Get Well Soon

by Jennifer Wright

  Shortly after their arrival, Cortés’s men imprisoned Montezuma II. However, when the Spaniards tried to seize Tenochtitlan they were met with formidable resistance by the city’s forces, who supposedly proceeded to stone their leader to death because of his bad judgment with the feathers and gold and other gifts. From six hundred to one thousand conquistadores died in the ensuing battle—so many that June 30, 1520, came to be known as La Noche Triste (the Night of Tears or the Night of Sorrows). The Spaniards fled, and the Aztecs rejoiced. Their new leader, Cuauhtémoc, decided never to welcome strangers who are unproven gods into the city again, and life in Tenochtitlan returned to normal for about ten minutes.

  The Spaniards weren’t with the Aztecs long enough to capture the city, but they were—you guessed it—able to leave smallpox behind. One of Cortés’s infected soldiers died during the battle, and his body was looted. The disease spread through the empire and devastated it. By September 1520 the inhabitants of Tenochtitlan had developed racking coughs and painful burning sores.13 One Aztec account described what was called “the great rash”: “Sores erupted on our faces, our breasts, our bellies, we were covered with agonizing sores from head to foot … the sick were so utterly helpless they could only lie on their beds like corpses, unable to move their limbs or even their heads. They could not lie facedown or roll from one side to the other. If they did move their bodies, they screamed in pain.”14 Aztec cities like Texcoco, which was estimated to have fifteen thousand citizens before the plague, would be left with only six hundred people, or 4 percent of its former population, by 1580.15 Smaller towns and villages would simply be obliterated. Today, it’s estimated that smallpox killed around 90 percent of the native people of the Americas.16

  Even in Europe, where the disease was known, smallpox was terrifying because it was so contagious. Ole Didrik Lærum, a modern-day professor of medicine at the University of Bergen, claimed that “sometimes being in a room next door to someone who was infected was all it took.”17 Smallpox was even more terrifying and deadly to people who had never experienced it. One Spanish priest graphically described that the Aztecs “died in heaps, like bedbugs. In many places it happened that everyone in a house died and, as it was impossible to bury the great number of dead, they pulled down the houses over them so that their homes become their tomb.”18

  When Cortés returned in 1521, he was able to take the Aztec capital with ease. In addition to disease, “many died only of hunger … for they had no one left to look after them … No one cared about anyone else.”19 Sahagún, the friar and author of Historia General, who would claim to have buried ten thousand people before he died of smallpox himself in 1590, said that people lived in terror of any contact with their neighbors, much as Europeans had during the bubonic plague (which only killed 30 percent of the people in Europe). Sahagún worried that “the [Aztec’s] land would revert to wild beasts and wilderness”20 as there were too few Spaniards to settle it, and the Aztecs would soon be extinct. The few remaining Aztecs began a new calendar, which counted time anew from the year they first experienced “the Great Leprosy.” This makes sense. The disease was so devastating, and the obliteration so complete, that their entire world could only be grouped as what came before and what came after.

  Like the Aztecs, the Incas felt their world similarly altered. They recounted the arrival of smallpox in a mythic manner, as if it were a vengeful genie released from a bottle. In the 1613 Antiquities of Peru, J. de Santa Cruz Pachacuti-Yamqui Salcamayhua writes of the Incan telling of the beginning of the plague:

  There came a messenger with a black cloak, and he gave the Inca a kiss with great reverence, and he gave him a “pputi,” a small box with a key. And the Inca told the same Indian to open it, but he asked to be excused saying that the Creator had commanded that only the Inca should open it.

  Understanding the reason why, the Inca opened the box, and there came fluttering out things like butterflies or scraps of paper, and they scattered until they vanished. And this was the smallpox plague.21

  Anyone familiar with Greek mythology will see the similarity between this tale and the story of Pandora’s box. In that story, the first woman on earth opens a box that releases all the evils in the world, which fly out like insects. However, she manages to squeeze it shut just in time to keep hope from flying away as well.

  There is no hope in the Incan story. There is only death. Pachacuti-Yamqui Salcamayhua’s story ends: “Within two days the general Mihicnaca Mayta died, with many other distinguished captains, all their faces all covered with burning scabs. And when the Inca saw this, he ordered a stone house to be prepared for him in which to isolate himself. And there he died.”22 This ending seems considerably less mythological than the first part of the story.

  The Spaniards shrugged off the horrors and devastation of the plague, saying, as Pedro Cieza de León did, “But the matters of the Indies are the judgments of God, and come from His profound wisdom, and He knows why He permitted what happened.”23

  That is … not a satisfying answer. Why were the effects of smallpox so devastating to these empires? In large part, the high death toll occurred because the Amerindians, prior to the arrival of European visitors, had absolutely no exposure to the kind of diseases that sixteenth-century Europeans considered a normal part of life. Therefore, they had no resulting immunities. That’s not to say that smallpox wasn’t a scourge in Europe as well; it killed around four hundred thousand people—many of them children—each year in Europe well into the eighteenth century.24 But those surviving the disease developed immunity, and a small degree of immunity could be passed down through parents.

  Smallpox is thought to have originated with farm animals—especially cattle, but also horses and sheep—and then crossed species to infect humans. Europeans had a great deal of contact with those animals, whereas the Inca and Aztec people had none. As Jared Diamond, the author of Guns, Germs and Steel, explains: “The Incas had llamas, but llamas aren’t like European cows and sheep. They’re not milked, they’re not kept in large herds, and they don’t live in barns and huts alongside humans. There was no significant exchange of germs between llamas and people.”25 The devastation of smallpox in the Americas was not due to a vengeful God or a mysterious man bearing an evil box, but rather to the fact that Amerindians did not spend as much quality time with their domesticated llamas as Europeans did with their cows.

  Now, maybe you are reading these tales of destruction and thinking, Oh, God, I myself do not have a cattle farm, or I am a proud llama farmer (there’s got to be one somewhere), and are therefore convinced that you would surely die if you contracted smallpox because of your sad immune system—and what if terrorists purposefully incubate smallpox and come in a suicidal pact and spread it to us, and we all die and our civilization perishes and everything is very bad? I am with you, citizen! Considering what happened to the Romans and the Amerindians, an outbreak of smallpox is an extremely frightening prospect. Fortunately, the World Health Organization officially declared the disease eradicated worldwide in 1979. Accordingly, we are no longer even vaccinated to prevent it. However, after September 11, 2001, the U.S. government became as concerned as you might be right now. It stockpiled enough vaccine to protect every person in the United States, and the vaccine is effective within three days of being exposed to the disease. Worst-case scenario: if some very evil people unleashed smallpox into the general population, there is a plan in place to prevent many casualties. So though smallpox is a very scary disease, it’s not one we need to be especially fearful of today.

  This desirable state of affairs is largely thanks to Edward Jenner. In the eighteenth century the English doctor and scientist realized that milkmaids who had suffered from cowpox—a disease which results in only a few small sores on the hands—never contracted smallpox. He began injecting people who were not milkmaids with a small amount of pus from cowpox blisters, in an attempt to ensure that they too would never suffer smallpox. Now, there were people before him w
ho had attempted a similar (though less safe) procedure. A medical paper titled “The Myth of the Medical Breakthrough: Smallpox, Vaccination, and Jenner Reconsidered” asserts: “It is extremely rare that a single individual or experiment generates a quantum leap in understanding; his ‘lone genius’ paradigm is potentially injurious to the research process.”26 I don’t think that’s necessarily true. I love lone geniuses! I love heroes, and I will take them any way I can, because it’s inspiring to imagine one person hauling all of humanity forward.

  But in this case, Jenner metaphorically stood on the pox-touched shoulders of harem girls and Lady Mary Wortley Montagu.

  As far back as ancient Roman times, it was understood that people who had survived smallpox once did not get the disease again. Having already read about the kind of “cures” attempted for the bubonic plague, you can guess that this basic knowledge of immunity didn’t stop people in Europe from developing some alternative theories about how to treat the disease. In the seventeenth century Dr. Thomas Sydenham recommended “twelve bottles of small beer every twenty-four hours,”27 which I suppose at least temporarily distracted the patients from their disfiguring pox and made them feel confident about their ability to heal and look more attractive than ever. As, doubtless, did the fact that Sydenham believed in prescribing opium for everything.

  While Europeans were guzzling beer, a technique known as variolation became popular in the Ottoman Empire. Variolation generally entailed finding someone suffering from smallpox, drawing blood or fluid from one of their pustules, and injecting it into an uninfected person. Other methods of transfer might include rubbing infected bits of scab on open wounds or snorting smallpox crusts up your nose. The uninfected person would usually develop the disease but in a less severe form than if they had contracted it naturally. They would get a little bit sick rather than a lot sick, and hopefully recover with minimal damage. In the Turkish empire, as early as 1600, variolation was frequently performed on young girls who were being considered for the sultan’s harem. The injection would be done on parts of the body where, even if there were some scarring, it would be less likely to mar their beauty.

  Which was important in a harem girl, obviously. Smallpox was a killer, but it was also referred to as “beauty’s enemy.” Sahagún, in reference to the Aztec outbreak, wrote: “Many who came down lost their good looks, they were deeply pitted and remained permanently scarred. Some lost their sight and became blind.”28

  The women in Turkey who were variolated would experience less disfigurement, but there were still downsides. For one thing, they were perhaps going to have to live in a harem. Despite what nineteenth-century romantic paintings would have you believe, a harem was like a sorority house located in hell. On a more practical, disease-related note, harem dwellers could acquire all manner of blood diseases—like syphilis—from the variolation, or they could have a severe reaction to the smallpox sample and die. There was a 2 to 3 percent fatality rate from variolation. If a procedure had a one in fifty chance of killing you, the FDA would not look favorably upon it today. But the odds were certainly preferable to the much higher likelihood of death, blindness, or disfigurement from naturally contracted smallpox. For a group of women who would be living in close quarters and whose only means of gaining power was to be as beautiful and beloved by the sultan as possible, variolation may have been a very sound approach.

  Lady Mary Wortley Montagu, whose husband was the British ambassador to the Ottoman Empire in 1716, would never have made it as a harem girl. Although Lady Mary had been famously beautiful, she had suffered from smallpox and her face was marked by it. If a woman’s worth lay only with her beauty, as it did through much of history, contracting smallpox might seem to be a fate worse than death. Isobel Grundy, Lady Mary Montagu’s biographer, notes, “Smallpox discourse was gendered, referring to men it spoke of the danger to life, referring to women, of the danger to beauty.”29 Women in Europe—and presumably all over the world—tried desperately and often in vain to recover their looks after surviving smallpox. A line in the 1696 play Love’s Last Shift reads: “I take more pains to preserve a public reputation / than any lady took after the Smallpox to recover her complexion.”30

  When Lady Mary heard of the Turkish technique, she was fascinated and excited, reporting, “The French ambassador says pleasantly that they take the smallpox here by way of diversion as they do the waters in other countries.”31 She wrote of the process that she witnessed:

  The old woman comes with a nutshell full of the matter of the best sort of smallpox, and asks what vein you please to have opened. She immediately rips open that you offer to 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, and in this manner opens four or five veins. The Grecians have commonly the superstition of opening one in the middle of the forehead, one in each arm, and one on the breast, to mark the sign of the Cross; but this has a very ill effect, all these wounds leaving little scars, and is not done by those that are not superstitious, who chuse to have them in the legs, or that part of the arm that is concealed. The children or young patients play together all the rest of the day, and are in perfect health to the eighth. Then the fever begins to seize them, and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty [sores] in their faces, which never mark, and in eight days time they are as well as before their illness.32

  Lady Mary didn’t just latch on to a superstition. Instead she observed the effects of treatment on those around her. Although she did not benefit from the treatment, having already contracted smallpox, she had variolation performed (successfully) upon her two children. As word spread of the technique, it was tested in Newgate prison in 1721 on six inmates, who would each receive a pardon for submitting to the treatment. They all survived and were later found to be immune to smallpox.

  By the end of the eighteenth century, variolation had become common throughout the world. King Frederick II of Prussia had all of his soldiers treated, as did George Washington at Valley Forge in 1778. People in France were more resistant to the procedure, causing the philosopher Voltaire to fume, “Had [variolation] been practiced in France it would have saved the lives of thousands.”

  Edward Jenner—lone-ish genius and hero—was himself variolated against smallpox as a child in the traditional way. But he was intrigued by a dairymaid he heard declare, “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” In 1796 Jenner found a milkmaid with cowpox and injected the matter from one of her sores into an eight-year-old boy, who developed a mild fever and a loss of appetite but recovered quite quickly. Ten days later, Jenner proceeded to inject the boy with actual smallpox. The boy survived! With no signs of smallpox. That experiment sounds terrifying, but it worked. Jenner called the technique vaccination, as vacca was the Latin word for “cow.”

  Cowpox vaccination was superior to smallpox variolation in that the vaccine from the less dangerous cowpox disease didn’t kill anybody but still provided immunity. This was the first building block on the road to safe vaccines, which have since been developed for many life-threatening diseases. Polio. Measles. Meningitis. Diphtheria. We’ve triumphed over them all.

  At the time, though, vaccination was controversial. Many were opposed.

  In a 1911 issue of American Magazine, Sir William Osler, M.D., addressed the people who refused to vaccinate against smallpox:

  Here I would like to say a word or two upon one of the most terrible of all acute infections, the one of which we first learned the control through the work of Jenner. A great deal of literature has been distributed casting discredit upon the value of vaccination in the prevention of small-pox. I do not see how anyone who has gone through epidemics as I have, or who is familiar with the history of the subject, and who has any capacity left for clear judgement, can doubt its value. Some
months ago I was twitted by the editor of the Journal of the Anti-Vaccination League for a “curious silence” on this subject. I would like to issue a Mount-Carmel-like challenge to any ten unvaccinated priests of Baal. I will go into the next severe epidemic with ten selected, vaccinated persons and ten selected unvaccinated persons—I should prefer to choose the latter—three members of Parliament, three anti-vaccination doctors (if they can be found), and four anti-vaccination propagandists. And I will make this promise—neither to jeer nor jibe when they catch the disease, but to look after them as brothers, and for the four or five who are certain to die, I will try to arrange the funerals with all the pomp and ceremony of an anti-vaccination demonstration.33

  That is the best, snarkiest denouncement of people who do not believe in vaccines I have ever read. I especially like the part where he asks to pick which politicians will die.

  Today you may have heard from a vocal minority of people who do not believe in vaccination. Many of those people distrust vaccines because in 1998 a gastroenterologist named Andrew Wakefield published a paper in the Lancet claiming there was a link between children receiving the vaccine for measles, mumps, and rubella (MMR) and children developing autism.

  Wakefield was a fraud. In 2010 he was stripped of his medical license. He was found to have conducted unethical experiments and accepted hundreds of thousands of dollars from lawyers attempting to sue the makers of MMR vaccines.34 Wakefield was also attempting to create a new measles vaccine and would have profited handsomely if the MMR vaccine was discredited. He preyed upon people’s fears and their concern for their children in order to obtain personal advantage. After an investigation by the intrepid Sunday Times journalist Brian Deer, it was found that the medical histories of all twelve children in Wakefield’s study had been misrepresented.35 In 2010 the editor of the Lancet issued the following retraction: “it was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false.”36