As vicious, disfiguring diseases like smallpox have faded from public memory, so has the public urgency to vaccinate.

Now, rather than being fearful of diseases like smallpox, polio and measles, 21st-century parents are becoming fearful of vaccinations, says Tucson author Jennifer Lee Carrell, who penned the 2003 book "The Speckled Monster: A Historical Tale of Battling Smallpox."

Carrell says there are modern lessons to be learned from smallpox, a killer disease that disappeared from nature in 1977.

An Arizona Daily Star investigation in May found that 1 in 3 Arizona schools last year had kindergarten classes with vaccination rates so low that children were vulnerable to outbreaks of other serious, preventable diseases such as measles and whooping cough.

Carrell sees parallels between the parents in her book who were terrified of smallpox and modern American parents who are too afraid to vaccinate their children.

"I really think it's because major viral diseases are no longer scary to us because we no longer see them," Carrell said. "What's scary to us is autism. And that has been I think wrongly associated with vaccination - and I'm just following the scientific community on this."

Carrell's book focuses on two 18th-century parents who were so afraid of their children getting smallpox that they were willing to risk their children's lives in order to save them.

The protagonists of Carrell's book - Lady Mary Wortley Montagu and Dr. Zabdiel Boylston - were shunned because they introduced small amounts of smallpox into their children's skin as a way of protecting them from contracting the killer disease. Back then, the newfangled procedure of inoculation was seen as repulsive and dangerous.

Those early pioneers of inoculation knew firsthand the brutal reality of smallpox, which Carrell describes as a disease that could turn people into, "grossly swollen, groaning monsters barely recognizable as human, bubbling with pus and reeking with the sickly sweet smell of rotting flesh."

The disease was characterized by raised bumps that would become sharply raised, pus-filled blisters that would later crust and scab.

Carrell sat down with the Star earlier this month to talk about smallpox and American parents' current attitudes toward vaccinations.

Q: What do you think about the increasing number of American parents choosing not to vaccinate their children?

A: "Being someone who studied the original vaccination - the one vaccination is named for - I find it both frustrating and scary that there are now enough people not vaccinating their children to put a fairly wide population once again at risk for preventable diseases like measles and whooping cough.

"I understand it is a very personal decision, but I couldn't go through the world knowing I left my child unprotected. Also, there are a lot of people who depend on herd immunity - infants, pregnant women, immunosuppressed people, the elderly - they depend on the rest of us being healthy."

Q: How did you come up with the idea for writing "The Speckled Monster?"

A: "I came across Lady Mary Wortley Montagu in a footnote to a fairly famous poem by Alexander Pope called "Eloisa to Abelard." In the note it said it was thought that he wrote this gothic romance, which was very unlike Pope, while he was under the spell of this amazing woman who was then galavanting around Turkey. …

"I read her letters, and there is a letter home from Turkey about having the 'Chief Inoculatress' of Constantinople (now Istanbul) inoculate her son. But the dates didn't add up. It was 75 years too early for (vaccination pioneer Edward) Jenner. Then I did some research and discovered the difference between inoculation or variolation, which uses live smallpox virus, and vaccination, which uses the related cowpox virus."

Q: So are inoculation and vaccination different things?

A: "Vaccination is one of those brand names that has become generic. Technically, it means inoculation with the vaccinia virus, which is the cowpox virus. In 1796, Jenner discovered that this procedure triggered immunity against smallpox. The specific term for what Lady Mary and Boylston were doing 75 years earlier is variolation, or inoculation with variola, the smallpox virus.

"Their story got swept under the rug after Jenner. He knew that he was building on their success and made no bones about that. … But in the 19th century, the early historians of science and medicine simply passed over Lady Mary and Boylston.

"As far as I can tell, a high-society woman and an unknown American surgeon just weren't the people eminent Victorians wanted to enthrone as the founders of immunology."

Q: What is its origin of the word "vaccine"?

A: "The word comes from vaccinia, which is the cowpox virus. Its Latin derivation comes from vacca, the Latin word for cow (which also gave us the Spanish word for cow, vaca.)

"Vaccination is named for the virus that Jenner was using. He figured it out by listening to dairymaids. They were not scared of getting smallpox after they'd had cowpox, and they had proverbially 'creamy,' unscarred skin to back up their notion, so he paid attention. (Many survivors of smallpox were disfigured by deep, pitted scars or pockmarks on their faces and bodies.)

"Once dairymaids had seen cowpox sores on their hands, they believed they were immune to smallpox. They didn't know why, they just thought they were, and in fact they were right. …

"Cowpox, unlike smallpox, is not generally lethal or highly contagious in humans. So here's the wonder of Jenner's discovery: Vaccination gives you immunity to smallpox, but it cannot give you smallpox, or spread it. In other words, it offers the benefit without the terrible risk."

Q: What kind of harm did smallpox cause?

A: "It could kill one in three people that it infected. Smallpox was so contagious that in an epidemic situation, up to 80 to 90 percent of people who were vulnerable could catch it. That is why it is potentially so dangerous as a weapon. …

"In epidemics, the disease wasn't the only problem, either: Whole towns would be quarantined. Ships wouldn't dock. Suppliers wouldn't bring food or fuel into infected towns. People starved. If it was in the wintertime, they froze to death."

Q: Your book says the disease was the most voracious killer ever to stalk the human species.

A: "I'll quote from my book: 'With a victim count in the hundreds of millions, smallpox has killed more people than the Black Death and all the bloody wars of the 20th century put together.'

"Highly contagious and ferociously lethal, it was also an agonizing and monstrous way to die."

Q: Lady Mary and Dr. Boylston learned about inoculating against smallpox from people who practiced folk medicine in Turkey and Africa. How long do you think that practice was around?

A: "No one knows. Because the practitioners were illiterate we don't have good records of either how they discovered it or how long they were practicing it before it came to the attention of people who could write it down."

Q: So inoculation could have been going on for hundreds of years?

A: "Possibly centuries: It's anybody's guess. We have no idea how long it was going on in West Africa, for instance, before it was brought to Boston by slaves, where it then came to Boylston's notice."

Q: The early inoculations against smallpox in some cases proved fatal, correct?

A: "Variolation is always dangerous. But when it was practiced well, the way it was practiced in Turkey and West Africa, it didn't involve cutting, it involved poking and scraping. So you would open up a pustule and scrape out a little bit of the pus (from an infected person) and then you would make a little poke or scratch on somebody's arm and put just a little bit - about what would fit on the point of a needle - into the scratch.

"Done right, the viral matter stays localized in the skin of your arm, and your body mounts an immunological reaction to it there.

"This version of variolation seems to have carried about 1-in-100 odds of death. If you use too much or cut too deeply and it gets loose into the bloodstream, though, you end up with a full-blown case of smallpox, and then you face the same 1-in-3 odds as anyone else with the disease."

Q: So these pioneers were taking risks.

A: "They were taking huge risks, though not risks they understood precisely. No one yet knew about immune systems or germs of any kind, either bacterial or viral. Louis Pasteur's germ theory was still 140 years in the future.

"What made Lady Mary and Boylston different from other Europeans was their clear-eyed ability to say, 'This works, even though I can't explain it.' Boylston knew the African American community in Boston and Lady Mary visited the harems in Turkey, and they both saw the same thing: a lot of smooth, unscarred skin and children who weren't dying."

Q: What about the parents of 2012 who argue that vaccines are unsafe and cause illness?

A: "I think that is perversely an issue almost entirely of perspective. It would not be a position remotely tenable to anyone were it not for the amazing, astounding success of vaccination programs."

Q: Did smallpox go away because of vaccinations? Some parents who are against vaccinations have told the Star they believe smallpox went away on its own.

A: "Really, such a claim ranks as willful ignorance that is not only dangerous, but also disrespectful to the thousands of medical personnel, scientists and lay volunteers who spent decades working heroically in often dire situations to eradicate one of the worst scourges that has ever plagued humankind.

"I don't know anybody who could read history and say smallpox disappeared on its own. Scientifically that makes no sense because it is so highly contagious. It could not have disappeared without the vaccination.

"Right now, the virus exists only in two known places in the world - the CDC in Georgia and the Vector Institute in Koltsovo, Russia."

Q: What are the parallels between Lady Mary and Boylston and parents now who are skipping their children's vaccinations?

A: "I was interested in Lady Mary and Boylston's stories because they were willing to risk their children's lives in order to save them. To me as a storyteller, that is about as dramatic as you can get.

"I wasn't yet a mother. I didn't understand it in the same visceral way I now understand it, being a mother. I think the need to protect your child is the fiercest drive that your average human is going to experience. It's crucial to understanding why Boylston and Lady Mary did what they did, and why parents today make the decisions they make.

"When this need to protect your children works best, it's a balance of emotion and scientific rationality. Personally, I made the decision to vaccinate my child. But I understand the parents who can't get there, if that makes any sense. The anti-vaccination claims are loud and fervent enough to have given even me brief pause.

"In the end, the decision not to vaccinate is now spurred by the same sense of danger that once led parents to beg for vaccines. I think it's a scientifically flawed decision, but that doesn't change the emotional drive sending a parent in that direction."

Contact reporter Stephanie Innes at or 573-4134.