smallpox It is an infectious disease caused by a virus, eradicated at the present time. Three variants are known (in apes, bovine and human), of which the last one is the one with the highest morbidity and mortality –up to 60%–, being associated with major physical sequelae in patients who did not die. It was introduced in the American territory in the 16th century after the arrival of settlers who arrived from the Peninsula with much more devastating consequences than those it had in Europe.
Jenner, in 1796, decided to experimentally inoculate 8-year-old James Philips with part of the fluid extracted from the pustules on the hands of an English milkmaid affected by cowpox (contracted from from their cows). The child fell ill with this variant (also known as smallpox), but the course of the disease was much lighter and without the consequences of smallpox. An observed fact was the acquisition of immunization against smallpox, so in different parts of the globe, doctors began to devise ways to avoid acquiring such a fearsome disease.
Faced with growing concern about the state of the population of our American colonies, King Charles IV decided to commissionFrancisco Javier Balmis , military doctor and honorary surgeon of the king's court, the mission of immunizing these territories, thus ensuring the active population and the generation of resources. And it is at this point where the challenge lies:how to carry enough well-preserved fluid from the pustules to be able to administer it to such a large number of people? It must be taken into account that in the 18th century the freezing method could not be used nor, obviously, the lyophilization method for subsequent reconstitution and, in addition, a large quantity was needed to inoculate the population of the colonies (namely, Tenerife , Puerto Rico, Venezuela, Cuba, New Spain, Colombia, Peru, Bolivia, Chile, Ecuador, Philippines and China).
The pus used had to be fresh so that it could only be extracted from recently appeared pustules. In addition, a person who contracted the disease was immunized for life after the episode, so that after the disappearance of the pustules, the fluid could no longer be used:first because the lesions had already dried up and/or disappeared and second, because the disease could not be reproduced in the same person. Balmis had tried to contain the purulent fluid inside small glass bottles but had not endured long enough to be able to take it on a ship, after so many miles and months of travel, to ensure its arrival unscathed or its effectiveness.
The Royal Philanthropic Expedition
But Balmis has gone down in history as a person, not only intelligent and studious, but also proactive and innovative; With a strong and determined character, he found a risky solution, not without complications and recriminations by a large part of the population. He determined that, along with the rest of the medical personnel that he needed to carry out the mission, children between 3 and 10 years old would go on board according to the sources. These children (initially all boys) had to be in good physical condition, healthy and, obviously, not have previously suffered from the disease. The work of these children was none other than to act as human reservoirs of the smallpox vaccine . Balmis' claim was to vaccinate two children weekly with the pus extracted from the pustules of the two children vaccinated the previous week. Affected children had to be separated from the rest so as not to infect healthy children and had to follow close surveillance, both of the symptoms presented during the development of the disease and to prevent them from scratching the pustules and "wasting" the much coveted liquid.
This «experiment», which may well seem like an atrocity today, a little over two hundred years ago in our country it was not so. We must bear in mind that, in that historical context, medicine was at its dawn of knowledge, of experimentation andthere were no laws or ethics that we have today. The principles of bioethics did not exist, such as the law of patient autonomy, beneficence, non-maleficence and justice, all of them laws by which current medicine is governed and by which, that expedition today, would have been totally unthinkable. At that time, in the Kingdom of Spain, there were many humble families, of low sociocultural class, with many children to feed, some of whom died prematurely due to malnutrition and/or diseases due to lack of resources.
It was resolved that the Crown would take care of those children; of their food, clothing, hygiene and, even, they would be provided with studies and a profession, thus being in charge of the State until they could fend for themselves. Despite the temptation of the proposal, many families distrusted those promises and feared letting their children follow such a dangerous journey and with the certainty of never hearing from them again, so Balmis finally decided to take the children with them. foundlings . A total of 22 children departed from the port of La Coruña (thirteen of them from the Casa de Expósitos in Coruña; five from the Inclusa del Real Hospital de Santiago and the remaining four from the Casa de Desamparados de Madrid), none of them who would come home. The fluid reached American lands having used the 22 human reservoirs (one of whom died during the journey). But the trip continued, so, in the different regions where they docked, apart from vaccinating the population, setting up vaccination posts and instructing local health workers, they were in charge of selecting new subjects with whom they could continue to keep "alive" the vaccine.
The next problem that had to be solved was that of space, or rather, the number of passengers on board the ship. They could not continue collecting reservoirs and keep all those that had already been "used", either because of the limited capacity of the ship, or because of the lack of food on board, especially considering the complications they had to face throughout of the trip, as well as the contempt experienced by the authorities of various regions, ignoring and failing to comply with what was ordered from the court of King Carlos IV regarding the maintenance of all the members of the expedition. For this reason, Balmis had to leave the "22 Galleguitos" in New Spain, after procuring sustenance and shelter for them. He never heard from them again. From then on, not without difficulties, they were picking up and leaving children , including three slaves who had to be bought because they could not find healthy children with the required characteristics among the population of Havana. The trip ended for Balmis in 1806 with his return to Spain after having immunized the colonies of America and Asia.
This expedition, considered one of the largest and most important internationally, as an advance in medicine, raises various ethical and legal problems today. Not only were minors used without the consent of a legal guardian (although, today, they could be considered the rectors of hospices), but they were also used as an experimental means , causing them an infectious disease, exposing them to many dangers (long voyages with little food, exposure to different diseases, pirate attacks by the British and the Chinese, inclement weather, etc.) and, once they ceased to be useful , were abandoned in unknown land, again without legal guardians – although they were placed in different families after receiving the usual stipend, ultimately they were forgotten by history, both in medicine and in the country. It is true that recently, there has been a growing interest in knowing more about the identity of these children, true heroes of history without their knowledge, and thanks to the records we can know their names and where and when they were abandoned, first by their biological parents and, later, by the Kingdom that needed them to carry out a mission, thanks to which, the World Health Organization, was able to declare almost two centuries later, in 1980, as eradicated the disease of the smallpox . According to this data, and with the ethical and legal limitations of today, we must echo the research carried out relatively recently, with the economic, media and knowledge limitations of the moment and thanks to which, today we can have a healthcare considered one of the best in the world.
Bibliography
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