Skin Diseases

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CHAPTER 6

Smallpox: A Primer
Brenda J. McEleney

Smallpox, is a virus that plagued humanity for millennia. It was the first and only disease ever intentionally eradicated from the face of this planet, a scourge defeated in a remarkable, never-before-attempted campaign of generosity and cooperation by the nations of the world. Its eradication was a triumphant symbol of science and dogged persistence winning over nature. Moreover, its eradication was a gift of man to all mankind. Yet, is it possible that the same hand of man, that once rid the scourge of smallpox from the world, will be used to unleash this terror again on its unprotected citizens? This chapter, by providing a thorough review of the history, epidemiology, and current risks associated with this dreaded disease, addresses that question and its implications for the American public.

Origins of Smallpox
Smallpox has been described as one of the great scourges of mankind.1 Every corner of the world has felt its grip and known its devastation. Historians speculate that smallpox first appeared around 10,000 B.C. in the agricultural settlements in northeastern Africa. From there, it probably spread to India via Egyptian merchants. There is evidence smallpox is at least 3,000 years old. It was known in China as early as 1122 B.C. Its scars have been found on the mummy of Pharaoh Ramses V, who died in 1157 B.C., as well as on other mummies from the 18th and 20th Egyptian dynasties.2,3

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Smallpox: A Primer

The first known smallpox epidemic was recorded in 1350 B.C. During the Egyptian-Hittite war that year, Egyptian prisoners unwittingly spread smallpox to the Hittites. Even the Hittite King Suppiluliumus I and his heir fell victim to the virus. It devastated their civilization and assured the Egyptians victory.4 Records also show the ancients recognized subsequent immunity in those who survived the disease. Thucydidus noted this curiosity during the Athenian epidemic in 430 B.C. Rhazes, considered the greatest physician of Islam and the Medieval Ages, likewise documented postinfection immunity in 910 A.D., when he recorded the first known medical description of smallpox and its transmission.5 Insidiously, smallpox made its way around the world leaving devastation in its wake. The Crusades, the expansion of the Arab world, and the colonization of the Americas—wherever an infected individual came in contact with peoples previously unexposed—contributed to the spread of smallpox. Smallpox reached Europe in the 5th century and was a leading cause of death in the 16th and 17th centuries. It affected everyone, regardless of age, sex, or socioeconomic status. The commoners of Europe were hit particularly hard. An estimated 400,000 died from smallpox every year during the 18th century. One third of the survivors were scarred and many were blinded.6 In the 1500s, the Spanish and Portuguese transported the disease to the New World, which decimated the Aztec and Inca populations in Mexico and South America. Likewise in North America, European colonizers carried the smallpox virus that devastated the native populations there. Sadly, the first documented use of smallpox as a weapon can be attributed to the British, who gave blankets contaminated with smallpox to troublesome Native American Indians in Quebec in the late 18th century to intentionally expose them to the virus.7 Not only common folk succumbed to smallpox. The famous and powerful who died from smallpox includes: Marcus Aurelius in A.D. 180; King Boranarja IV of Siam in 1534; William II of Orange in 1650; Emperor Gokomyo of Japan in 1654; Queen Mary II of England in 1694; King Nagassi of Ethiopia in 1700; Tsar Peter II of Russia in 1730; and, King Louis XV of France in 1774. It is said that President Lincoln was feverish with smallpox when he gave the Gettysburg address in 1863. Two days afterwards he broke out with the trademark rash.8, 9 142

McEleney

Epidemiology
Smallpox is a viral disease...
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