History of Small Pox

Running head: A HISTORY OF SMALLPOX INCLUDING ORIGIN 1

A History of Smallpox Including Origin,

Vaccination, Epidemics, and Eradication

Autumn Funderburg

Ohio University

A HISTORY OF SMALLPOX INCLUDING ORIGIN

Variola virus (VARV), otherwise known as smallpox, is a contagious disease

caused by a viral infection (Baker-Blocker, 2013). VARV has one distinct trait:

pathogenic specificity to humans; the variola virus is not susceptible to animals. It is

believed that smallpox first made an appearance in African agriculture around 10,000

B.C., evolving from a cowpox strain virus present on camels. This newly evolved strain

spread then to Egypt via traveling merchants (Hsu, 2013). It was in Egypt that the earliest

known lesions from smallpox were found on well-preserved Egyptian mummies;

specifically, the mummy was that of Ramses V. The virus spread to Europe and was

prominent in the Middle Ages (Stefan, 2005). Brought then to the Americas in the 1520s

by the Spanish conquistadors, it was deadly for the native populations of America

(Barnard, 2014).

The variola virus consists of two strains: variola major and variola minor. Variola

major is the lethal strain while variola minor is the milder form of the two strains that is

different genetically from the major strain. Smallpox can be spread via physical contact,

airborne droplets, and through contact with scabs carried on fabrics such as bedding,

towels, or clothing (Baker-Blocker, 2013). The incubation period for the virus is between

seven to seventeen days. Symptoms begin with common flulike headaches, muscle aches,

and vomiting. As the virus progresses, a rash forms on the skin, eyes, throat, and internal

organs (Barnard, 2014). The rash has four stages progressing from lesions (any damage

to tissue) to fluid-filled vesicles to pustules (small blisters that contain pus) to scabs

(Baker-Blocker, 2013). The lesions form on the face first, more often than not, and are

highly contagious. Smallpox will remain contagious until all the scabs have separated

from the skin; this stage usually leaves scars on the body. Smallpox may lead to serious

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complications that can include dehydration, blindness, scarring, sterility in men, and

death.

Before modern virology and the germ theory, it was thought that diseases were a

form of divine punishment. However, in the 18th century a scientific connection had been

established between smallpox and immunity. A smallpox epidemic occurred in Boston,

Massachusetts in 1721. It was during this epidemic in Boston that the correlation between

disease and public health was recognized in America. How smallpox spread was still

unknown leading to home quarantining and patient isolation (Kass, 2012). Streets were

cleaned, garbage was removed, and government regulations for incoming and outgoing

ships were enforced. While these regulations were helpful, it did not entirely stop the

spread of smallpox. Reverend Cotton Mather, a Harvard graduate with interest in science

and medicine, convinced Dr. Zabdiel Boylston to start a variolation program to stop the

spread of smallpox (Stefan, 2005). Variolation was simply the process of introducing pus

from a pustule off a smallpox victim to a non-immune person (Stefan, 2005). Mortality

rates dropped among those that had been inoculated, and the variolation program was

deemed successful. While this process did not originate in America, Boylston and Mather

helped to spread the process throughout all the colonies of New England.

Fast-forwarding to the American Revolution when a major epidemic occurred, yet

again, in Boston, Massachusetts. There was one issue with inoculation: those inoculated

suffered from the smallpox virus as though they had naturally acquired smallpox. This

meant that contagion was highly likely unless practiced under strict quarantine, making

inoculation highly controversial (Fenn, 2003). The disease was beginning to affect

healthy soldiers under George Washington. Smallpox had been endemic in England for

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sometime before the epidemics in New England therefore, the British soldiers were more

likely to be inoculated. Variolated British soldiers guarded war zones while non-

variolated American Soldiers were falling victims to defeat and to smallpox. It was after

this that George Washington required that all his soldiers be variolated before beginning

new military operations (Stefan, 2005). Beginning in the spring of 1977, American forces

went through inoculation at West Point, Morristown, Valley Forge, Alexandria,

Dumfries, and Fairfax (Fenn, 2003).

The disease quickly moved westward, attacking susceptible populations and then

South, striking Mexico City in 1779 (Fenn, 2003). This led to more southern travel down

into the South American Continent and back up into North America to Texas and New

Mexico leading to epidemics in 1780. These epidemics targeted not only revolutionary

troops, but Native American tribes as well. With Native American horse trade, the

disease made its way to Canada back down into Missouri. These epidemics lasted from

1776-1782.

Twelve years later, in the year 1794, Benjamin Jesty was one of the first to

recognize the connection between the cowpox virus and smallpox immunity. Jesty used

the pus of cowpox lesions found on the udders of dairy cows in an attempt to protect his

family from an outbreak of smallpox (Stefan, 2005). Using a lancet, he transferred the

pus from the udder lesions to the arms of his wife and two sons (Stefan, 2005). Jesty is

recognized as the first to vaccinate against smallpox; however, he did not follow the

vaccination with scientific evidence or trials. His vaccination was ill received after his

wife’s arm became badly infected from the cowpox inoculation. After physical and

verbal abuse from his local community, Jesty and his family moved away. Years later

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Jesty had his two sons variolated with the smallpox virus and no symptoms showed. This

validated Jesty’s theory, however for fear of more abuse from the local community, he

did not publicize his findings. (Jesty, 2010)

Following in the footsteps of Jesty, Edward Jenner experimented with

vaccinations against smallpox using cowpox material. After hearing tales of dairymaids

being naturally protected from smallpox after being exposed to cowpox, he made the

decision to utilize these cowpox lesions, similar to Jesty. The subject of vaccination was

an 8-year-old boy named James Phipps. Jenner used the pus from a cowpox lesion off the

hand of a dairymaid. The symptoms of the cowpox variolation caused mild fever and

discomfort and, after nine days, loss of appetite and a cold sweat. The next day there was

vast improvement and Phipps was no longer showing symptoms. Several months later,

Jenner performed the same inoculation procedure on Phipps using the pus from a

smallpox lesion and no disease developed. (Stefan, 2005) With the vaccination deemed

complete, he published a small booklet, An Inquiry into the Causes and Effects of the

Variolae Vaccinae, a disease discovered in some of the western counties of England,

particularly Gloucestershire and Known by the Name of Cow Pox, and was now in search

of more volunteers in which to perform his newly discovered vaccination. It was not easy

convincing the public, however, and many resisted vaccination. It was slandered by

powerful doctors of the time as unsafe and unnatural. Dr. Benjamin Mosely is considered

the leader of the anti-vaccination movement. Mosely performed inoculations and feared

that vaccinations would steal his source of income. He arranged political cartoons and

propaganda with rumors that people would transform into cows if they used Jenner’s

method. (Kean, 2013) Jenner fought back against the resistance with science. His

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dedication to the eradication of smallpox and scientific evidence credit him as the first to

successfully perform a purposeful vaccination in the year 1796. With the help and

support of surgeon Henry Cline, Dr. George Pearson, and Dr. William Woodville,

vaccination reached most European countries by 1800 (Stefan, 2005).

The vaccinations were effective, however, immunity was not life-long. It was

later discovered that immunity from the virus after vaccination is around 10 years

(Mackelprang, 2005). The cowpox strain was becoming weak the more it was used

because of ongoing passage. In 1896, Dr. Edward Ballard contributed an important factor

to Jenner’s vaccination discovery: to regain strength of and enhance the virus strain,

cowpox must be deliberately passed back into the calves. This allowed for mass

production of sufficient supplies of the cowpox material for vaccination. (Hsu, 2013)

While vaccination had been considered successful, it was slow to spread. It was in

short supply much of the time and hot climates proved difficult for storage of the vaccine.

Researchers developed a dried form of the smallpox vaccination in the 1920s, but its

quality was inconsistent. In 1949, freeze-drying was discovered to be an effective method

in sustaining the vaccine and was used commercially by 1954. The vaccine was now able

to withstand tropical climates without refrigeration, unlike the non-freeze-dried version,

and was able to last months. (PBS, 1998)

The first worldwide plan to abolish smallpox was formed by the World Health

Organization in 1948. At this point in time, there were still 90 countries with a smallpox

threat. Another worldwide plan to abolish smallpox was formed by the World Health

Organization in 1958. Neither plan was successful until the formation of the Smallpox

Eradication Programme in 1966. (PBS, 1998) At this point in time there were still an

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estimated 10 to 15 million cases of smallpox worldwide (Mackelprang, 2005). The

Smallpox Eradication Programme had a ten-year plan to combat the disease on a global

scale (WHO, 2010). Starting with the poorest countries, the program slowly but surely

continually helped to eradicate smallpox country by country. It is the first human

infection that has been completely eradicated by mankind (Jesty, 2010). The last three

cases of smallpox were reported in Somalia in 1977 and England in 1978 and, after a

150-year-old long journey, smallpox was declared officially eradicated by the World

Health Organization in 1980. (PBS, 1998)

In the event of a smallpox outbreak, the Advisory Committee on Immunization

Practices (ACIP) has recommended that there is one smallpox response team per state.

The team is a group of health professionals that provide care to patients with smallpox.

With a low risk of an epidemic, the general population generally does not receive the

smallpox vaccination. (Margolis, 2009) There are only two locations in the world that

have a sample of the smallpox virus. This includes the CDC in Atlanta and the Soviet

Union in Russia.

More recently, there has been the threat of using smallpox as a biological weapon

in an act of bioterrorism. Smallpox is one of the four main microorganisms that pose a

potential threat. Being the only viral threat, smallpox is unresponsive to antibiotics. The

other three potential threats are bacterial threats and include botulism, anthrax, and

plague; all are responsive to antibiotics. Because the general population is not vaccinated

it is susceptible to exposure from an attack if bioterrorism were to occur. While an

outbreak is unlikely, strategies have been created to respond to an intentional smallpox

release if one were to strike including approaches for a population-wide vaccination on

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first presentation of symptoms, a preemptive population vaccination, and a ring

vaccination. (Mackelprang, 2005)

“The speckled monster,” as it was once known, is one of the most historical

viruses to date. It led to the decline of many populations all over the world throughout its

years of endemics and epidemics. Despite its negative connotation, smallpox contributed

a great deal to the world of science with the help of Benjamin Jesty and Edward Jenner.

The discovery of variolation and vaccination opened doors for public health and the

prevention of many other diseases including polio, typhoid, hepatitis, and rubella.

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References

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Baker-Blocker, A.P. (2013). Smallpox. Magill’s Medical Guide (Online Edition).

Barnard, B. (2014). 7 Plagues That Changed History. New York Times Upfront, 147(3),

19-21.

Fenn, E 1. (2003). The Great Smallpox Epidemic of 1775-82. History Today, 53(6). 10-

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Hsu. J. L. (2013). A brief history of vaccines: smallpox to the present. South Dakota

Medicine: The Journal Of The South Dakota State Medical Association, Spec

no33-37.

Jesty, R., & Williams, G. (2011). Who invented vaccination?. Malta Medical Journal,

23(2), 1-5.

Kean, S. (2013). POX IN THE CITY. Humanities, 34(1), 34.

Mackelprang, R., Mackelprang, R., &Thirkill, A. (2005). Bioterrorism and smallpox:

policies, practices, and implications for social work. Social Work, 50(2), 119-127.

doi:10.1093/sw/50.2119

Margolis, A.R., & Grabenstein, J.D. (2009). Immunizations against bioterrorism:

smallpox and anthrax. Journal Of The American Pharmacists Association: Japha, 49(4),

566-568. doi:10.131/JAPhA.2009.09522

Morgan, A.J. (2013). Edward jenner and the discovery of vaccination—an appeal for the

Edward jenner museum. Vaccine,31(43), 4933-4934.

doi:http://dx.doi.org/10.1016/j.vaccine.2013.07.046.

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Smith, R.P. (2013). Lesions. Magill’s Medical Guide (Online Edition).

World Health Organization declares smallpox eradicated 1980. (1998, January 1).

Retrieved March, 29, 2015, from

http://www.pbs.org/wgbh/aso/databank/entries/dm79sp.html

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History of Small Pox

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