Known as one of the most devastating diseases humanity has ever faced, Smallpox killed 300 million people in the 20th century. The disease is transmissible by face to face contact, infected bodily fluids and scabs, contaminated objects, and airborne. It has been eradicated since 1980, and in the 1970s, routine smallpox vaccination ceased.
If you had smallpox when it first appeared, everyone could tell because of the pustules on your skin. In the 17th and 18th centuries, approximately one-third of the population in London was scarred and two-thirds were blind. The variola major type of smallpox had a 30% mortality rate; whereas, the variola minor type of smallpox had a 1% mortality rate. The spread of smallpox was rapid due to wars, movements of populations, trade routes and caravans, and the slave trade. There were many supposed remedies for smallpox, to include, bloodletting, leeches, fasting, laxatives, purgatives, diuretics, heat therapy, and cold therapy.
There was nothing that had any effect on the mortality of smallpox until inoculation was created. Inoculation involved having a sample of smallpox scraped onto the arm—or thigh for some women. This cause a few pustules to appear; however, they did not become infected with smallpox. In 1746, data from the London Smallpox and Inoculation Hospital showed that the mortality rate for smallpox was 20%. If patients had inoculation, their mortality rate was lowered to 1%. In the 1760s, changes were made to inoculation to make it more safe. These changes included smaller incisions, less preparation time, isolation of inoculees, and simultaneous inoculation of groups.
In the 1760s, it was also discovered that chickenpox is not the same as smallpox. In 1796, Edward Jenner discovered the smallpox vaccine. Jenner had heard about milkmaids who had gotten cowpox and then were resistant to smallpox. Jenner tried his first experiment with smallpox vaccination on his son. Jenner inoculated his son with swinepox. His son then was inoculated with smallpox and did not become infected. Jenner made the inference that it must have been the swinepox inoculation that prevented him from getting smallpox. Jenner published his work and word traveled around Europe. The vaccine was passed from arm to arm of orphaned children to keep the vaccine viable.
Although this vaccination could prevent many people from dying of smallpox, it was still not supported by everyone. Reasons for being anti-vaccine included inoculators losing money, idea of reduction in poor population, interference with God’s plan, questions of safety, source of vaccine, and unknown duration of immunity. Even with these objections, data was provided which supported the vaccine as far as prevention. Data was collected from 1919-1928 on incidences of smallpox in areas with compulsory laws, local options, no laws, and laws prohibiting compulsory vaccination. In areas with compulsory laws, there was a 6.6% incidence rate of smallpox. For areas with local options, there was a 51.3% incidence rate of smallpox. In areas with no laws, there was a 66.7% incidence rate of smallpox. Lastly, in areas with laws prohibiting compulsory vaccination, there was a 115.2% incidence rate of smallpox.
Luckily, smallpox was eradicated using surveillance and containment. When someone was found to have smallpox, they were isolated to contain the disease. Then everyone around them was vaccinated to prevent the disease from spreading. The difficulty with this was finding those infected with smallpox before they transmitted the disease to others. WHO declared eradication of smallpox in 1980.
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