11 February 2009

Smallpox

Smallpox is something that has been forgotten. Dr Grumble's students puzzle over smallpox vaccination scars that are an incidental finding in many patients over a certain age. Amazingly, Dr Grumble is yet to find a new student who can even guess what causes these scars.

Dr Grumble is not an expert on smallpox but it is one of the first diseases that he learned about. He remembers well the fearfulness, almost terror, smallpox caused in 1962 when he was a young child in South Wales. Dr Grumble can remember his father telling him that a South Wales obstetrician had contracted smallpox after attending a post mortem on a pregnant patient who had died unexpectedly. It turned out that she had had smallpox. Smallpox, you see, does not necessarily present with all those ghastly pustules you see in the pictures of old. As far as Dr Grumble can recall, the disease had been spread around by the index case, a recent immigrant from Pakistan, who had visited various prostitutes. This made any idea of contact tracing awkward.


Medical people don't much get frightened by medical scares that appear on a regular basis in the press. Dr Grumble works daily alongside patients with nasty pathogens. It doesn't worry him. But it used to. He can remember, as a student, trying to hold his breath as he went into cubicles in the infectious diseases ward. He used to wonder how the old professor that used to teach him so well could possibly have lived so long working with infectious diseases every day.

But smallpox is another thing altogether. That still frightens Dr Grumble - even though it is long gone. And in 1962 the Grumble family was, well, scared. Dr Grumble's father was, you see, an obstetrician so it could easily have been him. Except that, unlike the obstetrician who died, Dr Grumble's father had been vaccinated many times. But, though a live vaccine, immunity following smallpox vaccination wanes. In a very short time Dr Grumble's father came home with some vaccine and he immunised us all. The public, some of whom had previously unwisely shunned vaccination, were soon clamouring for it and 900,000 people were eventually vaccinated. But 25 people contracted smallpox and 9 died.


Smallpox was a most terrible scourge which used to cause widespread fear, maiming and terrible death on a grand scale. Its eradication has been a most fantastic achievement. We have Edward Jenner and his vaccination and the World Health Organisation to thank.

Dr Grumble saw one of the very last cases of smallpox while working as a medical student in Ethiopia. He hopes he has seen his last case of measles. He hasn't seen one for a very long time. We must eradicate this disease. We owe it to the people of the third world. There is hope. Here's what they have achieved in Yemen.

From 2006 to 2007, reported cases of measles nationwide plummeted from 30,000 cases, 5,000 of which were fatal, to 13 cases only.

“In 2008, there were three reported cases of measles, and no fatalities,” said Dr Mohammad. (Source)
Well done Dr Mohammad. Persuading primitive people to be immunised can be a problem in the third world where you may have to combat ignorance or strange traditional beliefs.

11 comments:

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Anonymous said...

The US "vaccine court" ruled today that there is no causal link between MMR vaccination and autism.

Anonymous said...

"Well done Dr Mohammad. Persuading primitive people to be immunised can be a problem in the third world where you may have to combat ignorance or strange traditional beliefs."

Hello Dr G, rofl, maybe you could use your profits from the collaboration with Andrea to get me a new laptop - am not sure splurting coffee over it is conducive to longevity ;-)

Re med students - present the scar to them as primary complaint, you never know, dermatology/parasites could become interesting!
j

Dr Grumble said...

Sorry about the keyboard!

Unfortunately, Dr G is not going to fall for Andrea's blandishments.

jayann said...

Yes, that 1962 outbreak was scary. We were all lined up and vaccinated (in the village, not in school, for some reason) and I was in voluntary quarantine. My father was in hospital near the worst outbreak and could not come home for some while.

Dr John Crippen said...

1962 must have been when I was vaccinated too. Although I lived in Lancashire, I was at boarding school in Yorkshire. I had the vaccination two days or so before returning to school and then was ill in the sick bay for two or three days as a result of the immunisation. So were many others.

There is an interesting account of the outbreak here:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1079469


John

Dr Grumble said...

Thank you, Dr Crippen, for the interesting link. An interesting point is the mention of the fever hospital. Where would such cases go now? The DGH down the road?

The old isolation hospitals were designed with infection control as a priority. Hospitals were built with wards far apart and in separate buildings. One I remember had each ward built on a mound and then elevated further on stilts presumably so that air could circulate underneath. Such was the concern about infection in those days.

jayann said...

You were vaccinated then, John? Now I really had to be vaccinated.

-- Oh I see. Bradford. I think I only knew about the South Wales one.

Scarlet O'hairless said...

Not sure why I should have suddenly thought of "smallpox" just now - enough to make me Google for it.
But I was a very young and naive 15year old pupil at Llanelli Boys Grammar in the 1st year of the 2 year 'O' Level period when the scare broke out. That's how it was referred to - "The Scare". There was almost a panic to get vaccinated. I remember my mother taking me to the surgery, and Dr Meldrum said he was short of the vaccine, but could split a phial between us both. - Duly done.
But "what happened next" was unbelievable - as I see it now. We started hearing that more people were contracting the "Vaccine Fever" (VF) than Smallpox itself - true or not I don't know, but I fell very ill. Dr Meldrum never spoke to my parents in front of me - and just like the other "life threatening situations I've been in (a few) - I felt 100% and wondered what the fuss was. Ultimately I ended up in Morriston Hospital, and my mother told me that whilst the "authorities" would not admit it, Dr Meldrum assured her on the quiet, that I had the "VF", and instead of circulating my body, it had gone to my head. I can't vouch for the veracity of this, but I know I was curious, and one night I waited until the ward staff were "busy" and went into the Sister's office and went to the filing cabinet I'd noticed on my recce visits to ask her the "what have I got" question. My file said "PUO". I let a couple of days pass, then on one of the "Doctor's Rounds" I asked what "PUO" meant, and he was curious how I'd heard of it - simple, I'd just heard nurses mention it in general. "Pyroxia of Unknown Origin" was the reply. My parents never got confirmation beyond this, but Dr Meldrum said the authorities were just as worried about spreading a scare over the vaccine as they were about Smallpox itself, and that more people had died from VF than Smallpox itself. Again, I can't vouch for the veracity of the statement - just my memory of it all.
Upshot was that I missed 3 month's school, and didn't get high enough pass grades in 'O' Levels to advance to the 2 year 'A' Level stream. Next year I did. At the end of the 1st 'A' Level year, my father was transferred with work to London, and since my parents "don't trust you to do it on your own down here" - I went with them. No way was I going to start agin with a different curriculum, so I left school - no real qualifications.
Lack of that "piece of paper" to prove I was "educated to a satisfactory level" truly affected my life, but think I still did well.
What is certain, I have done one helluva lot better than if I'd been given a full dose of the vaccine!!!

Scarlet O'hairless said...

Not sure why I should have suddenly thought of "smallpox" just now - enough to make me Google for it.
But I was a very young and naive 15year old pupil at Llanelli Boys Grammar in the 1st year of the 2 year 'O' Level period when the scare broke out. That's how it was referred to - "The Scare". There was almost a panic to get vaccinated. I remember my mother taking me to the surgery, and Dr Meldrum said he was short of the vaccine, but could split a phial between us both. - Duly done.
But "what happened next" was unbelievable - as I see it now. We started hearing that more people were contracting the "Vaccine Fever" (VF) than Smallpox itself - true or not I don't know, but I fell very ill. Dr Meldrum never spoke to my parents in front of me - and just like the other "life threatening situations I've been in (a few) - I felt 100% and wondered what the fuss was. Ultimately I ended up in Morriston Hospital, and my mother told me that whilst the "authorities" would not admit it, Dr Meldrum assured her on the quiet, that I had the "VF", and instead of circulating my body, it had gone to my head. I can't vouch for the veracity of this, but I know I was curious, and one night I waited until the ward staff were "busy" and went into the Sister's office and went to the filing cabinet I'd noticed on my recce visits to ask her the "what have I got" question. My file said "PUO". I let a couple of days pass, then on one of the "Doctor's Rounds" I asked what "PUO" meant, and he was curious how I'd heard of it - simple, I'd just heard nurses mention it in general. "Pyroxia of Unknown Origin" was the reply. My parents never got confirmation beyond this, but Dr Meldrum said the authorities were just as worried about spreading a scare over the vaccine as they were about Smallpox itself, and that more people had died from VF than Smallpox itself. Again, I can't vouch for the veracity of the statement - just my memory of it all.
Upshot was that I missed 3 month's school, and didn't get high enough pass grades in 'O' Levels to advance to the 2 year 'A' Level stream. Next year I did. At the end of the 1st 'A' Level year, my father was transferred with work to London, and since my parents "don't trust you to do it on your own down here" - I went with them. No way was I going to start agin with a different curriculum, so I left school - no real qualifications.
Lack of that "piece of paper" to prove I was "educated to a satisfactory level" truly affected my life, but think I still did well.
What is certain, I have done one helluva lot better than if I'd been given a full dose of the vaccine!!!

Dr Grumble said...

Thanks for that interesting account, Scarlet.

The vaccine had its risks and it is remarkable that we managed to eradicate smallpox given the trouble that we have these days with much safer vaccines.