Smallpox the First: a human triumph!


Lady Mary Wortley Montague (1689–1762)

Source: Reidel 2005, Photo courtesy of the National Library of Medicine.

Smallpox the First

Did you hear the good news? Smallpox is dead!  The smallpox virus was murderous.  It killed more people than war.  In the 20th century alone, smallpox killed between 300 million (300,000,000 or 3*10^8) and half a billion (500,000,000 or 5*10^8) people.  The first disease conquered by humans: How did we vanquish this angel of death?

Lady Mary Montague was an aristocratic beauty.  You can see her above, Turkish style. Her husband was British Ambassador to the Ottoman Empire.  When Mary was 26 years old, she got smallpox.  She was lucky and survived; 1 in 3 (1/3 or 33%) did not. Her brother died.


In the 17th and 18th centuries (1600-1799) smallpox killed kings and queens in Europe (Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France), China, Ethiopia, and Japan.

Like other smallpox survivors, Mary was scarred, including on her face.  Yet, she still seems so beautiful in this image painted after her illness, presumably in Turkey.

The scars are the mark of a grand battle between virus and immune system, with the latter winning.  Its name is derived from ‘pockes’ derived from French for pustules (blisters or bags full of pus). A scab forms as the liquid pus solidifies with white cells attacking and holding the virus to prevent its spread.  As with measles, once infected with smallpox you have lifelong immunity.  Which means you won’t get sick again, even if you inhale the virus from an infected person: the usual means of spread; though hands are often guilty.

The pustules of smallpox are small compared to those of syphilis, traditionally called the pox (not bigpox!).  The pustule is a bag of pus which are the white blood cells of immunity fighting the virus.  The pus is infectious, as virus is present, and remains present in the scab.  These materials were the basis of the first attempts at protection through the immune system’s memory.

One year after she got smallpox, Mary arrived in Constantinople.  It was the year 1716.  The Ottoman  Empire was was still at its peak, with more advanced medical practice than in Europe. Mary learnt about the practice of variolation.

As with most inventions, it originated in China, perhaps as early as the 10th century (900-999 AD). Fresh smallpox scabs were ground into a dry powder that was then inhaled through the nose. Then, perhaps from the 15th century, the pus from the smallpox pustules was used to introduce the virus through a small break in the skin.  This was called variolation. Perhaps a contraction  of variola (smallpox) and inoculation – the process of introducing the material.

We learnt that vaccines work through immune memory, with the vaccine ‘looking like’ the bug.  Variolation used the bug itself. The trick was to get enough viruses to generate immunity from the virus, but not too many that would cause severe disease .  (Of course, nobody even knew about viruses at this time.)

Mary observed during her travels around the Ottoman Empire that variolation protected against smallpox.  So, she decided to protect her children through this practice, and  helped to make the procedure popular, including with the Royal Family, when she returned to England in 1721.  It was a dangerous procedure – inevitably some got a severe infection and died. And the person who was variolated could infect others and cause outbreaks.  (In China, the practice included quarantine after variolation to prevent spread.)

So, we salute Mary for helping to build the foundation for the next step: use of cowpox to protect against smallpox.  Jenner showed that this was so, and thus is credited with ‘creating’ the first vaccine. But it was nature that created smallpox, Jenner proved that it worked.  Jenner himself had been protected as a child through variolation. Pasteur coined the term ‘vaccine’, and was amongst the first to develop vaccines.  A process we continue to develop new technologies for, as we better understand the immune system and develop new biological tools.

By the 20th century, many people were benefitting from smallpox vaccine.  But it was still killing up to 50 million people a year, until it was eradicated in 1977 through immunisation.  (Some sources record 1980 as the year, because smallpox eradication was certified by the WHO in 1980).

The speckled monster, as smallpox was called, scared and scarred humanity for as long as recorded history.  The smallpox virus probably emerged as human societies changed from stone-age hunter-gatherers to farmers.  This happened about 10 thousand years ago (10,000 or 10^4 or 10k, which represents kilo – Latin for 1,000 (10^3); mega is 1 million (1,000,000 or 10^6); giga is 1 billion (1,000,000,000 or 10^9).

The first vaccine, and the first disease eradicated by humans.  There can be more, but that all depends on our collective efforts, and particularly that of the weakest link as we can learn from the story of polio eradication.



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