13 O’Clock Episode 282 LIVE: The Tuskegee Syphilis Study

Half a century after it was exposed, the Tuskegee Syphilis Study remains one of the darker chapters in American medical history, and led to several reforms in medical ethics, particularly in regard to informed consent for human subjects. Beginning in 1932, the US Public Health Service conducted a study to determine the course that syphilis would take if left untreated. Tragically, the subjects of the study were all impoverished African-American sharecroppers, none of whom were told what the study was for and whether they had syphilis or not. Worse still, the engineers of the study refused to allow the subjects to undergo treatment for the disease, even after penicillin was proven to be an effective remedy; not only did more than a hundred men die as a result of this refusal, but several of the men also passed the disease on to their wives, and some of their children were later born with congenital syphilis as well. Join Tom and Jenny on this grim journey through medical malfeasance on a sickly and somber episode 282.

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Lady Mary Montagu and the Discovery of the Smallpox Vaccine

Though Edward Jenner is credited with developing the first smallpox vaccine, inoculation had long been practiced in other parts of the world.

LadyMaryWortleyMontagu

Smallpox had for many years been a scourge in the West, sweeping through the densely populated cities of Europe in periodic epidemics, killing as many as 35% of the people it infected and often leaving the survivors scarred for life. From the wealthiest noble to the humblest peasant, residents of London and Paris lived in abject fear of the next wave of infection. There was no known way to prevent the spread of the disease, and no known cure. But while the populace of the West cowered under smallpox’s shadow, they had no idea that the cultures of China, the Middle East, and Africa had known how to prevent the disease for centuries, and that their method would soon be introduced into England by one very brave and determined woman.

Lady Mary Montagu and the First Inoculations

Lady Mary Wortley Montagu, a member of the British nobility and the wife of an ambassador, was living in Turkey while her husband was posted there. She had firsthand experience with the horrors of smallpox—she had contracted the disease in 1715, and though her prognosis had been grim, she had managed to survive. Before her illness, she had been widely lauded as one of the most beautiful women in Britain; afterward, her face was so misshapen and scarred that she always wore a veil in public. Though she no longer had to fear smallpox for herself, she lived in mortal terror of her two children contracting it. So when she heard the Turks had a method for preventing smallpox, she wanted to hear all about it.

The method had been practiced for centuries, though Westerners knew little to nothing of it. It is possible that inoculation against smallpox was known in India as early as 1000 BC, though the first definitive mention of the treatment was made in 1549, by Chinese author Wan Quan. The inoculation (or variolation, as it was called in the early days) worked on a similar principle to modern vaccines—small particles of diseased matter from an infected person, either in the form of pus or powdered scabs, was blown up the inoculee’s nose or inserted through a tiny cut in the skin. The patient would then develop a mild case of smallpox, after which he or she would be forever immune. There was a small chance the inoculation would be fatal, but it was an infinitesimal risk compared to the mortality rate of full-blown smallpox. Lady Mary, hearing of the method described by doctors Emmanuel Timoni and Jacob Pylarini, became determined to introduce the knowledge to England; to show her commitment to the cause, she vowed to have her own children inoculated.

The Smallpox Vaccine Comes to England

The British public were wary when Lady Mary returned home in 1721 and began making her campaign for variolation. Smallpox was horrible and often fatal; why give yourself a dose of it on purpose? But Lady Mary was relentless, and despite widespread condemnation of her and of Dr. Charles Maitland, who she persuaded to perform the inoculations, she gave the treatment to her children (aged 4 and 5), both of whom survived their ordeals with no lingering effects. Soon others were bringing their children to Lady Mary to have them variolated, and though one or two of the inoculated patients did die of smallpox, on the whole the experiment was a rousing success, so much so that the British Royal Family conceded to having their own children inoculated; still leery of the procedure’s safety, however, they insisted that the inoculations first be performed on six prisoners, who would earn a pardon if they survived. All did, and the royal children were variolated.

Cotton Mather and the American Inoculations

During this time, Lady Mary Montagu had also been corresponding with American minister Cotton Mather, who had noticed that his family’s African slaves seemed immune to smallpox. When Mather asked one of the slaves, Onesimus, about this, the man answered that a similar method of variolation as that practiced in Asia and the Middle East was also common in Africa. Mather convinced Dr. Zabdiel Boylston to inoculate Boylston’s son and two slaves, all of whom recovered, and was instrumental in sowing acceptance for the vaccine in the young United States.

Dr.Edward Jenner Vaccinating Young Boy

Edward Jenner and the Modern Vaccine

Early studies of the use of the cowpox virus to prevent smallpox had been done in 1727 and 1766, but it is British physician Edward Jenner who is generally credited with developing the first smallpox vaccine; the word vaccine was taken from the Latin “vaca,” for cow. The cowpox virus is similar to smallpox, and so conveys immunity to the more deadly disease, but is mainly prevalent in cows and not fatal to humans, making the vaccine much safer. Jenner experimented with his cowpox vaccine in 1796, and presented his findings to the Royal Society, after which he went on to experiment on 23 other people. The vaccine was hugely successful, bringing the death rate from smallpox down to essentially zero.

Over the years, Jenner’s work was published around the world, and widespread vaccination became the norm. In the late 1970s, the disease of smallpox was officially eradicated, though two samples of the deadly variola virus that causes it still remain—one at the CDC in Atlanta, Georgia, and one at the State Research Center of Virology and Biotechnology in Koltsovo, Russia. These are kept for research purposes in the event of a new outbreak, due either to natural causes or bioterrorism.

Source:

Carrell, Jennifer (2003). The Speckled Monster: A Historical Tale of Battling Smallpox. The Penguin Group. ISBN: 0452285070.