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What is smallpox?
Smallpox is a highly contagious disease caused by the variola virus. It is usually spread by inhaling droplets discharged from the nose and mouth of an infected person.(1) Smallpox can also be transmitted through infected blankets, linens and clothing.(2)

Symptoms begin 12 days after exposure to the virus: fever, nausea, vomiting, headache, back ache, and muscle pains. Two to five days later, the victim experiences severe abdominal pain. A rash develops on the face, inside the eyes, and subsequently covers the whole body. During the next six to ten days, the rash transforms into pus-filled sores (pustules) that could become secondarily infected by bacteria. As recovery begins, fever and other symptoms subside. The pustules crust over and may leave scars. The disease usually confers permanent immunity; the infected person will not contract it again.(3)

Antiviral medications and other drugs do not work to shorten the duration or alleviate the symptoms of smallpox. Treatment is focused on providing nutrition, increasing comfort, and reducing secondary infections. In addition, the patient is usually isolated from the public to prevent spread of the virus.(4)

Is smallpox dangerous?
Doctors differentiate between several clinical forms of the disease, including variola major, variola minor (alastrim, Kaffir-pox), fulminating (purpura variolosa), malignant, modified, (varioloid), and variola sine eruptione (without a rash).(5,6) Some forms are more serious than others. Secondary infections can cause hemorrhaging and gangrene. Corneal infections can lead to blindness. Death -- caused by an infection of the lungs, heart, or brain -- is a possibility as well.(7) The case-fatality rate can reach 20 percent or higher.(8)

How common is smallpox?
The disease is thought to be at least 3000 years old, spreading from Africa to India and China. Pock marks have been found on mummified skulls unearthed in Egypt. Epidemics of smallpox may have occurred in 1350 BC during the Egyptian-Hittite war, in 430 BC in Athens, and in AD 180 during the initial stages of the declining Roman Empire. In the 1500s, Spanish and Portuguese conquistadors brought smallpox to the New World, where it spread to Aztecs, Incas, and Native Americans.(9-18)

By the 18th century, smallpox was common throughout Europe. In Sweden, between 1774 and 1798, the annual incidence rate ranged from 3 to 10 cases per 1,000 people (about 1/2 percent to 1 percent of the population). In London between 1685 and 1801, the number of smallpox cases ranged from 3 to 24 per 1,000 (about 1/2 percent to nearly 2 1/2 percent of the population). In Copenhagen between 1750 and 1800, smallpox cases ranged from 9 to 18 per 1,000 (about 1 percent to 2 percent of the population). Smallpox deaths during this period ranged from 1 per 5000 cases of the disease to 4 per 1000 cases.(19,20)

During the 19th and 20th centuries, smallpox continued to infect susceptible people. By 1967, the disease remained endemic in 31 countries.(21) In 1972, the U.S. ended smallpox vaccinations.(22) By the mid-1970s, Pakistan, India, Nepal, Bangladesh and Ethiopia were declared free of the disease.22 On October 26, 1977, Ali Maow Maalin, a Somali cook, was the last person to contract a natural case of smallpox.(23) In 1980, the World Health Organization (WHO) announced that smallpox had been eradicated from the planet.(24)

How did smallpox disappear?
Variola had already stopped infecting people in more than 8 out of 10 countries throughout the world when WHO launched a worldwide vaccination campaign against smallpox in 1967.(25) At that time, only 131,000 cases were reported.(26) Yet, authorities credit their global initiative with eliminating the disease. Some medical historians question the validity of this claim. Scarlet fever and the plague also infected millions of people. Vaccines were never developed for these diseases yet they disappeared as well.(27)

Several reputable historians credit multiple public health activities -- sanitation and nutrition reforms -- with reducing the incidence and severity of the early problematic diseases, including smallpox, plague, dysentery, scarlet fever, typhoid, and cholera. During the late 18th and early 19th centuries, "the etiology of disease was largely unrecognized and the breeding places of disease were undiscovered."(28) With the advent of the industrial revolution, droves of people left the countryside to seek employment in the cities. Unsanitary and crowded living conditions contributed to the spread of disease.(29) Protective measures were inconsistently applied before health authorities coordinated community efforts to: 1) clean streets, backyards, and stables, 2) remove trash, construct sewage systems, and properly dispose of human waste, 3) drain swamps, marshes, and stagnant pools, 4) purify the water supply, 5) improve the roads so that food could be rapidly transported to the cities and distributed while still fresh and nutritious.(30,31)

A brief history of smallpox inoculations:
By the 18th century, it was common knowledge that survivors of smallpox became immune to the disease. As a result, doctors intentionally infected healthy persons with smallpox organisms hoping to provoke a less severe infection than the naturally occurring illness. For example, children were often exposed to viral matter (pus) extracted from persons with "mild" cases of smallpox. This early preventive technique was named variolation (from variola).(32)

In China, variolation was practiced in one of two ways. Sometimes smallpox scabs were ground into a powder and blown into the nostrils of healthy persons through a tube.(33) Other times dried matter of smallpox lesions was soaked into a moistened cotton swab and inserted directly into the nostrils of healthy persons.(34)

In 1715, Peter Kennedy, a Scottish physician, recommended collecting smallpox fluid on the 12th day of infection, keeping it warm, and introducing it to the patient through a scratch in the skin. This technique -- inserting viral matter from a smallpox victim into a deliberate cut on a healthy person -- became the model for future applications and research.(35) It quickly became customary for the upper and middle classes to submit to the procedure. But it was an uncertain and hazardous practice. Often, smallpox by variolation was indistinguishable from an attack of ordinary smallpox. And it rarely conferred permanent immunity; the variolated were still likely to re-contract the disease. For some, it was followed by "malaise, disorders of the skin, and grave constitutional derangements."(36) The trouble and risks of variolation were disliked and feared but were accepted in the name of duty. Doting parents were grateful when the operation was accomplished without serious mishap. The variolated often died from the procedure, became the source of a new epidemic, or developed other illnesses from the lymph of the donor, such as syphilis, hepatitis or tuberculosis.(37-40) Before children were subjected to this practice, they were bled, purged, and deprived of food. Such preparation often lasted several weeks: "There was bleeding till the blood was thin, purging till the body was wasted to a skeleton, and starving on a vegetable diet to keep it so."(41)

Variolation spread throughout England, Europe, Canada, and the American colonies. However, the primary side effect of the procedure was smallpox itself.(42) This caused researchers to seek alternatives to the dangerous and uncertain medical technique.

During the late 18th century, English folklore and some dairy-maids believed that if they caught cowpox, they would be immune to smallpox.(43) Cows are sometimes infected with a rash on their udders that can be transmitted to dairymaids when they milk the animals. The disease is relatively harmless in both cows and humans.(44) In 1774, an English farmer named Benjamin Jesty sought to prove that cowpox (caused by the vaccinia virus) protected against smallpox. He extracted diseased matter from infected cows and vaccinated (from vaccinia) his wife and sons. None of the Jestys developed smallpox during later epidemics. However, his wife nearly lost the arm in which she had been vaccinated because of severe inflammation, and Jesty was rebuked by his neighbors as an inhumane brute for experimenting on his own family.(45)

In 1796, Edward Jenner, an English doctor, also tried to prove that cowpox protected against smallpox. Jenner inserted cowpox matter into a deliberate cut on James Phipps, a healthy 8-year-old boy. The boy caught cowpox. Seven weeks later, Jenner injected smallpox matter into the boy and claimed he was immune to the disease.(46) His medical colleagues disputed his claim: "We know that it is untrue, for we know dairymaids who have had cowpox and afterwards had smallpox."(47) Soon thereafter, even Jenner admitted: "There were not wanting instances to prove that when the cow pox broke out among the cattle at a dairy, a person who had milked an infected animal and had thereby apparently gone through the disease in common with others, was liable to receive the smallpox afterwards."(48)

But Jenner persisted. In 1798, he published Inquiry, a vulgar treatise on horsegrease cowpox.(49) He knew of men who milked cows soon after dressing the heels of horses afflicted with "grease," an oily and detestable horse disease. Jenner now insisted that these men were immune to smallpox, and that children would forever be protected from the disease if they were injected with cowpox after the cow was infected with the rancid secretions from horses' heels. Jenner published Inquiry in order to recommend horsegrease cowpox. He carefully discriminated it from plain cowpox, which, he admitted, had no protective virtue.(50) But the public was appalled by Jenner's recommendations. Horsegrease cowpox was disgusting, and they wanted nothing to do with it. Still, many attempts were made to verify Jenner's prescription for protecting children; every experiment ended in failure.

Jenner's peers were pleased to learn of his failures. One commented: "The very name of horsegrease was like to have damned the whole [budding practice of vaccinations]."(51) This may have been why, in 1806, when the esteemed Dr. Robert Willan published On Vaccine Inoculation, a monograph on the most recent developments in the field, Jenner was freely cited, yet neither horsegrease nor horsegrease cowpox was ever mentioned. Instead, plain cowpox was exalted as the true prophylactic.(52)

Since the public preferred the diseased secretions from cows' teats (cowpox) over the oozing pus from horses' heels (grease), Edward Jenner saw no reason to object. Besides, the time was ripe to deliver people from "the inconveniences, uncertainties, disasters, and horrors of variolation."(53) Thus, in 1802, and again in 1807, Jenner petitioned the House of Commons for monetary support to promote vaccinations. He claimed that his product had "the singularly beneficial effect of rendering through life the person so inoculated perfectly secure from the infection of smallpox."(54)

Upon Jenner's bold declaration, Parliament granted his request, mass inoculation campaigns were launched, and soon thereafter cases of smallpox among the vaccinated were reported. At first they were denied. When denial was no longer possible -- because the vaccinated were obviously afflicted with the disease -- Jenner and his supporters claimed that if vaccination did not prevent smallpox, it at least provoked milder forms of the disease. But when the vaccinated caught the disease and died, new explanations became necessary. These deaths were claimed to result from "spurious" cowpox.(55) Jenner explained that when the vaccinated recovered from the ordeal, the cowpox was genuine; otherwise it was spurious!(56)

By the time Jenner died in 1823, three kinds of smallpox vaccination were in use: 1) cowpox -- often promoted as "pure lymph from the calf," 2) horsepox, or horsegrease injections, promoted as "the true and genuine life-preserving fluid," and 3) horsegrease cowpox, the foul concoction originally promoted in Jenner's Inquiry. All were known to cause suffering and death.(57)

In the years following Jenner's death, vaccine failures were blamed on incorrectly administered inoculations. The usual practice of making one puncture for the injection was considered incomplete and ineffective. Two or more punctures were recommended. According to Dr. Marson, chief surgeon of Smallpox Hospital at Highgate, England, "A good vaccination is when persons have been vaccinated in four or more places."(58) Of course, "the mothers nearly always protest," he stated, especially since "some of the vaccinators use real instruments of torture," where multiple "ivory points are driven into the flesh."(59) But research has proved again and again that the number of puncture marks has no influence over the success or failure of the practice -- the very reason re-vaccination was advocated. Contemporary medical authorities now asserted that "vaccine prophylaxy is only real and complete when periodically renewed."(60) People must be vaccinated again and again "until vesicles cease to respond to the insertion of virus."(61)

To bolster their claim that smallpox inoculations were safe and effective, vaccine proponents often resorted to medical ploys. For example, smallpox victims who were previously vaccinated and required hospital services were frequently registered as unvaccinated. According to Dr. Russell of the Glasgow Hospital, "Patients entered as unvaccinated showed excellent marks (vaccination scars) when detained for convalescence."(62) Even the renowned George Bernard Shaw was aware of the medical shenanigans used to hoodwink the public: "During the last epidemic at the turn of the century, I was a member of the Health Committee of London Borough Council. I learned how the credit of vaccination is kept up statistically by diagnosing all the re-vaccinated cases (of smallpox) as pustular eczema, varioloid or what not -- except smallpox."(63)

This article was excerpted from
the Vaccine Archives of Neil Z. Miller.
All Rights Reserved.

The most extensive information on the smallpox vaccine
may be found in the book: Vaccine Safety Manual

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