St. Louis continues to be focal point against smallpox

ST. LOUIS -- St. Louis has a long history of being in the forefront of efforts to eradicate smallpox.

One of the nation's first vaccine programs was in St. Louis, which, like many other parts of the world saw deadly, widespread smallpox outbreaks.

Today, Saint Louis University researchers are on the forefront of smallpox vaccine development.

As European fur trappers, traders and other people traveled the Mississippi and Missouri Rivers in Colonial times, the disease spread to American Indians. By the 1800s, the city was one of a handful in the nation to produce one of the virus' first vaccines.

"St. Louis continues to be a focal point for national preparedness for smallpox," said Bruce Clements of the Center for the Study of Bioterrorism and Emerging Infections at Saint Louis University. "It seems only natural given our history."

Preparing for bioterrorism

Saint Louis University researchers currently are working with the smallpox vaccine and preparing Americans for the possibility of bioterrorism.

University physicians already have determined that the existing smallpox vaccine stockpile can be extended by diluting it. Researchers are now trying to determine whether people who have previously been vaccinated can be given a small booster shot to re-immunize them.

Professors are also working on plans to administer mass vaccinations, develop reference and training materials for health care workers and prepare public messages to be delivered in the event of an outbreak.

Once among the Earth's most feared diseases, smallpox killed hundreds of millions of people in past centuries, but it hasn't been seen in this country since 1949. Its eradication was one of public health's greatest victories.

But because no one has been vaccinated in decades, the population is highly vulnerable. While all stocks of the virus beyond two official labs were supposed to be destroyed, experts fear that hostile nations or terrorist groups have smallpox and could use it in an attack.

Smallpox and cholera were the city's greatest threats when St. Louis first attempted a public health program in 1832.

With a population of 270,000 in 1872, a smallpox epidemic killed 1,591 in St. Louis. Most people who died lived in crowded areas along the Mississippi riverfront.

That November, five nuns arrived from Germany, bringing food, clothing and medicine to people in poorer neighborhoods. They carried small bells which helped alert people they had been in contact with smallpox victims. The women eventually became known as the "smallpox sisters" and more officially, the Franciscan Order of St. Mary.

In the beginning, the sisters struggled to keep up with the disease. In 1873, 837 people died from the virus. Over the next two years, 1,050 more would succumb.

By 1877, the sisters opened their first hospital, near today's downtown. Six years later the city's health commissioner asked the nuns to take over the care of smallpox patients.

The patients were at the city's quarantine hospital, accessible only by riverboat. There, patients in some 600 beds would wait for their fevers, vomiting and virus-induced pustules to subside or their deaths. From May 1883 until May 1885, the nuns nursed about 1,500 people, with about 90 percent recovering. Because of the virus' infectious nature, some nuns contracted it and died.

Over the decades, the sisters of the order dedicated themselves exclusively to healing. They eventually owned and operated more than a dozen area hospitals, going on to become SSM Health Care. That group now owns or manages 21 hospitals in four states.

In the late 1800s, Dr. R.M. Higgins oversaw the St. Louis Vaccine Farm, on 320 acres near the present-day suburb of Manchester.

At the time, the farm was one of only five in the country producing a life-saving vaccine first developed in 1796 by the English physician Edward Jenner. Jenner used cowpox virus to immunize against smallpox, making the world's first ever vaccine.

The method used to produce the vaccine that exists today is nearly identical to those used on Higgins' farm.

Heifer calves received the vaccination on their udders. Within days, drained blisters could be processed into vaccine.

As time passed and mass vaccination became common, smallpox claimed fewer lives. The city recorded its last case in 1944, the state in 1949.

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