Cold Open

It’s July 1st, 1520 in the Aztec city of Tenochtitlan, Mexico, and a battle is underway.

The nobleman, Cuitlahuac, is one of tens of thousands of Aztecs who have taken up arms against Spanish Invaders who are trying to conquer their city.

The Spanish conquistador Hernan Cortes arrived on these shores with his soldiers about a year ago. At first, the Aztecs hoped to befriend the Europeans. They welcomed them as their guests, showering Cortes with gifts of gold and letting him set up camp in their main city.

But Cortez did not come in peace. Within months, his soldiers started murdering Aztec priests and chiefs in an attempt to secure power. Cuitlahuac’s brother – the Aztec emperor –  was among the many who were slain. Now Cuitlahuac and his fellow citizens are hungry for revenge. They drive the Spanish to the city’s edge is a series of violance skirmishes. And as the last of the departing Spaniards disappear into the distance, Cuitlahuac stops to catch his breath. He looks around at the streets littered with the bodies of the Spanish. His sword is sticky with blood, and his arm aches from the fight. But he has strength enough to rattle his shield in triumph. The Aztecs have done it and the Spanish are gone.

Though defeated in battle, these Spanish invaders have inadvertently left behind an enemy more powerful than any army. When Cortes and his men return in less than a year, Cuitlahuac and 40 percent of the city’s inhabitants will be dead, and the surviving Aztec people will be too weak to mount a defense. They will have been struck down by a deadly virus now known as “smallpox.” Millions more will be killed by this disease in Mexico and far beyond, until centuries later, it will be announced by scientists that this curse on humanity has finally been eradicated on December 9th, 1979.

Introduction

From Noiser and Airship, I’m Lindsay Graham and this is History Daily.

History is made every day. On this podcast—every day—we tell the true stories of the people and events that shaped our world. 

Today is December 9th, 1979: The Defeat of Smallpox.

Act One: Advances in Science

It’s March 1718, in the city of Constantinople, what is today Istanbul, Turkey, 200 years since smallpox devastated the indigenous populations of Mexico.

Lady Mary Wortley Montagu, an English aristocrat, dabs the heat from her forehead as she ushers an old lady into the British embassy. Lady Mary hopes this local medicine woman might be able to help protect her son from smallpox. 

Lady Mary moved to Constantinople a year ago with her husband, the British ambassador. She was once a darling of the British aristocracy – a beautiful and witty woman who spent her days mingling with the royal family. Until she herself contracted smallpox. The disease left her with terrible scars and damaged eyesight. But she survived.

Not everyone is so lucky. Smallpox epidemics lay waste to millions around the globe every year. In its most potent form, the disease kills 30 percent of adults who catch it; and 80 percent of children.

But not in Turkey. Though smallpox is widespread here, the people survive in greater numbers, and they suffer from milder symptoms. And when she first arrived, Lady Mary noticed the locals have beautiful skin, barely any scars. Then, one day while spending her free time with the wives of local Turkish officials, she saw an old woman administer an unusual procedure called ‘variolation’ - something her Turkish friends claim protects against smallpox.

It's common knowledge in these days that those who survive smallpox are immune to catching the virus again. And Variolation involves deliberately infecting healthy people with a mild form of smallpox, by rubbing the pus from an infected person into small cuts on their arms and wrists. The process causes far less severe smallpox symptoms than if the virus is caught naturally. But crucially - it still seems to provide immunity against future infections. 

Lady Mary has never forgotten the terror of the dark days when she nearly died from the disease. She doesn't want her son to experience that sort of pain, especially in a foreign country so far from home. So she tracked down the old medicine woman and brought her to a private room at the British Embassy. Waiting inside is the embassy surgeon, a man named Charles Maitland. Lady Mary wants Maitland to oversee the woman as she administers the procedure on her son.

Maitland has heard of variolation, but he knows very little about it. It’s already practiced in China, India, and Africa; but not Europe. His ignorance led him to try to talk Lady Mary out of it. But she wouldn’t listen.

Now, Maitland watches nervously as the old woman lays out the tools of her trade: a needle to scratch the child’s skin, and a nutshell which contains pus from a smallpox victim.

Lady Mary lifts her child onto her lap and exposes his soft, white skin. Then she turns to the old lady and tells her to get on with it. 

After the variolation, her son will recover from the mild illness caused by the procedure, without any scars. And Lady Mary will become a true believer in the process. Years later, back in London, she will insist that Charles Maitland administer the procedure to her three-year-old daughter, who will also recover. Soon, word will spread among Lady Mary’s influential circle, and eventually reach the Princess of Wales, whose oldest daughter nearly died from smallpox. The princess is desperate to inoculate her other children. But her physician is also reluctant. So too is her father-in-law, the King of England. Before the King risks trying out variolation on his grandchildren, he will want proof that the process is truly safe.

***

It’s August 9th, 1721, in Newgate Prison, London, a few months after Lady Mary’s daughter was successfully variolated.

Ann Tompion, a 25-year-old pickpocket, stands in a cell with five other prisoners under the watchful eye of a small group of doctors. All these prisoners have been sentenced to death for their crimes, but today they are smiling. They have volunteered to take part in an experiment, in exchange for their freedom.

The Princess of Wales was not the only person keen to explore the benefits of Lady Mary’s discovery. A group of physicians also saw its potential in combating smallpox. They petitioned the king, asking if they could conduct an experiment on condemned prisoners to see if variolation works. In exchange, these prisoners would be given a full pardon. The King agreed. And Ann the pickpocket was one of the first volunteers.

She eagerly rolls up her skirt as she glances at the doctors in their fancy clothes. Rumor has it that one of them is even the king’s personal physician.

But Ann is unimpressed and wipes her nose with the back of her hand. She doesn’t flinch as the surgeon makes the first incision in her leg. It hurts, but not as much as the hangman’s noose would.

The next day, Ann’s incision shows sign of infection. And a few days later, her fever starts. Soon after, spots appear on her face. But the infection overall is mild, and she recovers quickly, without scars. The experiment seems to be a success.

A month later, on September 6th, Ann the pickpocket will be freed as promised, along with all the other volunteers. The outcome of the experiment is enough to convince the king to allow his granddaughters to be subjected to variolation, though he will not permit it to be done to his male heirs. But for most other folk, variolation will soon become common practice across Western Europe.

But the king’s hesitance is founded: variolation is dangerous. It infects healthy people with smallpox. Those infected mostly suffer mild symptoms, but a small percentage of them will still die. And they can pass the virus on, which risks further epidemics.

It will be another 70 years before a safer, more effective method of inoculation is discovered, with the development of the very first vaccine.

Act Two: The First Vaccination

It’s May 14th, 1796, in Gloucestershire, England, 70 years after the Newgate prison experiment.

Edward Jenner, a country doctor, is about to conduct an experiment of his own. In front of him, sits a perfectly healthy 8-year-old boy. Dr. Jenner has a theory he hopes will help stave off smallpox, a disease which he calls ‘the speckled monster’, and ‘the most dreadful scourge of the human species’.

In the 1790s, variolation is still the only method used for inoculation against smallpox. But Dr. Jenner knows all too well that variolation is flawed and still dangerous. When he was eight years old, he was subjected to the process. It was a terrible experience; he almost died. And since then, he’s studied smallpox obsessively in search of a better way to inoculate against the disease. Today, in pursuit of that goal, Dr. Jenner plans to infect this boy with a different disease… After thoroughly examining the boy, Dr. Jenner calls into the room another patient: a milkmaid named Sarah Nelmes. Sarah has caught cowpox from Blossom, one of the cows she milks. It’s a disease similar to smallpox, but far less life-threatening. She has minor blisters on her hands, but for the most part, her skin is silky and smooth and she feels okay.

Being out in the country, Dr. Jenner often sees patients with cowpox. He’s also aware of a common folklore: that milkmaids like Sarah have clear skin because cowpox gives them immunity to the virus’s deadlier cousin, smallpox. Dr. Jenner has an inkling that there may be truth in the myth. And he’s going to test that theory today.

Dr. Jenner smiles encouragingly at the boy as he cuts two incisions into the child’s arm. He is impressed by the boy's bravery. Next' Dr. Jenner takes Sarah’s hand and cuts open one of her blisters. He scrapes some of the infection onto his scalpel as she shudders and turns away, not quite as brave. Carefully, Dr. Jenner wipes the pus from her hand into the boy’s cuts before applying bandages.

Six weeks later, the boy comes back to see Dr. Jenner. This time, the doctor infects the child with the more deadly smallpox virus. He's carefully watched, but the boy does not present any symptoms. A few weeks later, Dr. Jenner tries again with the same result: still no symptoms. To Jenner, this proves the theory: cowpox can give immunity to smallpox. Additionally, this process of inoculation is far safer than variolation because cowpox is not deadly, nor does it seem to spread from human to human.

Dr. Jenner has just invented the first vaccination in human history. In acknowledgement of its origin, the name of his discovery comes from the Latin word ‘vacca’, meaning ‘cow’.

As a result of Dr. Jenner’s work, vaccination will become a new weapon in the fight against smallpox. But it will be another 160 years before the whole world will unite and rid the world of the scourge that during the 20th century alone kills around 300 million people.

***

It’s October 30th, 1977, in the town of Merca, on the southern coast of Somalia.

A man named Ali Maow Maalin lies in bed, sick; his body is covered in a rash and his head is pounding. Ali works as a cook and an occasional vaccinator at a local hospital for the World Health Organization's smallpox eradication team. A couple of weeks ago, he offered to direct a young family was suspected smallpox to an isolation camp on the edge of town. Then he came down with a fever himself.

The world is on the verge of wiping out smallpox, thanks to a global drive by the World Health Organization – or the WHO. Over the last 10 years, the WHO has chased down outbreaks, isolated villages and towns, and provided vaccinations. Their efforts have been so effective that Somalia is the last country on Earth, suffering an outbreak. But it's finally under control, with all suspected cases contained in isolation camps like the one Ali went to last week.

Ali knows he shouldn’t have risked being in a car with the young family. He's not vaccinated. It looked too painful at the time and he never told anyone that he never got around to it. He knows he should inform the authorities that he’s ill. But he doesn’t want to be sent to an isolation camp. So instead, Ali hopes he can just lie here in bed until the sickness goes away.

But Ali’s infection is discovered when one of his friends reports his condition to local disease surveillance officials. He is immediately isolated and a containment response is put into motion: WHO officials shut down the town and trace all of Ali’s contacts; police set up checkpoints; the hospital where Ali works closes its doors to new patients. And as part of the effort to contain Ali’s infection, WHO vaccinates 50,000 people. 

Ali is lucky: he will survive, having contracted a milder form of smallpox, and the disease does not spread further.

Six months later, the WHO’s office in Nairobi states that Ali Maow Maalin was the world’s last known smallpox case. Sadly, WHO is wrong. Despite their best efforts, smallpox has still one more victim to claim.

Act Three: The Final Push

It’s August 24th, 1978, at East Birmingham Hospital, in England, a year after Ali Maow Maalin was presumed to be the last person ever to catch smallpox.

Professor Alasdair Geddes, a consultant at the infectious diseases unit at the hospital, cannot believe his eyes. In the bed in front of him, a woman lies barely conscious, her skin covered in a rash of spots ballooning into pus-filled blisters. Janet Parker, a 40-year-old medical photographer, was rushed into the unit by ambulance staff. Her mother wouldn’t accept the General Practitioner’s diagnosis of chickenpox, remembering how different that rash was when she nursed Janet through it as a child. Professor Geddes agrees with Janet’s mother. If he didn’t know better, he would suspect smallpox.

But the newspapers announced the last known case of the deadly virus a year ago in Somalia.

Professor Geddes has a terrible feeling that there could be an explanation. Janet works in the same building as a smallpox research laboratory run by his friend, Professor Bedson, at Birmingham Medical School. It’s possible the virus could have escaped.

Professor Geddes orders that all Janet’s contacts be traced and quarantined. Then he calls his friend, Professor Bedson. That night, the two men sit at the electron microscope in Professor Bedson’s laboratory and confirm what they already believe to be true: Janet has smallpox.

For the next three weeks, Great Britain’s second-largest city experiences a full-scale public health emergency in a bid to contain a possible outbreak. Janet’s house and car are fumigated by health officials, who also vaccinate anyone she may have come in contact with. Officials place hundreds of people in quarantine. And after all their efforts, only one other case is identified - Janet’s mother.

Eighteen days after first arriving at the hospital, on September 11th, 1978, Janet dies, becoming the last known victim of smallpox in the world. Her mother recovers fully, having been vaccinated both as a child and again when her daughter was diagnosed.

A year after Janet’s death, on December 9th, 1979, the Global Commission for the Certification of Smallpox Eradication declares the virus has been fully wiped out. The WHO’s program is considered a public health triumph. In just over a decade, global cases of smallpox have dropped from between 10 and 15 million to zero. Today, the smallpox virus exists only at two WHO-designated sites for research: a laboratory in the United States, and one in Russia.

Blossom - the cow that gave Sarah Nelmes cowpox 200 years ago - will not be forgotten. Her hide is at St George’s Hospital Medical School, and her portrait hangs at the Royal College of Pathologists. But it is Dr. Edward Jenner who will go down in history as the Father of Immunology, the man who set the world on the path to freedom from smallpox, a feat that was finally achieved on December 9th, 1979. 

Outro

Next on History Daily. December 10th, 1690. An economic crisis in Massachusetts Colony spurs the introduction of a new type of money in the West – the banknote.

From Noiser and Airship, this is History Daily, hosted, edited, and executive produced by me, Lindsay Graham.

Audio editing by Mollie Baack.

Sound design by Derek Behrens.

Music by Lindsay Graham.

This episode is written and researched by Vanessa de Haan.

Executive Producers are Steven Walters for Airship and Pascal Hughes for Noiser.