chronology, contagiousness, and containment. The roles of charity, quarantine, inoculation and vaccination.

1. Revisioning smallpox in Mexico City-Tenochtitlan, 1520-1950:chronology, contagiousness, and control (charity, quarantine, inoculation and vaccination)* * *Robert McCaa chronology, contagiousness, and containment. The roles of charity, quarantine, inoculation and vaccination.

2. Outline: Smallpox in Mexico C. • 0. Historiography • Myths and misperceptions • An aside: epidemics in Ancient Mexico • I. Chronology (periodicity) • Epidemic frequency in colonial times • Endemic in 19th and 20th centuries • II. Contagiousness • Genes or Care? • III. Containment • Charity • Vaccination • Inoculation (out of order, in time)

3. 0. Historiography

4. Three questions on smallpox in Mexico City: chronology, contagiousness, and containment • 1. What was the periodicity of smallpox in the history of the city? • 2. Why did so many natives die from the pox? Was it a matter of genes or ... (care)? • 3. How did smallpox become epidemic, then endemic, and finally extinct? • a. Charity and quarantine • b. Vaccination: voluntary to compulsory • c. Inoculation: did it protect or propagate the pox?

5. Pox myths: 1. chronology • “...on the very evening that the Aztecs drove the conquistadors out of what is now Mexico City, killing many while routing the rest, a smallpox epidemic began. --Oldstone, Viruses, Plagues and History (Oxford, 1998 [derived from McNeil’s Plagues and People]) • “In Mexico, ever since 1520, the natives had suffered from severe smallpox epidemics recurring every seventeen or eighteen years” (Humboldt, John Black translation, 1811, p. 111).

6. Pox myths: 1. chronology • “...on the very evening that the Aztecs drove the conquistadors out of what is now Mexico City, killing many while routing the rest, a smallpox epidemic began. --Oldstone, Viruses, Plagues and History (Oxford, 1998 [derived from McNeil’s Plagues and People]) • “In Mexico, ever since 1520, the natives had suffered from severe smallpox epidemics recurring every seventeen or eighteen years” (Humboldt, John Black translation, 1811, p. 111). • “As the number of inhabitants declined, due to epidemics, and as the number of susceptibles as well due to the immunity of survivors, in the 17th century, the mortality curves flatten out. This resulted in fewer sick people and fewer deaths.” --Bustamante (400 años de la Viruela, 1986).

7. Pox myths: 2. contagiousness • “...the Europeans’ capacity to resist certain diseases made them superior, in the pure Darwinian sense, to the Indians who succumbed.” --Jennings, The Invasion of America (1975). • “...even in the nineteenth century when some immunity had already been acquired by this race...”--Stearns and Stearns, The Effect of Smallpox (1945). • “...due to the immunity of survivors in the 17th century, the mortality curves flatten out. --Bustamante, 400 años de la Viruela, 1986.

8. Pox myths: 3. containment • A. Charity: • Did it make a difference? • Was motivation self-interest or “Christian”? • B. Quarantine: Did it work? • C. Inoculation: • When was it used? • Was its effect to prevent or propagate the disease? • D. Vaccination: • Why did smallpox become endemic in 19th century Mexico? • Were there more smallpox deaths in the 19th than in prior centuries?

9. An aside:Ancient “Mexico” was no “Golden Age”

10. Ancient Mexico • Epidemics existed (e.g., matlazahuatl, a severe form of typhus), but not smallpox, measles, malaria, yellow fever, or bubonic plague. • Epidemics in 1450, 1456, 1496, and 1507 (according to Anales de Cuahtitlan) • “There’s hardly a person who walks who doesn’t complain of the bowels.” • Skeletal archaeology shows porotic hyperostosis as nearly universal (perhaps due to extreme dependence on corn).

11. 1rabbit(1454):“agreathungerkilledmany of the people”

12. I. Smallpox chronology, periodicity

13. First epidemic, 1520: “Large bumps spread on people, some were entirely covered. They spread everywhere, on the face, the head, the chest, etc. [The disease] brought great desolation; a great many died of it.” --Sahagun, General History

14. Testimonies:Dating the epidemic... “It began in Tepeilhuitl [at the end of September]. ... The disease of the pustules lasted a full sixty days; after sixty days it abated and ended. ... It broke out in Teotl eco, and it abated in Panquetzaliztli. The Mexica warriors were greatly weakened by it.” --Sahagun, General History

15. Dec. 1520: Death of Montezuma’s successor--from smallpox “…he governed only 80 days…” corpse enshrouded in glyphs for smallpox

16. First epidemic: little effect on the outcome of the conquest • Hugh Thomas, Conquest of Mexico (1993): “Extravagant” the notion that the smallpox epidemic had an effect on the outcome of the conquest. • Chronology: Spaniards defeated June 30; epidemic began in late Sept. and ended in December; siege began in April, 1521. • Diplomacy: Aztecs unable to maintain dominion over suppressed peoples. • Strategy: Christians and their allies erected a total siege of the island city (won in Aug.)

17. 2nd epidemic, 1538:“this year of 7 rabbits [and of 1533] many people died of smallpox”--CodexTelleriano-Remensis

18. What was the periodicity of smallpox the city? • 16th c., 2: 1520, 1533 [?], 1538 • rather infrequent • 17th c., 5: 1615, 1653, 1663, 1673, 1696 • from mid-17th century: Humboldt’s rule of every 17 or 18 years • 18th, 6: 1711, 1733, 1748, 1761, 1779, 1797 • probably the worst century for smallpox epidemics • was this due to increased communication? • 19th, 3: 1804, 1829, 1840 • 20th, 1: 1915 [during the revo--few deaths]

19. Testimonies: Virgin of Guadalupe procession 1545: • “The precious friars gathered a great many children, female and male, who had just reached the age of six or seven; they went along flogging themselves. … As soon as they arrived at her churchly home, the friars offered very many prayers. And God the giver of life willed that through the intercession and prayers of the compassionate personage, his precious, revered mother, the epidemic would begin to subside. The next day, not many people were being buried any longer, and finally perhaps two or three people as the epidemic came to an end.”

20. Smallpox, 1650-1810 (near Mx. City)

21. Smallpox: not a big killer in 19th century Mexico City, thanks to vaccination

22. Nor in the 20th... republic city 1911 390 1912 429 ... 1922 11966 542 1923 13076 401 1924 12964 124 1925 11008 36 1926 5477 22 1927 6638 5 ... republic city 1943 4011 64 1944 2350 17 1945 1054 3 1946 561 4 1947 549 22 1948 1101 32 1949 461 16 1950 153 7 1951 54 0 1952 31 0 republic city 1898 23467 187 1899 38269 178 1900 27642 685 1901 13416 53 1902 28116 57 1903 23987 300 1904 16878 159 1905 10305 203 1906 14210 696 1907 19854 184 ...

23. II. Contagiousness

24. 2. Why did so many natives die from the pox: genes or care? • Genetic interpretation, a crude Darwinism, is favored (Stearn and Stearn, Jennings, Bustamante, and others). • The role of care, on first experience: • Natives did not know how to care for the ill • Adult caregivers were themselves ill from the disease

25. Jennings, The Invasion of America (1975:22) • “...the Europeans’ capacity to resist certain diseases made them superior, in the pure Darwinian sense, to the Indians who succumbed.” • “smallpox was smallpox...the Indians on the north [bank of the Rio Grande] had as little biological immunity to this epidemic scourge as the Aztecs had.” • “...even in the nineteenth century when some immunity had already been acquired by this race...”--Stearns and Stearns

26. Bustamante, 400 anos de viruelas en Mexico: • “Los seres humanos, aislados en América por miles de años, formaron una población inmunológicamente autóctona, con factores de susceptibilidad o de resistencia diferentes a los de la gente del Antiguo Mundo.” • “As the number of inhabitants declined, due to epidemics, and as the number of susceptibles as well, due to the immunity of survivors in the 17th century, the mortality curves flatten out. This resulted in fewer sick people and fewer deaths.”

27. Testimonies: care? (text vs. pictures, 1582) “Many others died of starvation, because as they were all taken sick at once, they could not care for each other, nor was there anyone to give them bread or anything else.” --Motolinía

28. III. Containment

29. III.A. Charity

30. Charity,1544-1545:killerepidemic (not smallpox)among the Indians

31. Order establishing block-by-blockcharity commissions, Mexico City7 Nov., 1797

32. Charity campaign not begun until week nine of epidemic (1797)

33. III.B. Vaccination, 1804-1952

34. How did smallpox become epidemic, then endemic, and finally extinct? • Epidemic: throughout colonial era to 1840. • Endemic, 1840-1954: from voluntary (1804) to compulsory vaccination (1882) • Extinction, 1903-1954: • mandatory universal vaccination by six months of age throughout the Republic (1903) • mobile brigades to quarantine, vaccinate, and suffocate outbreaks (1931-)

35. Sporadic vaccination campaigns, often impelled by an imminent outbreak, converted smallpox from epidemic to endemic killer

36. Testimonies: Dr. Luis Muñoz, chief medical officer (1864) • “The vaccine, more widely extended than inoculation had ever been, diminished in a considerable way the number of people at risk (‘aptas’), and at the same time removed the reservoir (‘focos’) of contagion which was necessary for the disease to thrive.”

37. By 1900, smallpox was no longer a Big Killer in Mexico

38. III. C. Inoculation, 1797 “...from the distinguished inaction of the Spaniards, inoculation was soon relinquished; and no other country in Europe has suffered so little from the Small Pox.”--Moore, History of the Smallpox, 1815, p. 288

39. The inoculationist shell game • Compare fatility rates from natural smallpox with that from inoculation • But, never consider the public health issue that inoculation without quarantine condemned to death many innocents. • Only in the 19th century would inoculation w/o quarantine become manslaughter (e.g., Moore, History of Smallpox, 1815, p. 305)

40. Did inoculation protect or propagate the disease? • Inoculation protected the inoculated: case fatality rate from artificial pox was 1/10th rate from natural pox (1%:10%) • Without quarantine, propagated the disease • Mexico City, inoculation with consent: yes • Durango, universal inoculation: no • Chiapas, sporadic...varied village to village • London, inoculation with little quarantine: yes • Boston, “general” inoculation: yes

41. Inoculation w/o quarantine began before mortality was countable

42. Testimonies: “Scurrilous verses”, 1797 Inoculations have been invented by the most poor and needy doctors … One sees that the inoculated are infected Unfortunate Mexico, one regrets that the poor doctors have infected you With experience one sees the evidence for this The very poor and hungry doctors who bring the smallpox have invented [inoculation].

43. Case of Durango • Eighty-seven percent of the susceptible population (4,400 individuals) was inoculated in a matter of days, of whom about one percent died. • Among those infected with the natural pox, the fatality rate was ten times as great. • The risks for the few women who were pregnant at the time were, in contrast, horrifying. • Of nine who were inoculated, one died and two aborted. • Natural pox struck three. One died, and all aborted.

44. Mass inoculation worked for Indians of Chiapas (correlation between inoculation rate and decline in mortality 1779 to 1797)

45. London: Inoculation made the old mortality ceiling the new floor

46. Case of London • Not widely practiced and had, at best, a marginal effect on mortality (Branton). • In London, inoculation is correlated with a surge in deaths due to smallpox (previous graph). • Quakers in London: increase in deaths due to smallpox epidemics (see Branton) • % increase in deaths by age during years of smallpox epidemics vs. normal years. age 1730-49 1750-74 1775-992-9 1.12 1.26 1.23

47. Moore, History of Smallpox, 1815 • “Had it been possible formerly to have persuaded every human being to have submitted to inoculation, a great saving of human lives would have ensued: but this was impracticable; and the experience of a century has shewn, that partial inoculation, by diffusing contagion, multiplied deaths.” (p. 303).

48. Moore, History of Smallpox, 1815 • 303: “All the benefits of inoculation, without the mischiefs, might however have then been obtained, by precluding the inoculated, while the infection was upon them, from intercourse with persons who had not already passed through the Small Pox. But instead of this salutary precaution being even now adopted, there are miscreants of the medical profession, so stimulated by avarice, and so divested of humanity, as to disseminate the contagion of Small Pox through the most populous quarters of London.”

49. Gil, Disertación físico-médica, 1784 • “I am not opposed to inoculation, if it is administered with the necessary precautions.” • “Inoculation propagates the pestilent effects of smallpox, if exact measures are not taken to quarantine both the natural and artificially infected.” • On London, Gil cited evidence from the Bills of Mortality (paragraph 41) showing that a substantial increase in smallpox deaths followed the general adoption of inoculation in the City after 1747. His analysis was correct (and unnoticed).

50. Conclusions &Reflections