VARIOLATION AND EARLY ATTEMPTS OF TREATMENT It is derived from the Latin word varius, meaning “stained,” or from varus, meaning “mark on the skin.” The term small pockes ( pocke meaning sac) was first used in England at the end of the 15th century to distinguish the disease from syphilis, which was then known as the great pockes ( 8). The word variola was commonly used for smallpox and had been introduced by Bishop Marius of Avenches (near Lausanne, Switzerland) in AD 570. The case-fatality rate in infants was even higher, approaching 80% in London and 98% in Berlin during the late 1800s. The case-fatality rate varied from 20% to 60% and left most survivors with disfiguring scars. The symptoms of smallpox, or the “speckled monster” as it was known in 18th-century England, appeared suddenly and the sequelae were devastating. In the 18th century in Europe, 400,000 people died annually of smallpox, and one third of the survivors went blind ( 4). Another factor contributing to smallpox in the Americas was the slave trade because many slaves came from regions in Africa where smallpox was endemic. During the French-Indian War (1754–1767), Sir Jeffrey Amherst, the commander of the British forces in North America, suggested the deliberate use of smallpox to diminish the American Indian population hostile to the British. The devastating effects of smallpox also gave rise to one of the first examples of biological warfare ( 1, 7). Similarly, on the eastern coast of North America, the disease was introduced by the early settlers and led to a decline in the native population. The disease decimated the local population and was instrumental in the fall of the empires of the Aztecs and the Incas. Unknown in the New World, smallpox was introduced by the Spanish and Portuguese conquistadors. The Arab expansion, the Crusades, and the discovery of the West Indies all contributed to the spread of the disease. The first stages of the decline of the Roman Empire ( AD 108) coincided with a large-scale epidemic: the plague of Antonine, which accounted for the deaths of almost 7 million people ( 6). The disease greatly affected the development of Western civilization. Smallpox was introduced to Europe sometime between the fifth and seventh centuries and was frequently epidemic during the Middle Ages. At the same time, smallpox has been reported in ancient Asian cultures: smallpox was described as early as 1122 BC in China and is mentioned in ancient Sanskrit texts of India. The mummified head of the Egyptian pharaoh Ramses V (died 1156 BC) bears evidence of the disease ( 5). The earliest evidence of skin lesions resembling those of smallpox is found on faces of mummies from the time of the 18th and 20th Egyptian Dynasties (1570–1085 BC). It seems plausible that it spread from there to India by means of ancient Egyptian merchants. It is believed to have appeared around 10,000 BC, at the time of the first agricultural settlements in northeastern Africa ( 3, 4). The origin of smallpox as a natural disease is lost in prehistory. Jenner's work is widely regarded as the foundation of immunology-despite the fact that he was neither the first to suggest that infection with cowpox conferred specific immunity to smallpox nor the first to attempt cowpox inoculation for this purpose. It seems prudent to review the history of a disease known to few people in the 21st century.Įdward Jenner (Figure (Figure1 1) is well known around the world for his innovative contribution to immunization and the ultimate eradication of smallpox ( 2). Smallpox has been identified as a possible agent of bioterrorism ( 1). Unfortunately, since the attack on the World Trade Center on September 11, 2001, the threat of biological warfare and bioterrorism has reemerged. With the rapid pace of vaccine development in recent decades, the historic origins of immunization are often forgotten. In modern times we do not have to worry about it thanks to the remarkable work of Edward Jenner and later developments from his endeavors. In science credit goes to the man who convinces the world, not the man to whom the idea first occurs.įor many centuries, smallpox devastated mankind.
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