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Skin Diseases
CHAPTER 6

Smallpox: A Primer
Brenda J. McEleney

Smallpox, is a virus that plagued humanity for millennia. It was the first and only disease ever intentionally eradicated from the face of this planet, a scourge defeated in a remarkable, never-before-attempted campaign of generosity and cooperation by the nations of the world. Its eradication was a triumphant symbol of science and dogged persistence winning over nature. Moreover, its eradication was a gift of man to all mankind. Yet, is it possible that the same hand of man, that once rid the scourge of smallpox from the world, will be used to unleash this terror again on its unprotected citizens? This chapter, by providing a thorough review of the history, epidemiology, and current risks associated with this dreaded disease, addresses that question and its implications for the American public.

Origins of Smallpox
Smallpox has been described as one of the great scourges of mankind.1 Every corner of the world has felt its grip and known its devastation. Historians speculate that smallpox first appeared around 10,000 B.C. in the agricultural settlements in northeastern Africa. From there, it probably spread to India via Egyptian merchants. There is evidence smallpox is at least 3,000 years old. It was known in China as early as 1122 B.C. Its scars have been found on the mummy of Pharaoh Ramses V, who died in 1157 B.C., as well as on other mummies from the 18th and 20th Egyptian dynasties.2,3

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Smallpox: A Primer

The first known smallpox epidemic was recorded in 1350 B.C. During the Egyptian-Hittite war that year, Egyptian prisoners unwittingly spread smallpox to the Hittites. Even the Hittite King Suppiluliumus I and his heir fell victim to the virus. It devastated their civilization and assured the Egyptians victory.4 Records also show the ancients recognized subsequent immunity in those who survived the disease. Thucydidus noted this curiosity during the Athenian epidemic in 430 B.C. Rhazes, considered the

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