During the 18th century, smallpox was the infectious disease that most aggressively decimated the population in Gipuzkoa (1).
In the 18th century, one out of every seven infant deaths was caused by smallpox.
The origin of smallpox is unknown, but there is evidence of its existence, at least two thousand years ago. (2)
Already in ancient times the technique of inoculating smallpox (variolization) had begun by deliberately infecting the person by introducing smallpox crusts through the nasal passages by means of a cannula. Those who received this treatment contracted a milder type of smallpox and developed lifelong immunity.
The discovery of the smallpox vaccine in 1796 was an important milestone in the battle against the disease, which, however, was not eradicated until well into the 20th century.
Description of the disease
Smallpox was a serious infectious disease, contagious, spread by periodic outbreaks and with a high lethality risk of 25% of those affected, especially among infants (3).
It was caused by the variola virus and spread through contact healthy people and infected people or through the exchange of contaminated objects.
The only effective treatment for the smallpox epidemic was prevention, variolisation and, from the 19th century onwards, vaccination.
The last case of natural infection in the world was diagnosed in October 1977 and in 1980 the World Health Organisation (WHO) certified the eradication of the disease worldwide.
Among the patients who survived, its main characteristics were scars all over the body and in some cases blindness.
The geographical location of Gipuzkoa, with its extensive coastline and commercial ports, and the proximity of the Spanish-French border, facilitated the movement of people who spread the disease.
For this reason, in the 17th century the intervals epidemics were four years and in the 18th century they became every two years (4).
The Enlightenment and smallpox
In the middle of the 18th century, the so-called "enlightenment" movement developed in Europe. Its main objective was its d aim to dispel the darkness of mankind's ignorance through the lights of knowledge and reason. (5)
There was a clash of ideas in all (philosophical, cultural, scientific, etc.) with the ideas of the Ancien Régime inherited from feudalism and averse to any cultural, political or even scientific change.
Medicine was no exception and in many cases resisted the Enlightenment. An example of this was the dispute over the inoculation of smallpox.
From 1760 onwards, inoculation became the battleground of the struggle the enlightened and the scholastics, which made it a symbol for those most influenced by traditional ideas.
It was no longer a medical technique to be studied, but a symbol that had to be overthrown to defend the country from the modern ideas coming from abroad.
In Gipuzkoa, the ideas of the Enlightenment brought together an intellectual elite that founded the Sociedad Bascongada de Amigos del País in 1763. (6)
In 1769, the R.S.B.A.P. contacted national and foreign doctors to gather data on possible treatments for smallpox. (7)
In 1771, the Society's doctor José Santiago Ruiz de Luzuriaga (8) read a paper about his experience in inoculating nine children with human smallpox in the tower house of Arancibia in Berriatua. Two of those children were his own children and another was the 5-year-old son of the Count of Peñaflorida.
Influenced by Luzuriaga's work, the R.S.B.A.P. stated "that they could not be indifferent to the successful invention of inoculation", and decided that year to finance inoculation in the three Basque provinces with 500 reales to be used for those people without economic resources who wished to inoculate their children. To promote it, it printed Luzuriaga's work, a copy of which was distributed free of charge to all doctors in the three provinces. (7)
In this way, the RSBAP gave a great boost to inoculation, giving visibility to what until then had been done in a very sporadic and, above all, clandestine manner.
The following year, the Basque enlightened doctors began to carry out inoculations throughout their territories. In Gipuzkoa alone, 1,202 people were inoculated in 1772.
The case of Hondarribia
There were municipalities that remained resistant to variolisation, such as Hondarribia.
In 1791 it became known in Hondarribia that a child in a hamlet had contracted smallpox. The town reacted as it had always done: sending the head doctor and isolating the sick person.
The Deputy General and Mayor, Pedro Antonio de Zuloaga, (9) a member of the RSBAP, believed that the time had come for the inoculation to reach his town, 20 years behind the rest of Gipuzkoa, and decided to inoculate his children. (10)
Pedro Antonio de Zuloaga contacted the head doctor in Hondarribia, Pedro Cantabrana. Both were aware of the town's negative predisposition towards the matter, so everything was carried out with the utmost discretion until it was finished.
They decided to start the next day to avoid leaks and that the whole process would be carried out in a country house far from the town centre. The doctor examined Pedro Antonio's three daughters "and found them to be quite healthy", but not the eight-month-old "because he was then suffering from a convulsive cough". (7)
Following Cantabrana's opinion, they postponed the inoculation of the little boy until later. The preparation of the three sisters aged 8, 7 and 2 began immediately.
Following the trend of the time, for seven days they were subjected to a vegetable diet of ripe fruit, warm water baths and a daily enema, while Pedro Antonio de Zuloaga made the necessary arrangements to obtain the essential smallpox in other parts of Gipuzkoa.
But in that city, which had a population inside the walls of 867 souls in the 1787 census, everyone knew everything, no matter how much effort one made to be discreet.
At the municipal session on 1 June, Joaquín de Arizaga, the ombudsman, raised his voice to complain "that he had learned how Mr. Diputado del Común Don Pedro Antonio de Zuloaga had gone to the town of Tolosa with the intention of bringing smallpox to inoculate his children".
Faced with this complaint, the mayors asked Zuloaga to suspend this inoculation, Pedro Antonio replied that he was not going to do it because he had the approval of various doctors whom he had consulted. And that the authority in this matter was the doctors and not the Town Council.(4)
The members of the council were fully aware that inoculation had already been spreading throughout Gipuzkoa for twenty years, and that they could not ban at a stroke an action started by such an influential person as the Count of Torre Alta. So an extraordinary municipal session was announced for the following day in the afternoon, which was ordered to be attended by the town's head doctor and surgeon(4).
The members of the council were fully aware that inoculation had already been spreading throughout Gipuzkoa for twenty years, and that they could not ban at a stroke an action started by such an influential person as the Count of Torre Alta. So an extraordinary municipal session was announced for the following day in the afternoon, which was ordered to be attended by the town's head doctor and surgeon.(4)
It was a convulsive session in which the inoculation was provisionally forbidden until a commission formed by two doctors, two theologians from the San Telmo convent in San Telmo and two lawyers decided how to proceed.(4) The decision was to forbid the inoculation.
The decision was to prohibit the inoculation of smallpox until such time as an epidemic had developed in the locality. The only one to vote in favour of the inoculation was one of the lawyers.(4)
In 1802, thirty years behind the rest of the province, new legislative changes brought inoculation to Hondarribia.
Legislative changes and the end of the disease
In 1792, the Royal Academy of Medicine of Madrid concluded that "inoculation was extremely useful for the conservation of the human race" and in 1798 King Charles III ordered that the inoculation method be put into practice in Hospitals, Foundling Homes, Misericordias, etc.
In 1798 the vaccine was discovered but it did not make inoculation disappear, because at the beginning it was very difficult to obtain the vaccine and it was necessary to continue for years with variolisation.
In 1815 vaccination was d compulsory throughout the State.(11)
Throughout the 19th century, attempts were made to make vaccination compulsory, but there was still a high level of rejection among the population, to the point that vaccination teams in many towns had to carry out their work under the protection of the public forces.
In 1903, around 100 people a year still died of the disease in Gipuzkoa and a Royal Decree was issued ordering compulsory vaccination throughout the state for children under 6 months of age.
Three days later, the Provincial Council, insisting on "vaccination and revaccination as the most effective means against the variola epidemic", offered "to reward with twenty-five cents of a peseta to all persons who, by means of a medical certificate, accredited having been vaccinated".
Infectious outbreaks were decreasing, with the one in Irún 1869 and 1871 being well documented, where 169 people died, and in 1918 there was an outbreak of smallpox in Lasarte. In this case, when there was an intention to transfer five sick people to the hospital in Hernani, the inhabitants of the town, supported by the town council, firmly prevented the transfer.(12)
In the Basque Country, the last cases of smallpox were recorded in isolation in the immediate post-civil war period. In Spain, the last case was registered in 1950, in Europe in 1953, and the last case in the world was in Somalia in 1977.(13)
References
(1) «De la peste al covid». Gipuzkoako Foru Aldundia. Koldo Mitxelena.
(2) «Cosas de Alde Zaharra». Ayuntamiento de Hondarribia.
https://www.hondarribia.eus/es/-/cosas-de-alde-zaharra-36
(3) «Viruela». Medline Plus. https://medlineplus.gov/spanish/ency/article/001356.htm
(4) «Pedro Antonio de Zuloaga y la inoculación de las viruelas». Ayuntamiento de Hondarribia.
https://www.hondarribia.eus/documents/124308/19169617/Zuloaga+-+Viruela/f4f4fd79-cd48-836c-5ffd-
(5) «la Ilustración». Enciclopedia de Historia. https://enciclopediadehistoria.com/la-ilustracion/
(6) «Real Sociedad Bascongada de Amigos del País». Auñamendi Eusko Entziklopedia.
https://aunamendi.eusko-ikaskuntza.eus/en/real-sociedad-bascongada-de-amigos-del-pais/ar-124801-
(7) Labaka, Olatz. «Los inicios de la inoculación en el País Vasco». Euskal Herriko Unibertsitatea.
https://addi.ehu.es/bitstream/handle/10810/55780/TFG_Labaka.pdf?sequence=1&isAllowed=y
(8) «Ruiz de Luzuriaga, José Santiago». Auñamendi Eusko Entziklopedia.
https://aunamendi.eusko-ikaskuntza.eus/es/ruiz-de-luzuriaga-jose-santiago/ar-122510/
(9) «Zuloaga Plaza, Pedro Antonio». Auñamendi Eusko Entziklopedia.
https://aunamendi.eusko-ikaskuntza.eus/es/zuloaga-plaza-pedro-antonio-de/ar-152766/
(10) Múgica Zufiría, Serapio. «Un caso curioso de viruela». Dialnet.
https://dialnet.unirioja.es/servlet/articulo?codigo=3416559
(11) Izaguirre, Juan Carlos. La viruela y su profilaxis.
https://static.errenteria.eus/web/eu/herria/artxiboa/Oarso/oarso1989/090_094-viruela.pdf
(12) «Rebelión por el traslado de la viruela». Noticias de Gipuzkoa.
https://www.noticiasdegipuzkoa.eus/gipuzkoa/2018/06/26/rebelion-traslado-viruela-3914412.html
(13) «Hace 40 años de la erradicación de la viruela». Asociación Española de Pediatría.
https://vacunasaep.org/profesionales/noticias/hace-40-anos-desde-la-erradicacion-de-la-viruela
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