Variolation and the Price of Goodness
A week had passed since the smallpox outbreak in Buyeo County. It was Saturday evening, and I'd finally met up with Seo-yeon after a long time. I spent Sunday resting at home when a Gatong message arrived from Munjong.
News had come from Buyeo. In the quarantined villages, the number of deaths was lower than before. Among those who used the prescribed medicine, more had recovered than not. It was effective.
In Joseon, they called the king the father of the people. As a father, Munjong's gratitude toward me must be sincere.
I was troubled. The day I heard about the smallpox in Buyeo, I immediately advised isolation and supportive treatment because I'd read in history books about how terrifying smallpox was. But what I was about to do now—transmitting a cure for smallpox—was an entirely different level.
People who were supposed to die would live. That was a good thing. But Joseon's population would grow far beyond what history recorded. The problem was that only medicine had advanced somewhat. Though Joseon emphasized agriculture with its scholar-farmer-artisan-merchant hierarchy, the kingdom's agricultural output was disastrously low. In other words, there was no way to feed the increased population.
Smallpox is the first disease in human history to be officially declared eradicated—in 1980. Even after Jenner discovered cowpox vaccination in 1796, it took that long. Until the declaration, humanity remained exposed to its threat. Roughly 30% of those infected died within two weeks. According to the WHO, 300 million people died of smallpox in the 20th century alone. Above all, mortality was highest among infants and children. Smallpox struck everyone, but in societies where it had become endemic, it hit children hardest—adults were often survivors from childhood infections.
Even the king's children were no exception. Among King Sejong's sons, the scourge of smallpox did not spare them. Grand Prince Gwangpyeong died at twenty, Grand Prince Pyeongwon at nineteen. Both were sons of Queen Soheon, Munjong's full brothers. If anything, the royal family suffered less because they were the king's sons.
Bosinsijok, 15th-century Joseon court-style eobyeong, palace-style garlic chicken, the decline of dentistry due to toothpaste, ultra-pure black ink. Aside from dentistry's fall, these could be laughed off. But the butterfly effect of conquering smallpox was no laughing matter.
Preventing the calamity of smallpox was a good deed. Fewer children would die. More adults would survive. Fewer homes would wail in grief. But Joseon couldn't run on goodness alone. The fields remained the same, but mouths multiplied. As those children grew, mouths would multiply further. Grain would fall short by exactly that much. Even if they rented out land to tenants, there wasn't enough, so they'd subdivide it finer. Hidden tenants would surge. Joseon's entire state apparatus would have to change.
This was the price pre-modern Joseon would pay for goodness—the butterfly effect, undoubtedly.
And so, I couldn't bring it up with Munjong.
I called Seo-yeon.
"Got time today? I'm thinking of having some daytime drinks. Wanna join?"
"Something wrong?"
"Nah, not really... It's exactly one week until I hit third-year residency. Kinda feeling off about it."
"Okay. Meet at that chicken place from last time. I'm not drinking soju."
I met Seo-yeon at our now-regular chicken joint. Sipping soju with the outwardly tough, inwardly tender Pride Chicken, her bright expression eased my heavy heart a bit. Today, too, she didn't pry. Even when she asked, she stopped at the right line and didn't dig deeper. I felt it—respect for what her loved one wanted to hide for now, faith that one day I'd tell her everything without reservation, emotions born of love.
"Seo-yeon, what does it mean to be a doctor?"
"Come on, oppa. Why are you talking such nonsense today? It's someone who saves lives."
Her words reminded me of my resolve as a doctor. Back when I started logging Munjong's clinical records—that resolve. A doctor's job is to restore breath.
"True, no matter how tangled my head gets, seeing an emergency patient just makes me think 'save them.' Spot on, as expected from my Seo-yeon."
We didn't have palace-style garlic chicken today, but we enjoyed delicious, fun chicken at our regular spot before heading home. The daytime soju left me a bit dizzy. I took a deep breath and sent a Gatong to Munjong.
'Yes, this is prevention too.' Once more, I rationalized my good intentions to myself. If Joseon had to pay a price for my goodwill, I would prevent that too.
This was the variolation method introduced by Jeong Yak-yong during King Jeongjo's reign.
[Read receipt.] No reply came for a long while.
Variolation was far less dangerous than smallpox itself, but still carried a 1-2% mortality risk for the inoculated.
Munjong repeated my message verbatim. A long silence followed.
I decided to transmit cowpox vaccination too. But finding cows infected with cowpox, as Jenner used in England, was nearly impossible in Joseon. Cowpox virus barely existed in Asia.
Munjong added one more line.
The compilation of the Annals of King Sejong had apparently started in earnest.
After ending the Gatong with Munjong, I opened the Annals of the Joseon Dynasty. New content not in the backup annals had been added under Sejong Annals records.
Munjong had bestowed gifts on the compilers and supervisors of the Sejong Annals. Eojeonghwan hadn't even started production yet... Now Jeon Sun-ui was in a bind—he had to make it succeed somehow.
We have at last begun compiling the Annals of King Sejong.
Heo Hu, Kim Jo, Park Jung-rim, Yi Gye-jeon, Jeong Chang-son, and Shin Seok-jo divided the years and served as compilers;
[Omitted]
accordingly, His Majesty ordered that each compiler receive one bolt of grass-green silk, and each supervisor receive one hoe of eojeonghwan.
Additionally, a report on the Buyeo County smallpox not in the backup had been added.
Initially, His Majesty issued a rescript to Governor Jo Su-ryang of Chungcheong Province: "Someone reports that in Buyeo County of your province, two or three villages have been nearly wiped out by a vile disease. Report in detail how many contracted the illness, how many have recovered, how many have died, and the symptoms."
Now, Jo Su-ryang reported: "I sent men to the villages of Buyeo County to inquire closely into the illness. It begins with chills and fever, headache, and body aches, followed by pustules in the mouth and throat, spreading from face and chest gradually to limbs and whole body. In severe cases, the throat closes, eyes redden, mind clouds, and they die. Upon examination, it seems to be smallpox.
"Of the deaths: In Gwanbuk Village (modern Gwanbuk-ri), where no isolation tent was set, 70 contracted, 49 recovered, 21 died. In Gu-a Village (modern Gu-a-ri), 63 contracted, 43 recovered, 20 died. In Seokgyo Village (modern Seokmok-ri), 53 contracted, 37 recovered, 16 died. Those still ill are not included.
"In Bukpo Village (modern Ssangbuk-ri), an isolation tent was set, the sick separated, and they were given a decoction of purple gromwell, cimicifuga, licorice, peony root, and cornus fruit: 57 contracted, 51 recovered, 6 died. This counts only those whose illness has resolved; the still-ill are recorded separately.
"Total: 243 contracted, 180 recovered, 63 died. Deaths in Bukpo Village, with isolation and decoction, were fewer than the other three."
His Majesty said: "Have the provincial medical instructor manage it, and supply from the three medical bureaus (Jeonuigam, Hye-min-guk, Jesaeng-won) any medicines not available locally."
Originally reported as two or three villages, but smallpox had spread to Bukpo Village too, and it seemed my advised isolation and supportive treatment had been applied. The three original villages matched smallpox's average mortality; Bukpo clearly showed isolation's effect.
I stared at the numbers for a long time. Without isolation, more would have died. Without the decoction, more would have died. But deaths were down. Crystal clear.
People whose names and faces I didn't know. Folks from some village in Buyeo County, lived and died there.
I thought again of what Seo-yeon said—a doctor's duty: "Putting lives back on track."
I reaffirmed my resolve as a doctor: "Restoring breath."
Fifty-one lives saved.
Whatever butterfly effects unfolded in Joseon, it was fine. At least for now.
The price of goodness—I would gladly bear it.