1 00:00:08,040 --> 00:00:18,120 Dear Diary, I've just been visited quite unexpectedly by the oddest of a kindly face, ruddy cheeks and a soft manner about him. 2 00:00:18,120 --> 00:00:24,640 Oh. The strangest questions came in the mail and said the sun was barely in the sky. 3 00:00:24,640 --> 00:00:33,680 It was so early. I was just finished up with the girls and he started asking all sorts of questions about the cocks of it. 4 00:00:33,680 --> 00:00:39,420 Don't you want to whatever at it? He asked if he saw blisters. 5 00:00:39,420 --> 00:00:45,030 Of course he may not. He mumbles and about our we shouldn't worry on the deadly smallpox. 6 00:00:45,030 --> 00:00:49,860 We hear so much about how we might. Emax talks the others. 7 00:00:49,860 --> 00:01:02,250 He was on his way. Really very strange. Welcome to the 18th century and to the fifth episode of our history of endemic series. 8 00:01:02,250 --> 00:01:08,790 We've arrived to the point when Europe is going through yet another major outbreak of smallpox, 9 00:01:08,790 --> 00:01:15,150 a disease that's been plaguing populations around the globe for centuries. 10 00:01:15,150 --> 00:01:23,460 In a moment, we'll hear just whom our diary writing milkmaid is describing and why he says central to the story. 11 00:01:23,460 --> 00:01:29,560 But first, let's find out exactly what this disease was. 12 00:01:29,560 --> 00:01:35,830 I discussed this with both Bloche Agoutis and Brian Angus, whom we met in previous episodes, 13 00:01:35,830 --> 00:01:42,430 and then with our historical expert today, Dr Roderick Bain from our faculty of history. 14 00:01:42,430 --> 00:01:48,490 As you'll hear, we had a few small drop outs in sound due to our respective Internet connexions. 15 00:01:48,490 --> 00:01:51,970 But I promise it's worth sticking with the story. 16 00:01:51,970 --> 00:02:00,310 Smallpox was a serious infectious disease caused by two variants of Vario, the virus barrier in a major and varied a minor. 17 00:02:00,310 --> 00:02:08,520 A lot of viruses coming from animals. And so smallpox probably dried as it is other hoax viruses. 18 00:02:08,520 --> 00:02:15,430 And it so happens it's closely related to cowpox, I say was because it has been eradicated. 19 00:02:15,430 --> 00:02:20,830 The last naturally occurring case was diagnosed in October 1977 and the World 20 00:02:20,830 --> 00:02:25,820 Health Organisation certified eradication of the disease in nineteen eighty, 21 00:02:25,820 --> 00:02:28,600 essentially for smallpox. Potts's eradicate it. 22 00:02:28,600 --> 00:02:38,110 It was spread mainly by fairly direct and prolonged face to face contact between people, most commonly by airborne respiratory droplets. 23 00:02:38,110 --> 00:02:52,240 So coughs, sneezes also by saliva's to sing Chevon drinks also skin to skin contact such as Handshake's or Hogg's also by products. 24 00:02:52,240 --> 00:02:56,820 So anti needles or unscreened lot. 25 00:02:56,820 --> 00:03:05,770 Interestingly, smallpox can only be spread by humans. Scientists have found no evidence that smallpox can be spread by insects or animals. 26 00:03:05,770 --> 00:03:10,720 Smallpox was highly fatal disease, highly infectious disease. 27 00:03:10,720 --> 00:03:15,370 It's difficult now to think for us to think about it because it's no longer with us. 28 00:03:15,370 --> 00:03:21,490 But it was the most horrific disease. If you're going to do a top 10 of unpleasant diseases, 29 00:03:21,490 --> 00:03:31,380 it's going to be near the top because it's such a hard hitting and frightening disease to have, but also just to be aware of and to dread. 30 00:03:31,380 --> 00:03:37,810 There's a little. It's very much a disease associated with dread as well, a demotion because of its its symptoms. 31 00:03:37,810 --> 00:03:42,820 It could be hugely disfiguring as well as, of course, fatal. 32 00:03:42,820 --> 00:03:47,830 It could also lead the survivors horribly mutilated because it tended to infect the face. 33 00:03:47,830 --> 00:03:51,150 And in addition, it caused blindness. 34 00:03:51,150 --> 00:03:57,730 And it's been estimated a third of populations or some populations in Europe were very deeply, badly affected by it. 35 00:03:57,730 --> 00:04:01,870 And perhaps even one in two people had it in experience at the time of their life. 36 00:04:01,870 --> 00:04:07,150 And it was also a disease which affected children out of proportion to other age groups. 37 00:04:07,150 --> 00:04:16,120 So that's another reason for its emotional impact, that it was one that affected families and it affected parents as well as as well as older people. 38 00:04:16,120 --> 00:04:21,160 There was a feeling that it was something that children were especially especially vulnerable to. 39 00:04:21,160 --> 00:04:26,830 One in three deaths in Europe that time could well have been to do with with smallpox. 40 00:04:26,830 --> 00:04:32,260 After Roderic had run through some of the terrible consequences of catching this disease, 41 00:04:32,260 --> 00:04:39,100 I asked Bolshy to take me through how the unlucky victim would typically experience it initially. 42 00:04:39,100 --> 00:04:47,380 You can have high fevers, body aches, vomiting. So the rash starts with small risk spots on the tongue or in the mouth, essentially. 43 00:04:47,380 --> 00:04:54,010 Then they change sores. They break open that that spreads large amounts of virus into the mask and throat. 44 00:04:54,010 --> 00:05:01,780 And this is the point that people are the most contagious, because when they cough out all this viral load onto people near them following this, 45 00:05:01,780 --> 00:05:09,900 they have the rash on the skin which starts in the face, spreads the arms down to the legs, hands and feet or within about 24 hours. 46 00:05:09,900 --> 00:05:15,930 And by the fourth day, the skin sores, they filled with this thick, opaque fluid and they have a bit of a dent in the middle. 47 00:05:15,930 --> 00:05:19,730 And this is the essentially the typical smallpox image that we know. 48 00:05:19,730 --> 00:05:25,420 And the very old virus can be found in Slivered in these sores and also the scabs and therefore loss. 49 00:05:25,420 --> 00:05:30,200 And people who come into contact with this flu starts to become infected themselves. 50 00:05:30,200 --> 00:05:38,860 Essentially, they, though, often scabs fall off. Then that's when the healing process starts and there's about 30 percent risk of death with smallpox. 51 00:05:38,860 --> 00:05:43,990 And those people are left with scars afterwards. This sounds awful. 52 00:05:43,990 --> 00:05:49,870 And I assume that it must have been a disease that inspired terrible fear in people at the time. 53 00:05:49,870 --> 00:05:55,330 Yes, it is. It's a disease that provokes a lot of distress and fear. 54 00:05:55,330 --> 00:06:03,160 It doesn't quite result in the same terror that you see in social disruption that you see with the plague, 55 00:06:03,160 --> 00:06:09,760 for example, because it's something that is both disgusted by the Demmer endemic and epidemic. 56 00:06:09,760 --> 00:06:17,380 It is always there. It is something that is that is not necessarily an invader from outside all the time. 57 00:06:17,380 --> 00:06:22,700 It is something that people are familiar with all of the time. It is always it always there in the background. 58 00:06:22,700 --> 00:06:28,650 And it's also something that does not necessarily wipe out men of working age and. 59 00:06:28,650 --> 00:06:32,850 Women of working age in the same way that the plague did. 60 00:06:32,850 --> 00:06:38,100 So it's not quite the same. Not quite the same social impactors as others. 61 00:06:38,100 --> 00:06:41,790 We're talking about Europe, of course, where there was more immunity to it. 62 00:06:41,790 --> 00:06:48,960 Natural immunity to it. And certain groups in places like North America where smallpox was introduced. 63 00:06:48,960 --> 00:06:58,530 17TH century onwards, it had a far more devastating impact because there was no record of immunity to that disease at all. 64 00:06:58,530 --> 00:07:02,940 So amongst the Native American populations, the indigenous populations there, 65 00:07:02,940 --> 00:07:12,000 the smallpox just cut massive swathe through those populations with very decisive and defining consequences. 66 00:07:12,000 --> 00:07:17,880 But the history of that continent before discussing the outbreak, we'll be looking at in the 18th century. 67 00:07:17,880 --> 00:07:22,410 I asked Robert to take me through a quick history of the disease to that point. 68 00:07:22,410 --> 00:07:33,570 So smallpox in the pre inoculation, pretty vaccination era was still very much a terrible disease to have. 69 00:07:33,570 --> 00:07:40,800 We have to be careful that we don't read too much into ancient history and tried to diagnose diseases that broke out in ancient Greece. 70 00:07:40,800 --> 00:07:52,040 And so when we don't have materials available to confirm the labels that we use today are often not quite applicable to what we were looking at that. 71 00:07:52,040 --> 00:07:58,890 But smallpox by which as it's represented in written sources and also in art as well. 72 00:07:58,890 --> 00:08:03,090 So paintings, illuminated manuscripts, 73 00:08:03,090 --> 00:08:10,940 that sort of evidence from the Middle Ages and mediaeval periods demonstrate that that afflictions like smallpox, 74 00:08:10,940 --> 00:08:17,050 if it was not smallpox, were very, very well, were certainly presence. 75 00:08:17,050 --> 00:08:20,820 There is a story that smallpox came back from the Crusades. 76 00:08:20,820 --> 00:08:27,390 So this is a story current at the time that the Crusaders brought smallpox back from the Middle East. 77 00:08:27,390 --> 00:08:29,400 And here again, we see the other ring of societies. 78 00:08:29,400 --> 00:08:37,020 We had we see societies being stigmatised as being dirty and vulnerable and disease disease ridden, 79 00:08:37,020 --> 00:08:45,780 and that the healthy Europeans are afflicted as a consequence of being in close touch with disease, unpleasant people. 80 00:08:45,780 --> 00:08:48,810 So you see that again during this period. 81 00:08:48,810 --> 00:08:56,490 But in actual fact, it's highly like the smallpox virus was endemic in Europe long before the Crusades had been there for centuries onwards. 82 00:08:56,490 --> 00:09:06,110 But it's really when when we come to the 17th century that we see the populations begin to move and begin to mix and begin to increase in size. 83 00:09:06,110 --> 00:09:12,030 Urbanisation, industrialisation sees populations living more closely together. 84 00:09:12,030 --> 00:09:16,320 Closely packed communities are more vulnerable to infectious disease. 85 00:09:16,320 --> 00:09:25,680 And it's then that we really see smallpox taking a grip and having this terrifying impact on populations across across Europe. 86 00:09:25,680 --> 00:09:31,640 And it's the 17th century that we really see that. But it was also a disease that would would would come and go. 87 00:09:31,640 --> 00:09:37,410 I think it's important to remember that because there were cases where societies were 88 00:09:37,410 --> 00:09:42,900 becoming communities are becoming immune to it through to early practises and inoculation. 89 00:09:42,900 --> 00:09:50,370 It meant that you'd have a reservoir of people who would become immune. 90 00:09:50,370 --> 00:09:54,480 And then, of course, when they start dying out and their children come through who are no longer immune, 91 00:09:54,480 --> 00:09:57,960 and then then they would suddenly become susceptible to smallpox again. 92 00:09:57,960 --> 00:10:04,980 So there was a cycle really of it coming and going. A bit of it waning and it increasing over time. 93 00:10:04,980 --> 00:10:12,210 And of course, 17th century, as well as a period of great movements, population movements of wars as well. 94 00:10:12,210 --> 00:10:16,800 So there's a lot of disruption to communities, people coming and going. 95 00:10:16,800 --> 00:10:23,730 For example, it was an active topic. There was a if there was a crop failure and you may see people from the countryside 96 00:10:23,730 --> 00:10:28,890 moving into urban areas and they might become not only bring the disease with them, 97 00:10:28,890 --> 00:10:34,800 but they would also perhaps have less immunity than the people in the cities that they were then join in. 98 00:10:34,800 --> 00:10:40,440 So they may have also had a rich reservoir of people in a city who were more susceptible 99 00:10:40,440 --> 00:10:45,210 to smallpox than than people who will literally be living in those cities for some time. 100 00:10:45,210 --> 00:10:53,640 This understanding of smallpox as both an epidemic and an endemic disease was also emphasised by Eric Adjunctive, 101 00:10:53,640 --> 00:10:58,430 associate professor in the history of medicine in boxwoods faculty of history. 102 00:10:58,430 --> 00:11:02,220 So before those inoculation, very early. 103 00:11:02,220 --> 00:11:10,450 And so that even before vaccination, what happens with smallpox is it becomes a kind of endemic disease in England and the 17 habits. 104 00:11:10,450 --> 00:11:15,270 But it's a cycle and again, it's regional. So like urban centres such as London. 105 00:11:15,270 --> 00:11:25,350 It's endemic. It's part of life because a lot of children. But in rural areas, it's something that comes in every 20 years, 30 years. 106 00:11:25,350 --> 00:11:34,070 And so there is an epidemic. What I found very. That is in the same contacts with me about how small parts of this goes to America 107 00:11:34,070 --> 00:11:39,290 as a place where they don't have smallpox and really devastates societies there. 108 00:11:39,290 --> 00:11:45,770 People often see that as being the most devastating epidemic in the historical record. 109 00:11:45,770 --> 00:11:53,070 You can kind of go close in and say smallpox is epidemic in some parts of England, endemic in other parts. 110 00:11:53,070 --> 00:11:58,940 And you can even go further out and say smallpox is endemic in Europe, but an epidemic in the Americas. 111 00:11:58,940 --> 00:12:08,770 And one of the interesting things about the Americas that smallpox is that it shows us how difficult it is to try to measure an epidemic. 112 00:12:08,770 --> 00:12:15,170 The debates on how many people are actually killed by smallpox in the Americas is constantly debated, 113 00:12:15,170 --> 00:12:19,430 partly because I don't know how to measure extreme mortality. 114 00:12:19,430 --> 00:12:23,210 Some people say it can kill off nine percent of populations, 115 00:12:23,210 --> 00:12:28,520 partly because there's a huge debate over actually indigenous populations and that they are. 116 00:12:28,520 --> 00:12:33,140 But also because it's people point out this is not the smallpox acting on its own. 117 00:12:33,140 --> 00:12:39,290 It's about smallpox and European colonisation, which can be quite brutal. 118 00:12:39,290 --> 00:12:46,310 Upended societies, often destroyed crops and livestock, ways of living alongside war and conquest. 119 00:12:46,310 --> 00:12:50,990 So I always say that smallpox in the Americas is a great example for getting us to break 120 00:12:50,990 --> 00:12:58,490 down this notion that disease just isn't this kind of individual entity acting on society. 121 00:12:58,490 --> 00:13:04,490 Because what we need to remember is that smallpox is working in tandem with human activity. 122 00:13:04,490 --> 00:13:10,100 I was keen to understand more about where we get most of our information on this period. 123 00:13:10,100 --> 00:13:13,460 Obviously, we left with written records, diaries, letters. 124 00:13:13,460 --> 00:13:22,200 Those are sortable personal documents that survived to give you a vivid insights, admittedly, from a literate population, of course. 125 00:13:22,200 --> 00:13:29,480 So we don't still really have the voices of of others about a section of society 126 00:13:29,480 --> 00:13:32,790 that the poorer sections of society are less educated sexual scientists. 127 00:13:32,790 --> 00:13:38,790 So we still don't really have that perspective that we had on other later diseases. 128 00:13:38,790 --> 00:13:42,710 If we're talking about the 17th century, we also have mortality rates. 129 00:13:42,710 --> 00:13:49,760 Of course, it builds mortality. We have documents that that record the causes of death in this period. 130 00:13:49,760 --> 00:13:58,190 And those are very helpful in allowing us to reconstruct the death rates and figures of a particular in Europe in this period. 131 00:13:58,190 --> 00:14:07,130 But again, the impact of smallpox on populations in the Americas and overseas and not in not in Europe, but in the new world again, 132 00:14:07,130 --> 00:14:14,630 is very it is very difficult for us to know these days because these were not societies that let the rich written record. 133 00:14:14,630 --> 00:14:22,030 We can also see smallpox being referred to in popular literature if the time was often used as a really easy way out for people. 134 00:14:22,030 --> 00:14:29,540 So I if you were writing a novel in the 19th century novel, 1996 novel, 135 00:14:29,540 --> 00:14:33,860 you could just say X and Y just die of smallpox and you wouldn't necessarily have to go into any detail. 136 00:14:33,860 --> 00:14:39,890 Was anybody reading that would know what you meant? You just wanted to kill off somebody in your book and you can often use smallpox, 137 00:14:39,890 --> 00:14:46,340 but it's definitely a feature of novels of that period when people were killed off in social order by just saying, 138 00:14:46,340 --> 00:14:53,720 you know, X and Y, you contracted smallpox and died. So it's a useful get out. 139 00:14:53,720 --> 00:15:00,110 I wondered what the medical profession looked like in the 18th century in comparison to how it's structured today. 140 00:15:00,110 --> 00:15:08,660 So the medical profession in Europe in the 18th century wasn't quite the medical profession that we're familiar with today. 141 00:15:08,660 --> 00:15:16,610 In some ways, it was a less respected and less authoritative recession. 142 00:15:16,610 --> 00:15:25,640 So the voice of a physician was not necessarily taken as being the be all and end all of medical advice. 143 00:15:25,640 --> 00:15:32,400 There was a great deal of folk medicine still in place around around Europe, at least at this time in these years. 144 00:15:32,400 --> 00:15:37,760 There were also a great, great number of alternative medical practitioners as well. 145 00:15:37,760 --> 00:15:42,230 You also had alternative medical remedies to diseases and other reflections, 146 00:15:42,230 --> 00:15:47,570 but also cheaper medical medical remedies because physicians cost money and poor members of 147 00:15:47,570 --> 00:15:53,780 society were not always able to access the facilities and hope that they could provide. 148 00:15:53,780 --> 00:16:00,520 So we have this image of quack's today. Quack doctors in which doctors take medicines and things. 149 00:16:00,520 --> 00:16:05,030 But in those days, quite a lot of the time, those were for a large portion of society. 150 00:16:05,030 --> 00:16:10,700 Those were the only ones that were available and they were perhaps more trustworthy because they'd been used for decades, 151 00:16:10,700 --> 00:16:17,870 some some old traditions and folk remedies to different types of medical flexion. 152 00:16:17,870 --> 00:16:25,040 So some of these things were trusted more than the advice of a professional medical doctor practitioner, as you might understand. 153 00:16:25,040 --> 00:16:29,100 I also wondered what some of those early remedies would look like. 154 00:16:29,100 --> 00:16:34,140 There were various remedies to smallpox before vaccination. 155 00:16:34,140 --> 00:16:43,590 Some of them would strike us today is extremely unusual. So, for example, the colour red was seen as something that could ward off or treat smallpox. 156 00:16:43,590 --> 00:16:49,490 There were a lot of alternate alternative solutions like purging, purging the body of blood. 157 00:16:49,490 --> 00:16:54,450 This is related to the to the human system by which the body was understood for many centuries. 158 00:16:54,450 --> 00:16:57,600 There were incantations and they were in some societies, 159 00:16:57,600 --> 00:17:04,650 they were gods and saints to whom you could pray in order to ward off all seek treatment for smallpox. 160 00:17:04,650 --> 00:17:11,400 My understanding was that the first big move away from these practises was very elation. 161 00:17:11,400 --> 00:17:17,230 So I asked Roderick to tell me more about this early practise correlation or inoculation. 162 00:17:17,230 --> 00:17:20,820 It's also known and in grafting was another way. 163 00:17:20,820 --> 00:17:27,360 That's not a time for it. It was described at the time as essentially is the deliberate infection of a 164 00:17:27,360 --> 00:17:33,750 healthy human body with smallpox in order to to make that fresh human body, 165 00:17:33,750 --> 00:17:40,320 that unaffected body immune to smallpox, essentially man taking pus from an infected individual. 166 00:17:40,320 --> 00:17:47,570 Ideally, a mild case of smallpox and then inserting that into the bloodstream of somebody who wasn't infected. 167 00:17:47,570 --> 00:17:55,160 And then they would suffer. They would come down with a with a case of they would become ill then something that becomes sensitive. 168 00:17:55,160 --> 00:17:56,630 What they would do, the idea the hope was, 169 00:17:56,630 --> 00:18:04,250 and it was proven quite often was that they would recover swiftly by comparison to a full dental infection of normal smallpox. 170 00:18:04,250 --> 00:18:09,390 And then not only would they recover, but they would also be immune for the rest of their life. 171 00:18:09,390 --> 00:18:15,900 This seemed to me rather similar to the chicken pox parties that I remember being taken to as a child. 172 00:18:15,900 --> 00:18:19,860 In some ways, the principle is similar in the sense that you are physical's. 173 00:18:19,860 --> 00:18:25,320 It was aimed at children were very much at the centre of the practise. 174 00:18:25,320 --> 00:18:29,990 The idea with parents would want to ensure that the children were new. 175 00:18:29,990 --> 00:18:39,890 And of course, the parents invariably knew very well the quite how distressing and devastating smallpox could be. 176 00:18:39,890 --> 00:18:46,170 So they was there was a great deal of enthusiasm for variation inoculation. 177 00:18:46,170 --> 00:18:53,910 Yes. It does mean taking your child to be deliberately infected with a disease that you cannot be 100 percent certain will not kill. 178 00:18:53,910 --> 00:19:04,770 And on top of that, the it is it is different to chicken pox parties in the sense that in order to enter the skin and in fact, 179 00:19:04,770 --> 00:19:09,860 the blood, you have to harm the body. So there was also trepidation about that. 180 00:19:09,860 --> 00:19:19,500 And it also put doctors in in a peculiar position is essentially they are not only harming the body with with with with their scalpels, 181 00:19:19,500 --> 00:19:20,100 but they're also, 182 00:19:20,100 --> 00:19:28,680 of course, inserting the disease that will make this child or the person whom you infecting could make them seriously ill and could kill them. 183 00:19:28,680 --> 00:19:36,510 The next big medical breakthrough after their relation came from a man who may well have heard of Edward Jenner. 184 00:19:36,510 --> 00:19:41,940 There is a story, of course, that Edward Jenner, a young English doctor, 185 00:19:41,940 --> 00:19:50,680 late late 18th century story, is that he became aware from his work as a doctor in Gloucestershire, 186 00:19:50,680 --> 00:20:03,060 he became aware that milkmaids dairymaid women who who milked cattle were protected from smallpox, that they did not they did not get it. 187 00:20:03,060 --> 00:20:07,870 And the idea was that somehow they were infected with that. 188 00:20:07,870 --> 00:20:11,160 They might they became infected with cowpox, which was a similar disease. 189 00:20:11,160 --> 00:20:19,230 Don't infected cows and nertz dairymaid, and therefore were somehow immune to smallpox. 190 00:20:19,230 --> 00:20:24,900 That's actually that was not his discovery that had be known for some some time. 191 00:20:24,900 --> 00:20:32,070 But he was certainly the first to try to put it on some kind of hard scientific grounding. 192 00:20:32,070 --> 00:20:37,380 And he was the man who decided to try to publicise, tried to spread, 193 00:20:37,380 --> 00:20:43,770 spread the word really of this on the basis of experiments that he had done personally in in 194 00:20:43,770 --> 00:20:51,240 Gloucestershire on individuals who he was able to show and demonstrate that they were cowpox, 195 00:20:51,240 --> 00:20:56,630 arantes, smallpox and developing gener very famously, 196 00:20:56,630 --> 00:21:07,340 I think very modestly said that he just the studies to show something that was already being practised by milkmaids, for example. 197 00:21:07,340 --> 00:21:13,860 Sure. You could protect against smallpox using another virus. And of course, that's what we're doing with these adeno viral vectors. 198 00:21:13,860 --> 00:21:18,420 We used genetic engineering to change them rather than just discover them. 199 00:21:18,420 --> 00:21:26,430 Of course, not all of Jenny's methods would have been allowed today if we were looking at it today through the through the lens of bioethics. 200 00:21:26,430 --> 00:21:32,740 I think we were. Raising eyebrows somewhat at Janna's methods. 201 00:21:32,740 --> 00:21:40,630 At that time, I can't imagine his his particular research all being weighed through by an ethics committee. 202 00:21:40,630 --> 00:21:43,630 He essentially, yes, 203 00:21:43,630 --> 00:21:53,380 infected a a a child who was the son of his gardener with cowpox and then subsequently in order to test whether that made him immune to smallpox. 204 00:21:53,380 --> 00:22:02,860 He then infected the child deliberately with smallpox. And in this case, very fortunately for all concerned, the child did not develop smallpox. 205 00:22:02,860 --> 00:22:08,740 There is an interesting dynamic here between the doctor and the physician and the child. 206 00:22:08,740 --> 00:22:14,320 And also, I think we. What was the relationship, you might wonder, between Jana and his God? 207 00:22:14,320 --> 00:22:23,040 Is there a degree of authority here that's and dynamic between employer and employee? 208 00:22:23,040 --> 00:22:27,730 These are the sorts of things that they will be flagged as as no go areas. 209 00:22:27,730 --> 00:22:34,900 But I think in those days, of course, there was a very different way of approaching ethical quandaries such as this. 210 00:22:34,900 --> 00:22:40,120 And he's gardener's son wasn't the only person on whom Jenna practised. 211 00:22:40,120 --> 00:22:44,900 So Jenna doesn't stop treating and then infecting more boxes. 212 00:22:44,900 --> 00:22:49,300 Gardener's son. He also treats his own son and others. 213 00:22:49,300 --> 00:22:53,650 And these all feature in his in the report that he writes up at the end of the 18th century, 214 00:22:53,650 --> 00:22:58,450 which is in which his findings and his recommendations go to go forward. 215 00:22:58,450 --> 00:23:08,170 And it's those that take to take his reputation, one in which his reputation is founded. 216 00:23:08,170 --> 00:23:14,200 And it's his findings, of course, that spread so quickly and rapidly across not just not just to the medical community, 217 00:23:14,200 --> 00:23:18,550 but through through populations and governments in general. 218 00:23:18,550 --> 00:23:24,940 Let's talk a bit more about this reaction from wider society and the impact of Jenny's discovery. 219 00:23:24,940 --> 00:23:31,330 Generous, swift to go into publication with his findings right at the end of the 18th century. 220 00:23:31,330 --> 00:23:38,680 And very quickly, his ideas are not only welcomed and supported, but they also spread. 221 00:23:38,680 --> 00:23:47,890 So they spread very rapidly around Europe. He is praised by individuals ranging from the senior members of the royal Saudi medicine all the 222 00:23:47,890 --> 00:23:56,050 way to Napoleon and the pope who consider him and his achievements worthy of the greatest praise. 223 00:23:56,050 --> 00:24:00,720 So he very much his methods swiftly follow as well. 224 00:24:00,720 --> 00:24:08,100 And so and to the extent that they are taken up on on on a mass scale really throughout in certain countries, 225 00:24:08,100 --> 00:24:12,950 and then, of course, they do spreads very rapidly also across to the United States as well. 226 00:24:12,950 --> 00:24:19,570 You know, it's interesting to reflect on the fact that this is a time that Britain was at war regularly with France. 227 00:24:19,570 --> 00:24:25,210 And yet it's also a time when Napoleon singles out general for particular praise as a man whose 228 00:24:25,210 --> 00:24:31,980 contributions essentially are some of the greatest to health that have ever been better be made. 229 00:24:31,980 --> 00:24:42,520 And the praise with Rich or the esteem with which Napoleon, in which humble opinion holds, generally even leads to the release of British prisoners. 230 00:24:42,520 --> 00:24:48,010 But you also find individual such as the pope as well, praising Jennifer for his contributions. 231 00:24:48,010 --> 00:24:53,320 And it's very much European wide phenomenon that he is at the centre all at the same time. 232 00:24:53,320 --> 00:24:57,880 The disease is still being distinguished by something that comes from elsewhere. 233 00:24:57,880 --> 00:25:03,920 By this point and then as it's as it starts to decline in Europe as a consequence of vaccination, 234 00:25:03,920 --> 00:25:12,770 it is associated increasingly of being a disease of other parts of the world, other parts of colonies and those sorts of. 235 00:25:12,770 --> 00:25:17,570 I heard that initially the Royal Society didn't entirely approve of Jenna's work. 236 00:25:17,570 --> 00:25:23,000 Yeah, that's true. Think they did. So the Royal Society initially were hostile and warned him that that wasn't the sort of thing that 237 00:25:23,000 --> 00:25:29,180 he should be going where there wasn't it wasn't exactly gonna be a career at the very staff, 238 00:25:29,180 --> 00:25:32,690 wasn't going to be a career enhancing statements. 239 00:25:32,690 --> 00:25:38,720 But then very rapidly when says proof with you, I became clear the evidence for his claims became clear. 240 00:25:38,720 --> 00:25:48,310 Then they then they turned around. I was curious as to whether the general public reaction at the time was overwhelmingly positive or more varied. 241 00:25:48,310 --> 00:25:53,930 You know, there are still mixed reactions to Janna's findings and his his grapes, 242 00:25:53,930 --> 00:25:58,240 his great discoveries and the scientific evidence that he's presenting. 243 00:25:58,240 --> 00:26:06,850 There are people who distrust the idea that anything from animal could alter human health or even should be used, you know? 244 00:26:06,850 --> 00:26:13,270 So there's even there is a religious some religious hesitancy amongst religious groups, Madison, 245 00:26:13,270 --> 00:26:20,350 hesitancy amongst religious groups about whether this is really what makes medical men should be doing in terms 246 00:26:20,350 --> 00:26:28,150 of perhaps upsetting God's work by fiddling about with more bodies and then injecting things into human bodies. 247 00:26:28,150 --> 00:26:33,850 So there's there's a bit of that. There's also some what wants the cost of it becomes clear. 248 00:26:33,850 --> 00:26:38,900 There is there is considerable resistance, partly because of the cost. 249 00:26:38,900 --> 00:26:42,790 And that's poor Mexican society just cannot cannot afford it. 250 00:26:42,790 --> 00:26:47,560 And they resent this intrusion into their lives of of of the states. 251 00:26:47,560 --> 00:26:54,190 There are also parallels that there are also some concerns about the effectiveness of the vaccine. 252 00:26:54,190 --> 00:26:58,960 For example, there are documented cases, of course, of people quite early on. 253 00:26:58,960 --> 00:27:06,340 Of people becoming no longer immune. And this is a feature of the vaccine in that it did not make people did not give people lifelong immunity. 254 00:27:06,340 --> 00:27:08,260 It gave them temporary music. 255 00:27:08,260 --> 00:27:15,030 So after about 10 years or so, when that immunes began to wear off, there were those who felt that it was something that could not be trusted. 256 00:27:15,030 --> 00:27:23,560 And at the same time, there there are cases of people being infected and injected with vaccine that was not clean and was not sterile. 257 00:27:23,560 --> 00:27:29,270 And there were complications because of that. People didn't trust the purity of the vaccine. 258 00:27:29,270 --> 00:27:37,550 And I think all of these have parallels today in amongst those who are members of various anti vaccine movements. 259 00:27:37,550 --> 00:27:42,100 This sounded rather like our modern experience with an organised anti vaccine 260 00:27:42,100 --> 00:27:46,630 movement casting suspicion on what Jenner and his contemporaries were doing. 261 00:27:46,630 --> 00:27:54,040 You do see perhaps more debates and discussion about the pros and cons of vaccines. 262 00:27:54,040 --> 00:28:00,690 But his very presence coming in at the 17th century beginning the 18th, you see some discussion, 263 00:28:00,690 --> 00:28:06,070 a growing movement of individuals who are hesitant about inoculation and vaccination. 264 00:28:06,070 --> 00:28:14,920 They are suspicious of governments. Clearly, governments state intervention into the lives of individuals because they fear 265 00:28:14,920 --> 00:28:22,570 that inoculation and vaccination of of people is not necessarily a safe, 266 00:28:22,570 --> 00:28:33,850 safe way for. So it's quite interesting that you do see these resonant emotions appearing in sources that are 200 years, 250 years old. 267 00:28:33,850 --> 00:28:39,340 And they do speak quite clearly today to similar fears about. 268 00:28:39,340 --> 00:28:41,450 About vaccines. 269 00:28:41,450 --> 00:28:51,080 With smallpox being so prevalent and such a big story at the time, I wondered why I hadn't seen it reflected much in art from the period. 270 00:28:51,080 --> 00:28:56,690 You know, you don't have a reason to go around painting somebody with smallpox and say someone like Lady Mary Montagu, 271 00:28:56,690 --> 00:29:01,910 who famously brought back the idea of inoculation, or at least her idea from Turkey, 272 00:29:01,910 --> 00:29:11,000 from Constantinople early in the 18th century, and was played a very important part in publicising inoculation, 273 00:29:11,000 --> 00:29:16,280 vaccination practises, first in England and then and then elsewhere in Europe. 274 00:29:16,280 --> 00:29:20,810 She herself had had smallpox and had been disfigured by it. 275 00:29:20,810 --> 00:29:26,420 In a sense. I think she had she had no eyebrow eyelashes or eyebrows and these things left in her face. 276 00:29:26,420 --> 00:29:29,910 Her skin was was was was badly affected. 277 00:29:29,910 --> 00:29:37,340 But if you do if you look at paintings, of course, they are humble, complimentary, and they don't pick up on that sort of stuff. 278 00:29:37,340 --> 00:29:40,820 Because you know what painter with that, you know, the reality, 279 00:29:40,820 --> 00:29:48,980 the real the the authenticity of which artists in the 20th century particular paints you may not see when it's 280 00:29:48,980 --> 00:29:53,790 when they when they commission to do paintings of the great Indigo did come down smallpox in 19th century, 281 00:29:53,790 --> 00:30:01,820 19th century. I was also interested in the extent to which smallpox was a disease of the poor, not the rich. 282 00:30:01,820 --> 00:30:08,330 Class has an interesting relationship to smallpox, particularly in England and Europe at this time, 283 00:30:08,330 --> 00:30:14,420 partly because if you compare it to what came before inoculation, it's it's it's a strange situation. 284 00:30:14,420 --> 00:30:20,690 And that's often the the the more wealthy classes would have access to funds with 285 00:30:20,690 --> 00:30:27,260 which they could spend on the whole host of strange remedies that were available, 286 00:30:27,260 --> 00:30:34,920 such as purging exposure to extreme heat, exposure to extreme colds, that kind of thing. 287 00:30:34,920 --> 00:30:43,340 Rich Thomas Sydenham, who is a great, great proponent of an advocate of skilled practitioner in the time, 288 00:30:43,340 --> 00:30:49,320 claimed that actually this was more harmful to those classes because they were being that they were the most, 289 00:30:49,320 --> 00:30:58,130 if you like, of untrained spam specialists who were unable to provide skilled and effective medical treatments, 290 00:30:58,130 --> 00:31:02,330 whereas the poor just had to contend with smallpox on its own. 291 00:31:02,330 --> 00:31:07,520 And he felt that that was perhaps a more favourable situation to be in. 292 00:31:07,520 --> 00:31:15,860 And he felt that the best practitioner as far as smallpox treatment is concerned was someone who did the bare minimum in terms of treatment. 293 00:31:15,860 --> 00:31:22,610 So that's one side of things. But then also, of course, to be able to go to a medical man, a practitioner, whether professional or not, 294 00:31:22,610 --> 00:31:27,530 seeking a solution to not seeking some sort of treatment you would have to pay for. 295 00:31:27,530 --> 00:31:31,550 So even with inoculation, you would have to pay for that. 296 00:31:31,550 --> 00:31:37,070 So there is still a degree to which the poorer sections of society still remain 297 00:31:37,070 --> 00:31:42,380 unable to access the types of treatment that actually worked at that time. 298 00:31:42,380 --> 00:31:51,980 Moving on to the end of its outbreak and indeed this disease, even though Jenah had been pioneering vaccination back in the 18th century, 299 00:31:51,980 --> 00:31:59,750 it wasn't until recently, indeed, when I was a student here that the world was finally rid of smallpox. 300 00:31:59,750 --> 00:32:05,820 Yeah, it is a long time. So it's you know, it's 180 years or so before more boxes eradicated. 301 00:32:05,820 --> 00:32:10,550 And that's the reasons for that. Quite, quite complex and and also numerous. 302 00:32:10,550 --> 00:32:15,830 But smallpox after Janna's vaccination is techniques are publicised. 303 00:32:15,830 --> 00:32:21,230 Smallpox continues. It is still there isn't disease in other parts of the world. 304 00:32:21,230 --> 00:32:30,410 A great killer has a terrible impact on society, continues to have this cause the same dread that you saw in Europe from 16, 305 00:32:30,410 --> 00:32:34,550 17, 18 centuries before vaccination became common. 306 00:32:34,550 --> 00:32:41,360 So it remains a very significant problem in parts of the world that do not necessarily matter so much, 307 00:32:41,360 --> 00:32:47,930 if you like, to Western and imperial governments and countries. 308 00:32:47,930 --> 00:32:54,910 So it takes a while for for smallpox vaccination to spread decisively around the world. 309 00:32:54,910 --> 00:33:01,430 And it's really the post-war wells in the 20th century when you find. 310 00:33:01,430 --> 00:33:11,930 Some discussion and then calls for a united worldwide efforts by the WTO to try to eradicate smallpox. 311 00:33:11,930 --> 00:33:14,000 But a lot has changed by then. 312 00:33:14,000 --> 00:33:24,710 So one of the key factors involved in eradicating smallpox that is now, which makes it possible, is that the smallpox vaccine is now by the 1950s, 313 00:33:24,710 --> 00:33:31,220 1960s is a free freeze dried vaccine, which can be held room temperature, 314 00:33:31,220 --> 00:33:38,240 whereas most vaccines today have to be held to be stored in the cold and have to be treated very carefully. 315 00:33:38,240 --> 00:33:45,050 The smallpox vaccine could essentially be left at room temperature for four months on end and would still be effective to be. 316 00:33:45,050 --> 00:33:51,200 You say it was ideal for more than any other remedy that had been contemplated. 317 00:33:51,200 --> 00:33:55,930 It was ideal for for it for use in countries that were hard to navigate. 318 00:33:55,930 --> 00:34:02,150 It took time to move around and in which it took time to track and trace everyone. 319 00:34:02,150 --> 00:34:09,070 And the number of organisations, not least the World Health Organisation, have played a huge role in this story. 320 00:34:09,070 --> 00:34:19,880 So Joe is one in a in a line of organisations that are dedicated to the health, improving the health to the public health of multiple countries. 321 00:34:19,880 --> 00:34:30,410 So the League of Nations in the 1920s and 30s had a medical division and sought to improve public health in various parts of the world. 322 00:34:30,410 --> 00:34:37,880 You also see private institutions like the Rockefeller Foundation engaging in public health programmes in various corners of the world. 323 00:34:37,880 --> 00:34:48,650 So there were examples that existed before the Second World War of international efforts to tackle all kinds of of disease. 324 00:34:48,650 --> 00:34:56,780 And the Second World War just underlines that need for collaboration and cooperation and the of countries working together, 325 00:34:56,780 --> 00:35:01,510 nations working together to tackle what we must remember are not national problems. 326 00:35:01,510 --> 00:35:08,600 The disease crosses borders. It hasn't. No, it's no great respecter of of nationality or national borders. 327 00:35:08,600 --> 00:35:20,270 So an organisation like the show with a global agreement was something that made sense in terms of the evolution of what institutions like this. 328 00:35:20,270 --> 00:35:26,110 And it was backed by by a vast number of countries in that post-war post-war period 329 00:35:26,110 --> 00:35:30,230 and that it engages on public health programmes in various corners of the world. 330 00:35:30,230 --> 00:35:35,480 But it's smallpox eradication programme at the end of 1950s is really, I think, 331 00:35:35,480 --> 00:35:42,830 one of the if not the most striking and successful public health programmes in history. 332 00:35:42,830 --> 00:35:49,760 In terms of the success that resulted, though, it's Roderic and then Brian and blotchy outline. 333 00:35:49,760 --> 00:35:55,610 We shouldn't underestimate how difficult it is to eradicate a disease entirely. 334 00:35:55,610 --> 00:36:04,550 It's very difficult to stress enough how hard it is to stop a pandemic, particularly when a virus is concerned. 335 00:36:04,550 --> 00:36:08,870 Smallpox was eradicated for some fairly unique reasons. 336 00:36:08,870 --> 00:36:13,970 One I mentioned before is that the vaccine was extremely effective. 337 00:36:13,970 --> 00:36:19,520 Although we might think that the W8 Joe and the fact that they started this programme is the key factor. 338 00:36:19,520 --> 00:36:24,260 It really is the fact that the vaccine that was in place in 1960s, 339 00:36:24,260 --> 00:36:33,800 70s was extremely effective and could be stored in a very end and handled in a very, very useful way, which most vaccines cartons. 340 00:36:33,800 --> 00:36:40,130 And another feature, which is ironic considering this is one of the most horrible features of this, 341 00:36:40,130 --> 00:36:50,420 of the disease, which is its disfiguring quality, its ability to hökmark permanently face and to cause blindness. 342 00:36:50,420 --> 00:36:59,030 These features and the fact that it manifests itself as a terrible postulating a fact which which is very much focussed on 343 00:36:59,030 --> 00:37:07,290 on the face and and the extremities of particular face this awful dreaded disease where the WHL set about searching for. 344 00:37:07,290 --> 00:37:15,440 In cases in Africa and then in particular in India, they were helped greatly by the fact that somebody who was ill with smallpox was relatively 345 00:37:15,440 --> 00:37:21,260 easy to find because communities would be well aware of who was ill and who was not ill. 346 00:37:21,260 --> 00:37:23,240 But today, of course, where we have a virus, 347 00:37:23,240 --> 00:37:29,870 where we're still understanding the symptoms and invariably they're not symptoms that are easily discernable. 348 00:37:29,870 --> 00:37:39,440 They are not ones that that are quite so glaring and identifiable as those that characterise smallpox. 349 00:37:39,440 --> 00:37:48,500 It's very tempting these days to pare back into the past, to look at lessons from from previous epidemics and previous pandemics. 350 00:37:48,500 --> 00:37:56,420 But we need to draw the right ones and we have to be careful. We don't exaggerate someone's successes in the past and overlook some of the 351 00:37:56,420 --> 00:38:01,090 difficulties and some of the challenges which were in place during those periods. A. 352 00:38:01,090 --> 00:38:03,520 Virus is a big sign, she said. 353 00:38:03,520 --> 00:38:10,210 We as a nation before DNA viruses, so they don't mutate very much and it's only in humans, so it's human to human transmission. 354 00:38:10,210 --> 00:38:17,320 So there's no animal reservoir for it to hide. So it was a good target to try to eliminate with a vaccine. 355 00:38:17,320 --> 00:38:23,180 So the development of the vaccine and wide deployment with the vaccine to eliminate it. 356 00:38:23,180 --> 00:38:28,810 Finally, this one of only two infectious diseases have ever been eradicated so far. 357 00:38:28,810 --> 00:38:37,030 So small pox and rinderpest. I did say that the last naturally occurring case was diagnosed in October 1977. 358 00:38:37,030 --> 00:38:43,690 It's worth mentioning that in 1978, Janet Parker, who was a medical photographer who worked at the Bevin, 359 00:38:43,690 --> 00:38:48,100 a medical school, became the last recorded person to die from smallpox. 360 00:38:48,100 --> 00:38:54,520 Essentially, it was thought to be eradicated really at this point. And initially she was misdiagnosed as having chicken pox. 361 00:38:54,520 --> 00:38:58,930 However, there was a lot of international interest unconsented w.h. 362 00:38:58,930 --> 00:39:05,560 And it turned out that Professor Henry Budson headed the smallpox laboratory at the Birmingham Medical School. 363 00:39:05,560 --> 00:39:17,830 And this is where she worked. And there was only a handful of commission WHL research facilities that still had smallpox virus samples, essentially. 364 00:39:17,830 --> 00:39:22,150 So it was clear that the smallpox virus must have escaped from his laboratory. 365 00:39:22,150 --> 00:39:28,030 One of the theories is that it came through the vents, but no one really knows as she ended up dying. 366 00:39:28,030 --> 00:39:36,280 And both her parents and so ends up getting ill and being quarantined. And sadly, due to the guilt and the pressure, the professor took his own life. 367 00:39:36,280 --> 00:39:37,510 And in that case, though, 368 00:39:37,510 --> 00:39:44,560 it was a lesson that even eradicate infectious diseases can pose a threat as long as they're being kept in some labs in the world. 369 00:39:44,560 --> 00:39:50,410 And, of course, as you said, the risk of bioterrorism. And that's why smallpox is still quite interesting to us. 370 00:39:50,410 --> 00:39:54,700 And on that subject, Roderick left us with a final warning. 371 00:39:54,700 --> 00:40:01,370 Smallpox would make a deadly weapon if a nefarious state or group was tempted to use it. 372 00:40:01,370 --> 00:40:03,890 Because it's the perfect disease. 373 00:40:03,890 --> 00:40:11,090 The fact that it exists anymore, unless, you know, unless you consider the fact that it's on to, you know, it's in it's in it's very secure. 374 00:40:11,090 --> 00:40:16,400 It's preserved and very secure positions in labs in the US and Russia. 375 00:40:16,400 --> 00:40:20,270 But should it be extracted from those or should it be? 376 00:40:20,270 --> 00:40:23,840 If it's if it's constructed as a disease in a lab? 377 00:40:23,840 --> 00:40:31,070 If it was Re-created, which is not impossible, it would be a highly effective biological warfare weapon, 378 00:40:31,070 --> 00:40:36,050 because not only because it's so contagious, but because it's so distressing. 379 00:40:36,050 --> 00:40:43,430 It's such a terrifying disease, because as we discussed, it affects it affects the body and it affects the face. 380 00:40:43,430 --> 00:40:48,030 So it is very much something that literally is a terror weapon. 381 00:40:48,030 --> 00:40:57,830 You know? Next time on future anchors, we move on to another disease that many may think has disappeared like smallpox, 382 00:40:57,830 --> 00:41:03,200 which sadly is still endemic in many countries, namely cholera. 383 00:41:03,200 --> 00:41:07,070 We'll discuss a major outbreak in the 19th century. 384 00:41:07,070 --> 00:41:15,230 Why someone called Jon Snow, probably not the one you're thinking may or may not be central to that story. 385 00:41:15,230 --> 00:41:19,880 And what a water pump in the centre of London has to do with anything. 386 00:41:19,880 --> 00:41:26,720 I hope you can join me then for the next episode of our History of Pandemics season. 387 00:41:26,720 --> 00:41:34,950 I'm Peter Milliken, and you've been listening to Future Makers. 388 00:41:34,950 --> 00:41:45,370 Future Makers was created in-house at the University of Oxford and presented by Professor Peter Milliken from Hartford College. 389 00:41:45,370 --> 00:41:52,260 Our voice set to today was Anna Wilson. The school for the series was designed and created by me. 390 00:41:52,260 --> 00:41:59,070 Richard Watts and the series is written and produced by Ben Harwood and Steve Pritchard. 391 00:41:59,070 --> 00:42:06,630 Thank you. On behalf of the whole team for listening to the history of Pandemic's. 392 00:42:06,630 --> 00:42:12,810 COVA, 19, has exposed the deep flaws in our relationship with the world and each other. 393 00:42:12,810 --> 00:42:16,830 We all long for a return to normality, but is back to normal. 394 00:42:16,830 --> 00:42:22,470 Really what we want? We need to seise this moment to reimagine our systems. 395 00:42:22,470 --> 00:42:29,490 And that's exactly what we'll do in the new series of REIMAGINE, which we're calling Systems Reset. 396 00:42:29,490 --> 00:42:36,240 In this series, you'll meet the visionaries who are revolutionising the story of who we are and how we engage with the world. 397 00:42:36,240 --> 00:42:42,000 We are dumping on the future. We had dumphy ecological degradation. We adopt a technological risk. 398 00:42:42,000 --> 00:42:50,040 I think we have stock talk about this talk of a new human dimensional relationship near human potential and Walcott's foster. 399 00:42:50,040 --> 00:42:56,340 We'll talk about how to thrive in an entangled ecosystem, redesigning public health and economic systems, 400 00:42:56,340 --> 00:43:00,660 the kind of leadership we need in the 21st century and much more. 401 00:43:00,660 --> 00:43:06,060 It's time to summon our moral imaginations and create systems that are fit for purpose. 402 00:43:06,060 --> 00:43:10,770 It's time for a declaration of interdependence. So join me. 403 00:43:10,770 --> 00:43:15,720 Peter Drawback for Reimagine a podcast from the school's Centre for Social Entrepreneurship 404 00:43:15,720 --> 00:43:22,728 in Oxford reimagined a podcast about people who are inventing the future.