The history of smallpox extends into pre-history; the disease likely emerged in human populations about 10,000 BC.[1] The earliest credible evidence of smallpox is found in the Egyptian mummies of people who died some 3000 years ago.[2] During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning monarchs, and was responsible for a third of all blindness.[3] Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease.[4]
During the 20th century, it is estimated that smallpox was responsible for 300–500 million deaths.[5][6][7] In the early 1950s an estimated 50 million cases of smallpox occurred in the world each year.[8] As recently as 1967, the World Health Organization estimated that 15 million people contracted the disease and that two million died in that year.[8] After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in December 1979.[8] To this day, smallpox is the only human infectious disease to have been completely eradicated.[9]
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There are no unequivocal records of smallpox in Europe before the 6th century CE, but it has been suggested that it was a major component of the Plague of Athens that occurred in 430 BCE, during the Peloponnesian Wars, and was described by Thucydides. A recent analysis of the description of clinical features provided by Galen during the Antonine Plague that swept through the Roman Empire and Italy in 165–180, indicate that it was probably caused by smallpox.[10] Although some historians believe that many historical epidemics and pandemics were early outbreaks of smallpox, contemporary records are not detailed enough to make a definite diagnosis.[11][12] In the 2nd century, returning soldiers brought the disease home with them to Syria and Italy, where it raged for fifteen years and greatly weakened the Roman empire, killing up to one-third of the population in some areas.[13] Total deaths have been estimated at 5 million.[14] A second major outbreak of disease in the Roman Empire, known as the Plague of Cyprian (251–266), was also either smallpox or measles.
Most of the details about the epidemics are lost, probably due to the scarcity of surviving written records from the Early Middle Ages. The first incontrovertible description of smallpox in Western Europe occurred in 581, when Bishop Gregory of Tours provided an eyewitness account describing the characteristic symptoms of smallpox.[12] Waves of epidemics wiped out large rural populations.[15] The establishment of the disease in Europe was of special importance, for this served as the endemic reservoir from which smallpox spread to other parts of the world, as an accompaniment of successive waves of European exploration and colonization.
Around 400 AD, an Indian medical book recorded a disease marked by pustules and boils, saying "the pustules are red, yellow, and white and they are accompanied by burning pain … the skin seems studded with grains of rice." The Indian epidemic was thought to be punishment from a god, and the survivors created a goddess, Sitala, as the anthropomorphic personification of the disease.[16][17][18] Smallpox was thus regarded as possession by Sitala. In Hinduism the goddess Sitala both causes and cures high fever, rashes, hot flashes and pustules. All of these are symptoms of smallpox.
The clearest description of smallpox from pre-modern times was given in the 9th century by the Persian physician, Muhammad ibn Zakariya ar-Razi, known in the West as "Rhazes", who was the first to differentiate smallpox from measles and chickenpox in his Kitab fi al-jadari wa-al-hasbah (The Book of Smallpox and Measles).[19]
Smallpox was a leading cause of death in the 18th century. Every seventh child born in Russia died from smallpox.[8] It killed an estimated 400,000 Europeans each year in the 18th century, including five reigning European monarchs.[20] Most people became infected during their lifetimes, and about 30% of people infected with smallpox died from the disease, presenting a severe selection pressure on the resistant survivors.[21]
In northern Japan, Ainu population decreased drastically in the 19th century, due in large part to infectious diseases like smallpox brought by Japanese settlers pouring into Hokkaido.[22]
The Franco-Prussian War triggered a smallpox pandemic of 1870–1875 that claimed 500,000 lives.[23][24]
In 1849 nearly 13% of all Calcutta deaths were due to smallpox.[25] Between 1868 and 1907, there were approximately 4.7 million deaths from smallpox in India. Between 1926 and 1930, there were 979,738 cases of smallpox with a mortality of 42.3%.[26]
| Year | Location | Description |
|---|---|---|
| 1520–1527 | Mexico, Central America, South America | Smallpox kills millions of native inhabitants of Mexico. Unintentionally introduced at Veracruz with the arrival of Panfilo de Narvaez on April 23, 1520[28] and was credited with the victory of Cortes over the Aztec empire at Tenochtitlan (present-day Mexico City) in 1521. Kills the Inca ruler, Huayna Capac, and 200,000 others and weakens the Incan Empire. |
| 1561–1562 | Chile | No precise numbers on deaths exist in contemporary records but estimates are that the natives lost between twenty and twenty five percent of their population. According to Alonso de Góngora Marmolejo so many Indian laborers died that the Spanish gold mines had to shut down.[29] |
| 1617–1619 | North America northern east coast | Killed 90% of the Massachusetts Bay Indians |
| 1674 | Cherokee Tribe | Death count unknown. Population in 1674 about 50,000. After 1729, 1738, and 1753 smallpox epidemics their population was only 25,000 when they were forced to Oklahoma on the Trail Of Tears. |
| 1692 | Boston, MA | |
| 1702–1703 | St. Lawrence Valley, NY | |
| 1721 | Boston, MA | |
| 1736 | Pennsylvania | |
| 1738 | South Carolina | |
| 1770s | West Coast of North America | Kills out 30% of the West Coast Native Americans |
| 1781–1783 | Great Lakes | |
| 1830s | Alaska | Reduced Dena'ina Athabaskan population in Cook Inlet region of southcentral Alaska by half.[30] Smallpox also devastated Yup'ik Eskimo populations in western Alaska. |
| 1860–1861 | Pennsylvania | |
| 1865–1873 | Philadelphia, PA, New York, Boston, MA and New Orleans, LA | Same period of time, in Washington D.C., Baltimore, MD, Memphis, TN, Cholera and a series of recurring epidemics of Typhus, Scarlet Fever and Yellow Fever |
| 1877 | Los Angeles, CA | |
| 1902 | Boston, Massachusetts |
After first contacts with Europeans and Africans, some believe that the death of 90–95% of the native population of the New World was caused by Old World diseases.[31] It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas. For more than 200 years, this disease affected all new world populations, mostly without intentional European transmission, from contact in the early 16th century to until possibly as late as the French and Indian Wars (1754–1767).[32]
In 1519 Hernán Cortés landed on the shores of what is now Mexico and was then the Aztec empire. In 1520 another group of Spanish arrived in Mexico from Hispaniola, bringing with them the smallpox which had already been ravaging that island for two years. When Cortés heard about the other group, he went and defeated them. In this contact, one of Cortés's men contracted the disease. When Cortés returned to Tenochtitlan, he brought the disease with him.
Soon, the Aztecs rose up in rebellion against Cortés and his men. Outnumbered, the Spanish were forced to flee. In the fighting, the Spanish soldier carrying smallpox died. After the battle, the Aztecs contracted the virus from the invaders' bodies. Cortes would not return to the capital until August 1521. In the meantime smallpox devastated the Aztec population. It killed most of the Aztec army and 25% of the overall population.[33] The Spanish Franciscan Motolinia left this description: "As the Indians did not know the remedy of the disease…they died in heaps, like bedbugs. In many places it happened that everyone in a house died and, as it was impossible to bury the great number of dead, they pulled down the houses over them so that their homes become their tombs."[34] On Cortés's return, he found the Aztec army’s chain of command in ruins. The soldiers who still lived were weak from the disease. Cortés then easily defeated the Aztecs and entered Tenochtitlán.[35] The Spaniards said that they could not walk through the streets without stepping on the bodies of smallpox victims.
The effects of smallpox on Tahuantinsuyu (or the Inca empire) were even more devastating. Beginning in Colombia, smallpox spread rapidly before the Spanish invaders first arrived in the empire. The spread was probably aided by the efficient Inca road system. Within months, the disease had killed the Sapa Inca Huayna Capac, his successor, and most of the other leaders. Two of his surviving sons warred for power and, after a bloody and costly war, Atahualpa become the new Sapa Inca. As Atahualpa was returning to the capital Cuzco, Francisco Pizarro arrived and through a series of deceits captured the young leader and his best general. Within a few years smallpox claimed between 60% and 90% of the Inca population,[36] with other waves of European disease weakening them further. A handful of historians argue that a disease called Bartonellosis might have been responsible for some outbreaks of illness, but this opinion is in the scholarly minority.[37] The effects of Bartonellosis were depicted in the ceramics of the Moche people of ancient Peru.[38]
Even after the two mighty empires of the Americas were defeated by the virus and disease, smallpox continued its march of death. In 1561, smallpox reached Chile by sea, when a ship carrying the new governor Francisco de Villagra landed at La Serena. Chile had previously been isolated by the Atacama Desert and Andes Mountains from Peru, but at the end of 1561 and in early 1562, it ravaged the Chilean native population. Cronicles and records of the time left no accurate data on mortality but more recent estimates are that the natives lost between twenty and twenty five percent of their population. The Spanish historian Marmolejo said that gold mines had to shut down when all their Indian labor died.[39] Mapuche fighting Spain in Araucanía regarded the epidemic as a magical attempt by Francisco de Villagra to exterminate them because he could not defeat them in the Arauco War.[29]
In 1633 in Plymouth, Massachusetts, the Native Americans were struck by the virus. As it had done elsewhere, the virus wiped out entire population groups of Native Americans. It reached Mohawks in 1634,[40] the Lake Ontario area in 1636, and the lands of the Iroquois by 1679. During the 1770s, smallpox killed at least 30% of the West Coast Native Americans.[41][42] The smallpox epidemic of 1780–1782 brought devastation and drastic depopulation among the Plains Indians.[43] This epidemic is a classic instance of European immunity and non-European vulnerability. It is probable that the Aboriginals contracted the disease from the ‘Snake Indians’ on the Mississippi. From there it spread eastward and northward to the Saskatchewan River. According to David Thompson’s account, the first to hear of the disease were fur traders from the Hudson’s House on October 15, 1781.[44] A week later reports were made to William Walker and William Tomison, who were in charge of the Hudson and Cumberland Hudson’s Bay Company posts. By February, the disease spread as far as the Basquia Tribe. Smallpox plagued whole tribes and left few survivors. E. E. Rich described the epidemic by saying that “Families lay unburied in their tents while the few survivors fled, to spread the disease.” [45] After reading Tomison’s journals, Houston and Houston, have calculated that out of the Aboriginals that traded at the Hudson and Cumberland houses, ninety-five percent died of smallpox.[43] Paul Hackett adds to the mortality numbers suggesting that perhaps up to one half to three quarters of the Ojibway situated west of the Grand Portage died from the disease. The Cree also suffered a casualty rate of approximately seventy-five percent with similar effects found in the Lowland Cree.[46] Not only did smallpox devastate the Aboriginal population, it did so in an unforgiving way. William Walker described the epidemic stating that “the Indians [are] all Dying by this Distemper … lying Dead about the Barren Ground like a rotten sheep, their Tents left standing & the Wild beast Devouring them.” [44]
A particularly virulent sequence of smallpox outbreaks took place in Boston, Massachusetts. From 1636 to 1698, Boston endured six epidemics. In 1721, the most severe epidemic occurred. The entire population fled the city, bringing the virus to the rest of the Thirteen Colonies.
In the late 1770s, during the American Revolutionary War, smallpox returned once more and killed an estimated 125,000 people.[47] Peter Kalm in his Travels in North America, described how in that period, the dying Indian villages became overrun with wolves feasting on the corpses and weakened survivors.[48]
By 1832, the federal government of the United States established a smallpox vaccination program for Native Americans.[49]
In 1789, near Sydney, smallpox decimated the native population of coastal New South Wales, eventually killing around 50% of Indigenous Australians.[50] The extent of this outbreak is disputed but another confirmed outbreak of smallpox occurred in 1828–30 in New South Wales near Bathurst.[51] Smallpox also killed many New Zealand Māori [52] and nearly wiped out the native population of Easter Island.[53]
Recent scholars, Christopher Warren (2007)[54] and Craig Mear (2008),[55] have shown that the 1789 outbreak of smallpox was caused by British supplies of virus imported with the First Fleet. Most earlier writers proposed that the 1789 outbreak was caused by a hypothetical transmission from Macassar in Sulawesi.