Smallpox

[[File:Smallpox virus virions TEM PHIL 1849.JPG|thumb|right|165px|These went extinct in the wild before [[Vaccine hysteria|the modern anti-vaxxers]] could organize conservation efforts.]]
{{biology}}
{{cquote|Upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an [[epidemic]] of disease which threatens the safety of its members.|||[[U.S. Supreme Court]] giving the justification for mandatory smallpox vaccinations in 1905<ref>[https://supreme.justia.com/cases/federal/us/197/11/ U.S. Supreme Court: Jacobson v. Massachusetts, 197 U.S. 11 (1905)] ''Justia''.</ref>}}
'''Smallpox''', also known as variola, was an infectious disease caused by the variola [[virus]], a member of the Poxviridae family, and characterized by high fever and aches with subsequent widespread eruption of pimples that blister and pustulate. The eruptions scab over and leave scar tissue behind. It gets its name to distinguish it from the "great pox", today known as [[syphilis]].<ref>[https://web.archive.org/web/20160206191747/http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp Smallpox Disease Overview] ''Centers for Disease Control and Prevention'' (archived from February 6, 2016).</ref> 

Smallpox came in two forms. The least dangerous was called variola minor or alastrim, which produced a relatively mild infection and had a death rate of approximately one percent. The more serious form of smallpox was called variola major, which can present in several ways. The most common presentation of variola major was called classic ordinary smallpox where a patient endured the symptoms listed above. Other, more serious presentations of smallpox included flat smallpox and hemorrhagic smallpox where the victim bled excessively rather than forming pustules. Flat and hemorrhagic pox were usually fatal, though as a whole variola major had a mortality rate of approximately 30%.

The disease was declared to have been eradicated in 1980, following centuries of [[inoculation]] efforts. The eradication of smallpox is often considered one of the greatest achievements in public health.<ref>(February 20, 2021). [https://www.cdc.gov/smallpox/history/history.html "History of Smallpox"]. ''Centers for Disease Control and Prevention''.</ref>

==History==
[[File:Justus Sustermans - Portrait of Ferdinando II de' Medici - WGA21969.jpg|thumb|right|165px|Portrait of Ferdinando II de' Medici (1626)]]
Though the exact origins of smallpox are unknown, variola major likely jumped species from cows or other domesticated animals at least 3000 years ago.<ref>[https://pubmed.ncbi.nlm.nih.gov/22185833/ Emergence and reemergence of smallpox: the need for development of a new generation smallpox vaccine] by Sergei N. Shchelkunov (2011) ''Vaccine'' 29(Suppl 4):D49-53. doi:10.1016/j.vaccine.2011.05.037.</ref> Because smallpox would have required sustained contact with domestic animals and a certain level of population density, the likeliest sites for its origin would have been the locations of concentrated agricultural settlements in Asia or Africa, c. 10,000 BCE.<ref name=hopkins/>{{rp|13}} Pharaoh Ramses V, who died in 1157 BCE, is believed to have died from smallpox.<ref name=hopkins>''The Greatest Killer: Smallpox in History'' by Donald R. Hopkins (2002) University of Chicago Press. 2<sup>nd</sup> edition. ISBN 0226351688.</ref>{{rp|14-15}}

[[European]]s have had smallpox epidemics with mortality rates ranging from 20-98%.<ref name=riedel>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/ Edward Jenner and the history of smallpox and vaccination] by Stefan Riedel (2005) ''Proc. (Bayl. Univ. Med. Cent/)'' 18(1):21–25. doi:10.1080/08998280.2005.11928028.</ref> [[Native Americans]], who had no initial immunity, had mortality rates as high as 94%.<ref>''American Holocaust: The Conquest of the New World'' by David E. Stannard (1993) Oxford University Press. ISBN 0195085574.</ref>{{rp|87}}

===Smallpox blankets===
It has often been alleged that smallpox was used by [[Colonialism|colonists]] to commit [[Native American genocides|genocide on Native Americans]] using blankets from a smallpox ward,<ref>[https://quod.lib.umich.edu/cgi/p/pod/dod-idx/did-the-us-army-distribute-smallpox-blankets-to-indians.pdf?c=plag;idno=5240451.0001.009;format=pdf Did the U.S. Army Distribute Smallpox Blankets to Indians? Fabrication and Falsification in Ward Churchill’s Genocide Rhetoric] by Thomas Brown (2006) ''Plagiary: Cross‐Disciplinary Studies in Plagiarism, Fabrication, and Falsification'' 1(9):100‐129</ref> but it has been shown that smallpox is only communicated by person-to-person inhalation.<ref>[https://www.nlm.nih.gov/nichsr/esmallpox/rao.pdf Smallpox] by A. R. Rao (1972) The Kothari Book Depot.</ref>{{rp|86-89,91-92,95}} There were, however, local incidents of Europeans intentionally infecting Native Americans with smallpox, and the initial spread of smallpox among Native American populations was devastating.<ref name=hopkins/>{{rp|234,236,246}}

==Inoculation and vaccination==
[[File:A physician inspects the growth of cowpox on a milking maid' Wellcome V0011690.jpg|thumb|right|165px|A physician inspects the growth of cowpox on a milking maid, c. 1800]]
Connecting the survival of smallpox infection and immunity, the practice of [[inoculation]] began to be exercised during the 18<sup>th</sup> century, although the practice of variolation (exposing a person to a small amount of the virus by inhalation or by scratching the skin) can be found dating back to 1000 CE in India, Western Asia, and China.<ref name=riedel/><ref name=gross>[https://www.ijidonline.com/article/S1201-9712(98)90096-0/pdf The myth of the medical breakthrough: smallpox, vaccination, and Jenner reconsidered] by C. P. Gross & K. A. Sepkowitz (1998) ''Int. J. Infect. Dis.'' 3(1):54-60. doi:10.1016/s1201-9712(98)90096-0.</ref> In 1706, an enslaved African named {{wpl|Onesimus (Bostonian)|Onesimus}} informed {{wpl|Cotton Mather||,}} his slave owner in [[Massachusetts]], about the method of variolation for smallpox that he had received when he lived in Africa.<ref name=gross/> Mather later convinced a physician, Zabdiel Boylston, to conduct a variolation experiment during a 1721 smallpox outbreak in Boston.<ref name=gross/> Mather and Boylston then used a [[statistical]] analysis to demonstrate the efficacy of variolation at preventing smallpox deaths: the fatality rate among non-variolated people who contracted smallpox was 14% vs. variolated people at 2%.<ref name=gross/>

===Vaccine===
[[File:Vaccination set, London, England, 1925-1928 Wellcome L0058079.jpg|thumb|right|165px|Smallpox vaccine kit, 1920s]]
In 1796, observing that individuals who contract cowpox become immune from smallpox, [[Edward Jenner]], a British physician, inoculated a young boy with cowpox and then challenged his immune system with smallpox.<ref name=gross/> Although a challenge trial with a potentially fatal disease would be considered unethical by modern standards, Jenner was correct in his observation. Jenner was not the first person to vaccinate with cowpox; it was being used in Europe for decades years prior.<ref name=gross/> Jenner himself was inoculated with smallpox as a boy of 8 in 1757.<ref name=gross/> Jenner's test on a single boy was not even the first experiment with cowpox vaccination. What Jenner ''can'' rightfully be credited for, though, is the relentless promotion of vaccination to prevent smallpox, and thereby changing how medicine was practiced.<ref name=gross/> Many people were involved in the development and promotion of smallpox vaccination,<ref name=gross/> and Jenner serves as an example of how often the so-called "[[great man theory]]" is fallacious.

The smallpox [[vaccine]] is manufactured from the vaccinia (cowpox) virus, and is the best available protection against smallpox infection, although there have recently been attempts to develop anti-viral medications. The smallpox vaccine is not without its issues. Because it is a live-virus vaccine, it cannot be administered to individuals who are immuno-compromised, or women who are [[pregnant]] or [[breastfeeding]]. The vaccine also causes severe reactions in people who have ever had any type of skin condition, particularly eczema. In all, the vaccine has a severe complication rate of 1 in 1000 (0.1%), with side effects ranging up to death in approximately 1 case per million (0.0001%).<ref>[https://www.cdc.gov/smallpox/vaccine-basics/vaccination-effects.html Side Effects of Smallpox Vaccination] (Page last reviewed: July 12, 2017) ''Centers for Disease Control and Prevention''.</ref> By contrast, the disease itself had a mortality rate of about 30%<ref>[https://www.fda.gov/vaccines-blood-biologics/vaccines/smallpox Smallpox] ''U.S. Food & Drug Administration''.</ref> a significant portion of the infected people will infect other people, while vaccinated individuals do not transmit the disease. And yet [[Naturopathy|some people]] still say [[Anti-vaccination movement|the vaccine wasn't necessary and shouldn't have been used]].

==Eradication==
{{cquote|It is now too manifest to admit of controversy, that the annihilation of smallpox — the dreadful scourge of the human race — will be the final result of vaccination.|||Edward Jenner in 1801<ref>[https://www.proquest.com/openview/7dd09b0f3f102595360490ae920aa755/1?pq-origsite=gscholar&cbl=24144 A Review of Epidemic Small-pox as it has prevailed in New York City at different periods during the last fifty years] by J. Lewis Smith (1854) ''New York Journal of Medicine and Collateral Sciences'' 13(1):59.</ref>}}

Jenner predicted shortly after his initial trial vaccination that smallpox would eventually be eliminated as a threat to humanity. Although many western nations had achieved mandatory vaccination programs, other countries could not afford the expense. As early as 1958, the [[Soviet Union]] called for the eradication of smallpox by a volunteer effort. Beginning in 1967, the World Health Organization began a worldwide vaccination campaign with the purpose of eradicating smallpox. The last natural case of variola major occurred in 1975, and the last natural case of variola minor in 1977.

==The post-smallpox era==
Following the eradication of smallpox, an accident occurred in 1978 resulting in the death of a British journalist. Based on this accident, all samples outside the control of the [[CDC]], and the Soviet Ministry of Health were ordered destroyed. Despite subsequent calls for the destruction of the US and Russian stocks, they are still kept as the last remaining official stocks of smallpox samples.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377425/ Should Remaining Stockpiles of Smallpox Virus (Variola) Be Destroyed?] by Raymond S. Weinstein (2011) ''Emerg. Infect. Dis.'' 17(4): 681–683. doi:10.3201/eid1704.101865/</ref>

Despite the existence of these official stocks, defectors from the former Soviet Union have alleged that the Soviet military commissioned the development of smallpox as a [[Weapons of mass destruction|biological weapon]] from the 1970s to 1990s.<ref>''Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World&nbsp;— Told from Inside by the Man Who Ran It''by Ken Alibek & Stephen Handelman (2000) Delta. ISBN 0385334966.</ref>{{rp|107-122}}

[[Conspiracy theory|Conspiracy theories]] that smallpox might still exist in stocks outside of the former Soviet Union and the USA led to [[mainstream media]] dealing with the plans "in case of smallpox outbreak" during the [[Iraq War]].<ref>[https://www.ph.ucla.edu/epi/bioter/iraqmayhavesmallpox.html Experts: Iraq May Have Smallpox] by Matt Kelley (October 8, 2002) ''Associated Press'' via ''UCLA Department of Epidemiology''.</ref> Ultimately [[Saddam Hussein]]'s smallpox were as hard to find as his other [[weapons of mass destruction]].<ref>[https://www.ph.ucla.edu/epi/bioter/noevidencespox.html No Evidence Iraq Stockpiled Smallpox] by Dafna Linzer (September 18, 2003) ''Associated Press'' via ''UCLA Department of Epidemiology''.</ref>

==Gallery==
<gallery>
File:Ramses V mummy head.png|The mummy of Ramses V, showing evidence of pox scarring
File:The cow pock.jpg|Anti-smallpox vaccination cartoon from 1802
File:Pustular eruption of smallpox on face Wellcome L0032958.jpg|Stages of pox eruptions from smallpox infection
File:Kalighat Shitala.jpg|Sheetala (शीतला), the [[Hindu]] goddess believed to cure smallpox and other diseases
File:Hogu-byeolseong (Korean Smallpox goddess).jpg|Hogu-byeolseong, the [[Korea]]n smallpox goddess
</gallery>

==See also==
*[[Anti-vaccination movement]]
*[[Rabies]]

==References==
{{reflist}}

[[Category:Disease]]
[[Category:Medicine]]
[[Category:Viruses]]

Categories: Disease, Medicine, Viruses