Smallpox

Smallpox, or variola (from Latin varus meaning pimple), is a highly contagious viral disease, one of the very worst to afflict humankind since timeimmemorial. It is believed to have originated in northeastern Africa with the first agricultural settlements--around 10,000 B.C., spreading to India via Egyptian merchants, and was known in China in ancient times. Several early historians described plagues with the characteristic symptoms ofsmallpox (chills, headache, backache, nausea, vomiting, fever, and red spotson the skin that develop into pus-filled blisters). Greek historian Thucidydes (died c. 326 B.C.) chronicled a disease that broke out during the Peloponnesian War in the fifth century B.C., noting that a person who contracted this disease and survived was called "fortunate andhappy," since he could never get the disease again. The early Christian historian, Eusebius (died c. 379 B.C.), writing in the third century, referred to an epidemic (thought to be smallpox) in which "whole familieswere cut off very rapidly, so that two or three bodies of the dead were carried out from one house for burial at the same time. All places...overflowed with tears, sorrow and wailings."

Smallpox reached Europe from Arabia in the sixth century, and Crusaders returning to Europe from the Holy Land between 1094 and 1204 spread this disease across the continent. Smallpox probably arrived in the Western Hemisphere withthe Spanish conquistadors in the sixteenth century, and slaves transported from Africa brought the disease to the American colonies. In 1721, nearly halfthe residents of Boston contracted the disease, establishing the record forthe worst epidemic to hit the New England town.

Cotton Mather (1633-1728), a Puritan leader, tried to convince others that inoculation would deter the disease. Mather had learned about the art of inoculation from his slave, Onesimus, who was immune to smallpox because of the practices of the Garamanti in Africa. It had been 15 years earlier that Onesimustold Mather: "People take the Juice of the Small Pox, and Cut the Skin, andput in a drop; then by 'nd by a little sick; then few small pox; and no bodydye of it; no body have small pox any more."

Mather tried to share his knowledge with medical practitioners, but he was chastised by those who believed inoculation was a "superstitious" African practice. Only Dr. Zabdiel Boylston (1679-1766) heeded Mather's pleadings. Boylston inoculated his own six-year-old son and two slaves, but his procedures appalled much of the community. At the time, Mather wrote: "The Destroyer, beingenraged at the proposal of anything that may rescue the lives of our poor people from him, has taken a strange possession of the people on this occasion.They rave, they blaspheme, they talk not only like idiots, but also like Franticks, and not only the physician who began the experiment but I also am an object of their fury...."

Lady Mary Wortley Montagu (1689-1762) introduced smallpox inoculation into Europe in the early eighteenth century after she accompanied her husband, the British ambassador to Constantinople, to Turkey in 1717, there discovering a local practice called ingrafting. This procedure, nearly identical to the one performed by the Garamanti in Africa, also conferred immunity to smallpox. When Lady Montagu returned to England she had her own daughter inoculated and, with the support of Caroline, Princess of Wales, smallpox inoculationcaught on despite vehement opposition from medical and religious leaders. However, inoculation was a double-edged sword. Because few people died from inoculated smallpox, they dropped their defenses and failed to take quarantine precautions; a mild case of inoculated smallpox was still contagious and couldspawn a deadly natural epidemic. There were also side effects from these inoculations, such as blindness, tuberculosis, eye diseases, and disfiguring pockmarks.

The first major step toward controlling smallpox came at the end of the eighteenth century when Edward Jenner heard stories from milkmaids who said they were immune to smallpox because they had contracted cowpox from cows' udders.Jenner heeded their folk wisdom, making it scientific fact when he performedhis first vaccination on May 14, 1796, by scratching the arms of eight-year-old James Phipps with the lymph from a cowpox pustule on the hand of dairymaidSarah Nelmes. On July 1, he introduced fresh smallpox lymph into young James, and waited for a reaction. There was none. This was the first scientific effort at controlling infectious diseases through deliberate vaccination. Jenner, envisioning the implications of his discovery, wrote in 1802, "it now becomes too manifest to admit of controversy, that the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final resultof this practice." Over the next century and a half, vaccination against smallpox became a universally accepted public health practice.

At the end of World War II, smallpox was still reported in 95 countries. TheWorld Health Organization of the United Nations believed global eradication of the virus was an attainable goal and, in 1966, appropriated $2.5 million for a program to promote mass vaccinations. The following year, 42 countries reported 10 million cases of smallpox. On October 22, 1977, the last known caseof naturally acquired smallpox was reported in Somalia, and on December 9, 1979 in Geneva, Switzerland, a World Health Organization panel declared that smallpox had been eradicated from the world.

Stocks of the freeze-dried virus were maintained in several research labs toproduce vaccine in the event that the disease reappeared. In 1978, medical photographer, Janet Parker, working at the University of Birmingham Medical School in Britain, contracted smallpox from an escaped laboratory virus and died. Public health officials worldwide realized that the real danger from smallpox no longer lay in nature but in the laboratory. The World Health Organization (WHO) encouraged all labs with stocks of the virus to destroy them or sendthem to two designated repositories: the Centers for Disease Control in Atlanta, Georgia, or the Research Institute of Viral Preparation in Moscow, Russia. The WHO, United States, and Russia subsequently agreed to destroy all remaining stock of the smallpox virus in December 1993. Because arguments remainagainst total destruction of the virus--one that no further studies of the virus will be possible, and another that complete eradication may not occur--total destruction of the stored virus has been postponed twice--once in 1993 and again in 1995. The current deadline for destruction of the variola strain of the smallpox virus is scheduled for June 31, 1999. If it does take place, it will be the first deliberate total elimination of any biological species.

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