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First practices of Variolation within Chinese culture (~15th century) (Hope) 

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First practices of Variolation within Chinese culture (~15th century) (Hope) 

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Variolation was initially practiced by the Chinese, and was used by inhaling powdered smallpox scabs, usually taken from an individual with a mild case. There is little information as to whether this method was successful in curing or preventing the smallpox disease.
https://www.labroots.com/trending/microbiology/4928/variolation-vaccination

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The hesitation in England(1721)(Isabella) 

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The hesitation in England(1721)(Isabella) 

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When Lady Montagu brought the news of variolation the people of England did not like what they heard and called for prof of it working: of course very little people stepped up to try it so they resorted to condemned prisoners. The promised the prisoners freedom if they survived(good news they did). This prof led to more people in England willing to try the variolation.

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Edward Jenner (1749-1823), a physician from Gloucestershire in England, is widely regarded as the 'father of vaccination' ( Milestone 2). However, the origins of vaccination lie further back in time and also further afield. In fact, at the time Jenner reported his famous story about inoculating young James Phipps with cowpox and then demonstrating immunity to smallpox, the procedure of 'variolation' (referred to then as 'inoculation'), by which pus is taken from a smallpox blister and introduced into a scratch in the skin of an uninfected person to confer protection, was already well established.

Variolation had been popularized in Europe by the writer and poet Lady Mary Wortley Montagu, best known for her 'letters from the Ottoman Empire'. As wife of the British ambassador to Turkey, she had first witnessed variolation in Constantinople in 1717, which she mentioned in her famous 'letter to a friend'. The following year, her son was variolated in Turkey, and her daughter received variolation in England in 1721. The procedure was initially met with much resistance - so much so that the first experimental variolation in England (including subsequent smallpox challenge) was carried out on condemned prisoners, who were promised freedom if they survived (they did). Nevertheless, the procedure was not without danger and subsequent prominent English variolators devised different techniques (often kept secret) to improve variolation, before it was replaced by the much safer cowpox 'vaccination' as described by Jenner.

But how did variolation emerge in the Ottoman Empire? It turns out that at the time of Lady Montagu's letter to her friend, variolation, or rather inoculation, was practised in a number of different places around the world. In 1714, Dr Emmanuel Timmonius, resident in Constantinople, had described the procedure of inoculation in a letter that was eventually published by the Philosophical Transactions of the Royal Society (London). He claimed that "the Circassians, Georgians, and other Asiatics" had introduced this practice "among the Turks and others at Constantinople". His letter triggered a reply from Cotton Maher, a minister in Boston, USA, who reported that his servant Onesimus had undergone the procedure as a child in what is now southern Liberia, Africa. Moreover, two Welsh doctors, Perrot Williams and Richard Wright, reported that inoculation was well known in Wales and had been practised there since at least 1600.

Patrick Russell, an English doctor living in Aleppo (then part of the Ottoman Empire), described his investigations into the origins of inoculation in a letter written in 1786. He had sought the help of historians and doctors, who agreed that the practice was very old but was completely missing from written records. Nevertheless, it appears that at the time, inoculation was practised independently in several parts of Europe, Africa and Asia. The use of the needle (and often pinpricks in a circular pattern) was a common feature, but some places had other techniques: for example, in Scotland, smallpox-contaminated wool (a 'pocky thread') was wrapped around a child's wrist, and in other places, smallpox scabs were placed into the hand of a child in order to confer protection. Despite the different techniques used, the procedure was referred to by the same name - 'buying the pocks' - which implies that inoculation may have had a single origin.

Two places in particular have been suggested as the original 'birthplace of inoculation': India and China. In China, written accounts of the practice of 'insufflation' (blowing smallpox material into the nose) date to the mid-1500s. However, there are claims that inoculation was invented around 1000 ad by a Taoist or Buddhist monk or nun and practised as a mixture of medicine, magic and spells, covered by a taboo, so it was never written down.

Meanwhile, in India, 18th century accounts of the practice of inoculation (using a needle) trace it back to Bengal, where it had apparently been used for many hundreds of years. There are also claims that inoculation had in fact been practised in India for thousands of years and is described in ancient Sanscrit texts, although this has been contested.

Given the similarities between inoculation as practised in India and in the Ottoman Empire, it may be more likely that variolation, as described by Lady Montagu, had its roots in India, and it may have emerged in China independently. However, given that the ancient accounts of inoculation in India are contested, it is also possible that the procedure was invented in the Ottoman Empire and spread along the trade routes to Africa and the Middle East to reach India.

Regardless of geographical origin, the story of inoculation eventually led to one of the greatest medical achievements of humankind: the eradication of smallpox in 1980. And of course, it inspired the development of vaccines for many more infectious diseases, turning this planet into a much safer place.

Further reading

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Edward Jenner (1749-1823), a physician from Gloucestershire in England, is widely regarded as the 'father of vaccination' ( Milestone 2). However, the origins of vaccination lie further back in time and also further afield.

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Techniques for Variolation continue to prosper (1731) (Hope) 

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Techniques for Variolation continue to prosper (1731) (Hope) 

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As some called it inoculation, one technique practiced by Brahmins consisted of dipping a sharp needle  into an infected smallpox pustule, and rupturing one's skin repeatedly (typically in a small circle in the upper arm region). This technique has mostly practices in India, and later on in other countries.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407399/

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Small pox in the early United States.(1763)(Isabella)

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Small pox in the early United States.(1763)(Isabella)

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In 1763 at Ford Pitt smallpox broke out and laid many ill and proved that the colonist were not safe from smallpox. Small pox was probably brought over through people moving in and trade, this possibly lead to a form of early biological warfare. It is thought(and argued about whether it actually happened) that around this time that the Native American in the area were gifted infected blankets in hopes that they would fall ill and die.

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North American colonists' warfare against Native Americans often was horrifyingly brutal. But one method they appear to have used-perhaps just once-shocks even more than all the bloody slaughter: The gifting of blankets and linens contaminated with smallpox. The virus causes a disease that can inflict disfiguring scars, blindness and death. The tactic constitutes a crude form of biological warfare-but accounts of the colonists using it are actually scant.

Colonial weaponizing of smallpox against Native Americans was first reported by 19th-century historian Francis Parkman. Parkman came across correspondence in which Sir Jeffery Amherst, commander in chief of the British forces in North America in the early 1760s, discussed its use with Col. Henry Bouquet, a subordinate on the western frontier during the French and Indian War.

For all the outrage the account has stirred over the years, there's only one clearly documented instance of a colonial attempt to spread smallpox during the war, and oddly, Amherst probably didn't have anything to do with it. There's also no clear historical verdict on whether the biological attack even worked.

Smallpox had spread at Fort Pitt.

Early American historian Elizabeth Fenn of the University of Colorado Boulder lays out her theory on what happened in her 2000 article in the Journal of American History. In the late spring of 1763, Delaware, Shawnee and Mingo warriors, inspired by Ottawa war leader Pontiac, laid siege to Fort Pitt, an outpost at the confluence of the Allegheny and Monongahela rivers in present-day downtown Pittsburgh.

The fort's commander, Capt. Simeon Ecuyer, reported in a June 16 message to his superior, Philadelphia-based Col. Henry Bouquet, that the situation was dire, with local traders and colonists taking refuge inside the fort's walls. Ecuyer wasn't just afraid of his Native American adversaries. The fort's hospital had patients with smallpox, and Ecuyer feared the disease might overwhelm the population inside the fort's cramped confines.

Bouquet, in turn, passed along the news about smallpox inside Fort Pitt to his own superior, Amherst, in a June 23 letter. In Amherst's July 7 response, he cold-bloodedly saw an opportunity in the disease outbreak. "Could it not be contrived to Send the Small Pox among those Disaffected Tribes of Indians? We must, on this occasion, Use Every Stratagem in our power to Reduce them."

"We must, on this occasion, Use Every Stratagem in our power to Reduce them."

On July 13, Bouquet, who at that point was traveling across Pennsylvania with British reinforcements for Fort Pitt, responded to Amherst, promising that he would try to spread the disease to the Native Americans via contaminated blankets, "taking care however not to get the disease myself." That tactic seemed to please Amherst, who wrote back in approval on July 16, urging him to spread smallpox "as well as try Every other method that can serve to Extirpate this Execreble [sic] Race."

What Amherst and Bouquet didn't know was that somebody at Fort Pitt had already thought of trying to infect the Native Americans with smallpox-and had attempted to do it.

William Trent, a trader, land speculator and militia captain, wrote in his diary that on June 23, two Delaware emissaries had visited the fort, and asked to hold talks the next day. At that meeting, after the Native American diplomats had tried unsuccessfully to persuade the British to abandon Fort Pitt, they asked for provisions and liquor for their return. The British complied and also gave them gifts-two blankets and a handkerchief which had come from the smallpox ward. "I hope it will have the desired effect," Trent wrote.

Though it's not completely clear who perpetrated the biological warfare attack, documentary evidence points to Trent as the probable culprit. As detailed in Fenn's 2000 article, the trader later submitted an invoice to the British military for purchasing two blankets and a silk handkerchief "to Replace in kind those which were taken from people in the Hospital to Convey the Smallpox to the Indians." Ecuyer certified that the items were used to spread smallpox, which indicates that he may have been in on the attempt as well. British Gen. Thomas Gage, who succeeded Amherst that year as colonial commander, eventually approved the payment.

"That's the one documented case that we have," says Paul Kelton, a historian at Stony Brook University, and author of two books on the role of epidemics in the European takeover of the Americas. It's not known whether Bouquet actually followed up on Amherst's letter and made additional attempts on his own to spread smallpox to the Native Americans, he says.

It's not clear that smallpox-infected blankets even worked.

It's also not clear whether or not the attempt at biological warfare had the intended effect. According to Fenn's article, the Native Americans around Fort Pitt were "struck hard" by smallpox in the spring and summer of 1763. "We can't be sure," Kelton says. Around that time, "we know that smallpox was circulating in the area, but they [Native Americans] could have come down with the disease by other means."

Historian Philip Ranlet of Hunter College and author of a 2000 article on the smallpox blanket incident in Pennsylvania History: A Journal of Mid-Atlantic Studies, also casts doubt. "There is no evidence that the scheme worked," Ranlet says. "The infection on the blankets was apparently old, so no one could catch smallpox from the blankets. Besides, the Indians just had smallpox-the smallpox that reached Fort Pitt had come from Indians-and anyone susceptible to smallpox had already had it."

The most important indication that the scheme was a bust, Ranlet says, "is that Trent would have bragged in his journal if the scheme had worked. He is silent as to what happened."

Even if it didn't work, British officers' willingness to contemplate using smallpox against the Indians was a sign of their callousness. "Even for that time period, it violated civilized notions of war," says Kelton, who notes that disease "kills indiscriminately-it would kill women and children, not just warriors."

But Kelton cautions against focusing too much on the smallpox blanket incident as a documented method of attack against Native Americans. He says the tactic, however callous and brutal, is only a small part of a larger story of brutality in the 1600s and 1700s. During this period British forces tried to drive out Native Americans by cutting down their corn and burning their homes, turning them into refugees. In Kelton's view, that rendered them far more vulnerable to the ravages of disease than a pile of infected blankets.

Fact Check

We strive for accuracy and fairness. But if you see something that doesn't look right, click here to contact us! HISTORY reviews and updates its content regularly to ensure it is complete and accurate.

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Did Colonists Give Infected Blankets to Native Americans as Biological Warfare? | HISTORY

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There's evidence that British colonists in 18th-century America gave Native Americans smallpox-infected blankets at least once-but did it work?

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The difference between Variolation and Vaccination(Isabella)

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The difference between Variolation and Vaccination(Isabella)

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Variolation is when they would use either pus or a dried scab from a person with smallpox(or in some cases cowpox) that had a mild case and would have the person either placed/rubbed on the skin or inhaled it. Vaccinations uses the mild cowpox virus and is injected into the persons body.

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by Dr. Talya Housman, Threadable Books

In the winter of 1764, smallpox descended on Boston and John Adams went to get inoculated against it. You might have heard that Edward Jenner pioneered the smallpox vaccine in 1796 - so how did Adams get inoculated in 1764?

Adams used an earlier method of inoculation called "variolation," rather than Jenner's "vaccination." Inoculation is the process of introducing a small amount of viral matter into the body in order to teach the body's immune system to fight off the virus, thus making the patient immune to future infection. Variolation used viral matter from smallpox patients, usually pus from a light case of smallpox. Jenner's vaccination, meanwhile, used matter from the milder cowpox virus. As a milder disease carrying the same immunities, cowpox matter was much safer.

Zabdiel Boylston, the uncle of John Adams's mother, Susanna Boylston Adams, is often credited for introducing variolation to the Americas in 1721. In fact, Onesimus, one of Cotton Mather's slaves, told Mather of the practice and Mather convinced his friend Boylston to try inoculation.[1] Around the same time, Lady Mary Wortley Montagu had her daughter inoculated in England after learning about variolation during her husband's diplomatic posting at the Ottoman court in Istanbul. Variolation was used in not only Africa and the Ottoman Empire but also China and India long before the Western world ever discovered this secret.

The impetus for Boylston and Mather's efforts in 1721 was the arrival in Boston of the sixth large outbreak of smallpox.[2] Boylston began inoculating hundreds but controversy erupted over his efforts.[3] Many worried about the intentional spread of disease. Others felt that if anyone died from inoculation, Boylston was guilty of murder. Fierce debate raged in Boston between supporters and opponents of the practice of variolation. The debate did not remain on the page - Boylston was physically assaulted on the street. However, Boylston and Mather collected information on infections and were able to show that inoculation dropped the smallpox mortality rate to 1 or 2% from approximately 15%.[4] By 1749, William Douglass, the fiercest opponent of inoculation, published an essay admitting inoculation's benefits and encouraging society to inoculate.[5]

Though variolation was well accepted by the time of Adams's 1764 inoculation, there remained about "500 Persons, who continue to stand it out, in spight of Experience, [and] the Expostulations of the Clergy." These individuals caused Adams to wonder if man was truly "a rational creature" since he would have seen himself as "a deliberate self Murderer" if he had refused to inoculate himself.[6] In addition, inoculation in 1764 was not an entirely uniform process. Adams wrote that in his recovery from the inoculation, "Each [doctor] has a few Particulars in Point of Diet, in which he differs from the others, and Each has Pills and Powders, different from the others to administer."[7]

As we all wait for scientists to develop a vaccine for the coronavirus, it's important to remember the controversy that followed the 1721 Boston inoculations as well as the gradual normalization of the variolation process that preceded Jenner's discovery. The development, adoption, and improvement of infectious disease response are messy processes - not a single "eureka" event. It is common to have initial disagreements among experts on treatments and often the first workable treatment is later replaced with an improved option.

It's easy to see dates like 1796 as the shining beacons in the lines of smallpox history - but to John Adams and much of Boston in 1764, they were thankful to live after 1721. Adams celebrated "Inoculation for the Small Pox" as evidence of America's "Glory of the Invention."[8] He praised Boylston's 1721 "discovery" and "practice" of smallpox inoculation "which has since proved of such inestimable benefit to Mankind."[9]
Dr. Housman's first book project uses digital tools to explore sexual crime in seventeenth century England. She has written on numerous historical topics including slavery, suffrage, religious freedom, industrialization, charitable giving, and pandemics for various public history organizations.
[1] Stefan Riedel, "Edward Jenner and the History of Smallpox and Vaccination," Baylor University Medical Center Proceedings, 18:1, (2005), 22.

[2] Shawn Buhr, "To Inoculate or Not to Inoculate?: The Debate and the Smallpox Epidemic of Boston in 1721," Constructing the Past, 1:1, (2000), 63.

[3] For more on this controversy, see Christianna Elrene Thomas Hurford, " In His Arm the Scar": Medicine, Race, and the Social Implications of the 1721 Inoculation Controversy on Boston, unpublished doctoral dissertation, (Ohio State University, 2012); Amalie M. Kass, "Boston's Historic Smallpox Epidemic," Massachusetts Historical Review, 14 (2012), 1-51.

[4] Buhr, "To Inoculate or Not to Inoculate," 66.

[5] William Douglass, A Summary, Historical and Political, of the first Planting Progressive Improvements, and present State of the British Settlements in North America, (Boston: Rogers and Fowle, 1749).

[6] John Adams to Abigail Smith, 17 April 1764 in Adams Family Correspondence, Vol. 1. [ link]

[7] John Adams to Abigail Smith, 14 April 1764 in Adams Family Correspondence, Vol. 1. [ link]

[8] John Adams to the President of Congress No. 9, 25 February 1780 in Papers of John Adams, Vol. 8. [ link]

[9] Obituary of Susanna Boylston Adams Hall, 29 April 1797 in Adams Family Correspondence, Vol. 12. [ link]

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Variolation vs. Vaccination: 18th Century Developments in Smallpox Inoculation

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by Dr. Talya Housman, Threadable Books In the winter of 1764, smallpox descended on Boston and John Adams went to get inoculated against it. You might have heard that Edward Jenner pioneered the smallpox vaccine in 1796 - so how did Adams get inoculated in 1764?

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The thought of a vaccination(1796)(Isabella)

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The thought of a vaccination(1796)(Isabella)

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In 1796, Doctor Edward Jenner noted that local milkmaids that once had cowpox seemed to be immune to smallpox(through variolation). This inspired him to run test on Sarah Nelmes, James Phipps, and a 9 year old boy. His test included taking a sore from Nelm and introducing it into Phipps arm, after that he observed that Phipps never contracted smallpox despite being in contact with it.

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Origin of Smallpox

The origin of smallpox is unknown. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The earliest written description of a disease like smallpox appeared in China in the 4 th century CE (Common Era). Early written descriptions also appeared in India in the 7 th century and in Asia Minor in the 10 th century.

Spread of Smallpox

Historians trace the global spread of smallpox to the growth of civilizations and exploration. Expanding trade routes over the centuries also led to the spread of the disease.

Highlights from History:

6th Century-Increased trade with China and Korea brings smallpox to Japan.

7th Century-Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

11th Century-Crusades further spread smallpox in Europe.

15th Century-Portugal occupies part of western Africa, bringing smallpox.

16th Century-European settlers and the African slave trade import smallpox into:

The Caribbean

Central and South America

17th Century-European settlers bring smallpox to North America.

18th Century-Explorers from Great Britain bring smallpox to Australia.

Early Control Efforts

Smallpox was a terrible disease. On average, 3 out of every 10 people who got it died. People who survived usually had scars, which were sometimes severe.

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus). During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules) by scratching the material into their arm or inhaling it through the nose. After variolation, people usually developed the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally.

The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox. To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes' hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner's gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise "On the Origin of the Vaccine Inoculation." In this work, he summarized his discoveries and expressed hope that "the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice."

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Global Smallpox Eradication Program

In 1959, the World Health Organization (WHO) started a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors that played an important role in the success of the intensified efforts included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the time the Intensified Eradication Program began in 1967, smallpox was already eliminated in North America (1952) and Europe (1953). Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977).

Last Cases of Smallpox

In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired variola major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. A member of the Smallpox Eradication Program team visited every house, public meeting area, school, and healer within 5 miles to ensure the illness did not spread. They also offered a reward to anyone who reported a smallpox case.

Ali Maow Maalin was the last person to have naturally acquired smallpox caused by variola minor. Maalin was a hospital cook in Merca, Somalia. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. On October 22, he developed a fever. At first healthcare workers diagnosed him with malaria, and then chickenpox. The smallpox eradication staff then correctly diagnosed him with smallpox on October 30. Maalin was isolated and made a full recovery. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign.

Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England's Birmingham University Medical School. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. She died on September 11, 1978. Her mother, who was providing care for her, developed smallpox on September 7, despite having been vaccinated two weeks earlier. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school building's duct system or by direct contact while visiting the microbiology corridor.

World Free of Smallpox

Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33 rd World Health Assembly declared the world free of this disease on May 8, 1980. Many people consider smallpox eradication to be the biggest achievement in international public health.

Stocks of Variola Virus

Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform research using the variola virus. They agreed to reduce the number of laboratories holding stocks of variola virus to only four locations. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. By 1984, England and South Africa had either destroyed their stocks or transferred them to other approved labs. There are now only two locations that officially store and handle variola virus under WHO supervision: the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

Page last reviewed:

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smallpox (variola major and variola minor)

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First vaccines given in the United States, 1800 (Hope)

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First vaccines given in the United States, 1800 (Hope)

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In July of 1800, Benjamin Waterhouse, who was a Harvard Medical School professor, had given the country's very first smallpox vaccines to his 5-year-old son and 6 other servants. The vaccine given had initially cam from Europe.
https://drive.google.com/file/d/1QG2naQrlNfgWMlyROzEYBi4BjTPN0aVc/view

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The switch from Variolation to Vaccination: 1800's(Isabella) 

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The switch from Variolation to Vaccination: 1800's(Isabella) 

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Beginning before the 1880's vaccination were discovered and slowly started to become accepted. This acceptance brought a new era for disease fighting and variolation was slowly phased out. Shortly after, in the context to the timespan of smallpox, vaccinations caused the eradication of smallpox.

# data[].attributes.attachment_link.readable_text
Origin of Smallpox

The origin of smallpox is unknown. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The earliest written description of a disease like smallpox appeared in China in the 4 th century CE (Common Era). Early written descriptions also appeared in India in the 7 th century and in Asia Minor in the 10 th century.

Spread of Smallpox

Historians trace the global spread of smallpox to the growth of civilizations and exploration. Expanding trade routes over the centuries also led to the spread of the disease.

Highlights from History:

6th Century-Increased trade with China and Korea brings smallpox to Japan.

7th Century-Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

11th Century-Crusades further spread smallpox in Europe.

15th Century-Portugal occupies part of western Africa, bringing smallpox.

16th Century-European settlers and the African slave trade import smallpox into:

The Caribbean

Central and South America

17th Century-European settlers bring smallpox to North America.

18th Century-Explorers from Great Britain bring smallpox to Australia.

Early Control Efforts

Smallpox was a terrible disease. On average, 3 out of every 10 people who got it died. People who survived usually had scars, which were sometimes severe.

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus). During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules) by scratching the material into their arm or inhaling it through the nose. After variolation, people usually developed the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally.

The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox. To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes' hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner's gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise "On the Origin of the Vaccine Inoculation." In this work, he summarized his discoveries and expressed hope that "the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice."

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Global Smallpox Eradication Program

In 1959, the World Health Organization (WHO) started a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors that played an important role in the success of the intensified efforts included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the time the Intensified Eradication Program began in 1967, smallpox was already eliminated in North America (1952) and Europe (1953). Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977).

Last Cases of Smallpox

In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired variola major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. A member of the Smallpox Eradication Program team visited every house, public meeting area, school, and healer within 5 miles to ensure the illness did not spread. They also offered a reward to anyone who reported a smallpox case.

Ali Maow Maalin was the last person to have naturally acquired smallpox caused by variola minor. Maalin was a hospital cook in Merca, Somalia. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. On October 22, he developed a fever. At first healthcare workers diagnosed him with malaria, and then chickenpox. The smallpox eradication staff then correctly diagnosed him with smallpox on October 30. Maalin was isolated and made a full recovery. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign.

Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England's Birmingham University Medical School. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. She died on September 11, 1978. Her mother, who was providing care for her, developed smallpox on September 7, despite having been vaccinated two weeks earlier. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school building's duct system or by direct contact while visiting the microbiology corridor.

World Free of Smallpox

Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33 rd World Health Assembly declared the world free of this disease on May 8, 1980. Many people consider smallpox eradication to be the biggest achievement in international public health.

Stocks of Variola Virus

Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform research using the variola virus. They agreed to reduce the number of laboratories holding stocks of variola virus to only four locations. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. By 1984, England and South Africa had either destroyed their stocks or transferred them to other approved labs. There are now only two locations that officially store and handle variola virus under WHO supervision: the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

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smallpox (variola major and variola minor)

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The first thoughts of anti-vaccination movements originated from concerned individuals who believed that the smallpox vaccine was "unchristian" and posed harm on children (and those who had been vaccinated). The Anti-Vaccination March in 1885 had tens of thousands of participants. A child's coffin and a statue of Jenner (invented vaccines) had also been used to deliver their anti-vaccination propaganda.
https://www.historyofvaccines.org/index.php/content/articles/history-anti-vaccination-movements

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Mass Vaccination to control spread (~1945) (Hope)

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Mass Vaccination to control spread (~1945) (Hope)

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In the beginning of the 1900s, Europe and North America had been able to successfully control the spread by the use of vaccines. At the same time, the disease was still heavily prevalent in countries such as South America, Africa, and Asia.
https://www.cdc.gov/smallpox/history/smallpox-origin.html

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The plan to get ride of small pox(1959)(Isabella)

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The plan to get ride of small pox(1959)(Isabella)

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In 1959 the WHO called for a program to start to rid the world of smallpox. Unlucky they lacked a couple things, mainly funds. Other than funds they lacked commitment from countries as well as shortage of the vaccination(not to mention and easy way to administer it).

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Origin of Smallpox

The origin of smallpox is unknown. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The earliest written description of a disease like smallpox appeared in China in the 4 th century CE (Common Era). Early written descriptions also appeared in India in the 7 th century and in Asia Minor in the 10 th century.

Spread of Smallpox

Historians trace the global spread of smallpox to the growth of civilizations and exploration. Expanding trade routes over the centuries also led to the spread of the disease.

Highlights from History:

6th Century-Increased trade with China and Korea brings smallpox to Japan.

7th Century-Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

11th Century-Crusades further spread smallpox in Europe.

15th Century-Portugal occupies part of western Africa, bringing smallpox.

16th Century-European settlers and the African slave trade import smallpox into:

The Caribbean

Central and South America

17th Century-European settlers bring smallpox to North America.

18th Century-Explorers from Great Britain bring smallpox to Australia.

Early Control Efforts

Smallpox was a terrible disease. On average, 3 out of every 10 people who got it died. People who survived usually had scars, which were sometimes severe.

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus). During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules) by scratching the material into their arm or inhaling it through the nose. After variolation, people usually developed the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally.

The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox. To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes' hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner's gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise "On the Origin of the Vaccine Inoculation." In this work, he summarized his discoveries and expressed hope that "the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice."

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Global Smallpox Eradication Program

In 1959, the World Health Organization (WHO) started a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors that played an important role in the success of the intensified efforts included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the time the Intensified Eradication Program began in 1967, smallpox was already eliminated in North America (1952) and Europe (1953). Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977).

Last Cases of Smallpox

In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired variola major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. A member of the Smallpox Eradication Program team visited every house, public meeting area, school, and healer within 5 miles to ensure the illness did not spread. They also offered a reward to anyone who reported a smallpox case.

Ali Maow Maalin was the last person to have naturally acquired smallpox caused by variola minor. Maalin was a hospital cook in Merca, Somalia. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. On October 22, he developed a fever. At first healthcare workers diagnosed him with malaria, and then chickenpox. The smallpox eradication staff then correctly diagnosed him with smallpox on October 30. Maalin was isolated and made a full recovery. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign.

Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England's Birmingham University Medical School. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. She died on September 11, 1978. Her mother, who was providing care for her, developed smallpox on September 7, despite having been vaccinated two weeks earlier. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school building's duct system or by direct contact while visiting the microbiology corridor.

World Free of Smallpox

Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33 rd World Health Assembly declared the world free of this disease on May 8, 1980. Many people consider smallpox eradication to be the biggest achievement in international public health.

Stocks of Variola Virus

Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform research using the variola virus. They agreed to reduce the number of laboratories holding stocks of variola virus to only four locations. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. By 1984, England and South Africa had either destroyed their stocks or transferred them to other approved labs. There are now only two locations that officially store and handle variola virus under WHO supervision: the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

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smallpox (variola major and variola minor)

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The invention of the jet injector, 1960's (Isabella) 

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The invention of the jet injector, 1960's (Isabella) 

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Well looking for a more widespread and easier way to administer vaccinations the jet injector was invented. Composed of a gas and springs that were used to send high pressured streams of fluid under the skin. This was of giving a vaccination was mainly popular with smallpox but left scars and sent fluid sometimes flying everywhere.

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What is a jet injector and how is it used for vaccination?

A jet injector is a medical device used for vaccination that uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a hypodermic needle. Jet injectors may be powered by compressed gas or springs. The devices were invented in the 1960s and were used successfully in mass vaccination efforts to eradicate smallpox and other diseases. In the past, the devices were often used to vaccinate members of the armed forces.

What flu vaccines are available via jet injector this season?

One flu vaccine, AFLURIA Quadrivalent ®, is approved for use with a jet injector this season. AFLURIA Quadrivalent ® (i.e., four ingredient) flu vaccine provides protection against an influenza A(H1N1) virus, and influenza A(H3N2) virus and two influenza B viruses. For more information, see What You Should Know for the 2020-2021 Season.

Who can be vaccinated with flu vaccine administered by jet injector?

Flu vaccination with AFLURIA Quadrivalent ® via jet injector is approved for use in people 18 through 64 years old. AFLURIA Quadrivalent may also be given by needle and syringe, for people 6 months old and older.

How effective is flu vaccine administered by jet injector?

Clinical trial data used in FDA's approval of the jet injector flu vaccine (i.e., the PharmaJet Stratis Needle-Free Injector used with the previous trivalent AFLURIA ®) demonstrated that vaccination using this jet injector method provided a non-inferior (i.e., similar) level of immune protection compared to the same flu vaccine administered via traditional flu shot.

What side effects are associated with flu vaccination administered via jet injection?

In adults 18 through 64 years old, the most common injection-site adverse reactions observed in a clinical study of the jet injector flu vaccine up to 7 days post-vaccination were tenderness, swelling, pain, redness, itching and bruising. The most common systemic adverse events within this period were myalgia (muscle pain), malaise (i.e., the feeling of discomfort or unease like when you are first getting sick), and headache.

Does flu vaccine administered by jet injector contain thimerosal?

Yes. The Afluria Quadrivalent® formulation used for administration by jet injector comes in multi-dose vials, which contain thimerosal. For more information, see Thimerosal Flu Vaccines.

Related Links

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A jet injector is a medical device used for vaccination that uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a hypodermic needle. Jet injectors may be powered by compressed gas or springs. The devices were invented in the 1960s and were used successfully in mass vaccination efforts to eradicate smallpox and other diseases.

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The invention of the bifurcated needle around 1970 (Hope)

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The invention of the bifurcated needle around 1970 (Hope)

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Benjamin Rubin invented the bifurcated needle to replace the jet injector, in a sense. It was much easier to sanitize and transport, and was much for efficient in giving a vaccine. The bifurcated needle heavily contributed to the eradication of the smallpox disease.
https://www.humanprogress.org/heroes-of-progress-pt-32-benjamin-rubin/

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Eradication of Small Pox(May 8th, 1980)(Isabella)

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Eradication of Small Pox(May 8th, 1980)(Isabella)

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Through a worldwide effort small pox was eradicated before the end of 1980, this was through the utilization of the smallpox vaccination. The key to the eradication of small pox was in the prevention of it, once you caught it there was no cure. Through the use of the vaccination it started to slow the spread until finally it was stopped.

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Until today smallpox is the only human disease that has been successfully eradicated. The eradication of smallpox is therefore a major success story for global health for several reasons: it was a disease that was endemic - and caused high mortality rates - across all continents; but was also crucial to advances in the field of immunology as the smallpox vaccine was the first successful vaccine to ever be invented.

Smallpox is an infectious disease caused by the variola virus which infects exclusively humans. No treatment existed so once you caught smallpox nothing could be done but let the infection run its course. Smallpox was responsible for millions of deaths in the past. The chart below illustrates this by visualizing the deaths due to smallpox as a share of all deaths in London from 1629 to 1902. In peak years, almost every fifth death was caused by smallpox! Death rates were similarly high in other European countries.

In 1796, British surgeon Edward Jenner invented the smallpox vaccine, the world's first vaccine against any disease. The dramatic decrease in smallpox deaths at the turn of the 19th century can be credited to his invention. Our entry's section on how eradication was achieved, we discuss how Jenner discovered the virus that protected people against smallpox infections and how he initially struggled to spread the word about it.

Global declines in smallpox cases

Thanks to the widespread roll out of Jenner's vaccine across Europe and North America, smallpox was almost entirely eliminated in these regions by the first half of the 20th century. When the WHO launched its 'Intensified Smallpox Eradication Program' in 1966, most cases were therefore restricted to South America, Africa and Asia - especially India -, where the vaccine's rollout had been slower and patchier.

The map below shows the number of smallpox cases by country - note the large differences in color brackets that were necessary to accommodate China and India's large case numbers. Large-scale vaccination campaigns however meant that the remaining countries saw rapid declines in the late 1960s and early 1970s. You can use the 'play' button at the bottom right of the map to see how case numbers evolved over time and by clicking on individual countries, you can see their reported smallpox cases in a line chart.

Eradication of smallpox by country

The more severe type of smallpox, caused by the variola major virus strand, was eradicated in 1975 in Bangladesh, shortly after India had been declared smallpox-free that same year. The variola minor virus, which caused a weaker form of smallpox infections, was still in circulation on the African continent, though. The last smallpox infection worldwide was documented in October 1977 in Somalia.

The map below shows the year in which smallpox ceased to be endemic for each country, with each decade corresponding to a different color.

Global eradication

The chart below illustrates how deadly the disease once was. Just the reported number of smallpox cases between 1920 and 1978 already amounted to 11.6 million cases; and that number was certainly smaller than the actual number of cases, although we don't know by how much. We discuss estimates of this discrepancy in the data quality section of our entry.

In the 1950s and 60s the number of reported cases started to decline and by the end of the 1970s there were no cases reported anymore. The WHO search teams continued to search for more smallpox cases but, with the exception of two tragic cases in Birmingham in the United Kingdom due to a laboratory accident in 1978, found none. Therefore, in 1980 the World Health Organization declared smallpox the first - and so far only human - disease to be eradicated globally.

Imagine what this means, a disease that was once common across the world and caused millions of deaths and disfigured the faces of even more simply does not exist anymore.

For more detailed information on the characteristics of smallpox, its global history, and the vaccine that ended the disease, visit our entry on Smallpox that we published simultaneously with this blog post.

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Smallpox is the only human disease to be eradicated - here's how the world achieved it

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Until today smallpox is the only human disease that has been successfully eradicated.1 The eradication of smallpox is therefore a major success story for global health for several reasons: it was a disease that was endemic - and caused high mortality rates - across all continents; but was also crucial to advances in the field of immunology as the smallpox vaccine was the first successful vaccine to ever be invented.

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Last known stores of the virus held in Atlanta and Moscow (current) (Hope) 

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Last known stores of the virus held in Atlanta and Moscow (current) (Hope) 

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Although the smallpox disease has been eradicated from the population for quite some time, there are few laboratories where the smallpox disease still exists. The samples of the disease are kept mostly for research purposes, just in case the disease were to ever become prevalent again. There is controversy over whether or not the samples should be destroyed.
https://www.history.com/news/the-rise-and-fall-of-smallpox