1. Running head: A HISTORY OF SMALLPOX INCLUDING ORIGIN 1
A History of Smallpox Including Origin,
Vaccination, Epidemics, and Eradication
Autumn Funderburg
Ohio University

2. A HISTORY OF SMALLPOX INCLUDING ORIGIN 2
Variola virus (VARV), otherwise known as smallpox, is a contagious disease
caused by a viral infection (Baker-Blocker, 2013). VARV has one distinct trait:
pathogenic specificity to humans; the variola virus is not susceptible to animals. It is
believed that smallpox first made an appearance in African agriculture around 10,000
B.C., evolving from a cowpox strain virus present on camels. This newly evolved strain
spread then to Egypt via traveling merchants (Hsu, 2013). It was in Egypt that the earliest
known lesions from smallpox were found on well-preserved Egyptian mummies;
specifically, the mummy was that of Ramses V. The virus spread to Europe and was
prominent in the Middle Ages (Stefan, 2005). Brought then to the Americas in the 1520s
by the Spanish conquistadors, it was deadly for the native populations of America
(Barnard, 2014).
The variola virus consists of two strains: variola major and variola minor. Variola
major is the lethal strain while variola minor is the milder form of the two strains that is
different genetically from the major strain. Smallpox can be spread via physical contact,
airborne droplets, and through contact with scabs carried on fabrics such as bedding,
towels, or clothing (Baker-Blocker, 2013). The incubation period for the virus is between
seven to seventeen days. Symptoms begin with common flulike headaches, muscle aches,
and vomiting. As the virus progresses, a rash forms on the skin, eyes, throat, and internal
organs (Barnard, 2014). The rash has four stages progressing from lesions (any damage
to tissue) to fluid-filled vesicles to pustules (small blisters that contain pus) to scabs
(Baker-Blocker, 2013). The lesions form on the face first, more often than not, and are
highly contagious. Smallpox will remain contagious until all the scabs have separated
from the skin; this stage usually leaves scars on the body. Smallpox may lead to serious

3. A HISTORY OF SMALLPOX INCLUDING ORIGIN 3
complications that can include dehydration, blindness, scarring, sterility in men, and
death.
Before modern virology and the germ theory, it was thought that diseases were a
form of divine punishment. However, in the 18th century a scientific connection had been
established between smallpox and immunity. A smallpox epidemic occurred in Boston,
Massachusetts in 1721. It was during this epidemic in Boston that the correlation between
disease and public health was recognized in America. How smallpox spread was still
unknown leading to home quarantining and patient isolation (Kass, 2012). Streets were
cleaned, garbage was removed, and government regulations for incoming and outgoing
ships were enforced. While these regulations were helpful, it did not entirely stop the
spread of smallpox. Reverend Cotton Mather, a Harvard graduate with interest in science
and medicine, convinced Dr. Zabdiel Boylston to start a variolation program to stop the
spread of smallpox (Stefan, 2005). Variolation was simply the process of introducing pus
from a pustule off a smallpox victim to a non-immune person (Stefan, 2005). Mortality
rates dropped among those that had been inoculated, and the variolation program was
deemed successful. While this process did not originate in America, Boylston and Mather
helped to spread the process throughout all the colonies of New England.
Fast-forwarding to the American Revolution when a major epidemic occurred, yet
again, in Boston, Massachusetts. There was one issue with inoculation: those inoculated
suffered from the smallpox virus as though they had naturally acquired smallpox. This
meant that contagion was highly likely unless practiced under strict quarantine, making
inoculation highly controversial (Fenn, 2003). The disease was beginning to affect
healthy soldiers under George Washington. Smallpox had been endemic in England for

4. A HISTORY OF SMALLPOX INCLUDING ORIGIN 4
sometime before the epidemics in New England therefore, the British soldiers were more
likely to be inoculated. Variolated British soldiers guarded war zones while non-
variolated American Soldiers were falling victims to defeat and to smallpox. It was after
this that George Washington required that all his soldiers be variolated before beginning
new military operations (Stefan, 2005). Beginning in the spring of 1977, American forces
went through inoculation at West Point, Morristown, Valley Forge, Alexandria,
Dumfries, and Fairfax (Fenn, 2003).
The disease quickly moved westward, attacking susceptible populations and then
South, striking Mexico City in 1779 (Fenn, 2003). This led to more southern travel down
into the South American Continent and back up into North America to Texas and New
Mexico leading to epidemics in 1780. These epidemics targeted not only revolutionary
troops, but Native American tribes as well. With Native American horse trade, the
disease made its way to Canada back down into Missouri. These epidemics lasted from
1776-1782.
Twelve years later, in the year 1794, Benjamin Jesty was one of the first to
recognize the connection between the cowpox virus and smallpox immunity. Jesty used
the pus of cowpox lesions found on the udders of dairy cows in an attempt to protect his
family from an outbreak of smallpox (Stefan, 2005). Using a lancet, he transferred the
pus from the udder lesions to the arms of his wife and two sons (Stefan, 2005). Jesty is
recognized as the first to vaccinate against smallpox; however, he did not follow the
vaccination with scientific evidence or trials. His vaccination was ill received after his
wife’s arm became badly infected from the cowpox inoculation. After physical and
verbal abuse from his local community, Jesty and his family moved away. Years later

5. A HISTORY OF SMALLPOX INCLUDING ORIGIN 5
Jesty had his two sons variolated with the smallpox virus and no symptoms showed. This
validated Jesty’s theory, however for fear of more abuse from the local community, he
did not publicize his findings. (Jesty, 2010)
Following in the footsteps of Jesty, Edward Jenner experimented with
vaccinations against smallpox using cowpox material. After hearing tales of dairymaids
being naturally protected from smallpox after being exposed to cowpox, he made the
decision to utilize these cowpox lesions, similar to Jesty. The subject of vaccination was
an 8-year-old boy named James Phipps. Jenner used the pus from a cowpox lesion off the
hand of a dairymaid. The symptoms of the cowpox variolation caused mild fever and
discomfort and, after nine days, loss of appetite and a cold sweat. The next day there was
vast improvement and Phipps was no longer showing symptoms. Several months later,
Jenner performed the same inoculation procedure on Phipps using the pus from a
smallpox lesion and no disease developed. (Stefan, 2005) With the vaccination deemed
complete, he published a small booklet, An Inquiry into the Causes and Effects of the
Variolae Vaccinae, a disease discovered in some of the western counties of England,
particularly Gloucestershire and Known by the Name of Cow Pox, and was now in search
of more volunteers in which to perform his newly discovered vaccination. It was not easy
convincing the public, however, and many resisted vaccination. It was slandered by
powerful doctors of the time as unsafe and unnatural. Dr. Benjamin Mosely is considered
the leader of the anti-vaccination movement. Mosely performed inoculations and feared
that vaccinations would steal his source of income. He arranged political cartoons and
propaganda with rumors that people would transform into cows if they used Jenner’s
method. (Kean, 2013) Jenner fought back against the resistance with science. His

6. A HISTORY OF SMALLPOX INCLUDING ORIGIN 6
dedication to the eradication of smallpox and scientific evidence credit him as the first to
successfully perform a purposeful vaccination in the year 1796. With the help and
support of surgeon Henry Cline, Dr. George Pearson, and Dr. William Woodville,
vaccination reached most European countries by 1800 (Stefan, 2005).
The vaccinations were effective, however, immunity was not life-long. It was
later discovered that immunity from the virus after vaccination is around 10 years
(Mackelprang, 2005). The cowpox strain was becoming weak the more it was used
because of ongoing passage. In 1896, Dr. Edward Ballard contributed an important factor
to Jenner’s vaccination discovery: to regain strength of and enhance the virus strain,
cowpox must be deliberately passed back into the calves. This allowed for mass
production of sufficient supplies of the cowpox material for vaccination. (Hsu, 2013)
While vaccination had been considered successful, it was slow to spread. It was in
short supply much of the time and hot climates proved difficult for storage of the vaccine.
Researchers developed a dried form of the smallpox vaccination in the 1920s, but its
quality was inconsistent. In 1949, freeze-drying was discovered to be an effective method
in sustaining the vaccine and was used commercially by 1954. The vaccine was now able
to withstand tropical climates without refrigeration, unlike the non-freeze-dried version,
and was able to last months. (PBS, 1998)
The first worldwide plan to abolish smallpox was formed by the World Health
Organization in 1948. At this point in time, there were still 90 countries with a smallpox
threat. Another worldwide plan to abolish smallpox was formed by the World Health
Organization in 1958. Neither plan was successful until the formation of the Smallpox
Eradication Programme in 1966. (PBS, 1998) At this point in time there were still an

7. A HISTORY OF SMALLPOX INCLUDING ORIGIN 7
estimated 10 to 15 million cases of smallpox worldwide (Mackelprang, 2005). The
Smallpox Eradication Programme had a ten-year plan to combat the disease on a global
scale (WHO, 2010). Starting with the poorest countries, the program slowly but surely
continually helped to eradicate smallpox country by country. It is the first human
infection that has been completely eradicated by mankind (Jesty, 2010). The last three
cases of smallpox were reported in Somalia in 1977 and England in 1978 and, after a
150-year-old long journey, smallpox was declared officially eradicated by the World
Health Organization in 1980. (PBS, 1998)
In the event of a smallpox outbreak, the Advisory Committee on Immunization
Practices (ACIP) has recommended that there is one smallpox response team per state.
The team is a group of health professionals that provide care to patients with smallpox.
With a low risk of an epidemic, the general population generally does not receive the
smallpox vaccination. (Margolis, 2009) There are only two locations in the world that
have a sample of the smallpox virus. This includes the CDC in Atlanta and the Soviet
Union in Russia.
More recently, there has been the threat of using smallpox as a biological weapon
in an act of bioterrorism. Smallpox is one of the four main microorganisms that pose a
potential threat. Being the only viral threat, smallpox is unresponsive to antibiotics. The
other three potential threats are bacterial threats and include botulism, anthrax, and
plague; all are responsive to antibiotics. Because the general population is not vaccinated
it is susceptible to exposure from an attack if bioterrorism were to occur. While an
outbreak is unlikely, strategies have been created to respond to an intentional smallpox
release if one were to strike including approaches for a population-wide vaccination on

8. A HISTORY OF SMALLPOX INCLUDING ORIGIN 8
first presentation of symptoms, a preemptive population vaccination, and a ring
vaccination. (Mackelprang, 2005)
“The speckled monster,” as it was once known, is one of the most historical
viruses to date. It led to the decline of many populations all over the world throughout its
years of endemics and epidemics. Despite its negative connotation, smallpox contributed
a great deal to the world of science with the help of Benjamin Jesty and Edward Jenner.
The discovery of variolation and vaccination opened doors for public health and the
prevention of many other diseases including polio, typhoid, hepatitis, and rubella.

9. A HISTORY OF SMALLPOX INCLUDING ORIGIN 9
References
Babkin, I. V., & Babkina, I.N. (2015). The Origin of the Variola Virus. Viruses, 7(3),
1100-1112.
Baker-Blocker, A.P. (2013). Smallpox. Magill’s Medical Guide (Online Edition).
Barnard, B. (2014). 7 Plagues That Changed History. New York Times Upfront, 147(3),
19-21.
Fenn, E 1. (2003). The Great Smallpox Epidemic of 1775-82. History Today, 53(6). 10-
17.
Hsu. J. L. (2013). A brief history of vaccines: smallpox to the present. South Dakota
Medicine: The Journal Of The South Dakota State Medical Association, Spec
no33-37.
Jesty, R., & Williams, G. (2011). Who invented vaccination?. Malta Medical Journal,
23(2), 1-5.
Kean, S. (2013). POX IN THE CITY. Humanities, 34(1), 34.
Mackelprang, R., Mackelprang, R., &Thirkill, A. (2005). Bioterrorism and smallpox:
policies, practices, and implications for social work. Social Work, 50(2), 119-127.
doi:10.1093/sw/50.2119
Margolis, A.R., & Grabenstein, J.D. (2009). Immunizations against bioterrorism:
smallpox and anthrax. Journal Of The American Pharmacists Association: Japha, 49(4),
566-568. doi:10.131/JAPhA.2009.09522
Morgan, A.J. (2013). Edward jenner and the discovery of vaccination—an appeal for the
Edward jenner museum. Vaccine,31(43), 4933-4934.
doi:http://dx.doi.org/10.1016/j.vaccine.2013.07.046.

10. A HISTORY OF SMALLPOX INCLUDING ORIGIN 10
Smith, R.P. (2013). Lesions. Magill’s Medical Guide (Online Edition).
World Health Organization declares smallpox eradicated 1980. (1998, January 1).
Retrieved March, 29, 2015, from
http://www.pbs.org/wgbh/aso/databank/entries/dm79sp.html