Smallpox and Vaccination

SMALLPOX AND VACCINATION. - Smallpox is a specific acute contagious disease, characterized by high fever and by an eruption of maculopapules that rapidly turn into vesicles and pustules; there follows the formation of scabs, and more or less deep scars remain, persisting for the whole of life.

Among the oldest diseases, its knowledge in China going back to about 1000 years before the Christian era, for many centuries it had an enormous diffusion throughout the world; in Europe the first epidemic, which broke out in France and in Italy, dates back to 570 A.D. The disease was fully identified around 1600 and was always greatly feared for the severity of its course and for the indelible disfigurements it left even in the case of recovery. The severity of smallpox depends on the epidemic constitution and on the course with which it manifests itself; in fact, alongside the forms of hemorrhagic and fulminant smallpox with very high mortality, there are barely sketched forms or epidemics of varioloid that can be considered benign as regards life.

The present disappearance of smallpox epidemics in civilized countries, particularly in Europe, must be attributed to improved hygienic and prophylactic measures and to the extension of smallpox vaccination. This is the first experiment made in contagious diseases for the purpose of inducing in individuals an immunity against the disease, and it is due to the English physician Jenner who, after 23 years of study, having with certainty ascertained that the local infection from cowpox, although developing without severity, immunizes man from human smallpox, inoculated for the first time in his own son, in 1789, lymph coming from pustules of the pig, thus rendering him immune to subsequent (1791-92) inoculations of smallpox; on 14 May 1796 he inoculated into a child pus from cowpox (cow-pox) that had developed on the hands of a milkmaid; two months later the child proved vaccinated and refractory to the inoculation of human smallpox. The vaccination thus invented spread, setting aside all the means previously used, such as "variolization" (inoculation of lymph from smallpox pustules of individuals affected by mild forms) or the introduction of smallpox scabs into the nostrils or even the practice of wearing the clothes of smallpox patients.

In the course of the centuries vaccination has always undergone further modifications and improvements, proving itself in general always very useful, though finding from time to time, especially in the Anglo-Saxon world, bitter detractors. From this first experiment the new means of treatment was generalized to other infectious diseases, still not dethroned even by antibiotic therapy, and the term "vaccination" assumed more universally the value of producing in an individual a state of immunity by means of the introduction of antigens or microbial toxins endowed with the capacity to stimulate in the individual the formation of defense substances, that is, of antibodies and antitoxins (v. MICROBIOLOGIA). It is practiced for many diseases besides smallpox (diphtheria, typhus, paratyphoid, tetanus, whooping cough, Malta fever, plague, yellow fever, etc.) both for preventive purposes and for therapeutic ends. The curative results, although often very good, do not have an absolute value for every infectious disease; on the other hand for some of them it has been imposed by law on large masses of individuals, thus giving rise to problems of social and medico-moral value. For example, in Italy there exist compulsory vaccinations of early infancy, at the beginning of school age or on the occasion of military service; the norms of international prophylaxis oblige vaccination for some diseases in individuals who travel from one nation to another; some professions require compulsory preventive vaccinations.

From the medico-moral point of view one can discuss the right of the State to impair the freedom of the individual, obliging him to submit to a vaccination, and the duty on his part to undergo it or spontaneously offer himself for it. On such problems some congresses of Catholic physicians have recently discussed. One can speak of a moral obligation every time it is a matter of avoiding the danger of a serious disease impending on the individual himself or on society, provided that, according to the current concept of medicine, there are serious probabilities of a useful effect and of the absence of grave harm for the individual. This in accordance with the dictate of morality, that the individual is bound to sacrifice part of his good for that of the collectivity, provided that it is not a matter of the danger of his own life or of grave impairment of his essential functions.

Alessandro Marolla