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Orphans for Smallpox

January 23, 2015 permalink

Balmis cowpox expedition

Near the turn of the nineteenth century Edward Jenner discovered that a relatively harmless infection of the cattle disease cowpox conferred lifelong immunity from smallpox, a scourge that killed up to a third of those infected and permanently maimed many of the survivors. The Spanish king wanted to vaccinate his subjects in the new world, but the technology of the time was lacking. Two centuries ago there was no refrigeration or sterilization. Spanish doctor Francis Xavier de Balmis devised a primitive means of transporting the cowpox vaccine across the Atlantic in living form. He used a human chain, transmitting the virus person-to-person en route. And the human subjects selected? They were boys taken from an orphanage.

You can listen to the story as the first part of the audio on Futility Closet The Balmis Expedition: Using Orphans to Combat Smallpox or local copy (mp3). The expand block contains a passage on the incident from Scourge: The Once and Future Threat of Smallpox by Jonathan B Tucker published in 2001 by Grove Press.



By the early 1800s more than 100,000 persons in Great Britain had been vaccinated. Although the wold was clamoring for Jenner's vaccine, it was difficult to obtain an adequate supply because outbreaks of cowpox in European cattle were sporadic and unpredictable and the disease did not exist on other continents. The vaccine consisted of the "matter" of cowpox — pus and lymph containing the live virus — which had to be extracted from pustules on the udders of infected cows at just the right stage of the disease. Since the cowpox material had to be "active" for vaccination to be effective, distribution and handling posed major hurdles. Although the vaccine could be preserved for a few months by drying it on threads, quills, glass, or slivers of ivory, it was rapidly inactivated by high temperatures or by exposure to sunlight, factors that were poorly understood at the time. As a result, cowpox material shipped over long distances often lost its effectiveness before arriving at its destination.

One solution to this problem was to keep the vaccine "alive" by transferring it from one human recipient to the next, a practice known as the "arm-to-arm" technique. First, an individual was vaccinated, and as soon as a cowpox pustule had appeared on his or her arm, matter from the lesion was then used to vaccinate other recipients. In 1801 in St Petersburg, Russia, for example, a recently vaccinated girl was sent to a local orphanage to serve as the source of smallpox vaccine for all children more than a week old. From then on, the orphanage continuously transferred the vaccine from one child to another for more than ninety-two years (1801-93).

The arm-to-arm method was also used to distribute Jenner's vaccine throughout the Spanish Empire. Spanish King Charles IV's daughter had been stricken with smallpox in 1798, and after she recovered, he arranged to have the rest of his family vaccinated. In 1803, the king, convinced of the benefits of the vaccine, ordered his personal physician, Francis Xavier de Balmis, to deliver it to the Spanish dominions in North and South America and, if possible, in Asia as well. To maintain the vaccine in a viable state during the long sea voyage, the physician recruited from the orphanages of Spain twenty-two young boys, aged three to nine years, who had never had cowpox or smallpox before.

During the trip across the Atlantic, de Balmis sequentially vaccinated the orphans in a living chain. Two children were vaccinated immediately before departure, and when cowpox pustules had appeared on their arms, material from these lesions was used to vaccinate two more children. This procedure was repeated at roughly ten-day intervals until the ships arrived in Venezuela so that at least one child always had a cowpox pustule at the right stage of maturation to provide the active vaccine. In return for the orphans' service, the Spanish royal court arranged foster families for them and paid their living and schooling expenses in the New World. Thanks to The Royal Smallpox Expedition, more than 100,000 people in Latin America were vaccinated. The expedition then recruited twenty-six more orphans and continued transferring the vaccine from arm to arm throughout the remainder of the three-year voyage, which included stops in the Spanish Philippines, Macao and Canton.

Source: Google Books