What is Smallpox?
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Smallpox is a highly contagious and often fatal disease unique to humans. It is caused by a virus called the ‘variola’ virus. ‘Variola’ is the Latin word for ‘spotted’ and refers to the small pus-filled blisters that appear on the face and body of an infected person.

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A cluster of variola virus particles as seen under an electron microscope. Smallpox was eradicated in a worldwide campaign thirty years ago. But for centuries, it was one of the most feared of all human diseases. It killed about thirty percent of the people it infected, and caused 300 million deaths worldwide in the 20th century alone.

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The origins of smallpox
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Not much is known about the origins of smallpox. Most likely it evolved from a virus affecting animals, such as cowpox, horsepox, or camelpox.

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(Right) Carving from the ancient Mesopotamian city of Nineveh, approx 1400BC
Scientists believe the virus made the leap from animals to humans in about 10,000BC, when the first farmers made settlements in the river valleys of Egypt, the Middle East, India and China.

From that point onwards, the smallpox virus only survived within the body of humans, passing in a chain of infection from the ancient world to the modern age.

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Smallpox in ancient history
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Classical writers describe epidemics of a sometimes-fatal disease that caused a rash across the body. This was probably smallpox, although it’s hard to be sure because ancient authors didn’t distinguish between similar diseases like smallpox and measles.

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(Right) Alexander the Great, whose troops were ravaged by smallpox during his march on India. (Mosaic found in the house of the faun, Pompeii)

Smallpox changed the fortunes of ancient civilizations. In 1350BC, Hittite armies were ravaged by smallpox caught from infected Egyptian prisoners of war. A thousand years later, the Carthaginian and Athenian empires suffered in their turn, and when Alexander the Great attempted to invade India in 327BC, his foot soldiers were struck down by a virulent and often fatal rash – almost certainly smallpox.

The disease entered China in about 250BC. The Chinese had built a wall to keep out the Huns, but it failed to keep out the virus they carried, and an “epidemic throughout the empire” followed.

Three to five days later, the characteristic rash developed, spreading from the face, hands and forearms to the rest of the body.

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Infection and Death
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Infection spread from person to person by inhalation (breathing), or via saliva or by touch. Infection was also possible via clothing and blankets, which meant you could catch the disease without direct contact with a smallpox victim.

Once in the body, the virus reproduced itself, creating tens of thousands of new viruses within every infected cell. After a 12-day incubation period the virus entered the bloodstream. At this point the victim noticed the early signs of the disease: headaches, vomiting and aching limbs.

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Edwin Davis, a smallpox patient during the Gloucester epidemic of 1896.

Three to five days later, the characteristic rash developed, spreading from the face, hands and forearms to the rest of the body. The rash became progressively more ugly until finally the victim’s body was covered with pustules oozing a straw-coloured liquid. Victims died when the spots become so numerous they overlapped and extended to the throat, causing the sufferer to choke; or when pneumonia set in; or when the scabs became poisonous with bacteria. It was a cruel disease, hideous to suffer and to watch.

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Smallpox arrives in Europe
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We don’t know exactly when smallpox reached Europe – but we know that ‘pox houses’ were built in the era of the Crusades, along the routes from Europe to the Holy Land. It’s likely that the movement of armies across Europe in these years hastened the spread of the disease.

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Constantine the African inspects samples of urine. Public domain Some historians believe smallpox in the medieval period was just a minor variant of the disease – a childhood illness like measles, but less severe. It certainly wasn’t feared like bubonic plague was feared. But in the two hundred years that followed the Black Death, smallpox grew more and more deadly. By the 16th century it was a major killer.Smallpox was ‘endemic’ throughout Europe – meaning it was a constant presence.

When the virus reached a dense population with low immunity, it became ‘epidemic’, and a major outbreak occurred. Epidemics were cyclical; with each passing generation, as immunity levels dropped, epidemics recurred.

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A disease without a cure
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No cure was ever found for smallpox.

But throughout history, different cultures found ways to control and prevent the spread of the disease, either by quarantining victims, or through inoculation and vaccination.

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The “Atlas” and “Endymion”, ships used for the containment of smallpox patients, at Deptford Creek, 1881.

Inoculation consists of boosting human immunity by giving people a mild dose of a disease – as with a flu jab today. Inoculation against smallpox was widely practised in India, China and the Middle East long before it became popular in Europe. It became common practise in Britain and America from the 1720s onwards

Vaccination is a special kind of inoculation, made popular by a Gloucestershire doctor, Edward Jenner, at the turn of the 19th century. Jenner inoculated patients against smallpox using a related virus, the cowpox virus. This proved a safe and non-infectious way of preventing the disease.

Jenner’s breakthrough paved the way for the global eradication of smallpox in the 20th century.

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Survival and Immunity
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Smallpox killed about 30% of those it infected.

The majority survived. But many were left either blind, or horribly disfigured. As the smallpox pustules dried up, they left pockmarks that covered the face and body. Paints, potions, beauty spots and veils were all used to disguise smallpox scars.

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The Apothecary, by Pietro Longhi, c.1752.

But those people who survived smallpox had one natural advantage over everyone else – their bodies were now immune to the virus, and they couldn’t catch smallpox again.

For this reason, survivors of smallpox were in demand as servants. Adverts for servants in the 18th century sometimes requested that they should have already had the smallpox ‘in the natural way’.

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A disease of childhood
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At least 80 percent of victims of smallpox were under the age of ten. The Germans called it ‘Kinderpocken’, or ‘child pox’.

Children are more susceptible to viral diseases because their bodies lack the resources to fight back; the ability to generate effective anti-bodies increases with age.

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A child with smallpox from a medical textbook, 1908.

So, in early infancy the death toll is the highest; almost half of children who caught smallpox under the age of four died. But then, by the age of 12, the fatality rate drops dramatically. Teenagers with smallpox have a 90% chance of surviving the disease.

Fatality rates then climb again in later life. For those aged over 60, the fatality rate reaches approximately 30%.

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Smallpox crosses the Atlantic
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From the late 15th century onwards, adventurers sailed to the Americas in search of fish, fur and gold, and they founded colonies in the New World. They brought to the Americas many species previously unknown there, including horses, cows, wheat, honeybees and earthworms, transforming the ecology of the New World in the process. But without realizing it, they also brought something more deadly: the smallpox virus.

The native populations of the Americas had never experienced smallpox before.

None were immune; they were a ‘virgin population’. So the disease spread with devastating effect. From the moment the first Europeans arrived in the Caribbean, whole tribes were wiped out. Half the native population of Puerto Rico died of smallpox within a few months in 1519.

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Smallpox devastates the Nahuatl Natives. An illustrated panel from the Florentine Codex, c.1585. Public domain Later that year, when Spanish explorers encountered the Aztec civilization of Mexico, they carried the virus with them, and the natives “died in heaps, like bedbugs”. Within a few months half the Aztec population of thirty million people had died, and a few hundred Spanish conquistadors were able to conquer an ancient civilization.

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Smallpox in North America
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In North America, too, European viruses wiped out Native tribes. In the three years before the Mayflower landed on the coast of New England, ninety percent of the Massachusetts Natives died of disease.

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An image of the "Great Dying," the cataclysmic scourge brought upon the native American population by epidemics in the early 17th century. Enormous epidemics soon swept westwards, inflicting terror and mass death among tribes along the Great Lakes: the Hurons and the Iroquois were especially hard hit. The tragedy continued well into the 19th century, as white America expanded westwards across the face of the continent.

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White America suffered too. The city of Boston experienced eight epidemics in the 18th century, and in some of these epidemics more than half of the population were infected. During the Revolutionary Wars between the British and American colonists, smallpox altered military strategy and shifted the course of battles.

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Famous victims
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Many famous people in history suffered from Smallpox, including three US Presidents: Abraham Lincoln, Andrew Jackson and George Washington.

Washington had pockmarks on his face – but these aren’t shown on his official portraits, and there’s no sign of them on his picture on the dollar bill.

Soviet dictator Joseph Stalin recovered from childhood smallpox at the age of seven. His face in adult life was covered with pockmarks, but he insisted photographs were retouched to make them less noticeable.

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A life-mask of Ludvig van Beethoven, taken around the time of the 5th Symphony (c. 1806). Note the pockmarks – evidence of smallpox. Mozart and Beethoven both had smallpox as children, and had pockmarked faces throughout adult life.

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Other famous victims include Cuitláhuac, the Aztec ruler of Tenochtitlan, Guru Har Krishnan, the 8th Guru of the Sikhs, two Japanese emperors, Kings of Burma and Siam, and (it is believed) the Roman emperor Marcus Aurelius.

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Fears of bioterrorism led US to retain smallpox virus... Russia manufactured own virus to 'investigate', also....
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Fears that terrorists could use the smallpox
virus for mass casualty attacks have led both
the United States and Russia to retain stocks
of the lethal smallpox virus for medical research.

The smallpox virus wiped out more than half the indigenous populations of North and South America when first introduced by African slaves The disease was declared eradicated in 1980, and the World Health Organisation had called for the destruction of the world's stocks of the smallpox virus by June, 1999.

But the pathogen is still held in secure facilities at the State Research Centre of Virology and Biotechnology, or VECTOR, in the Siberian city of Kotsovo, and at the Centres for Disease Control and Prevention in Atlanta.

President Bill Clinton reversed an earlier US government pledge to destroy the stocks after experts warned samples held at VECTOR might have leaked into the hands of terrorists or rogue states in the chaotic years after the Soviet Union collapsed.

Their concerns centred around claims made by Ken Alibek, a former VECTOR official who defected to the United States in 1992.

RUSSIA MANUFACTURED THE VIRUS TO 'INVESTIGATE' IT, TOO, WHEN THE US WERE FOUND TO HAVE STORED A SAMPLE
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Mr Alibek said that the Soviet Union had succeeded in splicing genes from other viruses to produce smallpox microbes that would be invulnerable to vaccines.

'We must keep smallpox stocks' US and Russia tells World Health Organisation 18 Jan 2011

"Given the extensive research in which the Soviet Union was engaged, there were reasons to believe there may be other facilities in Russia where stocks are held," said Amy Smithson, a disarmament specialist.

Experts said that the US needed to retain its stocks of the smallpox virus to combat future outbreaks, either caused by accident or rogue actors. Last year, the US Centres for Disease Control said that after 9/11, there was concern that the virus could be used "as an agent of bioterrorism." Last year, a group of 40 al-Qaeda terrorists were reported to have died of plague in Algeria, after a biological weapons experiment went wrong.

The US Institute of Medicine at the National Academy of Sciences also argues the virus could lead to "new and important discoveries with real potential for improving human health." New vaccines against smallpox continue to be produced.

Project Bioshield, a US government pandemic preparedness programme, last year received twenty million doses of smallpox vaccine for immune-compromised populations.

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ADDITIONAL
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On February 5, 2002, George W. Bush visited the RODS laboratory and used it as a model for a $300 million spending proposal to equip all 50 states with biosurveillance systems. In a speech delivered at the nearby Masonic temple ((((

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