What would it take for you to inject the ooze from a smallpox sore into your own body?
Not long ago, it may have been your only hope of surviving the disease.
This is the messed-up history of smallpox.
Smallpox was a disease caused by the variola virus, differentiated by a variety of presentations:
ordinary, modified, malignant, and hemorrhagic.
Smallpox got its name from the Latin word "varius," meaning "spotted" or "speckled,"
in reference to the pus-filled pimples that afflicted smallpox victims.
Since syphilis also causes similar rashes and was also known as "variola" in 15th-century
France, smallpox was distinguished by being referred to as "la petite vérole," which
translates to "the small pox."
Unfortunately, even if you survive smallpox, you'll most likely be stricken with sterility,
blindness, or pockmarks.
On the plus side, you would be immune to recurrent smallpox infections.
Smallpox was transmitted through airborne saliva and person-to-person contact and had
an incubation period of 7-17 days after exposure, so typically a person would only be infectious
once a fever had already developed.
As a result, smallpox would usually be transmittable once the person was already sick in bed, effectively
slowing down transmission rates, but that didn't stop smallpox from claiming over 300
million victims in the 20th century alone.
Through a collaborative worldwide effort, smallpox was technically eradicated by the
second half of the 20th century.
According to the World Health Organization, the last case of naturally occurring smallpox
was in 1977 in Somalia.
Ever since then, the only known cases of smallpox were the result of a laboratory accident in
England in 1978.
"Good news from Geneva.
The World Health Organization has made it official: smallpox throughout the world has
been virtually eliminated."
Medical historians use written records to assist in identifying diseases, but smallpox
has a very spotted history.
According to Baylor University Medical Center Proceedings, some scientists believe smallpox
originated in 10,000 BCE, but verifiable descriptions of smallpox only begin to appear in 1122 BCE
in China.
Others claim that the mummy of Egyptian pharaoh Ramses V, who died in the 1150s BCE, shows
signs of smallpox pustules, while scientists who recently sequenced smallpox DNA from a
17th-century Lithuanian mummy contend that the smallpox virus emerged as recently as
the 1500s.
There are suggestions that smallpox is discussed in the Sushruta Samhita, an ancient Sanskrit
medical text thought to have originated in the first millennium BCE.
However, anthropologists such as Ralph Nicholas argue that the disease mentioned, masurika,
is discussed too trivially to be about a disease as fatal as smallpox.
That suggests that either smallpox upped its severity over the centuries, or the affliction
referenced in the ancient text was misidentified as smallpox.
There are no confirmed references to smallpox in Europe until the 500s CE, but many try
attributing the various plagues in European history to smallpox.
Smallpox is thought by some scholars and physicians to be the main culprit of the plague of Athens
that decimated the city in 430 BCE, but bubonic plague, typhoid, typhus, and measles are all
contenders, and there's little consensus.
Since several diseases include symptoms of a rash and fever, it's difficult for historians
to identify illnesses from the past solely through written descriptions.
No matter where smallpox originated, soon it had spread across the Asian and European
continents.
According to "Smallpox and Its Eradication," published by the WHO, during the medieval
period, there were frequent epidemics of smallpox, brought on by the movement of the Crusades.
But these epidemics were nothing compared to the ones that would decimate the American
and African continents as a result of colonialism and enslavement.
In the 1500s, Spaniards brought smallpox with them in their colonization of Mexico, beginning
what would become an avalanche of epidemics that would wipe out and depress the populations
of the Aztecs, Inca, and Mapuche in South America, and the Mohawk, Iroquois, and Cherokee
in North America, just to name a few.
To the Native Americans, the Europeans seemed comparatively immune to the disease, since
most of them would have recovered from childhood infections, while the indigenous populations
of the Americas had no developed defenses.
This vulnerability was also weaponized by Europeans.
In 1763, British Field Marshal Jeffrey Amherst advocated giving smallpox-infected blankets
to indigenous Americans during Pontiac's War.
Having seen how the devastating effects of smallpox on the indigenous populations in
South America ensured the military success of the invaders, Amherst was quite amenable
to the suggestion of using biological warfare in his own invasion.
This notorious incident is known since it was documented by Amherst himself in his letters,
but it's not unlikely that many others used similar methods.
Variolation, also known as inoculation, was one of the processes through which people
would acquire smallpox immunity.
Per the US National Library of Medicine, the practice would involve infecting an individual
with residue from a smallpox scab or pustule, resulting in a less severe outbreak to induce
immunity, should the individual survive their encounter with smallpox.
While this process wasn't risk-free and could even cause an epidemic on its own, the 1-2%
mortality rate of variolation seemed preferable to the 30% mortality rate of naturally contracted
smallpox.
There are accounts of variolation in China as early as the mid-1500s, where smallpox
scabs and particles were blown up the nose to induce an infection.
In India, there are also descriptions of an inoculation technique in the 16th century
that mirrors vaccination today: A needle would be covered in fluid residue from smallpox
pustules and then used to puncture the skin repeatedly.
As variolation spread to Britain and colonial America, the origins of the technique were
attributed to the Ottomans.
It's possible that the Ottomans were the ones who originally spread the practice to India,
since they used a similar method of puncturing the skin.
But in the end, the origins of smallpox's inoculation are as murky as the origins of
the virus itself.
The man credited with inventing the first smallpox vaccine was English physician Edward
Jenner, who lived from 1749 to 1823.
Having grown up in the English countryside, Jenner noticed that milkmaids weren't vulnerable
to smallpox.
Growing up and becoming a doctor, he put a theory to the test in 1796 and infected his
gardener's son with pus from a cow's cowpox pustules.
After six weeks, Jenner attempted to infect the child again with smallpox, and after the
boy didn't fall ill, Jenner conceived of the first smallpox vaccine.
While Jenner was certainly not the first to suggest or experiment with infecting patients
with cowpox, he was soon set down in history books as the father of immunology.
But even the story of his original vaccine is suspect.
In 2017, virologists analyzed an early vaccine from 1902 and found that the vaccine used
a virus strain that is much closer to horsepox, publishing the results in The New England
Journal of Medicine.
According to Popular Science, since the vaccinia virus, the virus used in the smallpox vaccine,
isn't found in nature and doesn't quite resemble horsepox or cowpox or variola itself, there's
added confusion as to what the original vaccine could have been made from.
And since viruses change from host to host, and vaccines are created with the viruses
at hand, it's unlikely that the ingredients of the original vaccine will ever be known.
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