Introduction
Topic: The History of Smallpox
Grade: 7
Unit: 5
Time period: one 50-minute class period
Size and type of class: 22 students, high school
The aim
The purpose of this lesson is to educate students on the role of vaccines in the prevention of the smallpox epidemic and familiarize them with the history of vaccination and the creation of the first vaccine.
Student objectives
Students will be able to:
- Identify a virus as the cause of infectious disease;
- Identify sources of smallpox infection and describe the common ways of its transmission;
- Recognize the devastating impact of epidemics on the history of humanity;
- Describe the symptoms of smallpox;
- Demonstrate an understanding of the chronology of the disease;
- List the main vaccination strategies aimed at limiting the transmission of infectious disease.
Materials
- pens/pencils
- classroom blackboard
- recording sheets
- resources on smallpox and vaccination
Procedures
On May 8, 1980, the World Health Organization officially declared that victory in the war against smallpox had been achieved (CDC, 2016). It was a long-awaited triumph in more than 12,000 years of battle (Greenspan, 2015). The mummy of the twentieth century B.C. Egyptian ruler Ramses V had distinct bumps on the skin that indicate the presence of the disease (National Geographic, 2016).
The “speckled monster”, as an English physician who developed the first vaccine against smallpox aptly called it, roamed the world for thousands of years killing approximately the third of infected individuals (Flight, 2011). The fatality numbers for children were even higher, reaching eighty percent in London and Berlin (Riedel, 2005). It is estimated that the disease claimed the lives of more than 300 million people in the twentieth century (Flight, 2011).
Smallpox is a highly infectious and often lethal disease capable of quickly spreading from one infected individual to another. It is caused by the variola virus (CDC, 2016). Among the symptoms of the disease are an extensive skin rash and a high fever (CDC, 2016). The most common ways of transmission of the infection are the direct face-to-face contact with the infected person, their objects such as linen or clothing, or the contact with infectious bodily fluids like saliva (CDC, 2016).
At this point, students will be asked to name other epidemics familiar to them.
The origin of the disease is unknown; however, it is believed that it first appeared in Africa and later spread to China and India decimating large portions of the population (Brannon, 2016). The disease very similar to smallpox was described in an ancient papyrus recording events of 1350 BC Egyptian-Hittite war (Brannon, 2016). Presumably, it was the first historical record of the epidemic (Brannon, 2016). Hittite clay tablets have similar records (Brannon, 2016).
They also contain accusations of Egyptians intentionally infecting Hittites with the disease during the long war between the two cultures (National Geographic, 2016). Several historical records also reveal that the Antonine Plague in 180 A.D., which claimed the lives of three to seven million people and was one of the reasons behind the decline of the Roman Empire, was caused by the outbreak of smallpox (Greenspan, 2015). Among the victims of that epidemic was Roman Emperor Marcus Aurelius. It is also speculated that the Plague of Athens around 430 B.C. was conditioned by the variola virus (Greenspan, 2015).
As humans started to travel across the continents, smallpox reached Europe and North America. At that point, the epidemic swept across Africa and most of Asia and even initiated the rise of small religious groups dedicated to worshiping the god of smallpox (National Geographic, 2016). Between the eleventh and twelfth centuries, crusaders returning home from the East helped the disease spread through Europe (Flight, 2011).
By the middle of the eighteenth century, it was devastating every major city of the European continent (Brannon, 2016). The plague killed approximately a third of the infected people and left other victims completely disfigured or even blind (Greenspan, 2015).
Even though the effects of the plague were completely devastating in the Old World, it made an even worse impact on the virgin populations never exposed to it (Flight, 2011). Smallpox virus arrived in Mexico along with Spanish and Portuguese conquerors in 1519. It contributed greatly to the success of conquerors and the fall of the Aztecs and Incas. Presumably, smallpox wiped out large numbers of indigenous populations before the arrival of the famous Spanish conquistador Francisco Pizarro’s (Greenspan, 2015).
It is believed that the native population of North and South America was reduced by 90 percent, as a result of encountering the disease (Greenspan, 2015). Such a death toll was immeasurably greater than a loss in a war. One century later, the Indians of North America were ravaged by smallpox as well. The commander of British colonial forces in North America, Lord Jeffrey Amherst, proposed battling Indian tribes with the help of disease-infected blankets during the French-Indian War in 1763 (Greenspan, 2015).
Students will be proposed to expand on the history of colonial warfare by telling the story of smallpox-infected blankets.
The first accounts of the successful smallpox prevention practices date back as far as two thousand years ago. The technique known as variolation was developed in ancient China and involved inoculating healthy people by making them inhale small particles of skin taken from infected individuals (Silvers & Steptoe, 2001). It was practiced by Buddhist monks as early as at the beginning of the eleventh century (Brannon, 2016). The development of those practices marked the fall of smallpox. During such treatment, patients would contract a mild form of smallpox and later become immune to the disease.
This type of inoculation was commonly practiced in China and India by the 1700s (Brannon, 2016). Variolation techniques arrived in Europe at the end of the eighteenth century (Brannon, 2016). European physicians ground pus or skin from the pocks of infected individuals into a powder and inserted it into nostrils of healthy people. In the middle of the eighteenth century, smallpox claimed the lives of many European princes, thus propelling a need for the development of variolation practices (Riedel, 2005).
The most famous volunteers for inoculation were Therese of Austria along with her children, King Louis XVI of France, Russian Queen Catherine II and Prussian King Frederick II (Riedel, 2005). Moreover, King Frederick II initiated mandatory variolation of his army. Even though two to three percent of variolated patients died from smallpox, the total amount of fatalities was decreased by ten times (Brannon, 2016).
A real breakthrough in the battle against smallpox came centuries later when English physician Edward Jenner developed the first method of effective inoculation against the disease in 1796 (Riedel, 2005). It was discovered after he observed dairymaids who upon contracting cowpox became immune to deadly smallpox. It is believed that Jenner first saw the connection between the exposure to the bovine virus and being immune to smallpox after hearing a milkmaid say “I shall never have smallpox for I have had cowpox.
I shall never have an ugly pockmarked face” (Riedel, 2005). Years later, the doctor decided to conduct an experiment that forever changed the power balance in humanity’s war with plagues. On May 14, 1796, he took a small portion of the pus from the pock of a milkmaid infected with cowpox and introduced it into the body of the 8-year-old boy, James Phipps (National Geographic, 2016). The boy developed a fever that lasted for nine days and lost appetite. Only on the tenth day, he stopped feeling cold and discomfort (Riedel, 2005).
After the second inoculation a few months later, James did not develop any symptoms of the disease. Jenner concluded that the boy has developed protection from smallpox. The physician chose a Latin word, Vacca, meaning cow and a word for cowpox—vaccinia for coining the word “vaccine” (Riedel, 2005). Unfortunately, Jenner’s theory of vaccination was generally discredited in the scientific community during his lifetime. It became popular in London and other parts of Europe only by 1800 (Riedel, 2005).
At this point, students will be asked to explore the morality of Jenner’s experiment.
With the inoculation campaign targeting large numbers of people, it was possible to take an epidemic under control. Significant areas of Europe and North America were freed from disease by 1958 (Riedel, 2005). However, worldwide eradication of the epidemic started more than a hundred years later with the 1967 World Health Assembly’s resolution. It is estimated that ten to fifteen million people were infected with the disease that year (Greenspan, 2015). As a result of the inoculation campaign, almost one hundred thousand people were vaccinated around the world by the year 1800 (Brannon, 2016).
Small outbreaks of smallpox continued through the twentieth century and ended only with the worldwide implementation of the vaccination programs. The resolution issued by the World Health Organization in 1980 called the eradication of smallpox “unprecedented achievement in the history of public health” and stressed that it “demonstrated how nations working together in a common cause may further human progress” (Greenspan, 2015).
Only two places in the world still have samples of the virus causing the disease. Those are highly guarded scientific laboratories in the United States and Russia. Many controversies are surrounding the issue. One group of experts argues that the samples of smallpox must be destroyed, while others hold the opposite view claiming that humanity might need it for research in case the dangerous virus re-emerges in the future (Polgreen & Helms, 2001).
Evaluation
Each student will be provided with a recording sheet before the lesson. Later they will be asked to report on the knowledge they acquired using the sheets as guidance (The College of Physicians of Philadelphia, 2014). Each of the learning objectives will be assessed by evaluating the content of students’ oral reports and their recording sheets (The College of Physicians of Philadelphia, 2014).
Homework
The students will be divided into three groups each of which will be assigned to explore the library and Web resources containing information about the history of infectious diseases and the way ancient societies dealt with them. Among the options for the disease will be smallpox, polio, bubonic plague, and yellow fever. They will be asked to develop one of the following:
- a leaflet containing a list of rules for people in medieval societies to follow for prevention of an epidemic;
- a presentation on the danger of epidemics.
References
Brannon, H. (2016). The History of Smallpox: The Rise and Fall of the Disease.
CDC. (2016). Smallpox.
Flight, C. (2011). Smallpox: Eradicating the Scourge.
Greenspan, J. (2015). The Rise and Fall of Smallpox.
National Geographic. (2016). Smallpox, Smallpox Information, Infection Facts, News, Photos.
Polgreen, P., & Helms, C. (2001). Vaccines, biological warfare, and bioterrorism. Primary Care: Clinics In Office Practice, 28(4), 807-821.
Riedel, S. (2005). Edward Jenner and the history of smallpox and vaccination. Proceedings. Baylor University Medical Center Proceedings, 18(1), 21-25.
Silvers, M., & Steptoe, M. (2001). Historical overview of vaccines. Primary Care: Clinics In Office Practice, 28(4), 685-695.
The College of Physicians of Philadelphia (2014). The Scientific Method in the History of Vaccines.