Circumpolar Health 84:18?-190 COMMUNICABLE DISEASE CONTROL IN THE EARLY HISTORY OF ALASKA I. SMALLPOX ROBERT FORTUINE No disease struck more fear into the to have accepted the responsibility reluc­ hearts of men and women of the 18th and 19th tantly (6). centuries than smallpox. In Europe the Although the decision to vaccinate was disease had long been a grim companion, an en 1 i qhtened one, it no doubt i nvo 1ved a periodically snuffing out the lives or healthy· measure of company self-interest, scarring the faces of persons from all walks since smallpox was known to cause great of life, from beggar children to royalty. devastation and economic 1oss wherever it Among the more "primitive" peoples of the struck a population without previous expo­ world, however, smallpox was a terrible sure to it. Already in these early years angel of death which stalked through house­ the company had had promising young Cre­ holds and villages, leaving in its wake few, oles (an old term for individuals of mixed sometimes mutilated, survivors to tell the Russian and Native parentage), sent to tale. There was no defense against such an Russia for training, die of the disease enemy in their religious beliefs or their while in route to the capital (7). healing traditions. Despite these good intentions, however, The purpose of this paper is to de­ many problems became apparent in the vacci­ scribe briefly the story of smallpox in 18th nation program. Vaccine was chronically in and 19th century Alaska, but more particu­ short supply and what there was of it had larly to relate the crude but well meant often lost its potency on the long sea efforts to control the disease undertaken voyage to Alaska, if indeed it had ever been and carried out by officials of the Russian­ potent. Methods of administration were not American Company. standardized, and poor technique probably Smallpox probably first appeared in contributed to the lack of "take." Few Alaska about 1770, spreading northward from seemed eager to receive the vaccine, least the Stikine River district in southeastern of all the Native peoples who needed it the Alaska and causing a high mortality in the most. Indian villages (1). The disease probably By 1822, the 200 or so Russians, reached Alaska Indians through their regular Crea 1es, and A1 eut hunters at Sitka were contact with other Indian tribes of the finally vaccinated, thanks to the arrival of Northwest coast. Captain Nathaniel Portlock a large shipment of vaccine from Okhotsk. on his trading voyage in 1787 observed The following year the chief manager ordered several Tlingit with the typical scars of that the employees at all outlying company small pox and speculated, from the ages of posts be similarly vaccinated, but vaccine the youngest persons affected, that the supplies ran out before his task could be disease had been introduced into Alaska in completed (8). In October 1828, however, a 1775 by the Spanish (2), perhaps Perez and new shipment of vaccine permitted the Bodega y Quadra who were in A1 a ska waters feldsher at Kodiak to send his Creole that year. The narratives of these voyages, assistant to vaccinate in the outlying however, make no mention of smallpox either villages. By April 1829 over 500 persons in among the crews or among Native peoples, and Russian America were vaccinated against thus it is more likely once again that the smallpox (9). Over the next five or six disease spread to the coast through trade years, however, new supplies of vaccine were channels from the interior. Other 18th constantly in short supply. century records confirm the presence of the Smallpox broke out in Alaska in the disease as far north as Yakutat Bay (3,4). fall of 1835, probably brought overland from As early as 1808, a mere decade after the British territories to the east and an English rural physician named Edward south. At Tongass, the southern border of Jenner had reported his successful experi­ the Russian colonies, some 250 died out of a ments in preventing smallpox by the use of a population of 900 (10). The disease ap­ vaccine derived from cowoox, the di rectors peared at Sitka in November, quickly killing of the Russian-A.merican Company in St. sever a 1 A1 eut hunters there. It raged out Petersburg sent a supply of the new vaccine of control over the next few months, leaving to the co 1on i es with instructions for its in its wake 100 dead out of 161 persons who administration. The officers of the company became ill, a case fatality rate of 623 were told to vaccinate all Russians and as (11). Dr. Edward Blaschke, the chief many Natives as possible. Dr. Mordgorst, medical officer at the capital, did his surgeon on the Imperial Naval Ship Neva, was utmost to care for the sick but his minis­ charged with demonstrating the technique and trations were ineffective. Much more useful teaching the method to capable employees was his effort to vaccinate some 200 Rus­ (5). Among those who learned to vaccinate sians, Creoles, and Aleuts who had not were the Orthodox missionaries, who seemed become sick (12). 188 Infectious Disease Panic was already seizing many of the vaccination, their continued reliance on Tlingit of the surrounding villages as they their own shamans, the lateness of the saw their family members die around them vaccination effort, and the doubtful quality with high fever, utter prostration, and a of the vaccine itself (20). cruel disfiguring rash. Their own methods Kupreianov sent Dr. Blaschke himself to of treatment,· including the best efforts of try to prevent a similar disaster in the their shamans, were totally ineffective. As Unalaska District. Sailing on the ship the disease spread from household to house­ Polyfem, the doctor arrived at Unalaska May hold the survivors abandoned their families, 28, 1838, armed with strict instructions both the sick and the dead, and fled to from the chief manager to company officials other villages (13), often carrying with to see that the Aleuts cooperated. By the them the virus in the incubation stage. end of the su11T11er Blaschke had vaccinated According to the Orthodox missionary Veniam­ 1,086 Aleuts, of whom only five later inov, during the months of January and succumbed to smallpox. Among the unvac­ February 1836, some 300 Indians died near cinated, some 129 died of smallpox when the the fort, sometimes as many as eight to disease struck in August (21). twelve in a single day (14). By the time Meanwhile, the feldsher Galaktion was the epidemic burned itself out in south­ instructed to vaccinate the people of the eastern Alaska, some 400 Indians but only Atka District, but his program was delayed one European had died (15)--eloquent testi­ pending the arrival of a new supply of mony to the effectiveness of vaccination. vaccine from Kamchatka. Father Netsvetov, a The Tlingit initially refused vaccina­ Creole missionary stationed there, was tion, but their own high mortality, the specifically requested by the chief manager helplessness of their shamans, and the fact to encourage his flock to accept vaccination that the Russians did not get sick finally (22). It is uncertain whether the Atka persuaded even the skeptics that the Rus­ Aleuts were ever afflicted during the si ans possessed a superior tech no 1ogy. epidemic or indeed whether they even became Finally, but too late to save many, the vaccinated at all until some years later. A Tlingit clamored for vaccination, which was sma 11 pox outbreak is not mentioned in freely given by Dr. Blaschke. This accep­ Netsvetov's detailed diary of those years. tance of Russi an ways, i nci dentally, a 1so marked the beginning of the acceptance by The vaccination campaign also extended the Tlingit of the teachings of the Orthodox northward from Kodiak to the Alaska Peninsu­ missionaries (16). la, Cook Inlet, Prince William Sound, At the height of the epidemic in Sitka, Bristol Bay, and even the shores of Norton Chief Manager Kupreianov recognized that the Sound. On the peninsula, a company foreman disease posed a grave threat tci the safety named Kostylev succeeded in vaccinating some and economic stability of the other Russian 243 persons, despite resistance, and in his trading posts. In March 1837 he issued district only 27 persons died of smallpox, regulations to all captains of company ships all of them unvaccinated (23). In Bristol requiring them to vaccinate their crew Bay the vaccination effort was too late, members, air out thoroughly all items taken despite the best efforts of Surgeon's on board, remain at anchor for two days upon Apprentice Fomin who labored there from arrival at port, isolate persons with February 1835 through the fo 11 owing year. smallpox from the crew, and prohibit crew Some 522 smallpox deaths were reported from members from mingling with people on shore Alexandrov Redoubt (Nushagak) and Kuskokwim (17). Dr. Blaschke was also asked to Territory (24). The people of Cook Inlet prepare, for the benefit of all outlying and Pri nee Wil 1i am Sound resisted a 11 company posts, a set of instructions on how efforts to vaccinate them and consequently to prevent spread of the disease. mortality there was also very high (25). In spite of these precautions, however, The vaccinators also encountered smallpox broke out at Kodiak on July 8, resistance in the Yukon-Kuskokwim valley, 1837, although the news did not get back to with a consequent mortality as high as 36%, Sitka until the end of August. Fearing the according to one account ( 26).