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Hello, I'm Mike Cannon and this is conversation. What would you say is man's most magnificent achievement the landing on the moon or some other spectacular conquest of space and time? Or would you say, along with my guest on this conversation, the conquest of smallpox, one of the great scourges that has ever afflicted man?

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The virtual elimination of smallpox from the face of the Earth is man's greatest achievement in the view of my guest on this conversation, and we'll hear about it when I return in a moment. Conversation from the University of Florida. A discussion of social, political, scientific and religious issues of the day.

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Your host is Dr Michael Vegan in professor of Religion and history at the University of Florida. My guest on this conversation is Dr Parker, a small junior professor of immunology and medical microbiology in the University of Florida. Parker, Welcome to conversation. Thanks, Mike. Nice to be here.

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You have a very straightforward view that the conquest of smallpox is man's greatest achievement. And I suppose for us to understand that we have to know what a scourge smallpox has been in the history of humanity. What is small pox first of all, Well, Mike, I think most people's view of smallpox is that it's that thing that they got vaccinated for, and they don't quite remember much about it other than when they were a kid.

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They got a vaccination, and up until a little while ago, they had to go get another vaccination if they wanted to go out of the country for something. And that's about all they really know about it. But in truth, it's a disease that killed anywhere from 10 to 35% of the people that are infected for hundreds and hundreds of years, uh, and did so in a way that was not very pleasant at all, since virtually everybody came down with the disease.

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This means that maybe a quarter of the deaths in antiquity had been due to this disease for centuries. To give you a feeling of just what sort of a disease this was, I'd like to just briefly read you a little bit from a description by a doctor, Herrlich, of an epidemic in Bombay.

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Not very long ago, this was 1958 He says the majority of patients had fully developed smallpox in the supported stage with confluence pustules covering the entire body. The head was usually covered by what appeared to be a single postural. The nose and lips were glued together when the tightly filled vesicles burst.

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The puss soaked into the bed sheet, became smeared on the blanket and formed thick, yellowish scabs and crusts on the skin. When the pulse was taken, tags of skin remained stuck to the fingers. All the gravely ill patients were also tortured by mucosal symptoms. The tongue was more or less swollen in the shape and and hindered breathing through the mouth.

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The voice was hoarse and faltering. Swallowing was so painful that the patients refused all nourishment and, in spite of agonizing thirst, often refused all fluids. We saw patients with deep invasion of the respiratory passage. Whales and groans filled the room. The patients were conscious to their last breath.

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What a frightening description it really is. I I suppose we ought to pause right here before we proceed and say that we are going to show some slides, and, uh, those who might be very sensitive about the pictorial display of diseases of this nature might want to look away or turn off their screens and just listen to the audio portion.

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But is that typical? Or was that a particularly virulent? No, that was typical of this disease, and I and again, I think it's important to realize just what a magnificent accomplishment it is to rid the world of this disease. And I think for that reason it's worth showing some pictures that, uh, depict people in various stages of this disease.

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All right, This first slide shows a young Indian child who is fairly early in the disease, and you can see the smallpox pustules on his face and on his mucous membranes. The next picture shows a sicker child with again the pustules on his lips, especially in those you can see what a miserable how will this child must be feeling?

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Uh, the following slide gets worse. This is confluence smallpox. This patient is undoubtedly going to die from the disease. What is confluence? It means that there are so many pustules that they are actually touching each other, and the entire skin is just one series of pustules, and this is I.

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I would assume an extremely painful condition. Well, high temperature, high temperature, but Unfortunately, as the statement that I read points out, you remain conscious. It's not one of these diseases where you lose consciousness and are saved some of the suffering, so it's even worse than that.

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Another slide shows a patient later in the disease, and if you are fortunate enough to recover, the next slide shows the kind of scars that were left, and you can picture what this did to people for centuries. And it's not just skin lesions, but it also left blindness and deafness.

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So what we're talking about is a disease that attacked everybody just like chickenpox in our youth. But the difference was one out of four died with it. Now how does the disease originate? It's a viral disease, wherein I would sneeze if I had this disease. The virus would come out in the mucus that I sneeze.

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You would inhale it. It wouldn't it would attack. You know the droplet would implant on your mucous membranes in your nose or mouth, and that would then infect you. About two weeks later, you would develop a fever and a rash, and about two weeks after that, you had one chance in three or four of being dead.

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And how many I wonder in that particular epidemic died. Do you have any figures? Because I'm wondering how you cure the disease. I I know that the vaccination prevents the disease. But how does one cure? Well, even to this day and age, we have no cure for this disease, Which makes it all the more of a score.

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Exactly. Exactly. To give you an idea of the sort of impact that this disease had, let's say over 200 years ago. Uh, just what does the disease due to the attitudes of society, like to read you an ad from The London Times? This is an ad for it's not exactly your most recent newspaper.

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It's an ad from 17 74. Alright. Contemporary with the American Revolution? Yes, yes. Wanted a man between 20 and 30 years of age to be a footman and under butler in a great family. He must be of the Church of England and have had the smallpox in the natural way.

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Also a woman middle aged to wait upon a lady of great fashion and fortune. The woman must be of the Church of England have had the smallpox in the natural way. Very sober, steady and well behaved and understand dress, getting a place in fine linen and doing all things necessary for a young lady that goes into all public places and keeps the best company.

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I'd like to ask some questions about that, but let's go back to the parks and ask What is having parks the natural way? Well, this was because about that time, in truth, around 17 50 they developed an artificial way of preventing the disease by spreading the virus that causes the disease itself from one person to another.

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In essence, instead of letting you inhale the virus, they would take some of the matter out of one of those pustules that you saw on those slides and insert it into the skin, and that gave you the disease. And it was the real disease, but it was a milder form.

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Instead of having a 25% mortality, it only had a one or 2% mortality, and it was the first example where in a well, when we began to manipulate diseases and produce our own immunity with them, that was the first vaccination, then, well, it was called very realization because it wasn't the great breakthrough that subsequently came.

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The cowpox story that dealt with vaccination. Yes, I want to ask about the cowpox story, but But first, what is a vaccination? What does a vaccination do? Well, the vaccination actually gives you a viral infection the same way the smallpox does. The difference is that with this disease it's much milder.

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You don't die, and the net result is that the two diseases are so similar that the immunity to the one protects you from the other. So if a small amount of a disease some of the mucus from postural is implanted in my skin, let us say that small amount is sufficient to build up a great amount of antibody material.

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Is that correct? Well, agents, Yes. And that gives me immunity so that if I should come into the presence of the infection, I would have enough antibodies to withstand a major assault. Is that this? Virtually the That's exactly and there were. The thing was that originally with very realization, they used the actual virus that caused the disease itself, and there was something we still don't understand what, but there was something about it, given it through the skin.

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It produced a milder disease. Then, if inhaled and the infection spread, and then the natural way. Why do you suppose that that ad asked for a footman and a chambermaid who had had parks the natural way? What was the advantage? Well, I think it's because the other was a newfangled idea, and they weren't ready to quite trust it.

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But I think the other thing that it shows is that if you were lucky enough to have avoided getting the smallpox, then you couldn't even get a job in that day and age. So that, you know, we're talking today about how we no longer discriminate with regard to race, creed, color, sex.

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And here in 17 74 you can see that first of all, you had to be the right church to even apply, and you also had to have had the right diseases and in the right way and in the right way. Now there's a famous story about cowpox that leads us into the smallpox vaccination.

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What is that story? Well, there was a very gifted English physician named Edward Jenner, who, after going through his regular training as an apprenticeship training in rural England, went off and got some superb training as a scientist with one of the leading scientists of the time.

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When he came back to rural England to be just a country general practitioner, which was what he always wanted to be, he was told by all of the neighbors that if you get cowpox and the milkmaids all got cowpox, that they never came down with smallpox.

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And that was particularly evident because the milkmaids had these beautiful complexions without scars, whereas everybody else in the community had The scarred face is characteristic of the smallpox. So cowpox was a particular virus that was indigenous to cows to cattle, two cattle, all right. They didn't know anything about viruses at the time.

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All they knew was that it was a disease that gave the cow's teats, gave put sores on the cow's teats and that the milkmaids, if they had a scratch in their hand when they milk the cow, would get these lesions on their hands, and it looked very much like a smallpox lesions.

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But it did not spread. It did not produce a serious illness, and their faces were clean and clear. They were the beautiful girls of the time. All right. Now, Jenner said then if that's true, he ought to check it out, using the scientific method which he'd learned in London.

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So he proceeded to go ahead and very late, these people who said they'd had car parks and would be safe from it. Now you've sat on our human experimentation committee down in the health center. Uh, let me ask you, would you consider that to be an ethical experiment to spread the smallpox virus to these beautiful young women to see whether you could infect them?

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No, I don't, uh, at this particular stage of our moral development in medicine. But at that time, I suppose he thought any chance was an ethical chance if he could stop the spread of this scourge. In truth, I would even I would have defended for the Human Experimentation Committee even in that day and age, because the very realization was the best preventive therapy we had.

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All right, So, in essence, what he was using was the best therapy of the day. In spite of the fact that it would be absolutely, you know, unforgivable to do it in this day and age. And what he proved was, yes, they didn't get it. So then the next thing he did was to find one of these gals that had the cowpox purposely take the cowpox, spread it to a young man, an eight year old boy, and then subsequently proved that he was immune to the smallpox.

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This procedure is what has been followed, essentially unchanged for the ensuing almost two centuries so that the vaccination that you and I received as Children was cowpox. It was a cowpox virus that gave you that sore on your arm for a week or so and maybe a little bit of a fever and prevented you from having this terrible disease.

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And that was the discovery of Doctor Jenner that I think was one of the greatest discoveries ever. He published it in this book. And if your criteria for great books is saving lives, I would argue that this book has saved more lives than any other book that has ever been written and probably more lives than any other book that will ever be written.

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And this is entitled an inquiry into the causes and effects of the Is it very L A vaccine? Yes, A disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cowpox by Edward Jenner, M. D. F. R s, et cetera, and a quotation from the Cretaceous, which I'm afraid I cannot translate off the top of my head.

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Published in London in 17 98 17 98. But his discovery came somewhat before he did his work between 17 75 and 17 98 and published in 17 98. Now you have some more photographs. Yes, are that's a picture of close up of the book, and the next slide shows us A.

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Shows us the hand of the milkmaid that started this whole procedure. It's immortalized in the book itself, and that's taken from the book, and the next slide is an artist's rendition of Jenner giving Phipps the eight year old boy the first vaccination ever. The one that is saved countless millions, probably billions is a much better estimate of lives, and his bawling and his crying out against this act was the first of millions to follow.

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Yes, all right, I think that's enough for the slides for the time being. All right now, vaccination proceeded to be adopted, I suppose, first in England, the place of its discovery. But what happened to it subsequently? Well, interestingly enough, it wasn't really well adopted in England.

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Uh, if it's interesting to look at the attitudes of society and what impact they have on disease, it's a two way street. England was a country where, and they felt that it wasn't right for the government to tell people what to do with their bodies and the people that were practicing very realization the spread of the disease itself, which, incidentally, did give rise to epidemics.

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When it spread from those people to others, they felt that it wasn't right for them to be put out of business by this new thing. And so the disease continued in England and some people got vaccinated and some got very elated. But in the Germanic countries and in the the Scandinavian countries, where the government was more rigorous, they had rigid laws rigidly enforced and in so doing, virtually eliminated this disease.

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Yet it continued in England right into the 20th century. It isn't continued in this country. Ah, even into the 20th century. And in some states where we had laws that were not very rigidly applied, we had major outbreaks of smallpox. Now you speak Parker of the impact of disease on society and its attitudes.

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But you also speak, do you not of the impact of society and its attitudes on disease? Yes, yes, I I was trying to illustrate the ladder with that latter point and probably reverse those two. It was an example of how societies attitudes enable a disease like this, too proceed for a century and the principle of smallpox vaccination and gave rise to other vaccinations.

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It was the real start of the field of immunology and of man's ability to protect himself against a whole series of other diseases. The most recent dramatic example being the polio vaccine. Yes, and very successful example. Are there other examples that we might look for in the decades ahead?

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What is on the horizon? Well, I think smallpox is going to be the best example, and polio is probably going to be the second best, but we are now eliminating, or at least significantly, reducing measles and could virtually eliminate it, um, chicken pox. These the childhood diseases, all our ones that we're learning how to deal with and with time and luck could make significant progress.

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Now, what is the World Health Organization doing? Well, the thing is that although we were able to eliminate smallpox from this country, we had to maintain our immunization programs and we had to maintain a surveillance at our borders, and it became clear that under appropriate circumstances, the disease really could be beaten.

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So in 1967 the World Health Organization undertook a worldwide program to eliminate this disease. And I think we have a map, a slide that has a map on it, that we might look at 1967. The upper part of your map shows the countries where smallpox was endemic.

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That is where men were dying daily from this disease. Ah, what they Yes, I was just going to point out. Brazil seems to be one of the larger areas. But the major problems were in Africa and the Indian subcontinent. Now, by taking Jenner's original idea in making only two or three minor modifications, finding out how to preserve the vaccine with life realization like with your coffee, the freeze dried vaccine and finding a neat little needle for scratching the skin and deciding that rather than trying to vaccinate everybody, they would just vaccinate everybody in contact with the patient.

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With those three simple ideas, the World Health Organization sent teams into all of the places where there was smallpox. By 1972 you see that the map has the black areas in the map have shrunk to two areas in Africa and the Indian subcontinent. And today I think the exciting thing is that there is no more smallpox on the Indian subcontinent.

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And there is only one small area near between Ethiopia and Somalia, where there's a war going on, which is making it a bit difficult to get in there and do the job, that these are the only areas that's the only area in the entire world where there is a disease, as we can speak of the virtual elimination of smallpox from the Earth, certainly within two years, maybe within a year.

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In fact, the last case may have been in October, but they're watching. I wonder why India or the Indian subcontinent was the last major portion of the earth to be vaccinated against the disease. Well, there were a lot of cultural problems, as you can imagine, uh, people hid from the vaccination teams because they felt that vaccination produced the disease they didn't really understand.

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And so they would hide their people when they got smallpox. They would hide from the vaccinators when it was time to be vaccinated, and there were a fair number of these kinds of problems that lead to real difficulties. And it was not until the Indian government got very vigorously involved with the help of the World Health Organization that they were able to convince the people that they really should be vaccinated and that this was good.

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Parker. This is surely one of the great miracles of medical science. But people have no conception how extensive the disease was. I certainly did not. And I think that if you ask the average person, what is smallpox, or is it really a frightening disease? As say, for example, cancer is to most people.

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They doubtless would not know what it was in the first place and not think of it as particularly serious. They probably think of it as a case of the measles or something of that picture. But you are identifying smallpox as one of the dread. Disease is far more dread than cancer.

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Cancer was trivial compared to smallpox in that time. Just think, if you had four Children, you were virtually certain to lose one of the four before they were 10 years old. What do you think that would do to your attitudes towards the Children? I think I maybe not be as close to him, not want to get his yes.

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And perhaps your attitudes toward God and life, life and your fellow man, the universe Life For many people afflicted in this way or dreading the affliction, life must have seen short, mean and brutish. And if you survived, you had a good chance of being deaf or blind.

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And certainly when a survives card, what are some of the other scourges that affect mankind today, for which desperately we seek cures? Well, the last pandemic disease of mankind is influenza, and we speak of it. Almost in a friendly way is the flu and there are many people in our society at this season of the year who are having the flu.

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And yet that, too, is a terrible disease. Nothing like smallpox but the last disease that spreads in an uncontrolled fashion around the entire world. I hope that we're going to be able to see progress made there in the next decade that may enable us to better control that disease.

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There are different strains. Uh, many of them seem to come out of the Orient. Well, that's one of the again, one of the major problems. Smallpox virus remain constant for almost 2000 years. The records that go back to 200 a d described virtually the same disease, and the virus has remained constant for the 200 years that we've known about vaccination.

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Whereas the flu virus changes greatly, it puts on a whole new overcoat so that it can walk down the street, sort of as a undercover agent not being recognized by all of its previous enemies, like antibodies and things, so that every decade it totally changes its overcoat, and it sort of puts new patches on it every year, so that it's a much more difficult problem from the point of view of the immunologist.

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And if you vaccinate against one strain, you do not automatically control the other strange that might happen upon you. Unfortunately, that's true. What about the Great Asian flu vaccination program, which some describe as a great case of foresight and others as a immunological fiasco? The swine flu of last year?

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Your I'm sorry, Swine flu? Yes, of course. Um, well, it's a And if it's easy to call those kinds of things in hindsight, in hindsight, I think everybody involved wishes that they had not, perhaps gone and vaccinated everybody at the time. I don't think anybody would have argued against the production of the vaccine because if we had had an epidemic, it would have been of great help.

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Would have saved tens of thousands of lives. Um, but and and the argument was that if the epidemic broke out, there would not have been enough time to vaccinate people. And that was the reason for going ahead with the program. Now, in hindsight, it's easy to say that Well, gee, we really shouldn't have done it.

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Maybe we should have waited, and maybe we could have vaccinated everybody in time. Once the epidemic did start, Um, I personally feel that would've been the better action. I felt that way at the time and said so. But as these things go, it's, uh, again, not an easy decision.

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I wonder if many people thought that the medical community was crying work. They might be more reluctant the next time. That I think, is one of the really major themselves against a truly serious yes, that's a major problem. And we're going to see that probably next year or maybe light this spring.

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The Russian flu, the flu virus that has started in Russia and has spread to Taiwan and uh to the Scandinavian countries is undoubtedly going to get here. And then it's going to be very important for people to see their physicians, especially for older folks or for folks with heart trouble or lung trouble to get vaccinated for that specific virus.

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Now there's no need to do it now, and there's no rush. The vaccine is not ready yet. The virus is not here yet. The drug companies are right now tooling up to make it. They'll have it made in time. Ah, but that's going to be a problem this year.

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It's the our old friend, the A Texas the virus that's been around for several years, for which there are vaccines available. And again, it's important for the folks that have heart trouble or have chronic lung disease and for the elderly to see their physicians about that procedure.

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Thank you, Parker. To be four warrant is to be forearmed. And to hear this story is to understand why you say that this is perhaps, if not definitely man's greatest achievement. The conquest over smallpox. Thank you for being with me on conversation. It's my pleasure.