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Smallpox

Smallpox (also known by the Latin names Variola or Variola vera) is a highly contagious disease unique to humans. It is caused by two virus variants called Variola major and Variola minor. V. major is the more deadly form, with a typical mortality of 20-40 percent of those infected. The other type, V. minor, only kills 1% of its victims. Many survivors are left blind in one or both eyes from corneal ulcerations, and persistent skin scarring - pockmarks - is nearly universal. more...

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Smallpox was responsible for an estimated 300-500 million deaths in the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year.

After successful vaccination campaigns, the WHO in 1979 declared the eradication of smallpox, though cultures of the virus are kept by the Centers for Disease Control and Prevention (CDC) in the United States and at the Institute of Virus Preparations in Siberia, Russia. Smallpox vaccination was discontinued in most countries in the 1970s as the risks of vaccination include death (~1 per million), among other serious side effects. Nonetheless, after the 2001 anthrax attacks took place in the United States, concerns about smallpox have resurfaced as a possible agent for bioterrorism. As a result, there has been increased concern about the availability of vaccine stocks. Moreover, President George W. Bush has ordered all American military personnel to be vaccinated against smallpox and has implemented a voluntary program for vaccinating emergency medical personnel.

Famous victims of this disease include Ramesses V (see Koplow, p. 11, plus notes), Shunzhi Emperor of China (official history), Mary II of England, Louis XV of France, and Peter II of Russia. Henry VIII's fourth wife, Anne of Cleves, survived the disease but was scarred by it, as was Henry VIII's daughter, Elizabeth I of England in 1562, and Abraham Lincoln in 1863. Joseph Stalin, who was badly scarred by the disease early in life, would often have photographs retouched to make his pockmarks less apparent.

After first contacts with Europeans and Africans, the death of a large part of the native population of the New World was caused by Old World diseases. Smallpox was the chief culprit. On at least one occasion, germ warfare was attempted by the British Army under Jeffrey Amherst when two smallpox-infected blankets were deliberately given to representatives of the besieging Delaware Indians during Pontiac's Rebellion in 1763. That Amherst intended to spread the disease to the natives is not doubted by historians; whether or not the attempt succeeded is a matter of debate.

Smallpox is described in the Ayurveda books. Treatment included inoculation with year-old smallpox matter. The inoculators would travel all across India pricking the skin of the arm with a small metal instrument using "variolous matter" taken from pustules produced by the previous year's inoculations. The effectiveness of this system was confirmed by the British doctor J.Z. Holwell in an account to the College of Physicians in London in 1767.

Edward Jenner developed a smallpox vaccine by using cowpox fluid (hence the name vaccination, from the Latin vacca, cow); his first inoculation occurred on May 14, 1796. After independent confirmation, this practice of vaccination against smallpox spread quickly in Europe. The first smallpox vaccination in North America occurred on June 2, 1800. National laws requiring vaccination began appearing as early as 1805. The last case of wild smallpox occurred on October 26, 1977. One last victim was claimed by the disease in the UK in September 1978, when Janet Parker, a photographer in the University of Birmingham Medical School, contracted the disease and died. A research project on smallpox was being conducted in the building at the time, though the exact route by which Ms. Parker became infected was never fully elucidated.

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The history of smallpox
From Contemporary Review, 3/1/05 by Charles Foster

The Life and Death of Smallpox. Ian and Jenifer Glynn. Profile Books. [pounds sterling]17.99. x + 278 pages. ISBN 1-86197-608-9.

The story of smallpox is an old one and some nasty, pox-like things wander through Thucydides, Diodorus and ancient Sanskrit texts. The illness was tectonic in its effects on society: it caused tides of refugees to move across the world, and those refugees moved it. It was a demographic disease.

Ian Glynn is an eminent physiologist and Jenifer Glynn is a distinguished historian and one of the most tantalising speculations in their book is that smallpox may have been responsible for the birth of Islam. In the sixth century the Middle East generally was largely pagan, and chafing under its paganism: it was up for grabs by any conquering missionaries. Mecca was no exception. In AD 569 an army of Christian Abyssinians besieged Mecca, but was defeated by a mysterious plague that sounds very like smallpox. Before the Christians could renew their assault on the Arabian peninsula the Prophet had emerged and swept all before him. As his armies galloped into the Near East, Africa, Central Asia and Europe smallpox rode with them. Twelve hundred years later smallpox was the salvation of Protestant England when, in 1779, it paralysed a huge French and Spanish armada which, sailing in double columns to invade England, covered four and a half miles of sea. One could multiply for ever the examples of smallpox's political influence. The short and obvious point is worth making: this tiny virus has been more politically influential than the foreign policy of the most long-lived and expansionist empire.

The first natural shield proved to be the disease itself. The first in the West to deploy smallpox against itself was Lady Mary Wortley Montagu. She was the wife of the British Ambassador to Turkey in the early 18th century, and a bracingly unconventional woman who heard of a technique practised by peasant women to protect against the smallpox. They made a tiny cut in the skin of a healthy person, and inserted in it a small amount of matter from a smallpox pustule. The patient got a (usually) mild form of smallpox, and thereafter had a good level of immunity against the disease. The practice, known as 'inoculation', was slowly introduced to Europe. In England it was officially endorsed by the College of Physicians in 1755. Inoculation was a great improvement over complete vulnerability, but it had some major problems. The disease it gave was not always benign and, most importantly, it made inoculated patients, for a while, vectors of the infection. Some devastating eighteenth and nineteenth-century epidemics were probably attributable to it.

The great breakthrough came in 1796 when Edward Jenner, having pondered the apparent immunity of milkmaids to smallpox, inoculated a boy called Phipps with matter from a coxpox sore. It gave a solid immunity, but no clinical illness. Jenner was feted, and smallpox was doomed. The story of the elimination of smallpox is in itself an exhilarating one. It was hunted down and boxed into East Africa where it proved a resourceful and robust enemy. There remains of course the nightmarish possibility of a renaissance. Terrorists know well what smallpox could do to an unvaccinated and completely immunologically naive population.

All this is well told by the Glynns. With admirable and effective understatement they point up the contemporary parallels as they tell the story. They give the current MMR hysteria some particularly useful context. With careful, economic and compelling prose they follow the virus from its first emergence to its containment. As one would expect, they have written a splendid, readable, impeccably researched 'biography' of smallpox. It will be a classic of its genre.

COPYRIGHT 2005 Contemporary Review Company Ltd.
COPYRIGHT 2005 Gale Group

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