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The history of smallpox extends into pre-history. Genetic evidence suggests that the smallpox virus emerged 3,000 to 4,000 years ago. Prior to that, similar ancestral viruses circulated, but possibly only in other mammals, and possibly with different symptoms. Only a few written reports dating from about 500 AD to 1000 AD are considered reliable historical descriptions of smallpox, so understanding of the disease prior to that has relied on genetics and archaeology. However, during the 2nd millennium AD, especially starting in the 16th century, reliable written reports become more common. The earliest physical evidence of smallpox is found in the Egyptian mummies of people who died some 3,000 years ago. Smallpox has had a major impact on world history, not least because indigenous populations of regions where smallpox was non-native, such as
the Americas The Americas, which are sometimes collectively called America, are a landmass comprising the totality of North and South America. The Americas make up most of the land in Earth's Western Hemisphere and comprise the New World. Along with ...
and Australia, were rapidly and greatly reduced by smallpox (along with other introduced diseases) during periods of initial foreign contact, which helped pave the way for conquest and colonization. During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning
monarch A monarch is a head of stateWebster's II New College DictionarMonarch Houghton Mifflin. Boston. 2001. p. 707. for life or until abdication, and therefore the head of state of a monarchy. A monarch may exercise the highest authority and power ...
s, and was responsible for a third of all blindness. Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease. During the 20th century, it is estimated that smallpox was responsible for 300–500 million deaths. In the early 1950s an estimated 50 million cases of smallpox occurred in the world each year. As recently as 1967, the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
estimated that 15 million people contracted the disease and that two million died in that year. After successful
vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulatin ...
campaigns throughout the 19th and 20th centuries, the WHO certified the global eradication of smallpox in December 1979. Smallpox is one of two
infectious disease An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...
s to have been eradicated, the other being
rinderpest Rinderpest (also cattle plague or steppe murrain) was an infectious viral disease of cattle, domestic buffalo, and many other species of even-toed ungulates, including gaurs, buffaloes, large antelope, deer, giraffes, wildebeests, and warthogs ...
, which was declared eradicated in 2011.


Eurasian epidemics

It has been suggested that smallpox was a major component of the
Plague of Athens The Plague of Athens ( grc, Λοιμὸς τῶν Ἀθηνῶν}, ) was an epidemic that devastated the city-state of Athens in ancient Greece during the second year (430 BC) of the Peloponnesian War when an Athenian victory still seemed within r ...
that occurred in 430 BCE, during the
Peloponnesian War The Peloponnesian War (431–404 BC) was an ancient Greek war fought between Athens and Sparta and their respective allies for the hegemony of the Greek world. The war remained undecided for a long time until the decisive intervention of t ...
s, and was described by
Thucydides Thucydides (; grc, , }; BC) was an Athenian historian and general. His ''History of the Peloponnesian War'' recounts the fifth-century BC war between Sparta and Athens until the year 411 BC. Thucydides has been dubbed the father of " scientif ...
.
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
's description of the Antonine Plague, which swept through the
Roman Empire The Roman Empire ( la, Imperium Romanum ; grc-gre, Βασιλεία τῶν Ῥωμαίων, Basileía tôn Rhōmaíōn) was the post-Roman Republic, Republican period of ancient Rome. As a polity, it included large territorial holdings aro ...
in 165–180 CE, indicates that it was probably caused by smallpox. Returning soldiers picked up the disease in
Seleucia Seleucia (; grc-gre, Σελεύκεια), also known as or , was a major Mesopotamian city of the Seleucid empire. It stood on the west bank of the Tigris River, within the present-day Baghdad Governorate in Iraq. Name Seleucia ( grc-gre, � ...
(in modern Iraq), and brought it home with them to Syria and Italy. It raged for fifteen years and greatly weakened the Roman empire, killing up to one-third of the population in some areas. Total deaths have been estimated at 5 million. A second major outbreak of disease in the Roman Empire, known as the
Plague of Cyprian The Plague of Cyprian was a pandemic that afflicted the Roman Empire from about AD 249 to 262. The plague is thought to have caused widespread manpower shortages for food production and the Roman army, severely weakening the empire during the Cr ...
(251–266 CE), was also either smallpox or
measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
. The Roman empire stopped growing as a consequence on these two plagues, according to historians like
Theodore Mommsen Christian Matthias Theodor Mommsen (; 30 November 1817 – 1 November 1903) was a German classical scholar, historian, jurist, journalist, politician and archaeologist. He is widely regarded as one of the greatest classicists of the 19th century ...
. Although some historians believe that many historical
epidemic An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time. Epidemics of infectious d ...
s and
pandemic A pandemic () is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. A widespread endemic disease with a stable number of in ...
s were early outbreaks of smallpox, contemporary records are not detailed enough to make a definite diagnosis. Originally published as ''Princes and Peasants: Smallpox in History'' (1983), Around 400 CE, an Indian medical book recorded a disease marked by
pustule A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...
s and boils, saying "the pustules are red, yellow, and white and they are accompanied by burning pain … the skin seems studded with grains of rice." The Indian epidemic was thought to be punishment from a god, and the survivors created a goddess, Sitala, as the anthropomorphic personification of the disease. Smallpox was thus regarded as possession by Sitala. In Hinduism the goddess Sitala both causes and cures high fever, rashes, hot flashes and pustules. All of these are symptoms of smallpox. Most of the details about the epidemics are lost, probably due to the scarcity of surviving written records from the
Early Middle Ages The Early Middle Ages (or early medieval period), sometimes controversially referred to as the Dark Ages, is typically regarded by historians as lasting from the late 5th or early 6th century to the 10th century. They marked the start of the Mi ...
. The first incontrovertible description of smallpox in
Western Europe Western Europe is the western region of Europe. The region's countries and territories vary depending on context. The concept of "the West" appeared in Europe in juxtaposition to "the East" and originally applied to the ancient Mediterranean ...
occurred in 581 CE, when Bishop
Gregory of Tours Gregory of Tours (30 November 538 – 17 November 594 AD) was a Gallo-Roman historian and Bishop of Tours, which made him a leading prelate of the area that had been previously referred to as Gaul by the Romans. He was born Georgius Florent ...
provided an eyewitness account describing the characteristic symptoms of smallpox. Waves of epidemics wiped out large rural populations. The establishment of the disease in Europe was of special importance, for this served as the endemic reservoir from which smallpox spread to other parts of the world, as an accompaniment of successive waves of European exploration and colonization. In 710 CE, smallpox was re-introduced into Europe via Iberia by the
Umayyad conquest of Hispania The Umayyad conquest of Hispania, also known as the Umayyad conquest of the Visigothic Kingdom, was the initial expansion of the Umayyad Caliphate over Hispania (in the Iberian Peninsula) from 711 to 718. The conquest resulted in the decline of t ...
. The Japanese smallpox epidemic of 735–737 is believed to have killed as much as one-third of Japan's population. The clearest description of smallpox from pre-modern times was given in the 9th century by the Persian physician, Muhammad ibn Zakariya ar-Razi, known in the West as "Rhazes", who was the first to differentiate smallpox from
measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
and
chickenpox Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...
in his ''Kitab fi al-jadari wa-al-hasbah'' (''The Book of Smallpox and Measles''). Smallpox was a leading cause of death in the 18th century. Every seventh child born in
Russia Russia (, , ), or the Russian Federation, is a transcontinental country spanning Eastern Europe and Northern Asia. It is the largest country in the world, with its internationally recognised territory covering , and encompassing one-eight ...
died from smallpox. It killed an estimated 400,000 Europeans each year in the 18th century, including five reigning European monarchs. Most people became infected during their lifetimes, and about 30% of people infected with smallpox died from the disease, presenting a severe
selection pressure Any cause that reduces or increases reproductive success in a portion of a population potentially exerts evolutionary pressure, selective pressure or selection pressure, driving natural selection. It is a quantitative description of the amount of ...
on the resistant survivors. In northern Japan,
Ainu Ainu or Aynu may refer to: *Ainu people, an East Asian ethnic group of Japan and the Russian Far East * Ainu languages, a family of languages **Ainu language of Hokkaido **Kuril Ainu language, extinct language of the Kuril Islands **Sakhalin Ainu l ...
population decreased drastically in the 19th century, due in large part to infectious diseases like smallpox brought by
Japanese Japanese may refer to: * Something from or related to Japan, an island country in East Asia * Japanese language, spoken mainly in Japan * Japanese people, the ethnic group that identifies with Japan through ancestry or culture ** Japanese diaspor ...
settlers pouring into
Hokkaido is Japan's second largest island and comprises the largest and northernmost prefecture, making up its own region. The Tsugaru Strait separates Hokkaidō from Honshu; the two islands are connected by the undersea railway Seikan Tunnel. The lar ...
. The Franco-Prussian War triggered a smallpox pandemic of 1870–1875 that claimed 500,000 lives; while vaccination was mandatory in the Prussian army, many French soldiers were not vaccinated. Smallpox outbreaks among French prisoners of war spread to the German civilian population and other parts of Europe. Ultimately, this public health disaster inspired stricter legislation in Germany and England, though not in France. In 1849 nearly 13% of all
Calcutta Kolkata (, or , ; also known as Calcutta , the official name until 2001) is the capital of the Indian state of West Bengal, on the eastern bank of the Hooghly River west of the border with Bangladesh. It is the primary business, commerc ...
deaths were due to smallpox. Between 1868 and 1907, there were approximately 4.7 million deaths from smallpox in
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
. Between 1926 and 1930, there were 979,738 cases of smallpox with a mortality of 42.3%.


African epidemics

Smallpox is
exogenous In a variety of contexts, exogeny or exogeneity () is the fact of an action or object originating externally. It contrasts with endogeneity or endogeny, the fact of being influenced within a system. Economics In an economic model, an exogeno ...
to Africa. One of the oldest records of what may have been an encounter with smallpox in Africa is associated with the elephant war circa AD 568 CE, when after fighting a siege in Mecca, Ethiopian troops contracted the disease which they carried with them back to Africa. Arab ports in Coastal towns in Africa likely contributed to the importation of smallpox into Africa, as early as the 13th century, though no records exist until the 16th century. Upon invasion of these towns by tribes in the interior of Africa, a severe epidemic affected all African inhabitants while sparing the Portuguese. Densely populated areas of Africa connected to the Mediterranean, Nubia and Ethiopia by caravan route likely were affected by smallpox since the 11th century, though written records do not appear until the introduction of the slave trade in the 16th century. The
enslavement Slavery and enslavement are both the state and the condition of being a slave—someone forbidden to quit one's service for an enslaver, and who is treated by the enslaver as property. Slavery typically involves slaves being made to perf ...
of Africans continued to spread smallpox to the entire continent, with raiders pushing farther inland along caravan routes in search of people to enslave. The effects of smallpox could be seen along caravan routes, and those who were not affected along the routes were still likely to become infected either waiting to be put onboard or on board ships. Smallpox in Angola was likely introduced shortly after Portuguese settlement of the area in 1484. The 1864 epidemic killed 25,000 inhabitants, one third of the total population in that same area. In 1713, an outbreak occurred in South Africa after a ship from India docked at Cape Town, bringing infected laundry ashore. Many of the settler
European European, or Europeans, or Europeneans, may refer to: In general * ''European'', an adjective referring to something of, from, or related to Europe ** Ethnic groups in Europe ** Demographics of Europe ** European cuisine, the cuisines of Europe ...
population suffered, and whole clans of the Khoisan people were wiped out. A second outbreak occurred in 1755, again affecting both the
white White is the lightest color and is achromatic (having no hue). It is the color of objects such as snow, chalk, and milk, and is the opposite of black. White objects fully reflect and scatter all the visible wavelengths of light. White on ...
population and the Khoisan. The disease spread further, completely eradicating several Khosian clans, all the way to the Kalahari desert. A third outbreak in 1767 similarly affected the Khoisan and Bantu peoples. But the European colonial
settlers A settler is a person who has migrated to an area and established a permanent residence there, often to colonize the area. A settler who migrates to an area previously uninhabited or sparsely inhabited may be described as a pioneer. Settle ...
were not affected nearly to the extent that they were in the first two outbreaks, it has been speculated this is because of variolation. Continued
enslavement Slavery and enslavement are both the state and the condition of being a slave—someone forbidden to quit one's service for an enslaver, and who is treated by the enslaver as property. Slavery typically involves slaves being made to perf ...
operations brought smallpox to Cape Town again in 1840, taking the lives of 2500 people, and then to Uganda in the 1840s. It is estimated that up to eighty percent of the
Griqua Griqua may refer to: * Griqua people * Griqua language or Xiri language * Griquas (rugby) Griquas (known as the Windhoek Draught Griquas for sponsorship reasons since April 2022) are a South African rugby union team that participates in the a ...
tribe was exterminated by smallpox in 1831, and whole tribes were being wiped out in Kenya up until 1899. Along the Zaire river basin were areas where no one survived the epidemics, leaving the land devoid of human life. In Ethiopia and the Sudan, six epidemics are recorded for the 19th century: 1811–1813, 1838–1839, 1865–1866, 1878–1879, 1885–1887, and 1889–1890.Fenner, Frank, Donald A. Henderson, Isao Arita, Zdenek Jezek, and Ivan Danilovich Ladnyi. ''Smallpox and its Eradication''. Geneva: World Health Organization, 1988. WHO Library Database.


Epidemics in the Americas

After first contacts with
Europeans Europeans are the focus of European ethnology, the field of anthropology related to the various ethnic groups that reside in the states of Europe. Groups may be defined by common genetic ancestry, common language, or both. Pan and Pfeil (2004) ...
and Africans, some believe that the death of 90–95% of the native population of the
New World The term ''New World'' is often used to mean the majority of Earth's Western Hemisphere, specifically the Americas."America." ''The Oxford Companion to the English Language'' (). McArthur, Tom, ed., 1992. New York: Oxford University Press, p. 3 ...
was caused by
Old World The "Old World" is a term for Afro-Eurasia that originated in Europe , after Europeans became aware of the existence of the Americas. It is used to contrast the continents of Africa, Europe, and Asia, which were previously thought of by th ...
diseases. It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas. For more than 200 years, this disease affected all new world populations, mostly without intentional European transmission, from contact in the early 16th century until possibly as late as the French and Indian Wars (1754–1767). In 1519
Hernán Cortés Hernán Cortés de Monroy y Pizarro Altamirano, 1st Marquess of the Valley of Oaxaca (; ; 1485 – December 2, 1547) was a Spanish ''conquistador'' who led an expedition that caused the fall of the Aztec Empire and brought large portions of w ...
landed on the shores of what is now
Mexico Mexico (Spanish: México), officially the United Mexican States, is a country in the southern portion of North America. It is bordered to the north by the United States; to the south and west by the Pacific Ocean; to the southeast by Guatema ...
and what was then the
Aztec Empire The Aztec Empire or the Triple Alliance ( nci, Ēxcān Tlahtōlōyān, �jéːʃkaːn̥ t͡ɬaʔtoːˈlóːjaːn̥ was an alliance of three Nahua city-states: , , and . These three city-states ruled that area in and around the Valley of Mexico ...
. In 1520 another group of Spanish arrived in Mexico from
Hispaniola Hispaniola (, also ; es, La Española; Latin and french: Hispaniola; ht, Ispayola; tnq, Ayiti or Quisqueya) is an island in the Caribbean that is part of the Greater Antilles. Hispaniola is the most populous island in the West Indies, and th ...
, bringing with them the smallpox which had already been ravaging that island for two years. When Cortés heard about the other group, he went and defeated them. In this contact, one of Cortés's men contracted the disease. When Cortés returned to
Tenochtitlan , ; es, Tenochtitlan also known as Mexico-Tenochtitlan, ; es, México-Tenochtitlan was a large Mexican in what is now the historic center of Mexico City. The exact date of the founding of the city is unclear. The date 13 March 1325 was ...
, he brought the disease with him. Soon, the Aztecs rose up in rebellion against Cortés and his men. Outnumbered, the Spanish were forced to flee. In the fighting, the Spanish soldier carrying smallpox died. Cortés would not return to the capital until August 1521. In the meantime smallpox devastated the Aztec population. It killed most of the Aztec army and 25% of the overall population. The Spanish Franciscan Motolinia left this description: "As the Indians did not know the remedy of the disease…they died in heaps, like bedbugs. In many places it happened that everyone in a house died and, as it was impossible to bury the great number of dead, they pulled down the houses over them so that their homes become their tombs." On Cortés's return, he found the Aztec army's
chain of command A command hierarchy is a group of people who carry out orders based on others' authority within the group. It can be viewed as part of a power structure, in which it is usually seen as the most vulnerable and also the most powerful part. Milit ...
in ruins. The soldiers who still lived were weak from the disease. Cortés then easily defeated the Aztecs and entered Tenochtitlán. The Spaniards said that they could not walk through the streets without stepping on the bodies of smallpox victims. The effects of smallpox on
Tahuantinsuyu The Inca Empire (also known as the Incan Empire and the Inka Empire), called ''Tawantinsuyu'' by its subjects, (Quechua for the "Realm of the Four Parts",  "four parts together" ) was the largest empire in pre-Columbian America. The admin ...
(or the Inca empire) were even more devastating. Beginning in Colombia, smallpox spread rapidly before the Spanish invaders first arrived in the empire. The spread was probably aided by the efficient
Inca road system The Inca road system (also spelled Inka road system and known as ''Qhapaq Ñan''Qhapaq=rich, powerful, opulent, wealthy, privileged; ñan=road, way, path, route. Source "Diccionario quechua - español - quechua" Gobierno Regional Cusco - Cusco ...
. Within months, the disease had killed the Incan Emperor Huayna Capac, his successor, and most of the other leaders. Two of his surviving sons warred for power and, after a bloody and costly war,
Atahualpa Atahualpa (), also Atawallpa (Quechua), Atabalica, Atahuallpa, Atabalipa (c. 1502 – 26-29 July 1533) was the last Inca Emperor. After defeating his brother, Atahualpa became very briefly the last Sapa Inca (sovereign emperor) of the Inca Empi ...
become the new emperor. As Atahualpa was returning to the capital
Cuzco Cusco, often spelled Cuzco (; qu, Qusqu ()), is a city in Southeastern Peru near the Urubamba Valley of the Andes mountain range. It is the capital of the Cusco Region and of the Cusco Province. The city is the seventh most populous in Peru ...
,
Francisco Pizarro Francisco Pizarro González, Marquess of the Atabillos (; ;  – 26 June 1541) was a Spanish conquistador, best known for his expeditions that led to the Spanish conquest of Peru. Born in Trujillo, Spain to a poor family, Pizarro chose ...
arrived and through a series of deceits captured the young leader and his best general. Within a few years smallpox claimed between 60% and 90% of the Inca population, with other waves of European disease weakening them further. A handful of historians argue that a disease called
Bartonellosis Bartonellosis is an infectious disease produced by bacteria of the genus ''Bartonella''. ''Bartonella'' species cause diseases such as Carrión's disease, trench fever, cat-scratch disease, bacillary angiomatosis, peliosis hepatis, chronic bac ...
might have been responsible for some outbreaks of illness, but this opinion is in the scholarly minority. The effects of Bartonellosis were depicted in the ceramics of the Moche people of ancient
Peru , image_flag = Flag of Peru.svg , image_coat = Escudo nacional del Perú.svg , other_symbol = Great Seal of the State , other_symbol_type = National seal , national_motto = "Firm and Happy f ...
. Even after the two largest empires of the Americas were defeated by the virus and disease, smallpox continued its march of death. In 1561, smallpox reached
Chile Chile, officially the Republic of Chile, is a country in the western part of South America. It is the southernmost country in the world, and the closest to Antarctica, occupying a long and narrow strip of land between the Andes to the east a ...
by sea, when a ship carrying the new governor
Francisco de Villagra Francisco de Villagra Velázquez (1511 – 22 July 1563) was a Spanish conquistador, and three times governor of Chile. Early life Born at Santervás de Campos, he was the son of Alvaro de Sarría and Ana Velázquez de Villagra, who were not ma ...
landed at La Serena. Chile had previously been isolated by the
Atacama Desert The Atacama Desert ( es, Desierto de Atacama) is a desert plateau in South America covering a 1,600 km (990 mi) strip of land on the Pacific coast, west of the Andes Mountains. The Atacama Desert is the driest nonpolar desert in the w ...
and
Andes Mountains The Andes, Andes Mountains or Andean Mountains (; ) are the longest continental mountain range in the world, forming a continuous highland along the western edge of South America. The range is long, wide (widest between 18°S – 20°S ...
from Peru, but at the end of 1561 and in early 1562, it ravaged the Chilean native population. Chronicles and records of the time left no accurate data on mortality but more recent estimates are that the natives lost 20 to 25 percent of their population. The Spanish historian Marmolejo said that gold mines had to shut down when all their Indian labor died.
Mapuche The Mapuche ( (Mapuche & Spanish: )) are a group of indigenous inhabitants of south-central Chile and southwestern Argentina, including parts of Patagonia. The collective term refers to a wide-ranging ethnicity composed of various groups who sh ...
fighting Spain in Araucanía regarded the epidemic as a magical attempt by
Francisco de Villagra Francisco de Villagra Velázquez (1511 – 22 July 1563) was a Spanish conquistador, and three times governor of Chile. Early life Born at Santervás de Campos, he was the son of Alvaro de Sarría and Ana Velázquez de Villagra, who were not ma ...
to exterminate them because he could not defeat them in the
Arauco War The Arauco War was a long-running conflict between colonial Spaniards and the Mapuche people, mostly fought in the Araucanía. The conflict began at first as a reaction to the Spanish conquerors attempting to establish cities and force Mapuche ...
.Alonso de Góngora Marmolej
Historia de Chile desde su descubrimiento hasta el año 1575
Cervantesvirtual.com. Retrieved on 2011-12-06.
In 1633 in
Plymouth, Massachusetts Plymouth (; historically known as Plimouth and Plimoth) is a town in Plymouth County, Massachusetts, United States. Located in Greater Boston, the town holds a place of great prominence in American history, folklore, and culture, and is known as ...
, the Native Americans were struck by the virus. As it had done elsewhere, the virus wiped out entire population groups of Native Americans. It reached
Mohawks The Mohawk people ( moh, Kanienʼkehá꞉ka) are the most easterly section of the Haudenosaunee, or Iroquois Confederacy. They are an Iroquoian-speaking Indigenous people of North America, with communities in southeastern Canada and northern Ne ...
in 1634, the
Lake Ontario Lake Ontario is one of the five Great Lakes of North America. It is bounded on the north, west, and southwest by the Canadian province of Ontario, and on the south and east by the U.S. state of New York. The Canada–United States border span ...
area in 1636, and the lands of the
Iroquois The Iroquois ( or ), officially the Haudenosaunee ( meaning "people of the longhouse"), are an Iroquoian-speaking confederacy of First Nations peoples in northeast North America/ Turtle Island. They were known during the colonial years to ...
by 1679. A particularly virulent sequence of smallpox outbreaks took place in Boston, Massachusetts. From 1636 to 1698, Boston endured six epidemics. In 1721, the most severe epidemic occurred. The entire population fled the city, bringing the virus to the rest of the
Thirteen Colonies The Thirteen Colonies, also known as the Thirteen British Colonies, the Thirteen American Colonies, or later as the United Colonies, were a group of British colonies on the Atlantic coast of North America. Founded in the 17th and 18th centuri ...
. During the
siege of Fort Pitt The siege of Fort Pitt took place during June and July 1763 in what is now the city of Pittsburgh, Pennsylvania, United States. The siege was a part of Pontiac's War, an effort by Native Americans to remove the Anglo-Americans from the Ohio C ...
, as recorded in his journal by sundries trader and militia Captain,
William Trent William Trent (February 13, 1715–1787) was an American fur trader and merchant based in colonial Pennsylvania. He was commissioned as a captain of the Virginia Regiment in the early stages of the French and Indian War, when he served on the wes ...
, on June 24, 1763, dignitaries from the Delaware tribe met with Fort Pitt officials, warned them of "great numbers of Indians" coming to attack the fort, and pleaded with them to leave the fort while there was still time. The commander of the fort refused to abandon the fort. Instead, the British gave as gifts two blankets, one silk handkerchief and one linen from the smallpox hospital, to two Delaware Indian delegates.Fenn, Elizabeth A
Biological Warfare in Eighteenth-Century North America: Beyond Jeffery Amherst
; The Journal of American History, Vol. 86, No. 4, March, 2000
The dignitaries were met again later and they seemingly hadn't contracted smallpox. A relatively small outbreak of smallpox had begun spreading earlier that spring, with a hundred dying from it among Native American tribes in the Ohio Valley and Great Lakes area through 1763 and 1764. The effectiveness of the biological warfare itself remains unknown, and the method used is inefficient compared to respiratory transmission and these attempts to spread the disease are difficult to differentiate from epidemics occurring from previous contacts with colonists, as smallpox outbreaks happened every dozen or so years. In the late 1770s, during the
American Revolutionary War The American Revolutionary War (April 19, 1775 – September 3, 1783), also known as the Revolutionary War or American War of Independence, was a major war of the American Revolution. Widely considered as the war that secured the independence of t ...
, smallpox returned once more and killed thousands. Peter Kalm in his ''Travels in North America'', described how in that period, the dying Indian villages became overrun with
wolves The wolf (''Canis lupus''; : wolves), also known as the gray wolf or grey wolf, is a large canine native to Eurasia and North America. More than thirty subspecies of ''Canis lupus'' have been recognized, and gray wolves, as popularly u ...
feasting on the corpses and weakened survivors. During the 1770s, smallpox killed at least 30% of the Northwestern Native Americans, killing tens of thousands.Smallpox
The Canadian Encyclopedia ''The Canadian Encyclopedia'' (TCE; french: L'Encyclopédie canadienne) is the national encyclopedia of Canada, published online by the Toronto-based historical organization Historica Canada, with the support of Canadian Heritage. Available fo ...
Lange, Greg. (2003-01-23
Smallpox epidemic ravages Native Americans on the northwest coast of North America in the 1770s
. Historyink.com. Retrieved on 2011-12-06.
The smallpox epidemic of 1780–1782 brought devastation and drastic depopulation among the
Plains Indians Plains Indians or Indigenous peoples of the Great Plains and Canadian Prairies are the Native American tribes and First Nation band governments who have historically lived on the Interior Plains (the Great Plains and Canadian Prairies) of ...
. This epidemic is a classic instance of European immunity and non-European vulnerability. It is probable that the Indians contracted the disease from the 'Snake Indians' on the
Mississippi Mississippi () is a state in the Southeastern region of the United States, bordered to the north by Tennessee; to the east by Alabama; to the south by the Gulf of Mexico; to the southwest by Louisiana; and to the northwest by Arkansas. Missis ...
. From there it spread eastward and northward to the
Saskatchewan River The Saskatchewan River (Cree: ''kisiskāciwani-sīpiy'', "swift flowing river") is a major river in Canada. It stretches about from where it is formed by the joining together of the North Saskatchewan and South Saskatchewan Rivers to Lake Winn ...
. According to David Thompson's account, the first to hear of the disease were fur traders from the Hudson's House on October 15, 1781. A week later, reports were made to William Walker and
William Tomison William Tomison was a Scottish fur trader who helped found and build a number of trading posts for the Hudson Bay Company such as the Edmonton House. He was involved in the fur trade for over thirty years, during which time he served in York Fact ...
, who were in charge of the Hudson and Cumberland
Hudson's Bay Company The Hudson's Bay Company (HBC; french: Compagnie de la Baie d'Hudson) is a Canadian retail business group. A fur trade, fur trading business for much of its existence, HBC now owns and operates retail stores in Canada. The company's namesake b ...
posts. By February, the disease spread as far as the Basquia Tribe. Smallpox attacked whole tribes and left few survivors. E. E. Rich described the epidemic by saying that "Families lay unburied in their tents while the few survivors fled, to spread the disease." After reading Tomison's journals, Houston and Houston calculated that, of the Indians who traded at the Hudson and Cumberland houses, 95% died of smallpox. Paul Hackett adds to the mortality numbers suggesting that perhaps up to one half to three quarters of the Ojibway situated west of the Grand Portage died from the disease. The
Cree The Cree ( cr, néhinaw, script=Latn, , etc.; french: link=no, Cri) are a North American Indigenous people. They live primarily in Canada, where they form one of the country's largest First Nations. In Canada, over 350,000 people are Cree or ...
also suffered a casualty rate of approximately 75% with similar effects found in the Lowland Cree. By 1785 the Sioux Indians of the great plains had also been affected. Not only did smallpox devastate the
Indian Indian or Indians may refer to: Peoples South Asia * Indian people, people of Indian nationality, or people who have an Indian ancestor ** Non-resident Indian, a citizen of India who has temporarily emigrated to another country * South Asia ...
population, it did so in an unforgiving way. William Walker described the epidemic stating that "the Indians reall Dying by this Distemper … lying Dead about the Barren Ground like a rotten sheep, their Tents left standing & the Wild beast Devouring them." In 1799, the physician Valentine Seaman administered the first smallpox vaccine in the United States. He gave his children a smallpox vaccination using a serum acquired from
Edward Jenner Edward Jenner, (17 May 1749 – 26 January 1823) was a British physician and scientist who pioneered the concept of vaccines, and created the smallpox vaccine, the world's first vaccine. The terms ''vaccine'' and ''vaccination'' are derived f ...
, the British physician who invented the vaccine from fluid taken from cowpox lesions. Though vaccines were misunderstood and mistrusted at the time, Seaman advocated their use and, in 1802, coordinated a free vaccination program for the poor in New York City. By 1832, the federal government of the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territo ...
established a
smallpox vaccination The smallpox vaccine is the first vaccine to be developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox ...
program for Native Americans. In 1900 starting in New York City, smallpox reared its head once again and started a sociopolitical battle with lines drawn between the rich and poor, white and black. In populations of railroad and migrant workers who traveled from city to city the disease had reached an endemic low boil. This fact did not bother the government at the time, nor did it spur them to action. Despite the general acceptance of the
germ theory of disease The germ theory of disease is the currently accepted scientific theory for many diseases. It states that microorganisms known as pathogens or "germs" can lead to disease. These small organisms, too small to be seen without magnification, invade ...
, pioneered by
John Snow John Snow (15 March 1813 – 16 June 1858) was an English physician and a leader in the development of anaesthesia and medical hygiene. He is considered one of the founders of modern epidemiology, in part because of his work in tracing the so ...
in 1849, smallpox was still thought to be mostly a malady that followed the less-distinct guidelines of a "filth" disease, and therefore would only affect the "lower classes". The last major smallpox epidemic in the United States occurred in
Boston Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- most p ...
,
Massachusetts Massachusetts (Massachusett language, Massachusett: ''Muhsachuweesut assachusett writing systems, məhswatʃəwiːsət'' English: , ), officially the Commonwealth of Massachusetts, is the most populous U.S. state, state in the New England ...
throughout a three-year period, between 1901 and 1903. During this three-year period, 1596 cases of the disease occurred throughout the city. Of those cases, nearly 300 people died. As a whole, the epidemic had a 17% fatality rate. Those who were infected with the disease were detained in quarantine facilities in the hopes of protecting others from getting sick. These quarantine facilities, or pesthouses, were mostly located on Southampton Street. As the outbreak worsened, men were also moved to hospitals on Gallop's Island. Women and children were primarily sent to Southampton Street. Smallpox patients were not allowed in regular hospital facilities throughout the city, for fear the sickness would spread among the already sick. A reflection of the previous outbreak that occurred in New York, the poor and homeless were blamed for the sickness's spread. In response to this belief, the city instructed teams of physicians to vaccinate anyone living in inexpensive housing. In an effort to control the outbreak, the Boston Board of Health began voluntary vaccination programs. Individuals could receive free vaccines at their workplaces or at different stations set up throughout the city. By the end of 1901, some 40,000 of the city's residents had received a smallpox vaccine. However, despite the city's efforts, the epidemic continued to grow. In January 1902, a door-to-door vaccination program was initiated. Health officials were instructed to compel individuals to receive vaccination, pay a $5 fine, or face 15 days in prison. This door-to-door program was met by some resistance as some individuals feared the vaccines to be unsafe and ineffective. Others felt compulsory vaccination in itself was a problem that violated an individual's civil liberties. This program of compulsory vaccination eventually led to the famous ''
Jacobson v. Massachusetts ''Jacobson v. Massachusetts'', 197 U.S. 11 (1905), was a United States Supreme Court case in which the Court upheld the authority of states to enforce compulsory vaccination laws. The Court's decision articulated the view that individual liberty ...
'' case. The case was the result of a
Cambridge Cambridge ( ) is a university city and the county town in Cambridgeshire, England. It is located on the River Cam approximately north of London. As of the 2021 United Kingdom census, the population of Cambridge was 145,700. Cambridge becam ...
resident's refusal to be vaccinated. Henning Jacobson, a Swedish immigrant, refused vaccination out of fear it would cause him illness. He claimed a previous smallpox vaccine had made him sick as a child. Rather than pay the five dollar fine, he challenged the state's authority on forcing people to receive vaccination. His case was lost at the state level, but Jacobson appealed the ruling, and so, the case was taken up by the Supreme Court. In 1905 the
Supreme Court A supreme court is the highest court within the hierarchy of courts in most legal jurisdictions. Other descriptions for such courts include court of last resort, apex court, and high (or final) court of appeal. Broadly speaking, the decisions of ...
upheld the Massachusetts law: it was ruled Jacobson could not refuse the mandatory vaccination. In Canada, between 1702 and 1703, nearly a quarter of the population of Quebec city died due to a smallpox epidemic.


Pacific epidemics


Island South East Asia

There is evidence that smallpox reached the Philippine islands from the 4th century onwards – linked possibly to contact between South East Asians and Indian traders.Victor T. King, 1998, ''Environmental Challenges in South-East Asia'', London/New York, Routledge, pp. 78–79. During the 18th century, there were many major outbreaks of smallpox, driven possibly by increasing contact with European colonists and traders. There were epidemics, for instance, in the
Sultanate of Banjar Sultanate of Banjar or Sultanate of Banjarmasin ( Banjar: كسلطانن بنجر, Kasultanan Banjar) was a sultanate located in what is today the South Kalimantan Province of Indonesia. For most of its history, its capital was at Banjarmas ...
(South Kalimantan), in 1734, 1750–51, 1764–65 and 1778–79; in the Sultanate of Tidore (Moluccas ) during the 1720s, and in southern
Sumatra Sumatra is one of the Sunda Islands of western Indonesia. It is the largest island that is fully within Indonesian territory, as well as the sixth-largest island in the world at 473,481 km2 (182,812 mi.2), not including adjacent is ...
during the 1750s, the 1770s and in 1786.


Australia

Smallpox was externally brought to Australia. The first recorded outbreak, in April 1789, about 16 months after the arrival of the
First Fleet The First Fleet was a fleet of 11 ships that brought the first European and African settlers to Australia. It was made up of two Royal Navy vessels, three store ships and six convict transports. On 13 May 1787 the fleet under the command o ...
, devastated the Aboriginal population. Governor
Arthur Phillip Admiral Arthur Phillip (11 October 1738 – 31 August 1814) was a British Royal Navy officer who served as the first governor of the Colony of New South Wales. Phillip was educated at Greenwich Hospital School from June 1751 until ...
said that about half of the Aboriginal people living around
Sydney Cove Sydney Cove (Eora: ) is a bay on the southern shore of Sydney Harbour, one of several harbours in Port Jackson, on the coast of Sydney, New South Wales. Sydney Cove is a focal point for community celebrations, due to its central Sydney locatio ...
died during the outbreak. Some later estimates have been higher, though precise figures are hard to determine, and Professors Carmody and Hunter argued in 2014 that the figure was more like 30%. There is an ongoing debate, with links to the "History wars", concerning two main rival theories about how smallpox first entered the continent. (Another hypothesis suggested that the French brought it in 1788, but the timeline does not fit.) The central hypotheses of these theories suggest that smallpox was transmitted to
Indigenous Australians Indigenous Australians or Australian First Nations are people with familial heritage from, and membership in, the ethnic groups that lived in Australia before British colonisation. They consist of two distinct groups: the Aboriginal peoples ...
by either: * the First Fleet of British settlers to arrive in the Colony of New South Wales, who arrived in January 1788 (whether deliberately or accidentally); or * Makassan mariners visiting northern Australia. In 1914, Dr J. H. L. Cumpston, director of the Australian Quarantine Service tentatively put forward the hypothesis that smallpox arrived with British settlers.Cumpston, JHL "The History of Small-Pox in Australia 1788–1908", Government Printer (1914) Melb. Cumpston's theory was most forcefully reiterated by the economic historian Noel Butlin, in his book ''Our Original Aggression'' (1983). Likewise David Day, in ''Claiming a Continent: A New History of Australia'' (2001), suggested that members of Sydney's garrison of
Royal Marines The Corps of Royal Marines (RM), also known as the Royal Marines Commandos, are the UK's special operations capable commando force, amphibious light infantry and also one of the five fighting arms of the Royal Navy. The Corps of Royal Marine ...
may have attempted to use smallpox as a biological weapon in 1789. However, in 2002, historian John Connor stated that Day's theory was "unsustainable". That same year, theories that smallpox was introduced with settlers, deliberately or otherwise, were contested in a full-length book by historian
Judy Campbell Judy Campbell (born Judith Mary Gamble; 31 May 1916 – 6 June 2004) was an English film, television and stage actress, widely known to be Noël Coward's muse. Her daughter is the actress and singer Jane Birkin, her son the screenwriter and dir ...
: ''Invisible Invaders: Smallpox and Other Diseases in Aboriginal Australia 1780-1880'' (2002). Campbell consulted, during the writing of her book,
Frank Fenner Frank John Fenner (21 December 1914 – 22 November 2010) was an Australian scientist with a distinguished career in the field of virology. His two greatest achievements are cited as overseeing the eradication of smallpox, and the attempted con ...
, who had overseen the final stages of a successful campaign by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) to eradicate smallpox. Campbell argued that scientific evidence concerning the viability of variolous matter (used for inoculation) did not support the possibility of the disease being brought to Australia on the long voyage from Europe. Campbell also noted that there was no evidence of Aboriginal people ever having been exposed to the variolous matter, merely speculation that they may have been. Later authors, such as Christopher Warren, and Craig Mear continued to argue that smallpox emanated from the importation of variolous matter on the First Fleet. Warren (2007) suggested that Campbell had erred in assuming that high temperatures would have sterilised the British supply of smallpox. H. A. Willis (2010), in a survey of the literature discussed above, endorsed Campbell's argument. In response, Warren (2011) suggested that Willis had not taken into account research on how heat affects the smallpox virus, cited by the
WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book ''Horton Hear ...
. Willis (2011) replied that his position was supported by a closer reading of Frank Fenner's report to the WHO (1988) and invited readers to consult that report online. The rival hypothesis, that the 1789 outbreak was introduced to Australia by visitors from
Makassar Makassar (, mak, ᨆᨀᨔᨑ, Mangkasara’, ) is the capital of the Indonesian province of South Sulawesi. It is the largest city in the region of Eastern Indonesia and the country's fifth-largest urban center after Jakarta, Surabaya, Meda ...
, came to prominence in 2002, with Judy Campbell's book ''Invisible Invaders''. Campbell expanded upon the opinion of C. C. Macknight (1986), an authority on the interaction between indigenous Australians and Makassans. Citing the scientific opinion of Fenner (who wrote the foreword to her book) and historical documents, Campbell argued that the 1789 outbreak was introduced to Australia by Makassans, from where it spread overland.Campbell, Judy; 2002, ''Invisible Invaders: Smallpox and Other Diseases in Aboriginal Australia 1780–1880'', Carlton, Melbourne University Press, pp60–2, 80–1, 194–6, 201, 216–7 Nevertheless, Michael Bennett in a 2009 article in ''Bulletin of the History of Medicine'', argued that imported "variolous matter" may have been the source of the 1789 epidemic in Australia. In 2011, Macknight re-entered the debate, declaring: "The overwhelming probability must be that it mallpoxwas introduced, like the later epidemics, by akassantrepangers on the north coast and spread across the continent to arrive in Sydney quite independently of the new settlement there". Warren (2013) disputed this, on the grounds that: there was no suitable smallpox in Makassar before 1789; there were no trade routes suitable for transmission to
Port Jackson Port Jackson, consisting of the waters of Sydney Harbour, Middle Harbour, North Harbour and the Lane Cove and Parramatta Rivers, is the ria or natural harbour of Sydney, New South Wales, Australia. The harbour is an inlet of the Tasman Sea ( ...
; the theory of a Makassan source for smallpox in 1789 was contradicted by Aboriginal
oral tradition Oral tradition, or oral lore, is a form of human communication wherein knowledge, art, ideas and cultural material is received, preserved, and transmitted orally from one generation to another. Vansina, Jan: ''Oral Tradition as History'' (1985 ...
; and, the earliest point at which there was evidence of smallpox entering Australia with Makassan visitors was around 1824.
Public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
expert Mark Wenitong, a
Kabi Kabi The Gubbi Gubbi people also known as Kabi Kabi are an Aboriginal Australian people native to south-eastern Queensland. They are now classified as one of several Murri language groups in Queensland. Naming As is often the case, ethnonyms dist ...
man, and John Maynard, Emeritus professor of Aboriginal History at the University of Newcastle agree that this is highly unlikely, with the added obstacle of very low population density between the north coast and Sydney Cove. A quite separate third theory, endorsed by the pathologist Dr G.E. Ford, with support from the academics Curson, Wright and Hunter, holds that the deadly disease was not smallpox but the far more infectious chickenpox, to which the Eora Aboriginal peoples had no resistance. John Carmody, then at the
University of Sydney The University of Sydney (USYD), also known as Sydney University, or informally Sydney Uni, is a public research university located in Sydney, Australia. Founded in 1850, it is the oldest university in Australia and is one of the country's six ...
School of Medical Sciences, suggested in 2010 that the epidemic was far more likely to have been
chickenpox Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...
, as none of the European colonists were threatened by it, as he would have expected to happen. However Wenitong and Maynard continue to believe that there is strong evidence that it was smallpox. Another major outbreak was observed in 1828–30, near
Bathurst, New South Wales Bathurst () is a city in the Central Tablelands of New South Wales, Australia. Bathurst is about 200 kilometres (120 mi) west-northwest of Sydney and is the seat of the Bathurst Regional Council. Bathurst is the oldest inland settlement in ...
. A third epidemic occurred in the
Northern Territory The Northern Territory (commonly abbreviated as NT; formally the Northern Territory of Australia) is an Australian territory in the central and central northern regions of Australia. The Northern Territory shares its borders with Western Aus ...
and northern Western Australia from the mid-1860s, until at least 1870.


Polynesia

Elsewhere in the Pacific, smallpox killed many indigenous Polynesians. Nevertheless,
Alfred Crosby Alfred W. Crosby Jr. (January 15, 1931 – March 14, 2018) was professor of History, Geography, and American Studies at the University of Texas at Austin, and University of Helsinki. He was the author of books including ''The Columbian Exchange' ...
, in his major work, '' Ecological Imperialism: The Biological Expansion of Europe, 900-1900'' (1986) showed that in 1840 a ship with smallpox on it was successfully quarantined, preventing an epidemic amongst
Māori Māori or Maori can refer to: Relating to the Māori people * Māori people of New Zealand, or members of that group * Māori language, the language of the Māori people of New Zealand * Māori culture * Cook Islanders, the Māori people of the Co ...
of
New Zealand New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island country ...
. The only major outbreak in New Zealand was a 1913 epidemic, which affected Māori in northern New Zealand and nearly wiped out the
Rapa Nui Easter Island ( rap, Rapa Nui; es, Isla de Pascua) is an island and special territory of Chile in the southeastern Pacific Ocean, at the southeasternmost point of the Polynesian Triangle in Oceania. The island is most famous for its nearly ...
of
Easter Island Easter Island ( rap, Rapa Nui; es, Isla de Pascua) is an island and special territory of Chile in the southeastern Pacific Ocean, at the southeasternmost point of the Polynesian Triangle in Oceania. The island is most famous for its nearly ...
(''Rapa Nui''), was reported by Te Rangi Hiroa (Dr Peter Buck) to a medical congress in Melbourne in 1914.


Micronesia

The whaler ship ''Delta'' brought smallpox to the Micronesian island of
Pohnpei Pohnpei "upon (''pohn'') a stone altar (''pei'')" (formerly known as Ponape or Ascension, Proto-Chuukic-Pohnpeic: ''*Fawo ni pei)'' is an island of the Senyavin Islands which are part of the larger Caroline Islands group. It belongs to Pohnpei ...
on 28 February 1854. The
Pohnpeians The Micronesians or Micronesian peoples are various closely related ethnic groups native to Micronesia, a region of Oceania in the Pacific Ocean. They are a part of the Austronesian ethnolinguistic group, which has an Urheimat in Taiwan. Ethno ...
reacted by first feasting their offended spirits and then resorted hiding. The disease eventually wiped out more than half the island's population. The deaths of chiefs threw Pohnpeian society into disarray, and the people started blaming the God of the Christian missionaries. The Christian missionaries themselves saw the epidemic as God's punishment for the people and offered the natives inoculations, though often withheld such treatment from the priests. The epidemic abated in October 1854.


Eradication

Early in history, it was observed that those who had contracted smallpox once were never struck by the disease again. Thought to have been discovered by accident, it became known that those who contracted smallpox through a break in the skin in which smallpox matter was inserted received a less severe reaction than those who contracted it naturally. This realization led to the practice of purposely infecting people with matter from smallpox scabs in order to protect them later from a more severe reaction. This practice, known today as variolation, was first practiced in China in the 10th century. Methods of carrying out the procedure varied depending upon location. Variolation was the sole method of protection against smallpox other than quarantine until Edward Jenner's discovery of the inoculating abilities of
cowpox Cowpox is an infectious disease caused by the ''cowpox virus'' (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more ...
against the smallpox virus in 1796. Efforts to protect populations against smallpox by way of vaccination followed for centuries after Jenner's discovery. Smallpox has since been completely eradicated since 1979, because of the mass vaccination efforts of the World Health Organization.


Variolation

The word variolation is synonymous with inoculation, insertion, en-grafting, or transplantation. The term is used to define insertion of smallpox matter, and distinguishes this procedure from vaccination, where cowpox matter was used to obtain a much milder reaction among patients.


Asia

The practice of variolation (also known as
inoculation Inoculation is the act of implanting a pathogen or other microorganism. It may refer to methods of artificially inducing immunity against various infectious diseases, or it may be used to describe the spreading of disease, as in "self-inoculati ...
) first came out of East Asia.U.S. National Library of Medicine. "Variolation". Accessed October 29, 2012. www.nlm.nih.gov/exhibition/smallpox/sp_variolation.html First writings documenting variolation in China appear around 1500. Scabs from smallpox victims who had the disease in its mild form would be selected, and the powder was kept close to body temperature by means of keeping it close to the chest, killing the majority of the virus and resulting in a more mild case of smallpox. Scabs were generally used when a month old, but could be used more quickly in hot weather (15–20 days), and slower in winter (50 days). The process was carried out by taking eight smallpox scabs and crushing them in a mortar with two grains of ''
Uvularia grandiflora ''Uvularia grandiflora'', the large-flowered bellwort or merrybells, is a species of flowering plant in the family Colchicaceae, native to eastern and central North America. Description Growing to tall by broad, it is a rhizomatous herbaceou ...
'' in a mortar. The powder was administered nasally through a silver tube that was curved at its point, through the right nostril for boys and the left nostril for girls. A week after the procedure, those variolated would start to produce symptoms of smallpox, and recovery was guaranteed. In India, where the European colonizers came across variolation in the 17th century, a large, sharp needle was dipped into the pus collected from mature smallpox sores. Several punctures with this needle were made either below the deltoid muscle or in the forehead, and then were covered with a paste made from boiled rice. Variolation spread farther from India to other countries in south west Asia, and then to the Balkans.


Europe

In 1713,
Lady Mary Wortley Montagu Lady Mary Wortley Montagu (née Pierrepont; 15 May 168921 August 1762) was an English aristocrat, writer, and poet. Born in 1689, Lady Mary spent her early life in England. In 1712, Lady Mary married Edward Wortley Montagu, who later served a ...
's brother died of smallpox; she too contracted the virus two years later at the age of twenty-six, leaving her badly scarred. When her husband was made ambassador to
Ottoman Empire The Ottoman Empire, * ; is an archaic version. The definite article forms and were synonymous * and el, Оθωμανική Αυτοκρατορία, Othōmanikē Avtokratoria, label=none * info page on book at Martin Luther University) ...
, she accompanied him to Constantinople. It was here that Lady Mary first came upon variolation. Two Greek women made it their business to engraft people with pox that left them un-scarred and unable to catch the pox again. In a letter, she wrote that she intended to have her own son undergo the process and would try to bring variolation into fashion in England.Halsal, Paul. "Modern History Sourcebook: Lady Mary Wortley Montagu (1689–1762): Smallpox Vaccination in Turkey." Fordham University. Accessed October 29, 2012. www.fordham.edu/halsall/mod/montagu-smallpox.asp Her son underwent the procedure, which was performed by Charles Maitland, and survived with no ill effects. When an epidemic broke out in London following her return, Lady Mary wanted to protect her daughter from the virus by having her variolated as well. Maitland performed the procedure, which was a success. The story made it to the newspapers and was a topic for discussion in London salons. Princess Caroline of Wales wanted her children variolated as well but first wanted more validation of the operation. She had both an orphanage and several convicts variolated before she was convinced. When the operation, performed by the King's surgeon, Claudius Amyand, and overseen by Maitland,Glynn, Ian and Jennifer Glynn. ''The Life and Death of Smallpox.'' New York: Cambridge University Press, 2004. was a success, variolation got the royal seal of approval and the practice became widespread. When the practice of variolation set off local
epidemics An epidemic (from Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time. Epidemics of infectious d ...
and caused death in two cases, public reaction was severe. Minister Edmund Massey, in 1772, called variolation dangerous and sinful, saying that people should handle the disease as the biblical figure Job did with his own tribulations, without interfering with God's test for mankind. Lady Mary still worked at promoting variolation but its practice waned until 1743. Robert and Daniel Sutton further revived the practice of variolation in England by advertising their perfect variolation record, maintained by selecting patients who were healthy when variolated and were cared for during the procedure in the Sutton's own hygienic hospital. Other changes that the Suttons made to carrying out the variolation process include reducing and later abolishing the preparatory period before variolation was carried out, making more shallow incisions to distribute the smallpox matter, using smallpox matter collected on the fourth day of the disease, where the pus taken was still clear, and recommending that those inoculated get fresh air during recovery. The introduction of the shallower incision reduced both complications associated with the procedure and the severity of the reaction.Hopkins, Donald R. ''The Greatest Killer: Smallpox in History.'' Chicago: The University of Chicago Press, 2002. The prescription of fresh air caused controversy about Sutton's method and how effective it was in reality when those inoculated could walk about and spread the disease to those that had never before experienced smallpox. It was the Suttons who introduced the idea of mass variolation of an area when an epidemic broke out as means of protection to the inhabitants in that location. News of variolation spread to the royal families of Europe. Several royal families had themselves variolated by English physicians claiming to be specialists. Recipients include the family of
Louis XV Louis XV (15 February 1710 – 10 May 1774), known as Louis the Beloved (french: le Bien-Aimé), was King of France from 1 September 1715 until his death in 1774. He succeeded his great-grandfather Louis XIV at the age of five. Until he reached ...
following his own death of smallpox, and
Catherine the Great , en, Catherine Alexeievna Romanova, link=yes , house = , father = Christian August, Prince of Anhalt-Zerbst , mother = Joanna Elisabeth of Holstein-Gottorp , birth_date = , birth_name = Princess Sophie of Anha ...
, whose husband had been horribly disfigured by the disease. Catherine the Great was variolated by Thomas Dimsdale, who followed Sutton's method of inoculation. In France, the practice was sanctioned until an epidemic was traced back to an
inoculation Inoculation is the act of implanting a pathogen or other microorganism. It may refer to methods of artificially inducing immunity against various infectious diseases, or it may be used to describe the spreading of disease, as in "self-inoculati ...
. After this instance, variolation was banned within city limits. These conditions caused physicians to move just outside the cities and continue to practice variolation in the suburbs.


=Edward Jenner

=
Edward Jenner Edward Jenner, (17 May 1749 – 26 January 1823) was a British physician and scientist who pioneered the concept of vaccines, and created the smallpox vaccine, the world's first vaccine. The terms ''vaccine'' and ''vaccination'' are derived f ...
was variolated in 1756 at age eight in an inoculation barn in
Wotton-under-Edge Wotton-under-Edge is a market town within the Stroud district of Gloucestershire, England. Located near the southern fringe of the Cotswolds, the Cotswold Way long-distance footpath passes through the town. Standing on the B4058, Wotton is abo ...
, England. At this time, in preparation for variolation children were bled repeatedly and were given very little to eat and only given a diet drink made to sweeten their blood. This greatly weakened the children before the actual procedure was given. Jenner's own inoculation was administered by a Mr. Holbrow, an apothecary. The procedure involved scratching the arm with the tip of a knife, placing several
smallpox Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) cer ...
scabs in the cuts and then bandaging the arm. After receiving the procedure, the children stayed in the barn for several weeks to recover. First symptoms occurred after one week and usually cleared up three days later. On average, it took a month to fully recover from the encounter with smallpox combined with weakness from the preceding starvation. At the age of thirteen, Jenner was sent to study medicine in
Chipping Sodbury Chipping Sodbury is a market town and former civil parish, now in the parish of Sodbury, in the unitary authority area of South Gloucestershire, in the ceremonial county of Gloucestershire, England. It was founded in the 12th century by William ...
with Daniel Ludlow, a surgeon and apothecary, from 1762 to 1770The UCLA Louise M. Darling Biomedical Library History and Special Collections Division. "Smallpox: an online exhibit". Accessed October 29, 2012. Unitproj.library.ucla.edu/biomed/his/smallpox/jenner.html who had a strong sense of cleanliness which Jenner learned from him. During his apprenticeship, Jenner heard that upon contracting
cowpox Cowpox is an infectious disease caused by the ''cowpox virus'' (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more ...
, the recipient became immune to smallpox for the remainder of their life. However, this theory was dismissed because of several cases proving that the opposite was true. After learning all he could from Ludlow, Jenner apprenticed with John Hunter in London from 1770 to 1773. Hunter was a correspondent of Ludlow's, and it is likely that Ludlow recommended Jenner to apprentice with Hunter. Hunter believed in deviating from the accepted treatment and trying new methods if the traditional methods failed. This was considered unconventional medicine at the time and had a pivotal role in Jenner's development as a scientist. After two years of apprenticeship, Jenner moved back to his hometown of Berkeley in Gloucestershire, where he quickly gained the respect of both his patients and other medical professionals for his work as a physician. It was during this time that Jenner revisited the connection between cowpox and smallpox. He began investigating dairy farms in the Gloucestershire area looking for cowpox. This research was slow going as Jenner often had to wait months or even years before cases of cowpox would again return to the Gloucestershire area. During his study, he found that cowpox was actually several diseases that were similar in nature but were distinguishable through slight differences, and that not all versions had the capacity to make one immune from smallpox upon contraction. Through his study, he incorrectly deduced that smallpox and cowpox were all the same disease, simply manifesting themselves differently in different animals, eventually setting back his research and making it difficult to publish his findings. Though Jenner had seen cases of people becoming immune to smallpox after having cowpox, too many exceptions of people still contracting smallpox after having had cowpox were arising. Jenner was missing crucial information which he later discovered in 1796. Jenner hypothesized that in order to become immune to smallpox using cowpox, the matter from the cowpox pustules must be administered at maximum potency; else it was too weak to be effective in creating immunity to smallpox. He deduced that cowpox was most likely to transfer immunity from smallpox if administered at the eighth day of the disease. On May 14, 1796, he performed an experiment in which he took pus from a sore of a cowpox-infected milkmaid named Sarah Nelmes, and applied it to a few small scratches on the arm of an eight-year-old boy who had never before contracted either smallpox or cowpox, named
James Phipps James Phipps (1788 – 1853) was the first person given the experimental cowpox vaccine by Edward Jenner. Jenner knew of a local belief that dairy workers who had contracted a relatively mild infection called cowpox were immune to smallpox, an ...
. Phipps recovered as expected. Two months later, Jenner repeated the procedure using matter from smallpox, observing no effect. Phipps became the first person to become immune to smallpox without ever actually having the disease. He was variolated many more times over the course of his life to prove his immunity. When the next cowpox epidemic broke out in 1798, Jenner conducted a series of inoculations using cowpox, all of them successful including on his own son Robert. Because his findings were revolutionary and lacked in evidence, the
Royal Society The Royal Society, formally The Royal Society of London for Improving Natural Knowledge, is a learned society and the United Kingdom's national academy of sciences. The society fulfils a number of roles: promoting science and its benefits, re ...
(of which Jenner was a member) refused to publish his findings. Jenner then rode to London and had his book ''An Inquiry into the Causes and Effects of the Variolæ Vaccinæ'' published by Sampson Low's firm in June 1798. The book was an instant bestseller among the elite in London salons, in the medical establishment and among the ladies and gentlemen of the enlightenment. Knowledge of the ability of cowpox to provide immunity from smallpox was present in England before Jenner's discovery. In 1774, a cattle dealer named
Benjamin Jesty Benjamin Jesty (c. 1736 – 16 April 1816) was a farmer at Yetminster in Dorset, England, notable for his early experiment in inducing immunity against smallpox using cowpox. The notion that those people infected with cowpox, a relatively mild ...
had successfully inoculated his wife and three sons using cowpox. This was before Jenner discovered the immunization capabilities of cowpox. However, Jesty simply performed the procedure; he did not take the discovery any further by inoculating his family with smallpox matter to see if there would be a reaction or perform any other trials. Jenner was the first to prove the effectiveness of vaccination with cowpox using scientific experimentation.


United States

Benjamin Franklin Benjamin Franklin ( April 17, 1790) was an American polymath who was active as a writer, scientist, inventor, statesman, diplomat, printer, publisher, and political philosopher. Encyclopædia Britannica, Wood, 2021 Among the leading intel ...
, who had lost his own son to smallpox in 1736, made the suggestion to create a pamphlet to distribute to families explaining how to inoculate their children themselves, so as to eliminate cost as the factor in the decision to choose to inoculate children.
William Heberden William Heberden FRS (13 August 171017 May 1801) was an English physician. Life He was born in London, where he received the early part of his education at St Saviour's Grammar School. Full text at Internet Archive (archive.org) At the end of ...
, a friend of Franklin's and an English physician, followed through with Franklin's idea, printing 2000 pamphlets in 1759 which were distributed by Franklin in America. An American physician, John Kirkpatrick, upon his visit to London in 1743, told of an instance where variolation stopped an epidemic in
Charleston, South Carolina Charleston is the largest city in the U.S. state of South Carolina, the county seat of Charleston County, and the principal city in the Charleston–North Charleston metropolitan area. The city lies just south of the geographical midpoint ...
, in 1738,McCandless, Peter. ''Slavery, Disease, and Suffering in the Southern Lowcountry.'' New York: Cambridge University Press, 2011 where 800 people were inoculated and only eight deaths occurred. His account of the success of variolation in Charleston helped to play a role in the revival of its practice in London. Kirkpatrick also advocated inoculating patients with matter from the sores of another inoculated person, instead of using matter from the sore of a smallpox victim, a procedure that Maitland had been using since 1722.


Historical relationship to related viruses

Taterapox (which infects rodents) and
camelpox Camelpox is a disease of camels caused by the camelpox virus (CMPV) of the family ''Poxviridae'', subfamily ''Chordopoxvirinae'', and the genus ''Orthopoxvirus''. It causes skin lesions and a generalized infection. Approximately 25% of young ca ...
are the closest relatives to smallpox, and share the same common ancestor with smallpox about 4,000 years ago. It is not clear exactly when during this period
Variola Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) cer ...
first infected humans.
Cowpox Cowpox is an infectious disease caused by the ''cowpox virus'' (CPXV). It presents with large blisters in the skin, a fever and swollen glands, historically typically following contact with an infected cow, though in the last several decades more ...
, horsepox, and
monkeypox Monkeypox (also called mpox by the WHO) is an infectious viral disease that can occur in humans and some other animals. Symptoms include fever, swollen lymph nodes, and a rash that forms blisters and then crusts over. The time from exposure ...
are more distantly related. All of these viruses share a common ancestor about 10,000 years ago. All of these viruses belong to the genus
Orthopoxvirus ''Orthopoxvirus'' is a genus of viruses in the family ''Poxviridae'' and subfamily ''Chordopoxvirinae''. Vertebrates, including mammals and humans, and arthropods serve as natural hosts. There are 12 species in this genus. Diseases associated wi ...
.


References


Further reading

* * * "Hugh Walker and North Carolina's 'Smallpox Currency' of 1779", R. Neil Fulghum. ''The Colonial Newsletter'', a research journal of the
American Numismatic Society The American Numismatic Society (ANS) is a New York City-based organization dedicated to the study of coins, money, medals, tokens, and related objects. Founded in 1858, it is the only American museum devoted exclusively to their preservation ...
, New York. December 2005, pp. 2895–2934. * *


External links


Inoculation for the Small-Pox defended
��1750 article from ''
Gentleman's Magazine ''The Gentleman's Magazine'' was a monthly magazine founded in London, England, by Edward Cave in January 1731. It ran uninterrupted for almost 200 years, until 1922. It was the first to use the term ''magazine'' (from the French ''magazine'' ...
''
"Why Blame Smallpox?: The Death of the Inca Huayna Capac and the Demographic Destruction of Tawantinsuyu (Ancient Peru)"
Revisionist argument regarding smallpox in 16th-century Peru
History of Smallpox in South Asia
{{DEFAULTSORT:History Of Smallpox
Smallpox Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) cer ...
Smallpox