Arm-to-Arm Transfer
Smallpox is terrifying. In earlier centuries the devastation that raced through the “virgin soil” native tribes in the New World can never be fully comprehended by those of us who have never seen the disease. The horror that led family members to abandon one another and flee, carrying the disease with them, is truly a study in human history.
The Balmis Expedition
In November 1803, a small Spanish ship, the 160-ton corvette “Maria Pita” left the coast of Spain bound for the New World. The vessel was unarmed and under royal charter from the king of Spain. Immunity from attack was guaranteed by the two most powerful seafaring nations of the day: England and France.
No gold, jewels, spices, or useful plunder graced the hold of the tiny ship. The only cargo was packed in a huddled mass below decks. Twenty-two Spanish orphan boys, all between three and nine years of age, were embarking on a voyage to the New World. With no idea of destination or purpose they were bewildered and frightened. In charge of the group was the rectoress of their orphanage at Santiago de Compostela. She was the only female on board, and the rock on which the little lads depended. All twenty-two had been adopted by the king of Spain as his special wards.
The director of the expedition was the royal physician, Dr. Francis Xavier Balmis. Dr. Balmis had spent ten years in New Spain and had seen first-hand the smallpox epidemics that had carried off 50–90 percent of many native civilizations. He was convinced that Dr. Edward Jenner, the little known British physician, was correct in declaring that vaccination with cowpox virus could halt the spread of smallpox. The king of Spain, Carlos IV, had lost his own daughter to the disease. In addition, he was well aware of the calamity smallpox had visited on his colonies. He enthusiastically endorsed Dr. Balmis’ grandiose plan to vaccinate the New World.
But there was a major problem. Briefly, the dilemma was how to get the precious cowpox virus across the ocean in an active, viable state. The ingenious solution was “arm-to-arm” transfer, with the arms belonging to the twenty-two children setting out to sea in the “Maria Pita.” Every ten days, two boys would be vaccinated with the serum recovered form the arms of the two previous vaccines, called “vaccinifers.” After months at sea following this round-robin schedule, one boy reached Caracas, Venezuela, with active usable virus. From this boy others were vaccinated, virus recovered, and on and on. Clinics were set up, long waiting lines appeared. Doctors were trained and hundreds of thousands were vaccinated in South America, Mexico, and eventually the Phillipines.
The last major outbreak of smallpox occurred in 1972. A Muslim man returned to his home in Yugoslavia from his pilgrimage to Mecca. He became seriously ill. This small nation had gone forty-five years without a case of smallpox, and before the hospital staff realized what it was dealing with, the disease had spread into the city and province of Kosovo. The World Health Organization (WHO) isolated the nation. Over a period of three weeks, eighteen million vaccinations were given and the resources brought to bear for this monumental humanitarian effort almost defy belief. One hundred seventy-five cases had occurred with 30 deaths. On May 9, 1972, the nation was finally declared free of disease. Actions such as this led WHO to declare in 1979 that smallpox had been eliminated from the planet earth. It was certainly one of the most remarkable medical triumphs in the history of medicine. Yet the roots of this victory go back 176 years to the small ship setting out from Spain. The expedition, Dr. Balmis, the brave woman and her little orphan boys are now all but forgotten. They did not free the world from smallpox, but it was a beginning.