The answers to the above questions may surprise the average reader. The study of the pox family is very interesting and revealing as to what has happened in the past concerning this collection of killers.

This family of pox diseases in man and animals are caused by filtrable viruses and is known as variola which is a Latin term meaning “speckled.” To classify the variola virus properly we would place it in the family Poxviridae and the genus Orthopoxvirus. There are seven viruses listed in this genus, four of which can infect humans. They are the viruses of smallpox, cowpox, horsepox and monkeypox. Smallpox, however, seems to be the only virus in this genus that readily spreads from human to human.

Variola disease in man and animals alike runs a very unique pattern, in that it is first characterized by a rise in temperature. This is followed by a skin eruption of reddish appearing swellings called “papules.” These then turn into blister-like swellings containing fluid called “vesicles.” The vesicles in turn form into “pustules” which are the same swellings whereby the fluid they contain is replaced with pus. This then is the general picture of a pox disease in man or animals.

To understand about variola infections, let’s first discuss smallpox.

The origin of smallpox is probably lost in the pages of prehistoric times. We do know however that it was reported in Chinese records and described in 1122 B.C. An Arabian physician Rhazein, gave the very first detailed description of the disease in the early part of 10th century A.D. The writer and philosopher Galen described and recorded what he called a “pesta magna” in the 2nd century A.D. This “pestilence” is believed to have been smallpox.

Another widespread epidemic of this horrible disease occurred during the 6th century and was carried back from Asia Minor by crusaders to infect the countries and feudal estates of Western Europe. It spread rapidly and became the scourge of Europe during the middle ages and down through the 18th century.

During the 1700s it has been estimated by researchers of these facts and figures, that some 60 million people died of it, more than the total deaths of all of the wars which occurred during this period of time. This disease inspired more fear and terror in the population of the world at that time than any other factor.

An English nobleman, Lord Macouley, wrote the following about 1700: “The smallpox was always present, filling the churchyard with corpses, tormenting with constant fears all whom it had not stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.”

Smallpox not only killed but it often horribly disfigured the survivors, as another Englishman wrote in about 1600: “Envious and foule disease could there not be, one beautie in an age and free from thee.”

And, so it is known, that the disease smallpox, or variola, has been the greatest killer of mankind, some 300 million people, plus an untold number of survivors who were disfigured and maimed for life. It is difficult for one to comprehend that in the 18th century almost every living human was exposed to the great scourge, smallpox.

The first symptoms of smallpox in the human will occur about 10 days after exposure to the virus. They may include all or some of the following; dizziness, headache, nausea, vomiting, very high fever, and backache or joint aches. In a day or two the first red spots, papules, will appear on the body surface. This rash may spread over the entire body and the red spots will become filled with fluid. These vesicles or areas, become very hard as they fill with fluid from the capillaries. This, in turn, gives the affected areas a “pebbly” appearance and feel.

The fluid gradually gives way to pus and the pustule is formed. If the pustules are separated by unaffected skin the cases are known as “discrete” and these patients will often survive but pay a high price in facial and body disfigurement. This form of smallpox is known as “variola major” and has a 30% mortality rate.

If the pustules join together with no unaffected skin between them, the patient will often become unrecognizable in 4 or 5 days due to huge swellings of the skin areas of the body. The nose, throat and mouth may be so filled and swollen with these pustules that the victim cannot eat, drink or swallow. The skin on these patients when touched often will slough off in massive sheets. These people will suffer tremendously and many will die in 10 to 14 days. Medical people call these cases “confluent pox.”

Another form of smallpox, which will kill 75% of its victims, is known as “flat” pox. In this smallpox entity the pustules never rise above the skin level.

Another form of the disease, but the least common of all, will kill the patient in a short time. Usually 4 or 5 days after onset. It is the hemorrhagic form in which blood vessels all over and through the body leak blood. This form of very highly fatal smallpox is known as “black pox.”

Now one can understand the chances of recovering from the smallpox infection depends upon the type of infection you get, how big a dose of the virus you receive and how your body defenses react to the invasion of the virus. The young and the old, the malnourished and diseased, are easy victims for this master killer.

In studying the disease it has been found that smallpox is not contagious in the victim until the rash appears on the skin. If vaccination is done on the exposed person in the first few days, up to five after exposure, the illness from the smallpox will be reduced or prevented. This is a plus in controlling an outbreak.

In the late 1700s, practicing in western England was a country doctor named Edward Jenner. It was he who made one interesting discovery which led directly to the art of vaccination.

At that time it was common knowledge among country inhabitants in that area of England, that persons who milked cows and contracted cowpox from infected cows would not develop smallpox upon exposure to it.

It was this folk knowledge which prompted a Dorsetshire farmer named Benjamin Jesty to inoculate his family with cowpox in 1774. Some soldiers in George Washington’s Continental Army were reportedly doing the same by passing a string soaked in cowpox lesions through their skin.

In investigating this rumor or belief among the country folk, Dr. Jenner collected fluid from cowpox lesions on the hands of a milk maid named Sarah Nelms. He then transferred it into abraided skin on the arms of an eight year old boy, James Phipps. This occurred on May 14, 1796. In a few days a typical “take” was evident on the young fellow’s arm. This “take” was the appearance of the papules, which later turned to pustules, which then became scabs on the areas where the cowpox material had been placed.

Six weeks later the boy, Phipps, was inoculated with serum from the papules of a smallpox patient. He did not come down with the dreaded smallpox. He was immune to it as the country gossip had predicted. More experiments were performed with the same results. It was proven that a mild cowpox infection would produce immunity to the dreaded smallpox.

This procedure of Dr. Jenner was the first recorded vaccination ever performed to prevent a disease. In this case, when the cowpox was inoculated into man, the disease which was produced, was mild, localized to the inoculated area and was called “vaccinia.” Thus it was Dr. Jenner’s work that led to the term “vaccination” which came from the Latin word “vacca” which means cow. For many years the word “vaccination” literally meant the inoculation of cowpox for the prevention of smallpox in man.

Today the term vaccination is used to define a procedure whereby an antigen is injected to produce an immune reaction.

In 1799 Jenner published a paper entitled “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 Cowpox.” In this paper he reported it was possible to vaccinate people with fluids taken from the cowpox lesions, thus protecting them from smallpox.

An interesting sideline concerning myself is the fact I have been vaccinated 3 times in my life for smallpox and none of them “took.” Once, as a child in school and twice in the army during WWII. Maury Telleen had the same experience. Both of us can recall having cowpox on our hands as a result of milking infected cows! — By hand of course!! We both became immune to small pox and the vaccine simply did not “take.”

With a good vaccination program in effect, plus the isolation early on of smallpox patients, the United States and Europe were declared free of the disease by 1973. Vaccination stopped in the U.S. in 1972.

The World Health Organization undertook the massive task of eradicating smallpox from the globe in 1966. In October of 1975 the last natural occurring case was located in the person of a 3 year old girl from Bhola Island, Bangladesh, named Rahima Banu. She survived. In 1977 another case was found. He was Ali Maou Maalin, a Somali cook. He too survived.

Containing and then eradicating smallpox was a huge undertaking, but by 1978 the world was free of the disease and in 1980, the World Health Assembly recommended that all countries should cease vaccination.

Early on in the 19th century, scholars in both Europe and America proved that cowpox and smallpox were the same diseases except they occurred in two species of animals, that is, cattle and humans. They found that when the smallpox virus passed into cattle it lost much of its virulence and could be used as a vaccine. True cowpox therefore is known to be caused by the smallpox virus. It is also known that this infection can be transmitted from cow to cow by inoculation or by recently vaccinated workers.

Since the abolition of smallpox in the world today, the true cowpox of Jenner’s time has disappeared. It then seems likely that the bovine disease had its reservoir in the human population.

The cowpox seen today differs from the older form in that infection does not occur in those workers who milk and handle these animals. Vaccinea virus does not prevent the disease in the cattle and researchers were not successful in transmitting this disease by inoculation of normal healthy cattle. Thus, the cowpox of today is not the genuine old cowpox seen long ago. Today this condition in cattle is referred to as pseudo-cowpox.

Horsepox, also known as contagious pustular stomatitis, was at one time very common in Europe. It was described by early Roman writers and by veterinarians of the 1700s. In the course of the disease, an eruption of pocks or pustules occurs over any part of the skin or mucous membranes of the lips or about the nostrils and eyes. However, almost exclusively, they will erupt and form on the pasterns and fetlocks of the horse. The condition was often confused with so called “grease heel” or “grease.”

Jenner studied these conditions in horses and noted that the disease could be transmitted to cattle and to the stablemen or people who milked the affected cows. As in the case of cowpox, these people would become immune to smallpox.

In 1924 a German scientist, Zwick, published his findings after investigating the disease thoroughly. He concluded the causative agent to be the virus of vaccinia.

With the demise of smallpox in the world today, the old time horsepox is also gone. There is no record of this disease ever occurring in North America.

We know humans are the main host for the smallpox virus. However, monkeys may become infected with the virus and spread it to other monkeys and possibly back to man. In Brazil a smallpox epidemic in the human population was thought to have started in a group of monkeys. The bodies of the dead monkeys were examined and found to be covered with smallpox pustules. According to the literature, an orangutan kept in a zoo developed smallpox associated with a smallpox outbreak in Djakarta, Indonesia in 1951.

Since human and sub-human primates live in close contact with each other, either in the wild or in captivity, one must be aware that each are very susceptible to the smallpox virus.

Has Bioterrorism ever been employed in the Western Hemisphere and in North America? The answer is yes.

The British army used smallpox as a weapon during the French and Indian war which was fought in 1754 to 1767. Blankets used by smallpox victims were deliberately given to opposing American Indian tribes for the express purpose of starting smallpox outbreaks among them. To the American Indian, smallpox was extremely deadly. In this case, 50% of the population of the exposed tribes died of the disease.

The Aztecs and Incas were not necessarily defeated by the small Spanish armies of the conquistadors which were sent against them, as by the ravages of smallpox which the Spaniards inadvertently introduced into their populations. It is estimated that over half of their people died as a result of the smallpox epidemics.

Smallpox was introduced by the Spaniards into the Western hemisphere and by the time the continent was colonized, it is estimated 6,000,000 of the Indian population died of the disease.

The Mandans were a proud people that welcomed and gave much needed support and aid to the Lewis and Clark expedition during the first winter of their journey in 1804. In 1837, blankets were given to them containing smallpox virus. A village of 1600 was reduced to 31 survivors in just 3 weeks. As the chief lay on his deathbed, it was said that he cursed the day of the white man’s arrival, and he wished he had killed them all.

The same can be said for the Blackfoot tribe. They were a very powerful and proud people that dominated a vast area including much of Montana, parts of Wyoming, North Dakota and Canada. They were the American trapper’s worst enemy. Osborne Russell in his book, The Journal of a Trapper, describes a village of these people being ravaged by smallpox. The death toll from the smallpox among our North American Indians was staggering.

One can but imagine what it was like for these people to undergo an epidemic of smallpox, especially if it was thrust upon them with the idea of crippling their society so they could be managed. Whether it happened accidentally or intentionally, the result was always the same.

Some facts to remember about smallpox.

1. Smallpox in the human and the pox diseases as seen in monkeys, cattle and horses are caused by the same or closely related viruses.
2. The smallpox virus, when passed through cattle and horses, becomes weakened or attenuated. It is called vaccinea and is used for vaccination against smallpox.
3. The probability of a smallpox attack is very low, however, if it was to happen, the results would be worldwide and it would be devastating. Therefore, measures should be undertaken to reduce the risk of an attack and provide for a defense against it.
4. Vaccination will prevent the disease even if it is administered 5 days after exposure.
5. With the possible exception of monkeys and other subhuman primates, smallpox is now only hosted by human beings.
6. The smallpox virus will survive for days in clothing and bedding of infected people.
7. The most common route of infection is by inhalation of the virus during face-to-face contact with a smallpox victim.
8. In the case of an outbreak of smallpox, only a massive vaccination program would contain it. At the present time there are no drugs which could be administered to a victim which would destroy the virus and cure the patient.