SMALLPOX and VACCINATION. — Smallpox is an acute, contagious, specific disease characterized by high fever and an eruption of maculo-papules that rapidly turn into vesicles and pustules; this is followed by the formation of scabs and the residual of more or less deep scars that persist for life.
Among the oldest diseases, its knowledge in China dates back to around 1000 years before the Christian era; for many centuries it had an enormous spread throughout the world; in Europe, the first epidemic, which broke out in France and Italy, seems to have been in 570 AD. The disease was fully identified around 1600 and was always greatly feared for the severity of its course and the indelible disfigurements it left even in cases of recovery. The severity of smallpox depends on its epidemic nature and the course it takes; in fact, alongside hemorrhagic and fulminating forms of smallpox with very high mortality, there are barely sketched forms or epidemics of varioloid that can be considered benign with regard to life.
The current disappearance of smallpox epidemics in civilized countries, particularly in Europe, must be attributed to improved hygiene and prophylaxis measures and to the widespread practice of smallpox vaccination. This was the first experience in contagious diseases aimed at inducing immunity in individuals against the disease and is due to the English physician Jenner, who, after 23 years of study, having ascertained with certainty that the local infection of cowpox in cattle, although mild, immunizes humans against human smallpox, inoculated it for the first time into his own son in 1789, using lymph from swine pox pustules, thus rendering him immune to subsequent (1791-92) smallpox inoculations; on May 14, 1796, he inoculated a child with cowpox vaccine (cow-pox) developed on the hands of a milkmaid; two months later the child was found to be vaccinated and refractory to the inoculation of human smallpox. The vaccination thus invented spread, putting aside all previously used means, such as "variolation" (inoculation of lymph from smallpox pustules of individuals affected by mild forms) or the introduction of smallpox crusts into the nostrils or even the practice of wearing the clothes of smallpox sufferers.
Over the centuries, vaccination has undergone further modifications and improvements, generally proving very useful, although it has occasionally encountered fierce detractors, especially in the Anglo-Saxon world. From this initial experience, the new method of treatment was extended to other infectious diseases, a method that has not even been dethroned by antibiotic therapy, and the term "vaccination" has more universally assumed the meaning of inducing in an individual a state of immunity through the introduction of microbial antigens or toxins capable of stimulating the formation of defensive substances, i.e., antibodies and antitoxins (cf. MICROBIOLOGY). It is practiced for many diseases besides smallpox (diphtheria, typhoid, paratyphoid, tetanus, whooping cough, Malta fever, plague, yellow fever, etc.), both for preventive and therapeutic purposes. The curative results, although often very good, do not have absolute value for every infectious disease; on the other hand, for some of them, vaccination has been made compulsory by law for large groups of individuals, thus raising issues of social and medico-moral significance. For example, in Italy, compulsory vaccinations exist for early childhood, at the beginning of school age, or on the occasion of military service; international prophylaxis regulations require vaccination for certain diseases in individuals traveling from one country to another; some professions require compulsory preventive vaccinations.
From a medico-moral point of view, one may debate the right of the State to restrict the freedom of the individual by obliging him to undergo vaccination and the duty incumbent upon him to submit to it or voluntarily offer himself for II. Such problems have recently been discussed at some congresses of Catholic physicians. One may speak of moral obligation whenever it is a matter of avoiding the danger of a serious disease threatening the individual himself or society, provided that, according to current medical understanding, there are serious prospects of useful effect and absence of serious harm to the individual. This is in accordance with the dictates of morality, which hold that the individual is bound to sacrifice part of his own good for that of the community, provided that it does not involve danger to his own life or serious impairment of his essential functions.