History of Smallpox

The history of smallpox is one of the most significant in the history of infectious diseases. Caused by the variola…

By Staff , in History of Disorders , at September 24, 2024 Tags: health, medicine

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The history of smallpox is one of the most significant in the history of infectious diseases. Caused by the variola virus, smallpox was a highly contagious and deadly disease that plagued humanity for millennia. Its impact on human populations was catastrophic, but it also led to one of medicine’s greatest achievements: the development of the first vaccine and the eventual eradication of smallpox in 1980, the first (and so far only) disease to be eradicated globally.

Origins and Ancient History
Ancient Origins:
The exact origin of smallpox is uncertain, but it is believed to have emerged thousands of years ago. The earliest evidence of smallpox is found in Egyptian mummies, such as the mummy of Pharaoh Ramses V, who is thought to have died in 1145 BCE from smallpox-like symptoms. Scars resembling those caused by smallpox were discovered on his body.
Smallpox is thought to have evolved from a virus that infected animals, jumping to humans sometime around 10,000 BCE, potentially as humans began living in closer quarters with domesticated animals and developing larger, more settled communities.

First Documented Cases:
Smallpox appeared in written records in China and India as early as 1500 BCE. Ancient Hindu texts, known as the Sushruta Samhita, contain descriptions of a disease resembling smallpox.
In ancient China, smallpox was also a well-known disease, and it was highly feared. Chinese physicians developed an early form of variolation (a precursor to vaccination) in response to smallpox, which helped protect people from the more severe forms of the disease.

The Spread of Smallpox
Global Spread via Trade and War:
As societies became more interconnected through trade, migration, and conquest, smallpox spread throughout the world. It likely reached Europe from Asia or Africa by 500 CE, becoming endemic in various parts of the Roman Empire. The disease caused widespread devastation in many regions, including outbreaks in Byzantine and Persian empires.
Smallpox continued to spread along trade routes and via military campaigns, becoming more widespread in Europe, Africa, and Asia. By the 8th century, it was a major health problem across these regions.

Smallpox in the Americas (16th Century):
Smallpox had a particularly devastating impact when it was introduced to the Americas by European explorers and colonizers in the 15th and 16th centuries. The indigenous peoples of the Americas had no immunity to the disease, which had never existed on the continent before.
In 1519, the Spanish conquistadors, led by Hernán Cortés, brought smallpox to the Aztec Empire in what is now Mexico. The disease killed an estimated 25–50% of the native population, contributing to the downfall of the Aztec civilization.
Similarly, smallpox devastated the Inca Empire in South America and decimated indigenous populations across North and South America. The disease is believed to have killed millions of Native Americans, profoundly shaping the course of European colonization.

Smallpox in Early Modern Europe
Endemic in Europe:
By the 17th century, smallpox had become endemic in much of Europe, where it caused recurring outbreaks. The disease was particularly deadly among infants and children. Smallpox killed 30–40% of those infected, with survivors often left with severe scars (pockmarks) and, in some cases, blindness.
Royal families were not immune to the disease. European monarchs like Queen Mary II of England (died in 1694) and Tsar Peter II of Russia (died in 1730) succumbed to smallpox. Survivors, like Queen Elizabeth I, who contracted the disease in 1562, were often left permanently scarred.

Variolation: Early Inoculation:
Before the discovery of vaccines, a method called variolation was developed to protect people from smallpox. Variolation involved deliberately infecting a person with material from a smallpox sore (usually by scratching the skin with a needle dipped in smallpox pus). This generally caused a mild form of the disease and conferred immunity.
Variolation was practiced in parts of China, India, and the Ottoman Empire by the 17th century and was introduced to Europe in the early 18th century. Lady Mary Wortley Montagu, wife of the British ambassador to the Ottoman Empire, witnessed variolation during her travels in Turkey and introduced the practice to England in 1721.

The Discovery of Vaccination
Edward Jenner and the First Vaccine (1796):
The major breakthrough in the fight against smallpox came from Edward Jenner, an English physician, in 1796. Jenner observed that milkmaids who contracted cowpox, a less severe disease, seemed to be immune to smallpox. Cowpox, like smallpox, is caused by a virus in the same family, but it is much less dangerous to humans.
On May 14, 1796, Jenner conducted his famous experiment by taking pus from a cowpox sore on a milkmaid’s hand and inoculating an 8-year-old boy named James Phipps. Afterward, Jenner exposed the boy to smallpox, but Phipps did not develop the disease. This was the first successful demonstration of vaccination (derived from the Latin word “vacca” for cow).
Jenner’s discovery was groundbreaking. He published his findings in 1798, and the practice of vaccination spread quickly across Europe and the rest of the world. Jenner’s method was safer than variolation and provided lasting immunity without causing a full-blown case of smallpox.

The Global Impact of Smallpox Vaccination
19th and Early 20th Centuries:
After the success of Jenner’s vaccine, vaccination campaigns began to spread throughout Europe, North America, and other parts of the world. Vaccination helped to reduce smallpox outbreaks, though the disease remained endemic in many regions for much of the 19th century.
Compulsory vaccination laws were introduced in some countries during the 19th century, though they were often controversial and met with resistance. In England, for example, the Vaccination Act of 1853 mandated smallpox vaccination for infants, leading to opposition from the anti-vaccination movement, which argued that vaccination infringed on personal liberty and was potentially dangerous.

Efforts to Control Smallpox:
Throughout the late 19th and early 20th centuries, smallpox vaccination programs continued to expand. Public health initiatives focused on mass vaccination, quarantining infected individuals, and improving sanitation.
Smallpox epidemics still occurred, particularly in regions with limited access to vaccines. For example, there were major outbreaks in India, China, and Africa, where smallpox remained a significant public health issue.

The Global Eradication of Smallpox (1950s–1980)
The World Health Organization’s Campaign:
In the 1950s, smallpox was still endemic in many parts of the world, including Africa, Asia, and South America. Although vaccination had significantly reduced smallpox deaths in many countries, millions of people were still vulnerable to the disease.
In 1959, the World Health Organization (WHO) launched a global smallpox eradication program. The program initially faced challenges due to insufficient funding and vaccine supply, but it gained momentum in the 1960s, particularly under the leadership of Dr. Donald Henderson, an American epidemiologist.

Eradication Strategies:
The eradication campaign focused on mass vaccination and surveillance-containment strategies. Public health workers would vaccinate entire populations and isolate outbreaks by quickly vaccinating anyone who had come into contact with infected individuals.
Ring vaccination, a key strategy, involved identifying smallpox cases and vaccinating those in the immediate area, creating a “ring” of immunity around the infected person and preventing the disease from spreading.

Smallpox Eradication:
After more than two decades of coordinated global efforts, the last naturally occurring case of smallpox was diagnosed in Somalia in October 1977. In 1980, the WHO declared smallpox eradicated worldwide, marking the first time in history that humans had successfully eradicated a disease.

Legacy of Smallpox and Its Eradication
Global Impact:
The eradication of smallpox is considered one of the greatest public health achievements in history. It demonstrated the potential for global cooperation in fighting infectious diseases and set the stage for future efforts to combat diseases like polio and measles.
Smallpox eradication saved millions of lives and freed the world from a deadly scourge. Before eradication, smallpox was responsible for the deaths of an estimated 300–500 million people in the 20th century alone.

Smallpox Today:
With the eradication of smallpox, routine smallpox vaccination was discontinued in most countries by the early 1980s. However, smallpox remains a subject of concern in terms of bioterrorism or accidental release from laboratories. The virus is officially stored in only two locations: the Centers for Disease Control and Prevention (CDC) in the United States and the State Research Center of Virology and Biotechnology (Vector) in Russia.

Lessons for Public Health:
The success of the smallpox eradication campaign serves as a model for modern public health programs. It highlighted the importance of vaccination, surveillance, public health infrastructure, and international collaboration in the fight against infectious diseases.