Smallpox: How Did It Slip into Lebanon, and How Was It Fought?

Epidemiological investigation has proved that smallpox came into Lebanon this time from Iraq, as shown by the fact that the Iraqi health authorities had announced the outbreak of this epidemic there. Unfortunately, however, they did not announce it until after the infection had already spread to Lebanon by way of travelers. In all likelihood the infection was not carried by a sick person, but by a person carrying the germ, or by contaminated baggage.

The first smallpox cases appeared on December 19 last, and on the 21st an Iraqi girl stricken with smallpox, arriving from Mosul, was caught at one of the capital's bus garages; the health authorities placed her in quarantine at the hospital at once. Two days later the epidemic flared up in the Karantina and Slaughterhouse quarter, and on December 28 alone the cases reached 40.

From the very first case the Ministry of Health and the Municipality of Beirut hastened to apply the familiar sanitary regulations: they threw a quarantine cordon around the patient's house, disinfected the house, and vaccinated his family, his neighbors, the inhabitants of the quarter in which the case appeared — Hawd al-Wilaya — and the inhabitants of the neighboring densely populated quarters, such as Bashoura, Zuqaq al-Blat, and Musaytbeh. When the cases took on an epidemic form, the Ministry of Health hastened to obtain a republican decree providing for the compulsory vaccination of all inhabitants throughout Lebanese territory.

The Ministry began general compulsory vaccination on December 29, 1956, and on January 6, 1957 — that is, eight days after vaccination had been extended throughout Beirut and the districts on a scale of breadth and speed the like of which the country had never before witnessed — the flame of the epidemic went out and the cases dropped to zero.

Then a few cases began to appear in scattered places in the South and in Tripoli, but investigation proved that these cases had slipped out of the first focus of the epidemic — Karantina and the Slaughterhouse.

Up to the writing of these lines the number of cases has reached 180, and the deaths 37, while 60 persons have recovered and left the hospital; and for two days now no new case has occurred in any region of the Lebanese Republic. The country will be declared clean of the epidemic when 14 days have passed since the last case.

The number vaccinated up to today has reached one million one hundred and twenty thousand persons, according to lists kept in the Ministry's registers — this apart from those vaccinated by their private physicians, whose number is estimated at some fifty thousand persons. Vaccination will continue until all the inhabitants of every village and farmstead in Lebanon have been vaccinated; the compulsory vaccination campaign, however, will close at the end of this month, by which time everyone will have been vaccinated.

Smallpox is transmitted by a germ invisible to the most powerful microscopes (a "Virus"). The "virus" lurks in all the patient's secretions, and in his skin in particular, during the stage of the skin eruption — the pocks, which take different names according to the development of their form and substance: at first papules, then watery vesicles, then pustules, then crusts that fall away. The pus and the crusts are rich in the virus, and so the stage of suppuration and scaling is considered the most dangerous period of contagion.

The germ enters the body by way of the upper respiratory passages, such as the nose and the mouth. It remains latent in the body from 8 to 14 days before the clinical signs begin, whereas the vaccine gives the body immunity after the passage of 8 days. There is thus a race between the disease and immunity. The faster we vaccinate and the more time we gain, the more surely we outrun the disease and set before it a barrier of immunity which, in most cases, it cannot cross — and if it does cross it, the attack appears in a mild form of no danger.

We knew this rule, and we knew that victory in this battle joined between us and smallpox hung upon speed in vaccination and upon carrying immunity into people's bodies within eight days, before the disease could reach them in a period of eight days at the least and 14 at the most.

We brought vaccine from everywhere: from Beirut, Syria, France, and Switzerland. Automobiles and airplanes worked night

and day to carry the vaccine to us, and telephone and radio communications worked night and day to hurry the vaccine's arrival as fast as possible. We kept watch at the airport on burning coals, snatching the boxes of rescue from the airplanes after midnight to rush them to the Ministry's refrigerators or to the refrigerators of our own homes... to be distributed to the squads standing ready for work at the first light of morning. All the officials of the Ministry of Health mobilized for the work, and all the officials of the health department of the Municipality of Beirut, and dozens of students of the French Institute of Medicine and the American University of Beirut, and dozens of nurses of the Lebanese Red Cross and the Children's Welfare Society, and the women social workers, and dozens of young men of the popular organizations, and physicians and volunteers, men and women alike.

These squads were posted in every place where people meet or resort: in the ministries of state, the official departments, the police posts, the banks, the institutes, the hospitals, the houses of worship, and the theaters. Other squads were posted at the entrances of the city and along the roads leading to the South, the North, and the Bekaa, to vaccinate travelers; and squads went about the quarters vaccinating families in their homes, and squads toured the districts vaccinating the inhabitants in every hamlet and farmstead.

And today I raise my hands to heaven and thank God that victory over the epidemic was written for us in less than a month! We have come out of the battle victorious, and we have learned many things: we must remove the shanties from every place, and see to the establishment of sanitary facilities in every quarter and region, and repeat the compulsory vaccination campaign every five years, before the immunity of people's bodies is lost and they are exposed anew to the epidemic.