The small warriors of a big pox

Those who survived smallpox were lucky. For the rest of us, the only reminder of the disease is the pockmarked faces that we still see. There was nothing small about smallpox, though.

Sanjay Nagral
Nov 27, 2020, Mumbai Mirror

If you missed watching Om Puri in his earlier movies like Aakrosh, I would urge you to watch that stark story, a defining moment in Indian cinema. It was then also rare to have a lead actor with a pockmarked face. For that reason, Govind Nihalani was advised against casting the actor. Om Puri had spoken publicly about how as a child, after contracting smallpox, he was tied to a cot so he didn’t scratch his face. The severe itching made him scream in agony. Later, when he was attempting to enter the film industry, he was advised to undergo plastic surgery, which he refused.

Those who survived smallpox were lucky. For the rest of us, the only reminder of the disease is the pockmarked faces that we still see. There was nothing small about smallpox, though. The term was first used in the 15th century to distinguish it from syphilis, which was known as the great pox. Smallpox killed 30 per cent of those infected. The story of its successful global eradication is fascinating. Central to it is the vaccine. But the saga also exemplifies the human spirit.

Let’s start with the cow. Edward Jenner, a young English doctor, had heard that dairymaids were protected from smallpox after suffering from cowpox. Jenner concluded that cowpox not only protected against smallpox but could also be transmitted to another person as a deliberate mechanism of protection.

In 1796, Jenner found a young dairymaid, Sarah Nelms, who had fresh cowpox lesions on her hands. Using ‘matter’ from Nelms’ lesions, he inoculated a boy aged eight, James Phipps. Nine days later, James felt cold, lost appetite, but recovered. Jenner inoculated James again, this time with ‘matter’ from a smallpox lesion. No disease developed and Jenner concluded that protection was complete. A foundation for the smallpox vaccine as well as modern immunology had been laid. In 1798, Jenner published ‘An Inquiry into the Causes and Effects of the Variolae Vaccinae’. The Latin word for cow is vacca and cowpox is vaccinia; Jenner decided to call the new procedure vaccination.

Smallpox was a big killer in South Asia and British India was hence impatient for the introduction of the vaccine. After its endorsement, leading physicians wrote to British authorities seeking the vaccine. They also pointed out that ‘inoculation’ performed by local Brahmin Tikadars was dangerous, with a high fatality rate.

The British sent the vaccine matter from Istanbul to Baghdad where, after successful vaccination, it was sent to Basra. Boys on ships sailing for Bombay were inoculated and dried vaccine was sent on threads, sealed between glass plates. In June 1802, this was used to vaccinate a three-year-old British girl in Bombay, Anna Dusthall, who was ‘quiet and patient in suffering the operation’. The vesicle on her sore arm was squeezed to obtain lymph to vaccinate several other kids across India.

One part was sent to Ceylon where bribes were offered to parents for their children to be vaccinated. Another was sent inland to Hyderabad. After a successful trial, the local surgeon sent three lots of vaccine matter to Cochin – one on an ivory lancet, another between glass and a third on thread. The doctors in Cochin reported that the glass plates delivered the best results. Two recently vaccinated children, accompanied by a Brahmin trained in the procedure, were sent to Pune. A sample was sent to Chingleput where a boy was vaccinated to carry the virus on the final stage to Madras. In October, Anderson, a physician in Madras, seized an opportunity of the arrival of a Calcutta-bound ship from Australia to vaccinate a kid called Creswell who took it to Calcutta.

British parents in India responded rapidly to the opportunity. But the authorities had reasons to offer it to native servants and sepoys. After all, they were dependent on them for daily survival. There were no qualms about the passage of bodily matter across race, colour or caste. Anna Dusthall was of mixed race, and the areola around her vaccine pustule was ‘very distinct, in spite of the blackness of her skin’.

By the end of 1802, around 3,000 people were vaccinated in Bombay. The hope that Hindus would receive cowpox as a ‘gift from heaven through the medium of a long-venerated animal’ was not coming true. Anderson concluded that it would be preferable to use another term, and, as a substitute, suggested the Sanskrit ‘amrutum’ which connotes immortality and cow’s milk.

India was declared smallpox free in 1977 and the world in 1980. Across India stand temples of the goddess Shitaladevi who, as the legend goes, was born to fight smallpox. It is believed that this goddess has the ability to inflict victims when angered and calm fevers of the afflicted. For the eradication of smallpox in India, we have more than a goddess to thank. Jenner, the cow, small children in Istanbul, Baghdad, Basra, ships plying to India, Anna Dusthall... And the tiny arms of hundreds of native children.