoculation of the smallpox virus was referred to as variolation because the agent that causes smallpox is called the variola virus. This is where mothers completely dominate the smallpox story and are sadly under-shadowed. In fact, in the inoculation story, women actually had more balls than any of the men around them. When very early inoculation began, young boys were protected far better than young girls. So it was often the mother and her daughter(s) that walked this courageous path if they lived in a country that wasn’t trusting of the procedure.

Old Schooling It

It was widely recognized very early on that a person did not contract smallpox twice. If a person managed to survive it, they became immune. This level of immunology was understood thousands of years ago. Before the year 1000, the people of China and India had been practicing immunization through the process of variolation, which is really inoculation.

Basically, they gave the live smallpox virus to people, in a tiny amount, in the hopes they’d build immunity and get a mild case of the virus. Risky business. They had observed that contraction of smallpox protected children against future outbreaks (if they lived, obviously) and so they developed a procedure to attempt to safely immunize children. The earliest procedure involved nasal inhalation of dried smallpox scabs by three year olds.

Another quick shout out to our health care system for ditching scab therapy. 

Mothers make it less gross

I cannot even imagine what this felt like. Smallpox killed hundreds of thousands of children each year. As a mother myself, it is unfathomable to imagine the risk, the uncertainty and the knowing that if I mess up the procedure, my child dies. In addition to that fairly significant pressure, the mothers often didn’t live long enough to see if the inoculation worked. Other mothers did see; then they learned. It became a practice for many, many years. Not all women had the opportunity, resources or permission to see a physician so this was often an at-home treatment.

I feel upset when I need to put a band-aid on my daughter. These mothers were incredible.

Viral Risk Assessment

If a person naturally contracted smallpox during an epidemic, the chance of dying from the disease was about 1 in 5 or 6. When inoculating someone with the virus, the change of dying dropped to about 1 in 50. Whether they got the disease naturally or from deliberate inoculation with the smallpox virus, survivors were immune for the rest of their lives. Many people were willing to take the risk of exposure. It is hard to imagine a society accepting a medical procedure that gave them a 1 in 50 chance of living. It’s much better than 1 in 6 though. It seems like a fairly logical risk assessment. If I do this, I’m less likely to die. Assessment complete.

Let’s get into how variolation and inoculation became vaccination. It is a thrilling tale in which the main character is…a man. A man mixed up in a myth who took credit for the work of a woman. Very shocking plot twist. Let’s carry on.

Inoculation Invitation

In 1670, Circassian traders introduced variolation (inoculation, soon to be vaccination) to the Ottoman Empire in Turkey. Women from the Caucasus were in great demand in parts of Turkey; formerly Constantinople, now Istanbul. This was because of their legendary beauty (enter gender inequality). These women were inoculated as children on parts of their bodies where scars wouldn’t be seen.

There was a lovely woman named Mary Wortley Montague and she was a real badass. She was known as Lady Montague (she had nothing to do with Romeo or Juliet or any of their relationship issues). She had suffered from an episode of smallpox in 1715, causing her to be severely disfigured. Her 20 year old brother died from the disease 18 months after. Two years later, Lady Montague’s husband became an ambassador to the Sublime Porte in Turkey. So they moved from smallpox-ridden England to a land of magical medicine.

Shortly after their arrival in Istanbul, Lady Montague wrote a letter to her friend about her observations of the smallpox outbreak in that area of the world.

Lady Montague’s Letter

“I am going to tell you a thing, that will make you wish yourself here. The small-pox, so fatal, and so general amongst us, is here entirely harmless. . . .

There is a set of old women, who make it their business to perform the operation, every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer her, with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much matter as can lie upon the head of her needle, and after that, binds up the little wound with a hollow bit of shell . . . .”

Enter the Battlefield

There came a point when Lady Montague was told that her family was being recalled back to England. England continued to lose enormous numbers of people to the disease and because of this news, her young son was in jeopardy. Conflicted by what to do, she made a secret decision and arranged a visit by an old woman with a needle and a nut-shell. Then she inoculated her three year old with live smallpox. The procedure worked and her son, the first Englishman to undergo a smallpox inoculation, would never contract the disease.

This story comes with a few variations; as most historical accounts do. In one account, her son is five and the procedure is done by an embassy surgeon. The other account is the old woman. People who had survived smallpox often did the inoculations because they were immune. Either version of the story ends the same way. Lady Montague immunized her own kid with the world’s most deadly virus, brought him back to England as an immunity superstar and began her mission. Hell. Ya.

Same Battlefield, Different Battle

Lady Montague’s enthusiasm and dedication to spreading awareness about the successes of inoculation were met with disdain. Hatred. The English medical community would have none of it. The population was also very skeptical and did not want to understand how the procedure could possibly work. The reasons included:

• • Religion. This was unnatural and heresy. Dying was better.
  • What could medical experts learn from an untrained aristocrat. As if.
  • Financial. Money is our actual worst disease ever. Physicians during that time made a lot of money by prescribing useless treatments. Like freezing someone to death while getting them day drunk. This threatened those already established medical….procedures….
  • Finally, and most importantly, what could a man POSSIBLY learn from a woman? The concept of a woman changing the thinking of a man? Not possible.

Mothers Don’t Give Up

In 1721, another smallpox outbreak threatened London and she had a second child; a daughter. This time, she invited an audience to observe the inoculation procedure. That included the King’s own physician and the other physicians of the royal court. Her daughter breezed through recovery and was observed by a stream of visitors every step of the way. It was like an 18th century version of Big Brother. Her daughter grew up healthy and went on to marry a British Prime Minister.

Eventually, inoculation was accepted throughout most of Europe. One country resisted; France.

France was like “no goddamn way. You want me to put a live virus inside my body? Leave”.

France is Out

Due to the fear of the procedure being improperly performed (which could result in death), it was not widely accepted by France. They were a more conservative country and many believed it was too risky. This was definitely justifiable given that a previous epidemic of smallpox was blamed on an inoculation gone wrong. That event triggered a five year ban on all inoculations in Paris. The risk assessment, from their point of view, was that a poor outcome from inoculation or worse, a wide-scale public health event caused by the procedure, was more risky than what was already there with smallpox spreading across Europe.

Despite the DECADES of debate over the concept of inoculation, not to mention the five year ban on the procedure, it took one and only one smallpox death to settle the inoculation question in France once and for all.

One person. Countless people had died; science as they knew it back then had proven the efficacy of the inoculation, however, people did not want to change.

Long Live the King

On May 10th 1774, King Louis XV died from smallpox after a very public and excruciating two weeks. The entire kingdom watched his very painful demise. The successor, King Louis XVI, had himself inoculated the same year and insisted his two younger brothers were inoculated at the same time. In other words, the entire line of succession to the throne.

Let’s Go Viral

The next stage of popularizing inoculation is my favourite. Fashion! Not because I am a fashionable person (I’m not) but because it is fascinating to me that science can’t convince people to protect themselves but a hat can. Yes. A hat.

You see, after the successful inoculation of the royal family, the capitalists of the 18th century knew they could translate this medical innovation into profits. They commemorated the momentous event with a very special, fancy, outrageous looking head dress called the pouf à l’inoculation. It was all about the head gear back then. This particular pouf à l’inoculation would sit on top of a woman’s head and depicted the serpent of Asclepius (medical), a club (conquest), the rising sun (King) and a flowering olive branch (peace and joy from the royal inoculation). It was publicized by female clients
of the milliners (hat makers, capitalists) and instantly became the newest, coolest 18th century trend.

Let’s summarize. Capitalist men used women to sell their merch; treating a women’s body as a model for selling their inoculation celebratory cranial atrocity. I’m so grateful we’ve come so far from this…

Viral Friendships

If you research who developed inoculation, you will find countless attributions to the English scientist Edward Jenner. The story of Edward Jenner, as with the other historical accounts, has a few versions. He successfully developed a safe manner in which inoculation would work. This is when it became a vaccination. Edward Jenner’s work is regarded as the foundation of immunology and all those mothers I wrote about – this is where they are erased from history.

Jenner told the story of being a young boy and hearing a milkmaid exclaim “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.”. Milkmaids were known to be immune, somehow, to the virus. No one really knew why and this comment is attributed to the epiphany Edward Jenner had.

Cows Fix Everything

What really happened, according to other historians, was that Edward Jenner was an apprentice to a physician as a young boy and then grew up to work near a series of farms. Inoculation was commonplace and the farmers were receiving the smallpox inoculation. For some reason, they didn’t get sick. It appeared that the inoculation didn’t work on them. They also did not contract smallpox. The expected outcome of inoculation was a mild case of the virus; these farmers experienced no symptoms.

Puzzled by this, Jenner began to investigate why the farmers were seemingly immune to the smallpox inoculation. It was a friend of his who mentioned that he had experienced pox of some sort, itchiness and mild illness. It was common among farmers. Jenner then hypothesized that the farmers were not reacting to the inoculation because they had been infected with cowpox. In order to prove this, he had to experiment on children and other farmers to see if his hypothesis was correct. Let’s call this a ‘clinical trial’.

Sarah Nelms

In 1796, Jenner inoculated an 8 year old boy with cowpox. He developed symptoms and recovered. A few months later, Jenner inoculated him with the live smallpox virus to see if his hypothesis was correct. The boy did not contract the illness and Jenner proved that he had developed immunity from having cowpox.

How did run the clinical trial? He took matter from the legions of a woman named Sarah Nelms who had recently contracted cowpox. Her open sores were used to prove his theory. And that woman, who was the first to offer immunity to his patients, was a milkmaid.

There has been recent speculation that it was not cowpox but horsepox that was in the inoculation. Either way, the concept of using a like-virus and attenuated virus were born from Jenner’s experiments.

Edward Jenner decided to call his new procedure ‘vaccination’, from the Latin vaccinus, meaning “of or from a cow.” And here we are.

Pioneers of Today; Mothers of Yesterday

The foundation of immunology was, according to textbooks, attributed to Jenner. He is the clinician that created a safe way of protecting the population from smallpox. The true foundation of immunology far, far preceded his life. Not only did women risk the lives of their children to control the spread of the deadly illness, it was a woman who was bold enough to publicly inoculate her own child (keep in mind, we’re still fighting for gender equality and this was hundreds of years ago). Even that was not enough. It took the death of the King to finally convince the population that the treatment was less risky than the illness and could control the spread. And it was mothers who made the sacrifice for that discovery. 

Without the courage of those mothers and the knowledge they gained that would inform Jenner’s discovery, he would not have discovered anything. The basis of his hypothesis was the farmers who had no reaction to inoculation. If mothers hadn’t performed that procedure and proved its efficacy, Jenner would likely have be freezing people to death with acid beer and charging a literal arm and a leg for it.

Hats on for the Mothers

Smallpox predates our history. It was a global epidemic for centuries. In 1980, after a mass global vaccination program was launched, the World Health Organization deemed smallpox completely eradicated. It is the only virus we have ever eradicated. It is the only virus we have ever won the battle against. After Jenner’s discovery, it took another 200 years to eradicate the disease. Mothers fought that battle too; they taught themselves how to protect their children, they risked so much and their bravery is rarely acknowledged in the story of how humankind eradicated smallpox.

This is my dedication to them – to the courageous mothers who made it possible for my child to live without ever knowing smallpox. And for giving me hope that a deadly virus can be completely eradicated.

Mothers at this point in time are sending children back to school, mid-pandemic. Today is different than the 18th century (by a fairly small margin). There is no better time than now to remember that these brave pioneers who faced their own mortality and saved their children – they were human just like us. Our circumstances are different now; perhaps some strength can be found in knowing that we have the same courage as mothers of that past, who faced similar circumstances and made difficult decisions. Those mothers were us; the inner world is likely much more the same than we can imagine. That knowledge gives me hope that we, as a collective, can fight to protect children. One way or another, mothers show up on the battlefield.