Smallpox

The Parasitic Horror

A Tricky Virus

Starting in the early 1600s, a great disaster struck Native Americans living across the land that would become the United States and Canada. Their population was drastically reduced, from 20 million to less than one million. Ninety-five percent dead, with some tribes extinct! One cause of this great tragedy was a microbe so small that 50,000 of them could fit on the period at the end of this sentence.

This horror was the smallpox virus. As a parasite, it must continually find a new human host or it will die. For thousands of years, throughout Asia, Europe, and Africa, among emperors, kings, and poor folk too, smallpox made people so sick that they often died. The virus survived by traveling to new victims in a sneeze, a cough, or the pus of an oozing rash. Millions of contagious microbes lingered in scabs that fell, after four or five weeks, from the dried-up rash of survivors. Blankets and clothing could remain contagious for months.

Smallpox, the variola virus, can cover the body and be transmitted through contact with an infected person or with objects that have touched the infected person.

The smallpox virus, variola, is the largest virus. Poliovirus is the smallest. Each virus has a different lifestyle that we must understand in order to prevent or cure it.

Over the centuries, Old World populations built up defenses against smallpox. One in three people with the disease died. Lucky people who did not get sick passed on this natural resistance to their children. The survivors ended up with an army of defensive microbes in their bodies to protect them from another infection. But children were always born who had yet to catch it. Then a coughing visitor sick with smallpox would arrive. A new epidemic would sweep through the crowds until the tiny microbe ran out of hosts.

But smallpox was unknown in North America. Explorers, settlers, slaves, and missionaries from the Old World were the visitors who transported it there. Unseen and uninvited, this parasite played a huge role in the shaping of the United States.

New World, No Resistance

It is the early 1600s along the coast of Massachusetts. Native Americans meet European fishermen who have come ashore for freshwater. Soon a strange sickness with fiery pain and oozing rashes sweeps through the tribe. Traditional medicines offer no relief.

A mother cradles her feverish child, who has red spots in his mouth and a rash on his skin. The child coughs and sends a spray of saliva into the air, each droplet containing thousands of a tiny virus that no one can see. The mother inhales some into her nose.

Quickly, the virus drills into a cell of her body. Once inside, the parasite stops the cell from doing its normal work and turns it into a smallpox factory. Thousands upon thousands of new viruses are reproduced until--poof!--the cell explodes into a shower of hundreds of thousands of new microbes. The pox spreads to lymph nodes and travels through the bloodstream. Eventually, it sickens the lungs, spleen, eyes, liver--so many important parts of the body.

After a week, the mother is bedridden with severe aches, nausea, and high fever. The child dies. Mourners bring food and carefully remove the child in his soiled blanket. Without knowing it, they become new hosts for the parasitic virus.

This 1620 Plymouth scene shows Pilgrims unloading items from the Mayflower as a lone Native American watches.

Soon a rash breaks out on the mother's skin. When the blisters ooze with pus, it smells like rotting flesh. No one comes to help her. Too many are dead or dying, and the rest have fled in a panic to another village. They have become the visitors who continue the chain of infection. Any survivors will have deep pockmarks on their face, and some will be blind after four weeks of terrible sickness.

Since no Native Americans have been ill with this virus before, or with other illnesses introduced by Europeans, none have the defensive microbes left over from the sickness. Meeting no resistance, the parasite invades and overwhelms most of them.

When the Pilgrims arrive on the Mayflower in 1620, they find the deserted village of Patuxet. The land is already cleared and ready to be planted, but there are no people, only graves and scattered bones. Meeting no resistance, the Pilgrims move in and call it Plymouth.

More Than One Way to View an Epidemic

Shiploads of Puritans arrived in Massachusetts in 1630. In 1633 another smallpox epidemic raged. William Bradford, governor of the Plymouth colony, wrote about the death toll in one of the tribes, stating that more than 950 of 1,000 died, "and many of them did rott above ground for want of buriall."

In the Plymouth colony there were 20 deaths from smallpox. Most of the adults had been exposed to the disease before. The parasite mainly infected children under 12, who did not yet have immunity.

Because the Indians were dying in such great numbers, some colonists thought the disease was caused by God, for their benefit. Increase Mather, a Puritan clergyman in Boston, wrote, "The Indians began to be quarrelsome concerning the bounds of the land they had sold to the English, but God ended the controversy by sending the smallpox amongst the Indians...who were before that exceeding numerous. Whole towns of them were swept away, in some of them not so much as one Soul escaping the destruction."

Others, however, used direct observation to learn about the disease. They realized that smallpox spread when a sick person came into contact with a healthy person. As a harbor town, Boston had a steady supply of newcomers, and some arrived sick. In 1647, the city authorities decided to isolate them with a quarantine. Ships were not allowed to dock until infected passengers died and were buried at sea, or until the last crusty scabs of the pox fell off, which could take four or five weeks.

This was not the end of smallpox, however. Ships held in a long quarantine did not make money, so many devious captains found ways to slip through. The city of Boston had five major smallpox epidemics in the 1600s, even after the practice of quarantining had begun. And disease continued to invade new tribes as trade and exploration expanded to new areas of the country. Millions died all the way to the West Coast, leaving desperate survivors with a loss of confidence in their culture and their gods. Some Native Americans had been enslaved by Europeans looking for workers, but so many of them died that a trade opened up to bring slaves from Africa.

The Power of Information

Increase Mather had a son named Cotton. In 1677-78, when he was 15, Cotton survived a smallpox epidemic. Later he became a Puritan clergyman like his father. In 1706 he was given an African slave, and Cotton Mather learned something new: "Enquiring of my Negro-Man Onesimus, who is a pretty intelligent fellow, whether he ever had ye smallpox, he answered Yes and No; and then told me that he had undergone an operation, which had given him something of ye smallpox, and would forever preserve him from it, adding...whoever had ye courage to use it was forever free from ye fear of the contagion."

This operation was called inoculation. Mather read that it had also been used successfully in the Ottoman Empire. Matter was removed from a smallpox pustule on a mildly sick person and then inserted into needle scratches on the arm of a healthy person. At the scratch site, a single pockmark erupted. The body would make microbes to attack the virus and then protect the inoculated from getting full-blown smallpox.

When the next smallpox epidemic broke out in 1721, Mather urged all 10 of Boston's doctors to consider this procedure. But like many devout Christians, they believed that smallpox was God's punishment for sin and they should not interfere. Also they were afraid of the surgery, and with good reason. Inoculated people sometimes got a severe case of smallpox or developed an infection. One in 50 died. All inoculated patients had to be isolated for three or four weeks because during that time they were contagious.

One doctor, Zabdiel Boylston, used a sharp toothpick and a quill to inoculate his six-year-old son and two slaves. All three were mildly sick and then immune. Many people in Boston were outraged and afraid. An angry crowd threatened to hang Boylston, and someone threw a bomb through Mather's window that failed to explode. It carried a note: "Cotton Mather, you dog. Damn you! I'll inoculate you with this, with a pox to you!"

Privately, Mather had his son Samuel inoculated.

Dr. Boylston continued also, and 280 more people were inoculated. Only six of them (about 2 percent) died. Throughout Boston (population around 11,000) about 5,800 got smallpox and 844 (about 15 percent) died.

Enough people heard about this success that inoculation was used in other cities. After his son died of smallpox in 1736, Benjamin Franklin supported it in his newspaper, the Pennsylvania Gazette. Many people traveled great distances to get inoculated, but the numbers were not high enough to slow down the disease. The procedure was very expensive, and people had to take off weeks from work. Only wealthy families could afford it; inoculation became an event where they all remained together for the entire isolation period. Benjamin Franklin thought that the poor should not be the main victims of the disease. In 1774, while he was living in England, he helped to start the Society for the Inoculation of the Poor.

Biological Warfare

Native Americans were left out of the first inoculation programs. But even more tragic, they sometimes became targets of biological warfare, deliberate plans to infect them with the smallpox virus.

In 1763, France and England were at war for control of North America. Some Native American tribes under Chief Pontiac, an Ottawa leader, tried to drive the British out of tribal areas. In May, they surrounded the British stronghold of Fort Pitt in Pennsylvania.

After a month of siege, the British devised a plot.

Sir Jeffery Amherst, commander in chief, knew that the Native Americans were susceptible to smallpox. He wrote to Colonel Henry Bouquet asking, "Could it not be contrived to Send the Smallpox among those Disaffected Tribes of Indians?"

The colonel responded, "I will try to inocculate the Indians with some Blankets that may fall in their hands, taking care however not to get the disease myself."

Mah-to-toh-pa (Four Bears) was chief of the Mandan tribe, which almost became extinct as Europeans spread out across North America bringing new diseases and aggressively seeking land.

Amherst replied, "You will Do well to try to Innoculate the Indians by means of Blanketts as well as to try Every other method that can serve to Extirpate this Execrable Race."

Earlier, when two Native American chiefs were invited to visit the British camp, William Trent, a trader, wrote this in his diary: "Out of our regard for [the chiefs] we gave them two Blankets and an Handkerchief out of the Small Pox Hospital. I hope it will have the desired effect."

The chain of infection cannot be followed with certainty, but the tribes soon suffered another terrible epidemic.

Smallpox and the American Revolution

The American Revolution was fought while smallpox raged. During these years of war, between 1775 and 1783, more than 150,000 colonists in Canada and the United States died. About 25,000 were killed during battles with the British. Most of the others died of smallpox.

George Washington survived smallpox when he was 19 and had many pox scars on his face from the ordeal. He learned of the success of inoculation but for a long time resisted it for his troops because they would have to be quarantined afterward and would be unable to fight for weeks. And there was always a risk the disease could spread in spite of all precautions.

In April 1775, after the first battle of the American Revolution, the British retreated to Boston, where yet another smallpox epidemic was raging. The disease was killing Bostonians, but British soldiers had been inoculated and were protected.

The colonial militia camped outside the city and tried to cut off any supplies that might come to the British. But Washington feared a possible plot to spread smallpox to his troops. On November 27, 1775, he wrote to Congress that the British General "has ordered 300 inhabitants of Boston to Point Shirley in destitute condition. I am under dreadful apprehensions of their communicating the Smallpox as it is rife in Boston." Washington ordered sick people coming from Boston to stay away, and the army remained pox-free.

Meanwhile, other troops marched up to Quebec to try and win control of this key location from the British. In December 1775, Caleb Haskell, a fife player, wrote, "The smallpox is all around us." Later he became ill. "No bed to lie on; no medicine to take; troubled much with a sore throat." In the history of this disease, smallpox often determined who won the military battle. In this case, the British suffered far fewer losses than the colonial troops, and Quebec remained in the hands of the British. It did not become part of the colonies.

In 1776, the British gave up Boston. Fearing smallpox contamination on sheets and towels left behind, Washington at first only allowed his soldiers who had smallpox scars to enter the city.

Finally in January 1777, General Washington decided to inoculate his troops. He hoped "that in a short space of time we shall have an Army not subject to this the greatest of all calamities that can befall it." During the harsh winter of 1778 at Valley Forge, it was discovered that about 4,000 soldiers still had not been inoculated. There were more surgeries, and many soldiers spent the winter in bed cared for by others who were immune. After this, the number of smallpox outbreaks dropped considerably in the troops. The American Revolution ended successfully for the colonists. Native American cultures across North America, however, continued to lose battles with smallpox.

Smallpox survivors were left with deep, pitted scars. Some were blind. Native Americans called the sickness "rotting face." But Edward Jenner noticed that milkmaids had no scars, and, he wondered, why didn't they get smallpox?

The Power of Observation and the Face of a Milkmaid

Smallpox belongs to a family of poxviruses that affect every species that gathers in swarms, herds, flocks, and crowds. There are mousepox, monkeypox, skunkpox, pigpox, gerbilpox, sealpox, canarypox, penguinpox, dolphinpox, grasshopperpox (six kinds), turkeypox, beetlepox, and butterflypox, just to name a few. But it is cowpox that plays an amazing role in the history of smallpox.

In the 1790s, while Europe was at war with France, a country doctor in England named Edward Jenner noticed that milkmaids always had clear, smooth skin. When he investigated, he discoverd that during the smallpox epidemic of 1778, they did not get sick. And a song in country folklore indicated that milkmaids had a long history of no smallpox.

Where are you going, my pretty maid?

I'm going a-milkin', sir, she said.

What is your father, my pretty maid?

My father's a farmer, sir, she said.

What is your fortune, my pretty maid?

My face is my fortune, sir, she said.

Jenner investigated and learned that milkmaids got cowpox on their hands after milking a cow with pox on its udders. Cowpox was a mild disease that was never deadly and left no pockmarks. Could they be getting immunity to smallpox without actually getting the disease?

Jenner took pus from the pox of milkmaid Sarah Nelmes, made two small scratches on a boy's arm, and inserted the pus into the cuts. Cowpox could not be transmitted from person to person, so no quarantine was necessary. Jenner wrote that "on the ninth day, [the boy] became a little chilly, lost his appetite, and had a slight headache. Spent the night with some degree of restlessness, but on the day following he was perfectly well." Jenner then did a very risky thing. He tried to give the boy smallpox through inoculation. Fortunately, the boy was immune.

Jenner wrote a book about this procedure. Matter taken from the cow he called vaccine, which comes from the Latin for "obtained from a cow." The procedure was called vaccination. In the United States, a Harvard doctor named Benjamin Water house read the book. He tried the procedure on his five-year-old son and six others. Finding success, he wrote to President Thomas Jefferson about this incredible discovery.

This 1802 painting by James Gillray illustrates a common fear that vaccination could cause cow hair and cow parts to grow on human bodies.

Once again, people responded with fear and religious objections. Some thought it was unnatural to interfere with the will of God. Some worried that characteristics of cows might pop out of their bodies. One English doctor claimed to know a vaccinated girl who "coughed like a cow, and had grown hairy over her body."

But Thomas Jefferson supported the new procedure. He invited Native Americans to the White House to be vaccinated. He also sent supplies with the explorers Meriwether Lewis and William Clark and gave them instructions to vaccinate the various tribes they met. However, many Native Americans were suspicious and refused. An epidemic in 1837 almost wiped out the entire Mandan tribe along the Missouri River. All across the West, Indians continued to die in great numbers with devastating effects on tribal cultures from the Mississippi Valley to the Great Plains, and the Pacific Northwest.

This 1930s poster from the Chicago Department of Health was part of the worldwide effort to eliminate smallpox.

The Death of Smallpox

The vaccine did not reach everyone. In the 1900s, an estimated 300 million people worldwide died of smallpox. This was more than the number of people who died during wartime in the twentieth century, from AIDS, and the 1918 flu pandemic combined.

But the most amazing part of the smallpox story also occurred in the 1900s. Smallpox became the only natural disease to be totally eliminated. The last known case in the world occurred in 1977; the smallpox parasite was finally contained and could find no more hosts.

This happened for several reasons. The vaccine had continued to work and had been given to millions around the world, including newborn babies and anyone who had contact with smallpox victims. Also, smallpox did not remain in the body of survivors or hide in any nonhuman host. And the virus did not mutate, or change. It always acted the same, so the body's immune response could fight effectively.

Most doctors today have never seen a patient with smallpox. Well-guarded frozen samples of the virus are kept in Atlanta, Georgia, and in Koltsovo, Russia, for scientific study. There are reports that other samples also exist, but this is not known for sure. Everyone hopes that this tiny parasite will never again reappear to find a new host.

DISASTERS Copyright 2010 by Brenda Z. Guiberson