Three puzzles in the history of smallpox in Latin America

1. Three puzzles in the history of smallpox in Latin America • 1. Smallpox and catastrophe: What was the role of smallpox in the demog. catastrophe? 2. Genes or exploitation and experience: Why did natives suffer so greatly from the disease? • 3. Smallpox and recovery: Did smallpox become less virulent? What was the effect of public health campaigns (quarantine inoculation, and vaccination), versus population densities on smallpox mortality.

2. Not a puzzle: • 1. First smallpox epidemic struck Mexico City in 1520, killing many of its inhabitants (1/5 - 1/2). • 2. From 1803-06, the Balmis expedition carried vaccination around the world. • 3. Smallpox is credited with population recovery in the 18th century and often blamed for slow growth in 19th century Latin America. • 4. The last case of smallpox in Mexico occurred February, 1951 (and, in the world, in Somalia, 1977). • 5. Evidence on genetic immunity and smallpox is rarely examined--and weak.

3. Demographic catastrophe in 16th century Mexico: 50%+ decline

4. 1. Smallpox and catastrophe: What was the role of smallpox in the demog. catastrophe (Mexico)? • Epidemic of 1520 was devastating; 1538 less so • More severe was cocoliztli of 1545-6 and matlazahuatl of 1577-79 • Most chroniclers list few smallpox epidemics • Exploitation weakened native population

5. Fr. Bernardino de Sahagun’s General History (Florentine Codex, 1576), native voices: smallpox Mexico, 1520: “...Indeed many people died of them (pustules), and many just died of hunger. There was death from hunger; there was no one to take care of another; there was no one to attend to another.”

6. 1520: Death of Montezuma’s successor, from smallpox “…he governed only 80 days…” corpse enshrouded in glyphs for smallpox

7. 1538 “This year of seven rabbits of 1538 many people died of smallpox.”[note pustules on arms and legs.]

8. 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.”

9. Rhetorical exaggeration vs. evidence • Smallpox epidemic of 1520 “raged across the continent”, but note how slowly it spread from Veracruz to Mexico City, 300 miles, 3 to 5 months (May to September or October). • “In Mexico, ever since 1520, the natives had suffered from severe smallpox epidemics recurring every seventeen or eighteen years.” --Stearn and Stearn, 42. • Yet, of 17 colonial epidemics to 1745 listed by the chronicler Cayetano Cabrera y Quintero only 3 are for smallpox.

10. 9 other epidemics were probably as or more devastating than smallpox • tepitonzahuatl (measles), 1531. • cocoliztli (?), 1546-47 • matlazahuatl (typhus?), 1576-77 • famine and typhus, 1692 • typhus, 1737-39 • the great hunger, 1786-88 • typhus, 1813 • cholera, 1833 • influenza, 1918

11. 2. Genes or exploitation and experience: Why did natives suffer so greatly from the disease? • Genes: Stearn and Stearn (1945): “...even in the nineteenth century when some immunity had already been acquired by this race...” • Exploitation, the social context of epidemics: Audiencia Judge Alonso de Zorita (~1560) “So the Indian returns home from his toil [for Spaniards] ... famished, unhappy, distraught, and shattered in health. For these reasons pestilence always rages among the Indians.”

12. Genes: Francis 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.” • Must differentiate genetic vs. lifetime immunity.

13. Science: F. Black (1994) and Peter J. Bianchine & Thomas A. Russo (1995) • Black: “Smallpox was clearly more virulent in the Americas than in Europe but the causes for this remain an open question.” • Bianchine & Russo: “given comparable care when ill and knowledge regarding the potential for surviving the illness, the death rates for virgin-soil Indian populations and repeatedly exposed Caucasian populations for measles were similar.”

14. Smallpox mortality in London: 10-20% of deaths 1720-1797

15. Evidence from chronologies and parish burial books • Recall 17 epidemics 1520-1745: 7 in 16th century; 6 in 17th c; 4 in 18th to 1746; only 3 of smallpox: 1520, 1538, 1733/34. • 18th century was the century of smallpox epidemics in Mexico: 1733/4, 1761/62, 1779, 1797. • Evidence from parish burial books (Mexico): Center (Puebla), South (Chiapas), and North (Chihuahua).

16. Smallpox, 1650-1810 (near Mexico City)

17. Burials: by “calidad” (near Mexico City) Indians Others

18. Chiapas (South): after 1693, no recovery

19. Another parish in Chiapas: disaster in 1770

20. Epidemics Center, North and South

21. Ethno-racial composition, New Spain

22. 3. Smallpox and recovery: Did smallpox become less virulent?Yes, but only after 1797 • Inoculation, 1797: Yes. • Public health campaigns, 1797 • Vaccination, 1804-1960s

23. Spain: inoculation introduced in 1768; and New Spain in 1797. • Opposed in Spain: Protomedicato feared increased frequency of epidemics and exposure of uninoculated to higher risks. Public health versus private practice. • New Spain, 1797: Mass campaign in various regions of Mexico was effective in checking the epidemic of 1797 (e.g., Chiapas, Durango)Durangoilldied death rateInoculated 3824 39 1%Not 478 63 12%

24. Mass Inoculation Worked for Indians

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

26. First world-wide public health campaign: Balmis smallpox vaccination expedition, 1803-1806 • Jenner's Inquiry (1798) immedidately captured the interest of the Spanish Crown. Nov. 30, 1798, Charles IV issued an order that vaccination be extended throughout the Spanish dominions. • Spain: the Royal Academy de Medicine approved publications on this topic quickly. “se ha propagado en España con indecible rapidez, …” • Spanish America: Francisco Xavier de Balmis (1803-6) extraordinary philanthropic odyssey from Spain to the Americas and the Phillipines.

27. Smallpox: not a big killer in 19th century Mexico City

28. Smallpox not a big killer in 19th century Northern Mexico

29. Conclusion: three puzzles require more research and careful analysis • 1. Population catastrophe and care: smallpox probably less severe than other epidemics, although more frequent by 18th century. • 2. Genes: role is probably exaggerated; ruthless exploitation and lack of experience with epidemics greatly increased mortality. • 3. Public health: inoculation, charity and vaccination reduced smallpox mortality but only at the very end of the colonial period.